Nursing Clio is, once again, honored to have Elizabeth Reis as our guest contributor. Dr. Reis is a professor of women’s and gender studies at the University of Oregon and is the author of Bodies in Doubt: An American History of Intersex. She is a visiting scholar in the History of Science Department at Harvard University.
The previously obscure ultra-Orthodox Jewish rite of metzitzah b’peh (oral suction) has burst into the news lately and raised critical questions about genital surgery, consent, First Amendment rights, tradition, and the representation of Jews.
I would guess that most Americans, even Jewish-Americans, had never heard of metzitzah b’peh (oral suction) until the recent controversy between ultra-Orthodox Jews and the New York City Department of Health and Mental Hygiene. It refers to a custom performed after a circumcision in which a mohel (ritual circumciser) orally sucks the blood away from the baby boy’s penis. To insure the requirement that blood be shed and then hygienically removed (sucking was deemed the best means of achieving this hygiene anciently), metzitzah b’peh became part of circumcisions in the 2ndcentury, according to scholars. Most Jews, even observant Modern Orthodox Jews, have abandoned the practice. But a small minority adheres to and defends it, based on the First Amendment – somewhat surprisingly now on free speech grounds in addition to its religious liberty provisions.
An attorney representing adherents argued recently that requiring parental consent violates the mohels’ freedom of speech. By verbalizing the potential dangers involved with the procedure, the argument goes, mohels are being forced to say something they don’t believe. To their mind, the procedure is safe. Such novel First Amendment arguments aside, to my mind, safety is not the only issue, and a new regulation mandating consent forms is an inadequate solution to the problem. First Amendment rights (for religion or speech) do not provide carte blanche. The state can legally intervene in the face of clear and present danger, especially to protect children, regardless of parental consent, and metzitzah b’peh merits such intervention. Not only does it pose health risks but it defies broader community standards. There are some things that parents should not get to consent to on behalf of their children.
The best response to this controversy would involve not parental but rabbinical consent –religious leaders themselves taking the lead in modifying this tradition. There are other, safer, and more sterile ways to see that blood has been drawn and to clean the circumcision wound. If like other religious minorities Orthodox Jewish Americans have rights, they also have responsibilities as citizens and members of a larger national community – obligations Jews recognize in Hebrew Scripture. Reforming a tradition will be most successful if it comes from within the community. One physician from Borough Park, Brooklyn, who spoke to the Jewish Daily Forward last March on the condition of anonymity, makes such a suggestion, saying, “The best thing would be to focus on an intra-community education effort. I know there are Haredi [ultra-Orthodox] physicians trying to re-educate the public to make them more aware of the risk . . . . You need a critical mass of rabbis who will set off a chain reaction.”
Today the very thought of metzitzah b’peh conjures fears about the transmission of communicable disease, and indeed the procedure has been contested for quite some time in this country and in Europe too. In 1873 four babies in New York City contracted what appeared to be syphilis, and three of them died. The same mohel had circumcised all four and had performed metzitzah b’peh. Then, as now, the Board of Health got involved and requested an investigation, which was conducted by Dr. R.W. Taylor, surgeon to the New York Dispensary in the Department of Venereal and Skin Diseases. The question of whether the babies died from syphilis at all, much less syphilis caught from the mohel, could not be determined definitively.
Taylor nonetheless connected these and potentially other tragic deaths with circumcision and oral suction. Just below the surface was a disparaging assessment of Jewish immigrants.He coupled oral suction and syphilis with the “lower classes of Jews.”
Many Jewish people, myself included, would like to see ultra-Orthodox religious leaders abandon the practice of oral suction. At the same time, we wish to protect the rights and freedoms of religious minorities, Jews and non-Jews alike, and we are concerned about how such communities are treated in public discussions. A report last month on NPR’s “All Things Considered” that examined the metzitzah b’peh controversy, for example, fell into a portrayal of religious Jews as ignorant and backward, evidenced by the transcription of the radio broadcast’s unfortunate attempt to render the mohel’s voice in a pidgin English.
A. Romi Cohn, a mohel from Borough Park, is quoted regarding the health department’s proposed requirement of parental consent for this risky procedure: “But we have a mayor; he’s the mayor of the universe. We gonna follow his instructions.” And concerning the health and safety of the many babies he has circumcised, Cohn is quoted as saying, “If there’s any slight possibility – I’m not saying 50 percent, even 1 percent – that that baby gonna get hurt, we not allowed to perform that circumcision.”
Rendering speech in such jarring dialect – as African American critics have long noted – is often a tool of ridicule or derision. If listeners heard Cohn speak on the air, they could appreciate his accent but focus attention on his conviction that human life is a top priority; reading non-grammatical parlance, on the other hand, insinuates the prejudicial notion that Orthodox Jews are untrained, alien, and un-American, just as Dr. Taylor’s report for the New York Board of Health did 150 years ago.
Ultra-Orthodox Jews should live true to their word about protecting human lives and amend the practice, as other observant Jews have already done before them. They should respond to the risks of herpes and other communicable diseases, which the rite of metzitzah b’peh poses. And while adhering to the essence of their beliefs, they should adjust to the larger world they live in, respecting and supporting the society that supports their freedoms and way of life.
This article is reprinted with permission from The Hasting’s Center Bioethics Forum.