Monday, September 5, 2011

Circumcision

Dear Rabbi Slifkin,

I just learned a little about your work... I understand that your writings explore traditional rabbinic perspectives and how they may relate to issues of interest in modern science.

Please consider writing about the topic of male infant circumcision in our modern society, as there are a growing number of physicians who are speaking out against this procedure... Also, there appears to be a growing debate about human rights and constitutional issues related to this topic...

I look forward to reading some of your writings soon.

R

Dear R,

My parents vaccinated me against certain diseases when I was an infant, without my consent; I am grateful to them for having done so. Likewise, I am certainly extremely grateful to my parents for circumcising me when I was 8 days old, and not waiting until I was old enough to make my own decision.

Best wishes,
Natan Slifkin

37 comments:

  1. Is your response meant to be a joke?

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  2. > My parents vaccinated me against certain diseases when I was an infant, without my consent; I am grateful to them for having done so. Likewise, I am certainly extremely grateful to my parents for circumcising me when I was 8 days old, and not waiting until I was old enough to make my own decision.

    That’s disingenuous. Vaccinations are not comparable to circumcision. Vaccinations have clear benefits, while circumcision is medically neutral. NOT vaccinating your child, like withholding any medical treatment, is negligent and possibly abusive, while circumcision is again neutral. Vaccinations are recognized as beneficial by everyone except for anti-vacs conspiracy nuts, while it’s easy to see why some would object to body modification without the consent of the modified.

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  3. That's a religious, and NOT a medical decision. You are saying you are happy they made the decision to circumcise you so you would not have to undergo a much more painful procedure an adult?

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  4. Maybe a good topic for further discussion within bris milah is the possible danger of metsitsa bpeh, and whether it is actually part of mitsvas milah.

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  5. I have a different theological problem with circumcision. If a covenant with God is so important then why is it exclusive to men; why isn't there some kind of female covenant?

    Neal

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  6. R' Slifkin, I like your response: short and sweet. I'm sure your wife is happy with your parents' decision, too, unlike the feeling of this lady, Patricia Robinett: "when women learn of the pleasure they have lost due to the lack of foreskin, the blood of circumcisers and circumcision demanders might very well flow in the streets." from: http://ieet.org/index.php/IEET/more/4590

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  7. Not every person is grateful to their parents for having been circumcised. This is a balabatish answer. There is a struggle going on in the western world to outlaw female circumcision. The people involved don't differentiate between male and female circumcision. We should try to explain to them why they are different. Anyone?

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  8. Cute, but you didn't answer his question.

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  9. Circumcision being medically neutral (as opposed to medically bad) , I don't see how it's different from having the right to homeschool your child or to give your child an extreme ultra-orthodox education. Or to name your child whichever name you like. Or to pierce his or her ears for earings.

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  10. "The people involved don't differentiate between male and female circumcision. We should try to explain to them why they are different. Anyone?"

    For a religious viewpoint, my favorite answer is from Rabbi Matis Weinberg. Can someone point to the particular essay in Frameworks?

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  11. Perhaps there are no clear health benefits to this misswa, and the possible reasons for it are: 1.) To demonstrate our loyalty to HASHEM by virtue of our willingness to cause\endure pain for His sake.
    2.) To evoke strong emotions which meld with spiritual devotion.

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  12. Oy. Whenever the word "circumcision" appears anywhere on the Intrawebs you can be assured of a long-running (and long-winded) flamefest. I've never heard of a mind being changed by it.

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  13. what about the trillion things one's parents carve into thei minds?
    KT
    Joel Rich

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  14. http://www.circinfo.net/

    Professor Brian Morris, Professor Medicien University of Sydney

    CIRCUMCISION:
    An Evidence-Based Appraisal

    MEDICAL, HEALTH & SEXUAL

    2010 Edition




    Circumcision is a very popular procedure. The purpose of this website is to provide a balanced up-to-date review of scientific studies on circumcision that have been published mainly in reputable international medical and scientific journals after a formal, critical refereeing process by experts in the field.

    The information reviewed herein is the most extensive and accurate in the world. Listed are ~1,000 references. Most can be found by the reader in any medical library or internet referencing service, such as PubMed. The message they convey is quite clear. Unfortunately, the topic of circumcision has been made unnecessarily controversial because of emotive propaganda and opinions placed on the internet by extremist anti-circumcision organizations.

    It is the intention of the present overview to provide sound information that should be of assistance to parents, medical professionals as well as men and their partners who are seeking facts (rather than the fiction perpetrated by anti-circumcision groups). The author is a full professor in the medical faculty of a major very prestigious highly reputable university, has 40 years of scientific research experience and more than 280 research publications.

