Wednesday, July 15, 2009

To Circ or not to Circ?

Recently, a correspondent asked me about Reform Judaism's position toward circumcision. He pointed out that some of the early reformists - particularly in Europe in the 19th century - had advocated against dropping the pressure for circumcision along with other reforms they were pushing. His question was: Is this still the position of Reform Judaism, or has there been some 'backsliding' on this point?

I'm not sure that the early reformists ever did abandon circumcision along with other rituals and ceremonies that may have struck them as outdated. I do know that many couples affiliated with Reform Judaism choose for their newborn sons a circumcision performed by a physician in a clinical setting rather than by a traditional mohel at home. If a Jewish physician can be found and utilized, so much the better but even when it must be a non-Jewish doctor it does get done. When a rabbi or learned lay person can be present at the procedure to say the traditional blessings, that is usually desired - I have personally served in this way, saying the ceremony while the doctor did the circumcision, quite a few times. In recent years in Reform Judaism in the United States, a network of Reform mohalim (the plural of mohel) and even mohalot (that's the feminine plural), all of whom are doctors, has been developed for those Jewish couples who would prefer a practitioner who can perform the sacred rite, but still perform the procedure according to modern medical practice.

So, at least in the USA, my observation is that Reform Jews do circumcise their sons, with an accompanying Jewish ceremony when possible, in a clinical setting when possible. Some prefer to use a traditional mohel, but the majority do not. When my son was born, Clara and I engaged a traditional mohel. (I'll explain below.)

In countries other than the USA and Israel, current practice is a mixed bag. In Europe, for example many Jewish families who are not Orthodox choose not to circumcise their sons. This reflects a very different bias in the medical communities in Europe.

In America, it is very ingrained that male babies are circumcised. The vast majority of white infant males - somewhere in the 90's percentage-wise - are circumcised at birth in the hospital. Although the practice of circumcision has always been considerably less universal among a number of non-white groups, statistics show that among African-American and Latino males the rates are going up. Anecdotally, it seems that the rise in the circumcision rate of infant males in these groups is directly related to the fact that more babies are being born in the hospital as opposed to at home. But in any case, circumcision rates for non-white baby boys have been on the rise.

American doctors and their patients generally support the notion that circumcision is a useful prophylaxis for a number of diseases and conditions. This, despite the fact that the American Academy of Pediatrics has repeatedly published statements that disapprove of the practice of routinely performing neonatal circumcisions. The most recent statement, published in 1999, conceded that there may be potential benefits of infant circumcision but that the AAP does not recommend the practice given the potential risks. Despite this position, parents looking for a doctor to circumcise their baby sons generally have no trouble finding one, and medical insurance usually pays for the procedure.

In Europe generally, the situation is the opposite; it is often impossible for parents to obtain the services of a doctor to circumcise their sons within the existing nationalized health services. Sometimes, a traditional religious practitioner is the only alternative available. Instead of the nuanced position of the AAP, European medical societies oppose circumcision outright.

I personally believe that the American position is more correct; the argument that there are great potential benefits, particularly to women whose male sexual partners are circumcised, is convincing. Here's a place where information on this position can be found: And to be fair, I'm also including an information site that tries to make the opposite case:

So why did Clara and I choose a traditional mohel rather than a physician or a Reform physician/mohel? First, I want to make it clear that the Reform movement's efforts to create a cadre of mohalim/ot using clinical methods and also being friendly to Reform-affiliated families who have sensitivities about such issues as separating men and women at a circumcision (sometimes, but not always demanded by a traditional mohel), are a wonderful service. Many Reform-affiliated families also feel more comfortable with a practitioner with medical training. Finally, for couples consisting of a Jewish man and a non-Jewish woman, many traditional mohalim will not even agree to provide the service. But after having been present for dozens of circumcisions both by traditional mohalim and by physicians, we felt more comfortable using a traditional mohel who came with very glowing recommendations. It happened he was also a licensed medical doctor and a surgeon, but he used the traditional mohel's methods when performing brit milah.

I'm convinced that, for Jewish parents, a skilled and experienced mohel using the traditional methods is superior to a physician using modern clinical practice. First of all, the traditional practitioner's method makes the procedure go very quickly which surely reduces the trauma for the infant (not to mention those witnessing the rite!). Despite the abundant jokes about mistakes by mohalim, they do one thing repeatedly, and they usually become quite proficient at it. In contrast, physicians who perform circumcisions do them in addition to many other procedures - they simply don't do as many, day in and day out, as a traditional mohel. And the protocols they follow make the procedure take a long time - as long as ten minutes, while a traditional mohel generally completes the procedure part of the circumcision in less than a minute total.

But what about adult circumcision? Adult males who convert to Judaism are traditionally required to submit to circumcision. If they were circumcised hygienically at birth, an Orthodox or Conservative rabbi generally requires a ceremony called hatafat dam brit - the taking of a drop of blood as a symbolic compliance with the covenant.

I have never supervised the conversion of an adult male who was not circumcised at birth, reflecting the prevalence of the practice of neonatal circumcision in the USA. I have met male Jews-by-Choice who did get circumcised as adults, as inpatients at hospitals, and they did not seem traumatized by the experience. Although it is a far more complicated procedure on an adult than on a newborn, it is not unheard of. Years ago, when I was in the US Navy I saw many crewmembers on an aircraft carrier (which has a full hospital, including surgical theater, onboard) get circumcised while on an extended cruise on the orders of their wives (whose concerns were hygienic, not religious). For conversion candidates I do not require it personally, although I would counsel the candidate that uncircumcised his status might not be accepted in all sectors of the Jewish community. On the other hand, since Jewish males are not routinely asked to drop their pants to prove their bonafides...they could probably get away without doing it!

I do not require hatafat dam brit when I supervise a male conversion where the candidate was circumcised at birth. I offer it as a possibility and can attest, having witnessed the procedure, that it takes a nanosecond and is entirely trauma-free. Nevertheless, I believe that requiring it represents a stringency that I don't feel comfortable requiring. A man without a foreskin is a circumcised man, regardless of whether it was done for hygienic or religious reasons.

On a number of occasions I've discussed the subject of adult circumcision, not for converts but for Jewish males who were born in the Soviet Union where circumcision was not done in the medical system and it was not available as a religious rite either. Russian Jewish men who have resettled in the USA have often been pressured by Orthodox organizations to get circumcised. Those organizations sometimes even have funds to pay for the procedures. While I believe that these organizations are well-meaning, I understand that grown men are often squeamish about having any elective procedure done to their sexual organs. Although there are anecdotes about uncircumcised Jewish men being denied interment in Jewish ceremonies, or of burial societies performing the procedure on the deceased without telling the family, I don't believe that these phenomena are widespread. Therefore, if a Jewish man was not circumcised at birth and asks me if he should have it done now, I will counsel him to consider it but will fully accept him as part of my community if he decides not to.