Forward – March 5, 1999

Advocates Say Burden Now Falls on Community to Explain Benefits

Dr. Stuart Jaffee: “Our Guidebook is the Bible”

NEW YORK – Anti-circumcision activists are feeling energized by a new policy of the American Academy of Pediatrics saying that the medical benefits of circumcision are not sufficient to recommend the procedure routinely for newborn males.

Jewish ritual circumcisers, for their part, say the academy’s new policy will not alter Jewish practices; it merely puts fresh responsibility on the community to explain to parents the spiritual benefits of circumcision.

Doctors of the academy task force that authored the policy, meanwhile, say that the new policy should not be read as an anti-circumcision brief. Rather, they say, the policy documents some health benefits of the procedure and supports the right of families to circumcise their sons in accordance with their customs and beliefs. The main new medical recommendation in the new policy, they say, is that anesthesia should be used during the procedure to lessen the infant’s pain.

The conflicting reactions to the policy, the first revision of the academy’s position on the subject in 10 years, show that circumcision remains a controversial procedure. According to a statement available at the American Academy of Pediatrics web site, the academy concluded in 1971 “that there was not absolute medical indication for routine circumcision.” A 1989 policy, reacting to new research on urinary tract infections and sexually transmitted diseases, “concluded that newborn male circumcision did have potential medical benefits and advantages, as well as risks.”

Those benefits, according to the statement, are that circumcision decreases the chance that a male infant will develop a urinary tract infection in the first year of life to one in 1,000 from one in 100. Uncircumcised men are three times more likely to develop penile cancer, a rare disease, than are circumcised men. Circumcision may also reduce a man’s risk for developing certain sexually transmitted diseases, including HIV infection.

The new policy, according to a member of the American Academy of Pediatrics circumcision task force, Dr. Craig Shoemaker, “says there are potential medical benefits [to circumcision], but the potential benefits aren’t strong enough to warrant it routinely – it’s not like immunization.”

The policy, he said, “will not make either pole [in the circumcision debate] happy. We don’t say, ‘Every little boy should be circumcised.’ We don’t say, ‘Every little boy shouldn’t.’ What the statement says is, you shouldn’t do it without thinking about it. Unfortunately, that’s still being done in this country.”

However, such arguments do not deter the anti-circumcision forces, which claim that the procedure visits psychological trauma on the infant and interferes with adult male sexual pleasure.

“If [the academy] can’t recommend circumcision…the debate shifts from the medical claims to the ethics of forcing it on the child,” said the director of an anti-circumcision group, the Circumcision Resource Center, Ronald Goldman. “It weakens the case for doing it for health reasons if that’s been a factor in parental decisions.”

Mr. Goldman, author of “Questioning Circumcision: A Jewish Perspective” (Vanguard), said the new policy of the American Academy of Pediatrics might influence a significant number of secular Jews to abandon circumcision for their sons. The policy, he said, “acknowledges the extensive pain and trauma of circumcision” and “mentions 20 different possible complications” of circumcision. He said the policy showed physicians to be derelict in their responsibility to their patients, namely, male babies. “If they can cut off this normal, healthy body part, what other normal, healthy body part can they cut off at the parents’ request?” he asked.

But for Jewish ritual circumcisers, or mohelim, such as Dr. Stuart Jaffee, a urologist who was trained as a mohel by the Reform and Conservative movements, “the spiritual consideration is the first and foremost.”

“Our guidebook [for circumcision] is the Bible,” he said, calling circumcision a “token” of God’s contract with Abraham, “a contract that probably has lasted longer than any contract in the history of the world.”

“In the last 50 years, when American Jews were assimilating, it was nice to have studies that said the medical profession recommended [circumcision],” said Rabbi Daniel Frank, a mohel based in the Orthodox community of Monsey, N.Y. “Now that we don’t have that, we have to start underscoring the religious requirements….We have to remind Jews why circumcision has been important for centuries. It puts the burden on us.”

Rabbi Frank said that, in his understanding, Jewish law permits using anesthetics during ritual circumcision, which is known as brit mila. He said, however, that ritual circumcisers do not employ the painful clamps that hospital circumcisers do and so spare the infants much pain. The sweet wine in a small cloth given the infant to suck on is a sufficient anesthetic, he said. Painkillers, he said, “are to satisfy the parents…[they] need it for themselves more than for the baby.”

Dr. Jaffee, based in Worcester, Mass., said injected painkillers or even topical ointments could cause allergic reactions and so they are not practical for the home settings of most Jewish brits.

Whatever the American Academy of Pediatrics decides, Rabbi Frank said, Jews will cling to their commandment to circumcise. “In all settings where there was religious persecution, circumcision was a target, because anti-Semites recognized the deep connection circumcision created between Jews and their God,” he said. “Even when, in the 19th century, Jews were rethinking their own practices, when it got down to circumcision, that they couldn’t tolerate eliminating.”