This article was co-authored with Anne C. Epstein, MD, FACP.
Human rights start at home. We must defend them for children in the Jewish community as much as adults in others. Day eight in the life of Jewish boys should be no exception, even as we engage in the ritual excision of foreskin from their penises. Both the pain and unnecessary foreskin can be cut together.
We first read of circumcision in the Torah portion known as Lech Lecha (Genesis 12:1 - 17:27). In it, God makes a tremendous promise to Abraham. Sarah, who is 90 years old, will have a child. And through that child, God will give Abraham numerous descendents, and those descendents will include kings. God will give them the land of Canaan, and God will be their God forever. But in exchange, Abraham and all his descendents have to do something: they have to circumcise all their male babies.
So of course, Abraham immediately goes out and has himself and all the male members of his household circumcised -- and all males thereafter circumcised when they are eight days old. Shortly afterwards, Sarah becomes pregnant. Both kept their end of the bargain and provided a model for future Jews in their ongoing covenant with God.
Yet it is doubtful that Abraham and his household (presuming the historicity of the Torah portion) were even the first to be circumcised. Abraham came from Haran. In the area of Haran, archeologists have discovered statues of circumcised men that date from over a thousand years before Abraham in the early Bronze Age -- about 2800 BCE. There is evidence (such as the use of a stone knife in the Biblical stories of Joshua and Zipporah) that the tradition may in fact be even older, perhaps even as early as 3200 BCE. That means 5,000 years of circumcised penises in the Middle East!
In spite of -- and perhaps because of -- its ancient origins, the practice of circumcision has come under heated attack in recent years. If you go to the Internet and search for "circumcision," many of the sites are from groups that oppose the practice of circumcision, in part because it is painful.
Most Jews also believe that circumcision is emblematic of the human link to tradition. Our people faithfully adhered to it for millennia as a symbol of our covenant with God. But as modern people -- in our case a physician and a rabbinical student -- we are committed to minimizing pain.
It seems imperative to link the modern innovation of anesthesia to the ancient tradition of circumcision to ensure the right of Jewish baby boys not to suffer unnecessary pain. The American Academy of Pediatrics agrees. (It also has foregone either endorsing or warning against the circumcision of male infants, noting both potential medical benefits and the challenging prospect of elective surgery.)
Yet there is also the problem of choosing the right anesthesia for a circumcision procedure. Confusing and even disingenuous language abounds on circumcision websites. Some claim to provide "pain-free" circumcision but only supply an anesthetic cream. It is quite inadequate, as this article in Pediatrics shows; no other comparable surgery would be performed with anesthetic cream alone. The term "local anesthetic" is also ambiguous -- sometimes intentionally so -- and may simply be a fancier way of referring to the same inadequate topical cream.
What is needed for nearly painless circumcisions is "nerve block," delivered by needle to the penis itself. While the idea of an injection to the penis sets teeth on end, it is as close to pain-free as we can get in this sort of minor surgery. (For more, see this article by the Journal of the American Medical Association.) It hardly hurts -- in contrast to the cutting edge of the circumcision blade. And it can only be given by someone licensed to do so, namely a physician or nurse.
Dr. Epstein (who co-authored this article) officiated at one circumcision operation performed by a doctor who used a nerve block anesthetic on a baby. The baby didn't cry. He sucked on his pacifier calmly throughout the procedure. The surgeon was relaxed and took his time to do a careful job, and even cracked jokes -- much as he would likely do with his team in an operating room. The parents were relaxed and happy, the onlookers were relaxed and happy, and in fact everyone was happy. It was a joyous occasion, not an agonizing one. The surgeon was so inspired that he went out and studied to become a certified mohel (ritual Jewish circumciser).
That is the future of Jewish circumcision. The overwhelming majority of modern rabbis have determined that there is no halachic (Jewish legal) objection to anesthesia -- including the far more effective "nerve block" injection.
The Union for Reform Judaism has established a Berit Mila Program (circumcision program) for certified physicians (licensed to use anesthesia) who are also certified mohels. The Rabbinical Assembly has also created a course on Brit Milah (circumcision) for Conservative Jewish doctors. We urge other branches of Judaism to do the same. In addition, the traditionally trained mohel can perform a humane circumcision as long as he or she works with a certified nurse or physician who gives the baby a nerve block first. One way or another, the nerve block should be required for circumcisions within all streams of Judaism.
Even as our tradition calls upon us to affirm the human rights of others, we must not forget those who live in our houses, eat at our dinner tables, and rely on us for love, care, and protection. Human rights must begin in our homes. Day eight in the lives of Jewish boys should be no exception.
Anne C. Epstein, MD, FACP. is a board-certified Internal Medicine specialist and a Fellow of the American College of Physicians who is engaged in full-time private practice of medicine in the West Texas city of Lubbock, TX. Anne has served as President of Congregation Shaareth Israel, and during a 6-year period when the congregation had no Rabbi, Anne frequently led services, read and taught Torah, and officiated at life-cycle events. She still pinch-hits occasionally. This article is adapted with permission from Tikkun Daily.
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