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  15. G*3,

    I hope from the link that I have provided (circinfo.net) that you can see that it is sound argument to suggest that infant circumcision and infant vaccination can be spoken about in the same breath.

    Further, infant circumcision, although not painless has zero long term effects (in terms of abuse) as the infant nervous system is too immature for the baby to recall the procedure. Anyone who claims abuse and psychological trauma as a result of the procedure at that age is an attention seeker.

    Finnally, to those people who believe in G-d and mitzvot, the ability to perform a mitzvah does have the same spitirual benefits that vaccination has physical benefits. (I emphasise here that the weight of scientific evidence argues for a physical benefit to circumcision, a procedure easily and effectively done in infants.)

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  16. From Professor Brian Morris

    Circumcision – CONCLUSION

    Circumcision confers a lifetime of medical, health and sexual benefits. At least 1 in 3 uncircumcised males will, over their lifetime, develop a condition requiring medical attention. This means various degrees of suffering and some deaths. In contrast, circumcision can prevent or greatly reduce the risk of most of these medical conditions. The surgical risk of a circumcision in a modern setting is extremely low, while the long-term functional and cosmetic outcomes are generally excellent. Circumcision of the male partner also confers substantial sexual and medical benefits to a woman, by reducing her risk of disease, suffering, medical treatment and premature death.

    It is hoped that this review will have proved important informative to medical practitioners and health workers, thereby enhancing the quality of information that they can impart to parents of male children and to adult men. It should also prove to have educational value to others, especially the parents of boys, but also adult men, whether circumcised or not. It is hoped that as a result of reading the information presented herein the choice that has to be made concerning circumcision, especially of infants, will be a much more informed one.

    Although there are benefits to be had at any age, they are greater the younger the male. Issues of “informed consent” may be analogous to those parents have to consider for other medical procedures, such as whether or not to immunize their child. The question to be answered is “do the benefits outweigh the risks?” When considering each factor in isolation there could be some difficulty in deciding. However, when viewed as a whole the answer to whether to circumcise a male baby must surely be “YES”. Nevertheless, everybody needs to weigh up all of the pros and cons for themselves and make their own best decision. Hopefully the information provided herein will help in the decision-making process.

    (emphasis added)

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  17. I think most commenters have missed R. Slifkin's point. The trauma that would have been caused to R. Slifkin had his parents not circumcised him as baby would have been substantial, as adult circumcision is not a trivial procedure. Moreover, it would have been entirely foreseeable at birth that he would opt to be circumcised in the future. On the other hand, were R. Slifkin to decide as an adult that his circumcision was unnecessary, no harm was done to him by having had it.

    This is similar to the point that R. Rakeffet has made in his shiurim - for parents to create a child without having received a get (where one was required by halakha) is fundamentally unjust, because it will cause substantial suffering to the resultant mamzer should he ever decide to marry an Orthodox Jew, and it is an observable phenomenon that some children from even the most irreligious families embrace Orthodox Judaism. And if the child continues in the non-observant path of his parents, nothing has been lost.

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  18. Regarding the theological question by "Anonymous" why HASHEM didn't provide a covenantal mark for females. Isn't it enough to view the b'rith on males as representing the covenant with all of us? Not everything in life need be symmetrical.

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  19. Phil - R' Matis's essay is in FrameWorks on parshas Tazria. And it will answer the question about a female covenantr as well, I believe.

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  20. Yossi, you seem to have gotten the idea that I’m anti-circumcision. I’m not. The consensus of medical experts is that circumcision is medically neutral, and so I, too, am neutral on the subject.

    That said, vaccination is a bad analogy. Circumcision in much more like piercing a child’s ears.

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  21. I was very surprised when I read your article and the comments. For me your answer was essentially a humouristic one, like "I'm happy they have done it when I was a baby. Because if I have to do it as an adult it would be much more difficult!!!"
    The benefits on health of the circumcision are evident (it's a mean of fighting against AIDS and the sexually transmitted diseases). But do you really thing that you have to do a mitsva because it's good for your health? (A lot of people say it about cacherout but i'm sure that it is not the position of Maïmonide!).

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  22. All of the medical arguments for and against circumcision are irrelevant. The issue is, and always has been, attempts by anti-semites to band a cornerstone of Jewish practice.

    If doctors want to say there is no medical reason, fine. Let them. If doctors want to refuse to perform circumcisions, that's also their right. But when they start pushing for laws making it illegal for a Mohel to perform a Bris, then it's time to fight.

