New Responsum: B’rit Milah During the COVID-19 Pandemic (5780.3)

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Question
What should be the proper procedure regarding b’rit milah during the COVID-19 pandemic?
(Submitted by Rabbi Julie Pelc Adler, Director, B’rit Milah Program of Reform Judaism)

Response
In the midst of the current pandemic, it is understandable that parents and mohalim/ot are confused and frightened. We will examine the issues here carefully, one by one.

1. The importance of b’rit milah

In emphasizing the importance of b’rit milah the Talmud equates it to all the other mitzvot and, indeed, credits it with preserving the very existence of the world.^[1]  In Christian lands it was an unmistakable, permanent marker of Jewishness; in Muslim lands, it marked Jewish male children.  Its complex psychological significance in a classically male-centered Jewish spirituality cannot be overstated.^[2] It is true that the first generations of Reformers were deeply ambivalent about it; Kaufmann Kohler, for example, called it “a barbarous cruelty,” and recommended its abolition.^[3]  It is quite likely that most Reform Jews would have ceased to practice circumcision had it not been for the view that gained currency in the early 20^th century, that circumcision conveyed hygienic and health benefits.^[4]  Before World War II, lengthy post-partum hospital stays for middle- and upper-class women and their infants made it easy to arrange a hospital circumcision, with or without ritual.  In the postwar era, however, shortened hospital stays led to numerous inquiries about the acceptability of circumcision before the eighth day, or the reality of Jews simply ignoring b’rit milah in favor of medical circumcision.  While Responsa Committee chair Israel Bettan authored a strenuous objection to that widespread practice in 1954,^[5] Solomon Freehof was far more accommodating in 1960.^[6]  All Reform responsa since then, however, have followed R. Bettan in insisting on the importance of milah on the eighth day as a religious rite.^[7]  As a movement we have encouraged Reform Jews to choose b’rit milah  on the eighth day, and have facilitated this by training Reform mohalim/ot.

2. Circumstances for delaying b’rit milah

We are forbidden to endanger ourselves. As Maimonides writes:  “The Sages prohibited many things because they are life-threatening.  And anyone who ignores their words, and says, ‘I can go ahead and endanger myself; what business is it of anyone else what I do to myself?’ or ‘I pay no attention to that’ – they are to flog him for rebelliousness.”^[8] We are obligated to preserve ourselves from danger (and, as parents, we are responsible for preserving our children from danger). There is, therefore, unanimous agreement among all halakhic authorities that we delay b’rit milah if the infant is not healthy enough to undergo it.^[9] By contrast, there is far less consideration of whether b’rit milah might risk the well-being of an otherwise healthy infant.^[10]  However, there is a faint thread running through the halakha that is worth examining in detail. It begins with this Talmudic passage:

Rav Pappa said:  Therefore, on a cloudy day or on a day when a south wind is blowing, we do not circumcise [an infant], nor do we draw blood.  But nowadays, when people are accustomed to ignore [these strictures, we rely on the assurance that] Adonai preserves the simple (Ps. 116:6) [and we proceed on the assumption that no harm will follow].^[11]

This statement was never codified in the later halakha, but the Nimukei Yosef cites it approvingly:

The Ritba wrote in the name of his teacher [with reference to this passage]:  From here we learn that whoever does not wish to circumcise on a cloudy day has permission to do so, and is acting with clear justification in not relying on Adonai preserves the simple. And similarly it is appropriate not to circumcise on Shabbat if it is cloudy.^[12]

The discussion of this issue by the Arukh Ha-Shulḥan makes abundantly clear that the underlying concern is whether conditions are such that performing the rite could endanger the infant:

…But Rabbenu Yeruham wrote that neither a cloudy day nor a south wind delays the b’rit milah, because Adonai preserves the simple.  However, the strain of a journey – meaning that the infant is ill from the strain of having made a journey, does postpone the b’rit, until he is well.  Another authority wrote that anything other than some illness in the infant himself – such as having to go on a journey – does not delay the b’rit, just as we do not delay it for the sake of blowing winds.

