The New York City Board of Health unanimously passed a regulation on Thursday that will require consent from parents before an infant can have a form of Jewish ritual circumcision, prevalent in parts of the ultra-Orthodox community, in which the circumciser uses his mouth to remove blood from the incision.
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In a morning meeting, the nine-member panel of doctors and public health professionals said that thoughthe regulation had been challenged by some Orthodox Jewish religious authorities as an unconstitutional infringement of their religious freedom, the risk of disease from the ancient procedure was serious enough to warrant action.
Indeed, some panel members said they believed that requiring consent did not go far enough. “It’s crazy that we allow this to go on,” said Dr. Joel A. Forman, a professor of pediatrics at Mount Sinai School of Medicine.
Infectious disease experts widely agree that the oral contact, known in Hebrew as metzitzah b’peh, creates a risk of transmission of herpes that can be deadly to infants, because of their underdeveloped immune systems. Between 2004 and 2011, the city learned of 11 herpes infections it said were most likely caused by the practice. Two of those babies died; at least two others suffered brain damage.
While most ritual circumcisers, known as mohelim, no longer use oral contact to pull blood away from the circumcision incision — they use gauze or sterile glass pipettes instead — the practice has been strongly defended by ultra-Orthodox Jewish rabbis who believe the practice is both safe and faithful to Talmudic codes. More than 200 ultra-Orthodox rabbis have ordered their adherents not to comply with the regulation.
“This process is being created without a shred of evidence,” said Rabbi William Handler, one of a few ultra-Orthodox Jews who gathered outside the meeting in protest. “The city is lying, and slandering compassionate rabbis.”
In an effort to educate parents, the city will now require ritual circumcisers to inform parents in writing if they will use direct oral contact during the circumcision, and must receive their written consent. The consent form states that the health department advises against the procedure because of the possibility of herpes transmission, which may cause brain damage or death. The mohelim must keep that permission document on hand for one year.
Failure to comply may result in warning letters or fines to the mohelim. Enforcement, though, will be based on investigation of specific complaints and herpes cases, not spot checks or raids, and there are no mandatory punishments, said Dr. Jay K. Varma, the city’s deputy commissioner for disease control.
Orthodox groups, including Agudath Israel of America and the Central Rabbinical Congress, have announced that they plan to sue the city to block the regulation, which is scheduled to go into effect 30 days from official publication of the rule.
“We are convinced that this amendment will be thrown out by the courts,” said Rabbi David Niederman, a Satmar Hasidic leader.
The city believes about 3,600 male infants are circumcised with direct oral suction each year and estimates their risk of contracting herpes at roughly 1 in 4,000. The Centers for Disease Control and Prevention has called the procedure unsafe and recommended against it.
But among doctors that work with ultra-Orthodox families, there is some doubt whether regulation is the right course.
“They feel that if their child doesn’t have the metzitzah b’peh, he is not Jewish, so this, to them, is the most important act that they can do for their son in life,” said Dr. Kenneth I. Glassberg, the director of the division of pediatric urology at Morgan Stanley Children’s Hospital at NewYork-Presbyterian.
“Medically, I don’t approve of it,” he added of the oral contact, “but if you’re asking me, ‘Does it cause harm?’, I haven’t seen enough proof that it causes harm.”
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