    And the fight should be based on the First Amendment - banning circumcision is interfering with a Jew's right to practice Judaism.

    This is the only point that should be argued. Doctors can debate medical issues for a million years and never reach a consensus. The fact that God commanded Jews to have a Bris is not something any government has a right to dispute or interfere with.

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  23. Shamino: "The fact that God commanded Jews to have a Bris is not something any government has a right to dispute or interfere with."

    It is only so because circumcision is medically neutral. If it isn't, your argument falls. Government has a right to protect basic human rights, even if it interferes with religious observence.

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  24. I like Rav Hirsch's explanation. Bris milah symbolizes both self-control of our desires -- one of the most central components of Judaism -- as well as the dedication of all our abilities and powers to God.

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  25. The consensus of medical experts is that circumcision is medically neutral,

    G*3,

    You missed my point. The consensus of medical experts (i.e. medical scientist and professionall who have studied the topic) is that circumcision provides positive medical benifits, sufficiently strong enough to recomend it as they would immunization.

    The idea that circumcision is medically neurtal is the fallicy here. It has positive medical outcomes. Further, due to the nature of human development the procedure is best done in infants.

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  26. By the way G*3, I suspect the best anaolgy to infant circumcision is the choice to put grommets (tubes) into a child ear. They are both relatively mino, non-invasive medical procedures that have medical benefit for the child. When my twins were young they suffered from chronic ear infections, and my wife and I made the decision, with medical advice, to have grommets inserted as soon as advised. Other parents with children who suffered from chronic ear infection chose not to do so. Those parent thought that my wife and myself abused our children for making them undergo an unnecessary medical procedure. We thought they were cruel to their children for making them suffer the obvious pain of middle ear infections.

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  27. Yeedle-
    WRONG-the government has NO right to interfere with religious freedom. Judaism is an ancient religion and not just some cult with weird rituals that appeared yesterday. The UN declaration of Human Rights recognizes freedom of religion and the right of parents to raise their children in their value system.
    The question of whether brit milah meets with the approval of the medical community is irrelevant and so is the question of whether non-Jews should perform circumcizion.
    I would use the same arguments regarding shechita. The question of whether or not it is "humane" or not is irrelevant. It is again, a question of freedom of religion. Even if you could prove that it was just as "humane" as the shechita-banners claim they want, the radical anti-meat people would still complain about it.

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  28. R' Slifkin's linking of infant circumcision with infant vaccination seems right on the mark.

    Both are practices that are painful to the infant and yet confer no immediate or visible medical benefit to the child ("not visible" in the sense that protection against possible future ailments is, by definition, not visible). Both are widely adopted as the standard of care by American obstericians and pediatricians*, and parents generally have to be pro-active in asserting their choice if they want to refuse either procedure for their newborn.

    I'll also add that I have encountered people espousing strong rhetoric against male infant circumcision who, unbelievable as it may seem, had *absolutely* no idea they were espousing a classic component of anti-semitism.

    * For those who aren't aware of the very high prevalence of circumcision within the general US population, take a look at http://en.wikipedia.org/wiki/Circumcision#Non-religious_circumcision. According to one study cited, the prevalence of circumcision among US-born males was 91% for males born in the 1970s and 84% for those born in the 1980s!

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  29. Y Ben-David

    I think you are wrong to think that freedom of religion trumps laws-of-the-land. If the community feels that certain practices do not meet the moral and ehtical standards, then the community is free to pass laws that ban those prectices. Freedom of Religion means that the state/community may not pass a law that targets or preferences religion.

    For example, child protection laws prevent pediphilia. No amount of religious freedom is ever going to trump those laws, irrespective of how archaic or entrenched the religion is. Mormons, in the US, are fighting anti-poligamy laws. There freedom of religion does not automatically trump the state or federal family laws.

    Where the community to decide (through whatever mechanisms) that corcumcision is an adhorant and fundimentally abusive act, and pass laws against it, those laws would trump freedom of religion laws.

    The problem with that attitude, and as I have pointed out several times in this thread already, circumcision has positive health benefits and is best perfomred on infant boys. Further, it is likely (in the US) that any attempts to ban circumcision would be thrown out if it did not provide a health escape clause. Further, it is likely that it would run up against a tradition that allows a parent to make health choices on their childs behalf.