Obviously, we do not delay the b’rit for the purpose of going on a journey, but rather we carry it out. But it seems to me that it is obviously forbidden to take the infant on a long journey until he has recovered from the circumcision, lest he be endangered. However, it may be permissible to take him in a wagon, since in that case he is placed in one spot and appropriately covered with blankets and pillows. Also, one can see, when they have brought him on a journey by wagon, whether any weakness appears in him. This requires examination by experts in the body and face of the infant. Indeed, we have never heard what the Nimukei Yosef wrote, that on cloudy days it is permitted to delay the b’rit.  In fact, it is because Adonai preserves the simple that we are lenient on optional matters such as drawing blood on the eve of Shabbat…and thus all the more so with regard to an important commandment such as circumcision.  And the proof of this is that not a single one of the authorities saw fit to mention this.  So we learn that we do not use its guidance in fulfilling our obligation. Thus has the custom spread, and there is no changing it.^[13]

It is quite obvious that the original authority, Rav Pappa, was expressing a genuine medical concern, based on his best knowledge. As subsequent generations’ medical knowledge changed, however, they dismissed these concerns as nonsense – but did not replace them with their own medical concerns.  This may reflect the tacit trend toward stringency evident in the halakha over time, as seen in other practices such as the discontinuation of hafka’at kiddushinas a way of preventing agunot, or the Ashkenazic invention of “glatt kosher.”

Fortunately, we are under no obligation to adhere to the codified halakha when a minority viewpoint has clear merit.  And as we have stated before, we rely on medical expertise:  “As rabbis, we are not competent to render judgments in scientific controversies.  Still, we do not hesitate to adopt ‘the overwhelming view’ as our standard of guidance in this and all other issues where science is the determining factor.”^[14]

It is clear to us that b’rit milah may be delayed when performing the rite would endanger an otherwise healthy infant.

3. Does performing b’rit milah at this time endanger the infant?

The reality in North America is that parents can take many steps to minimize the chances of infection, but under current circumstances it is virtually impossible to eliminate all possibility of infection. Asymptomatic individuals are not being tested; the incubation period can be lengthy; and the virus is extremely contagious.  In many areas, by the time the infant reaches his eighth day, it is already highly probable that he has already been exposed to someone who is carrying the virus, unless he was born at home under conditions of strict isolation, and the medical practitioner(s) who delivered the baby were known to have tested negative for the virus.  In other areas, it appears that this will be the case before too long.

As of this writing, there is not enough science available to stand as definitive research on COVID-19 in infants. Anecdotal evidence continues to mount, however, indicating that infants do not appear to be seriously affected. Infant deaths from the virus are so rare that individual cases are being reported as news. It appears that in each case there were underlying health complications.^[15]  It seems counterintuitive, and understandably goes against parents’ instinctive reactions, but so far the evidence is that babies, including newborns, are far less susceptible to COVID-19 than are older adults, unless the infants have some other health problem. It appears that the adults who would be present at a b’rit milah could be at greater risk than the infant himself.

Furthermore, there is no guarantee that this virus will disappear soon.  Experts are saying that it will continue to circulate until there is a vaccine to treat it, with some saying that we will, therefore, require social distancing for 12-18 months.^[16] After that much time has elapsed, circumcision will be much more difficult and will carry its own set of risks.

Medical literature regards “newborn” circumcision as routine, requiring only local anesthesia, up to about age six weeks.^[17] Beyond six weeks, or when the baby grows larger than twelve pounds, it may be advisable to wait until he is six months old and perform the procedure under general anesthesia. There is a small indication that bleeding is a more likely complication for an older baby. Furthermore, as the baby ages, the foreskin is thicker and less pliable, so it is more difficult from a technical point of view to perform the circumcision using the more traditional Mogen clamp.

It would appear, then, that there is no absolute guarantee of safety for the infant; but he is no more at risk in a b’rit milah performed on the eighth day, even during the pandemic, than he will be at any time in his first year of life. That assumes, of course, that the b’rit milah is carried out in a way that does not add needless risk. It should be in the home, and there should be no one present other than the parents and the mohel/et.  All standard procedures to minimize transmission should be followed, including wearing masks and gloves. It would be advisable to reduce danger to the parents by not having the rite performed by a mohel/et who has been working in a hospital or clinic where COVID-19 patients are being treated.

Some parents will, doubtless, consider a medical circumcision immediately after birth, followed by hatafat dam b’rit at home. We would point out that the most significant risk factor for the virus is the number of people to whom one is exposed at close range. A hospital procedure will bring the infant into contact with at least as many adults as will a b’rit milah performed at home.

