March 4, 1999
Making the Cut
"Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits," said Dr. Carole Lannon, head of the AAP's task force on circumcision. The proven medical benefits include the decreased risk of urinary infection for the baby in the first year, and fewer instances of penile cancer when older. As for the lower risk of contracting sexually transmitted diseases, the AAP concluded that the use of condoms and other "behavioral factors" are more important in determining a person's risk.
The AAP has been back and forth on this issue. In 1971, it said no, circumcision wasn't necessary; in 1989, it cited new AIDS research and said, well, maybe. Now, after examining 40 years of available medical research, the group has concluded that there is not sufficient evidence to make circumcision a matter of universal recommendation, though it acknowledged some may want to continue the practice based on their own familial, religious and cultural practices. (The AAP's website, www.aap.org, contains the report in full.)
"I appreciate that at least the task force indicated that circumcision was an important part of religious and cultural identity," Rabbi Lewis Barth told me. Barth founded the brit milah program at Hebrew Union College 14 years ago, which has trained more than 200 liberal medical professionals (including some 50 women) in Jewish circumcision. "Usually, they leave religion out."
Nevertheless, fear of the new policy's impact was evident. A spokesman for Shaare Tzedek Hospital in Jerusalem called this reporter to protest that the American doctors hadn't mentioned that circumcision protects against phimosis and paraphimosis --problems of foreskin retraction, which affects 10 percent of those uncircumcised -- or that it decreases the rate of cervical cancer in female sexual partners as some research indicates.
Still, one suspects that Shaare Tzedek doctors do not fear that non-Jewish men will develop paraphimosis. They are justifiably concerned that if pediatricians retreat from circumcision, individual Jews themselves will flee the practice.
On Tuesday, with the Times story blazing, Dr. David Barron of UCLA-Santa Monica Medical Center and a trained mohel, addressed Rabbi Donald Goor's HUC class in Practical Rabbinics. Dr. Barron told me he became a mohel because, after years of doing hospital circumcisions, he wanted to offer his clients a ritual component to the procedure. The class that day was alive with projected scenarios from the AAP report such as the possible decline in non-Jewish circumcised men snowballing into pressure on assimilated Jews to follow suit.
On the other hand, the class wondered, if the "Who is a Jew?" battle flares up, would proof of circumcision be required for some religious privileges, like the right to stand under a chuppah in marriage?
With such concerns in mind, I considered the history of the problem. Jews have been practicing circumcision for at least 3,000 years. It is the essence of the covenant between God and Abraham defined in the Bible. Even highly assimilated Jews still maintain the practice, allowing their sons to assume this essential mark of Jewish eligibility even if membership isn't meaningful to them.
But to do so costs them nothing. Right after World War II, for reasons that are unclear, circumcision was taken up by American hospitals. By 1983, almost all American males were circumcised, most of them in hospitals. Thus, the American public became assimilated to a Jewish ritual even though the medical benefits were never absolutely proved. And we were flattered. Now we're confused.
Of course, those Jews who depend upon Western medical support to justify what is, at root, a religious ritual, will feel threatened by the AAP decision. Some might even forgo circumcision altogether. Having bought the secular notion that circumcision is good for everyone, they might feel diminished by the notion that it could be "just" a religious rite after all. It's as if they need biological proof that the Ten Plagues occurred before celebrating Passover.
But for the majority of Jews, the AAP decision was mostly academic on the question of whether or not to circumcise. "This ruling actually makes my life easier," Barron told me. "Now when I talk to a family I can ask them directly about their spiritual beliefs, or their cultural identification. I don't have to make any claims for medical benefits."
On the other hand, the AAP panel might have actually improved the ancient ritual: It declared that if circumcision is chosen, pain relief is essential. Some mohels have resisted anesthesia.
"I used to feel that the pain to the baby was small, and if this was the only pain he felt in his life, it wouldn't be too bad," said Barron, who began using anesthetic six months ago.
It always feels good when the pain ends.
Marlene Adler Marks, senior columnist of The Jewish Journal, is author of "A Woman's Voice: Reflections on Love, Death, Faith, Food & Family Life."
Her website is www.marleneadlermarks.com.