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  30. An interesting aside:

    During the recent brouhaha with the potential city-wide ban on juvenile male circumcision in San Francisco, I had a conversation on the topic with a friend of mine who is a professor of English at a small US liberal arts college (not Jewish, BTW). He pointed me to a pamphlet published in 1891 which Anne McClintock, author of "Imperial Leather" (apprently quite an influential book in some circles), claims to have launched the wide adoption of circumcision in the United States. The pamphlet is entitled "History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for its Performance," written by a Dr. P.C. Remondino (http://en.wikipedia.org/wiki/Peter_Charles_Remondino). You can download it at http://www.gutenberg.org/files/23135/23135-h/23135-h.htm. Regardless of the accuracy of the historical claim by Anne McClintock (I have no way to judge this), it is an extremely interesting read. The author is quite philo-semitic and displays a surprising level of familiarity with rabbinic literature.

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  31. For those who believe that a ban on male infant circumcision would automatically be considered to be in violation of the Free Exercise Clause of the First Amendent, Eugene Volokh, a UCLA law prof, seems to think otherwise:

    http://volokh.com/2011/05/23/proposed-san-francisco-circumcision-ban-and-religious-freedom/

    (He has several other well-sourced articles on this topic at his blog, BTW)

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  32. Yossi-
    Passing a law banning brit milah is "targetting religion", which you poing out is an attack on freedom of religion.
    It is true that the the Torah did allow slavery once. Same with polygamy. However, society banned these things which is being "Machmir" as far as the Torah sees things. There is no MITZVAH to own slaves or to have more than one wife...in fact, the Torah itself indicates a certain discomfort with these institutions (BTW-now that it seems impossible to prevent homosexual "marriages" in Western countries, it is now INEVITABLE that polygamy will be recognized as well, starting with pressure from the Muslims and the renegade Mormon groups).
    There is a concerted attack on religion developing in Western countries, using the arguments you have made. The USSR banned mikvaot on 'sanitation grounds', Nazi Germany and antisemitic interwar Poland banned shechita on "humanitarian grounds" and in Poland Jewish-owned factories were required to work on Shabbat and give only Sunday off to their Jewish workers. All of this was thinly disguised antisemitism. There was also an attempt by the League of Nations to institute a new "World Calendar" of 13 months of 28 days each, with the 365th day not part of any week. This means Shabbat would have longer the 7th day of the week and it would move throughout the "weeks" of this World calendar. Rabbi Joseph Hertz, the Chief Rabbi of the British Empire was active in fighting against this, seeing it as a antisemitic-anti-religious move. Today, much of the anti-Zionist propaganda is also based on anti-Judaism arguments ("who do these Jews think they are..they are racists since they refuse to intermarry..this makes Israel a pariah, racist state"...).
    Thus, attemps by "progressives" to ban or restrict religious practices such as brit milah really have nothing to do with "humanitarian" impulses but with much darker ones.
    We must be on the guard against these moves just as our ancestors were when Roman Emperor Hadrian tried to ban brit milah and other Jewish practices.

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  33. Rav Slifkin, I hate to say "I told you so," but I told you so.

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  34. Yeedle: "I don't see how it's different from having the right to homeschool your child or to give your child an extreme ultra-orthodox education. Or to name your child whichever name you like. Or to pierce his or her ears for earings."

    A person can disavow their education, change their name, or leave their earrings out and let the holes grow over, but they can never get all of their own foreskin back.

    HaRazieli: "1.) To demonstrate our loyalty to HASHEM by virtue of our willingness to cause\endure pain for His sake.
    2.) To evoke strong emotions which meld with spiritual devotion."
    1) But it's not we who are willing to endure it, but someone else who has no choice, and since when is causing pain to someone else a virtue in Judaism?
    2) Strong emotions - like anxiety, fear and revulsion?

    Yossi: Beware of quoting Prof. Morris, a molecular biologist (not a doctor of medicine) who never saw a reason to circumcise he didn't like, spins statistics like a dentist's drill, and has just co-authored a paper with the editor of a circumcision fetish site, in which they obsess together about different styles of circumcision. He is an outlier of circumcision advocacy, having said on Australian TV that it should be mandatory.

    No national medical association in the world recommends circumcision, and some, such as the Dutch, roundly condemn it. The WHO only recommends it for adult volunteers where HIV is rampant.

    You would not put grommets into a healthy child's ears, nor if grommets adversely affected hearing or permanently changed the ears' appearance.

    The proposed circumcision age-restriction (not a ban) in San Francisico did provide a "health escape clause".

    HaDarda"i: These men, some of them Jews, bitterly resent being circumcised, and would not have chosen it at birth or as adults.

    Shamino: Infant circumcision violates his First Amendment right to practise the religion of his choice as an adult without having had another, not of his choice, pre-emptively marked in his flesh. Sikhs, for example, value the intact body, not even cutting the hair.