Conclusions

1. B’rit milah on the eighth day is a mitzvah that we as Reform Jews take extremely seriously.
2. We take seriously the obligation of sh’mirat ha-guf, preserving our well-being, and we therefore recognize danger to an otherwise healthy infant as a valid reason for postponing a b’rit milah.
3. In keeping with our commitment to taking into account the best scientific and medical advice, given what we know about COVID-19, its transmission, and the danger it poses to infants, we do not find that performing the b’rit milahon the eighth day, with appropriate precautions, poses a more significant risk to the infant than delaying it until the pandemic has passed.

As we wrote recently, the COVID-19 pandemic constitutes a genuine emergency situation (sha’at had’ḥak). “In an emergency situation a bet din is responsible for taking action for the welfare of the community, and may issue a temporary ruling (hora’at sha’ah) to prevent the kahal from going astray.”^[18] People can “go astray” in all sorts of ways, including by allowing  self-preservation and concern for our families to turn into irrational fear and panic. We pray that this pandemic will pass, and that as many lives as possible will be spared, and that people’s livelihoods will not be destroyed; but in the meantime we will – we must – continue to live our lives.

Joan S. Friedman, chair
Howard L. Apothaker
Daniel Bogard
Carey Brown
Lawrence A. Englander
Lisa Grushcow
Audrey R. Korotkin
Rachel S. Mikva
Amy Scheinerman
Brian Stoller
David Z. Vaisberg
Jeremy Weisblatt
Dvora E. Weisberg

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[1] Nedarim 32a.

[2] See Lawrence A. Hoffman, Covenant of Blood: Circumcision and Gender in Judaism (Chicago: University of Chicago Press, 1996), and Shaye J.D. Cohen, Why Aren’t Jewish Women Circumcised? Gender and Covenant in Judaism (Berkeley: University of California Press, 2005).

[3] “Authentic Report of the Proceedings of the Rabbinical Conference Held at Pittsburg, Nov. 16, 17, 18, 1885,” in Walter Jacob, ed., The Changing World of Reform Judaism:  The Pittsburgh Platform in Retrospect (Pittsburgh:  Rodef Shalom Congregation, 1985), 101.

[4] See David Gollaher, “From Ritual to Science: The Medical Transformation of Circumcision in America,” Journal of Social History vol. 28, no. 1 (Autumn 1994): 5-36.

[5] ARR #55, “Circumcision on a Day Other Than the Eighth Day of Birth.”

[6] RR #21, “Circumcision Before Eighth Day.”

[7] ARR #56, “Circumcision Prior to the Eighth Day” (1977); CARR #28, “Berit Milah” (1978); CARR #100, “The Pressured Mohel” (1988).

[8] Yad, H. Rotze’aḥ 11:5.  See also Isserles’ gloss to ShA YD 116:5.

[9] Yad, H. Milah 1:16-17; ShA YD 262:2, 263:1.

[10] This question did arise in connection with metzitzah b’feh.  The majority opinion is that metzitzah is a hygienic matter, not an integral element of the mitzvah, and therefore any technique that makes it safer is permitted.  Isaac Klein, A Guide to Jewish Religious Practice (NY: Jewish Theological Seminary, 1979), 424.

[11] Yev. 72a.

[12] Nimukei Yosef, Yevamot 24a, s.v. ve-ha-id’na.

[13] Arukh Ha-Shulḥan YD 263:4-5.

[14] RR21, vol. 2, 5759.10, “Compulsory Immunization.”

[15] For example, see this news story: https://www.theguardian.com/world/2020/mar/29/coronavirus-illinois-governor-announces-rare-death-of-baby, accessed 10 April 2020.

[16] See, e.g., https://abcnews.go.com/Politics/federal-government-18-month-plan-life-return-normal/story?id=70046439, accessed 10 April 2020.

[17] For the research that provided the information in this paragraph I thank Dr. Bryan Hecht, M.D., Division Director of Reproductive Endocrinology, Obstetrics and Gynecology, MetroHealth, Cleveland, board certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, and a certified Reform mohel.

[18] Yad H. Mamrim 2:4, cited in 5780.2, “Virtual Minyan in Time of COVID-19 Emergency.”