Cantor Philip Sherman is exasperated.
During his 38-year career, the orthodox mohel has circumcised more than 20,000 infants in accordance with Jewish custom. But he’s rattled by a practice, employed mostly by ultra-orthodox mohels, that involves orally suctioning blood from babies’ penises after removing their foreskins with a scalpel. The process, known as metzitzah b’peh, gained public attention recently in the wake of Mayor Bill de Blasio’s decision to repeal a controversial policy that required written consent from parents before a mohel performs the rite.
Under former mayor Michael Bloomberg in 2012, the health department instituted the consent-form policy after determining that direct oral suction could transmit infections to infants, causing them to fall gravely ill and, in extreme cases, die. The health department has identified seventeen laboratory-confirmed cases of neonatal herpes tied to the ritual since 2000. Of those incidences, two babies suffered brain damage and another pair died.
Sherman is quick to point out that the practice is only common among ultra-orthodox mohels, who make up a “severe” minority of the Jewish population, particularly here in New York City. “It’s having a detrimental effect,” Sherman says, complaining about how the extremist mohels give others, and the religion at large, a bad rap. “I’d like to shout it from the rooftops: Only a few mohalim do this! Ninety-eight percent of the mohalim out in the world don’t do this.”
What is most upsetting, Sherman says, is that there are now non-observant Jews who will not have a bris for their children because they think all mohels perform the controversial ritual.
According to Sherman, mohels from other factions of the Jewish community — Modern Orthodox, Conservative, Reconstructionist, and Reform — do not perform circumcisions with direct contact, and it’s not a widespread practice in the Jewish community worldwide. People in ultra-orthodox communities want their mohels to perform metzitzah b’peh because they believe the circumcision is not “kosher” or legitimate without it. “They have elevated the custom to the status of a law,” Sherman says.
Mohels like Sherman approach the bris much like doctors, he says. They inform parents of the risks involved and go about the procedure itself in a very clinical fashion: wearing gloves, autoclaving instruments, and using a pipette or gauze to drain or squeeze out the blood after the circumcision so that there is no direct contact. “I have an obligation not to do any harm. If I have a cold and I’m doing bris, I wear a mask,” Sherman says.
In response to de Blasio’s scrapping the consent policy, Sherman says the practice’s greatest challenge has always been balancing parental rights and religious freedom with public health and safety. “Where do we draw the line?” he asks, admitting there isn’t a clear-cut answer to resolving the issue. But he is clear on the metzitzah b’peh being “dangerous,” a risk not only for the babies, but also for those who perform it, as the mohels themselves can contract diseases when they put their mouths on infant penises. “Blood-borne pathogens such as hepatitis B, hepatitis C, and HIV may be transmitted from an asymptomatic but infected neonate to the mohel,” reads a 2000 report from the Pediatric Infectious Disease Journal [below].
Following negotiations, rabbis and the de Blasio administration were able to come to a more community-oriented agreement, in keeping with the mayor’s promise to the Jewish community when he ran for office in 2013. According to the new terms, when a baby is diagnosed with the herpes simplex virus 1, the community will ask the mohel who carried out the circumcision to get tested. If his results are positive for the virus, then the health department steps in to test the mohel’s DNA to determine if the herpes strain matches that of the baby.
“Our goal has always been to communicate risk associated with the practice of direct oral suction before a neonatal herpes case is identified,” a health department spokesperson told the Voice. “What has changed is community support. Working with the community will improve our ability to communicate the risk associated with the practice of direct oral suction.”
In the past, the health department has rarely been able to identify infected mohels who pass the HSV-1 infection to a baby. Even in situations where the infected mohel was identified, he would decline to be tested for evidence of the virus. Working with the community appears to be the only way to reduce cases of herpes in newborns.
It was also no longer practical to continue the Bloomberg-era consent form policy because, as a de Blasio administration official told Capital New York, the health department collected only one form in the two-plus years since the policy’s enactment. And banning the practice altogether will only drive it underground.
The health department says it supports the mayor’s “realistic strategy” to reduce cases of pathogens being transmitted through the ritual. A lot now depends on the approval of the board of health, and the health department plans to persuade the board to consider amending the city’s health code.
The city will be asking the board to consider amending section 181.21 of the health code at a meeting on March 10. Upon approval for consideration, a public hearing and comment period will follow before the board decides to vote on the proposal.
Sherman agrees that involving the ultra-orthodox community is required to revise regulations for metzitzah b’peh. However, this doesn’t let parents off the hook. In fact, culpability rests with the parents if a child ends up with an infection after the ritual is performed. “Parents should do their due diligence,” he says. It’s up to parents to research lists of mohels and decide on what type of procedure to have.
For Sherman, it’s a matter of common sense: “We know that germs exist and germs can be contracted from person to person. Since I know that these germs exist, I’m not going to put my mouth on an open wound. It’s unacceptable.”