    Chizki: It may be that circumcision causes anti-semitism. Prof Leonard Glick, a Jewish medical anthropologist who has practised circumcision, suggests in this video (12:40) that it may have given rise to the blood libel.

    Chizki: you are right that 19th century lung-doctor Remondino's advocacy of circumcision was influential. (He singlehandedly created the "foreskins used to be of value when we ran naked through the brambles" meme that is still current.) He also thought circumcising black men would make them less likely to rape white women.

    Y. Ben-David. 97% of circumcision is not Jewish, and the Intactivist movement is concerned about all of it. Jews are not specifically targeted, just not specifically exempted either.

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  35. Interesting read from Glick's "Marked in Your Flesh": "that the Lord's covenant and his two definitive promises (prodigious reproduction success and a lavish land grant (all of Canaanite land) appears first in Genesis 15, an earlier J text but with one crucial difference, there is no mention of circumcision." "To seal this covenant the only requirement is that Abram offer several sacrificial animals- a heifer, goat, ram, dove, and one other bird. Here we find no mention of circumcision, no change of name, no mention of Isaac or Ishmael." "Like a number of their neighbors, the ancient Israelites had practiced circumcision, but not as a mandatory rite and probable seldom on infants; nor did they associate it with the idea of covenant."
    It was the Judean Priests who wrote Genesis 17 (P text) 13 centuries after Abraham's putative lifetime that called for male circumcision of infants. A initiation rite not so much for the infant but of the father who must circumcise his son himself for he is cognizant of the event whereas the infant is not. These type of circ.s were the cutting off the acroposthion (the part that hangs past the glans). No damage of tearing the foreskin from the glans (thus results scarring from the cut up to the tip of the glans) and no amputating the part covering the glans. The radical circ., also medically known as penile reduction, as we do happens centuries later. The Torah says not to mark the body, the original Covenant jives with the earliest Judea.

    Dr. John Taylor penile and heart researcher - Sexual Function of the Dartos Muscle (loosely):
    Upon erection the Dartos muscle tenses creating a one-piece solid skin tube, where any action on the penile shaft is transferred to act on the erogenous Taylor's Ridged Band and through its loop to the Frenulum, this action it transferred to act on the erogenous Frenulum, together the male's sexual nexus. No action on the shaft is wasted on these sexual structures.
    Circumcision always removes all of the erogenous Taylor's Ridged Band and part to all of it's connecting Frenulum. Having this hangman's noose of the male's sexual receptors missing no longer keeps the whole of the penile Dartos muscle tense. All action on the erect penile shaft is wasted to act on the Ridged Band and Frenulum. Action must be applied directly to the Frenulum remnant, if any remains.
    Circumcision cuts off 65%-85% of the male's sexual receptors (85% when the frenulum is cut or scraped off infant). This leaves 15% sexual receptors located in the glans corona where it's overpowered by the more populous pain/thermal receptors, ratio 5% to 95%. It is this case that men report "If I felt anymore sensitivity, I think I would die of a heart attack!" (Larry David) Circumcision changes the way, means, and type of sensations felt. Remember the intact penis feels stereoscopic pleasure coming from two pleasure sources, the ridged band playing WITH the corona. This is all destroyed cutting off all the ridged band and part to all the frenulum. Removing as much skin as retained has the strong potential to move the scrotum close to the body thereby interfering with the heat regulation of sperm and bring it closer to the now changed warmer denuded penis. Circumcision destroys several functions and sexually handicaps.

    Tikkun Alom.

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  36. The Royal Dutch Medical Association (KNMG) 2010 Circumcision Statement:
    "There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.

    "Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. The most common complications are bleeding, infections, meatus stenosis (narrowing of the urethra) and panic attacks. Partial or complete penis amputations as a result of complications following circumcisions have also been reported, as have psychological problems as a result of the circumcision.

    "Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.

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  37. Revered Hebrew sage Maimonides wrote in the 12th century that the purpose of circumcision was to reduce the distraction of pleasure receptive genitals, and that a woman who had bedded an intact man would never settle for a cut guy again.

    No medical association endorses routine circumcision. HE can decide for HIMSELF at a rational age whether to undergo properly anesthetized genital surgery, just as millions of men do with vasectomy.

    3% of good Jews in Israel and the US don't circumcise. In Sweden, it's about half. Cutting him at birth denies his right to choose to be that kind of good Jew, and sends a confusing message about the meaning of THOU SHALL NOT STEAL.

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