Not On Your Life
By: Rav Hayim Leiter
Tags: Jaundice, Circumcision, Brit Milah, Baby, Bris

I’ve lost a few Britot in my career and I couldn’t be prouder of it. There have been times when parents have asked me to be their mohel and later changed their mind. You could call these cases of irreconcilable differences: I won’t perform a Bris if there’s even the slightest doubt about a baby’s health and these parents, at the advice of medical professionals or other mohalim, have chosen to have the Brit Milah on time.

One of the major factors for these parents has been the importance of doing the Bris on the eighth day. There is no doubt that having the Brit Milah on the eighth day shouldn’t be taken lightly. It is the essence of the commandment and if all things are equal, it even pushes off Shabbat and Yom Kippur. The eighth day is also what we’ve been fighting to preserve in places like Iceland and Denmark, where lawmakers have threatened to ban neonatal circumcision. These countries have attempted to pass laws only allowing circumcision at age 18 so the individual can decide for himself. In response, organizations like Safer HaBrit have fighting to protect our ancient rite against such attacks. So, in many ways, the eighth day is sacrosanct but it’s not the end of the conversation.

The health and wellbeing of the child are also of paramount importance. One of the most common neonatal health issues a mohel encounters is jaundice — the yellowing of the skin and eyes due to an inability of a child’s liver to process waste, thus resulting in a buildup of bilirubin. The hospital can test the bilirubin level of the child, which can range between 0–45.5 mg per dL. A child suffering from high bilirubin levels has its own elements of danger and performing a Bris on such a child greatly complicates an already complex situation. Each mohel has his bilirubin number, referring to the highest number he is comfortable performing a Brit Milah.

As a general rule, when the baby requires phototherapy to lower the bilirubin level, I will not perform the Bris until there is an indication that things have leveled off. The problem is the higher the bilirubin number, the higher the risk involved. If one performs a Brit Milah when the child’s level is too high, it could result in hospitalization or death.

My rule of thumb is to always have the child tested if he is showing any signs of jaundice; one can never “guesstimate” with such matters. And even if the baby has been tested and all seems fine, if I show up on the morning of the event and the baby’s yellowness gives me pause, I’m sending everyone home. When it comes to a child’s safety, I’m uncompromising and for good reason.

Regarding illnesses such as jaundice, the rabbis have been clear on what the ruling is from the time of the Talmud on. The Shulchan Aruch states:

קטן שהוא ירוק סימן שלא נפל בו דמו ואין מלין אותו עד שיפול בו דמו ויחזור מראהו כמראה שאר הקטנים

“A child who is yellow, it is a sign that his blood has not descended and we do not circumcise him until his blood descends and his appearance returns to that of the rest of children.”

But in some of these health-related cases, there have been discrepancies between what I was willing to do, and what the doctors were recommending. As a general rule, Jewish tradition follows modern medicine. Some would even call this the Halacha. When it comes to the issue of Metzitzah B’Peh, that is the debate: to continue doing oral suction because it’s ‘how it’s always been done’ or to listen to modern medicine which clearly indicates that this practice could lead to either the child or mohel contracting infectious diseases. But what should a mohel do if he is concerned about an issue and the doctors are saying the baby is healthy to proceed with the Bris on time?

Rav Avraham Shteinberg is the leading researcher of halacha and medicine at Shaare Tzedek hospital. His legal work, Refuah K’Halacha deals with this very issue.

סומכים על הרופאים האומרים שמצבו של התינוק מסוכן שלא למולו, אבל אין סומכים עליהם למול את התינוק כשאומרים שמצבו אינו מסוכן, אם לפי התלמוד והפוסקים נחשב המצב למסוכן

“One should rely on the doctors who say that the baby’s status is dangerous so as not to circumcise him. But one should not rely on them to circumcise the baby when they say that his status is not dangerous if the Talmud and legal dicisers consider the status to be dangerous.”

At first glance, this seems crazy. Why would we rely on a 2,000-year-old book and/or some slightly younger rabbis to decide issues like this? Isn’t our medical science more advanced than theirs was? There is something to be said for that. And when it comes to Metzitzah B’Peh, I’m always going to side with modern medicine. But our rabbis knew more than meets the eye.

Just over a month ago there was a very rare, undetectable case of hemophilia in South Africa. The baby almost died at his Bris but thanks to the quick actions of the mohel, the baby was saved. As this articlebm states, “The Talmudic description of hemophilia was two millennia ahead of its time, as the first modern description was recorded in 1803.” So when it comes to medical issues, the rabbis are not to be a priori assumed to have no knowledge.

When it comes to medical issues and performing a Brit Milah, I am always going to err on the side of caution — be it the advice of modern medicine or the rabbis of the Talmud. Because as the Shulchan Aruch so eloquently states:

וצריך ליזהר מאד באלו הדברים, שאין מלין ולד שיש בו חשש חולי, דסכנת נפשות דוחה את הכל, שאפשר לו למול לאחר זמן וא”א להחזיר נפש אחת מישראל, לעולם

“One needs to be extremely careful in these matters, that he does not circumcise a newborn which has any concern of sickness, that life-threatening issues push off everything because it’s possible to circumcise him late, but it’s never possible to return a soul of Israel.”

So, after all this, I’m left with a question: Why would anyone ever take a chance?

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Rav Hayim Leiter is a mohel for the greater Jerusalem area and is the founder of Magen HaBrit, an organization protecting both Brit Milah and the children who undergo it.

This first appeared in the Times of Israel.