I would guess that most Americans, even Jewish Americans, had never heard of metzitzah b’peh until the recent controversy between ultra-Orthodox Jews and the New York City Department of Health. This phrase, translatable as suction by mouth, refers to a custom performed after a circumcision in which a mohel (ritual circumciser) orally sucks the blood away from the baby boy’s penis. Metzitzah b’peh became part of circumcisions in the 2nd century, when it was deemed the best method of satisfying the requirement to hygienically remove the blood shed during the procedure. Most Jews, even observant modern Orthodox Jews, have discarded the practice, which has been linked to a dozen cases of herpes infection and two deaths of infant boys in New York since 2002.
For years now ultra-Orthodox Jews, the mayor of New York, and the New York Department of Health have been trying to balance the demands of religious belief with the protection of vulnerable infants. Mayor Bill de Blasio has come up recently with a new “compromise” – if a baby contracts herpes or another infection that can be attributed, using a DNA test, to a particular mohel, then that mohel would be barred from performing metzitzah b’peh in the future. This resolution seems like closing the barn door after the horse has escaped.
In an effort to educate parents about the possible harm that metzitzah b’peh posed to their babies, back in 2012 New York’s Department of Health required mohels to describe the procedure, outline its advantages and disadvantages, and receive permission from the parents to proceed. But the requirement proved too hard to enforce. Many oral suction supporters opposed the “informed consent” solution; the mohels believed it violated their freedom of speech because they disagreed that potential dangers existed, and so they objected to expressing any sense of such danger to parents. Those who opposed the practice altogether were against the informed consent solution because they, like me, believed, that parents shouldn’t be able to “consent” to unnecessary and potentially harmful procedures for their babies.
While I understand the political pressures Mayor de Blasio now faces and appreciate his efforts to honor diversity, his new “solution” of testing after the fact undermines public safety. It exposes infants to harm that might be prevented, while it fails to mitigate the damage suffered.
Metzitzah b’peh violates a baby’s rights, and, without a compelling reason to override a person’s rights’ claims (which infants are in no position to claim, defend, or waive), it shouldn’t be allowed at all. The obligation to do no harm – particularly when an alternative exists, such as the sterile pipette used by modern Orthodox mohels – should take priority over religious practice in this instance. But if a compromise is the only way to make any progress, then instead of linking the infection with the mohel’s DNA after a baby has been infected, I think it makes more sense for mohels to be tested for herpes and other transmittable diseases before the oral suction procedure is performed. If a mohel doesn’t want to submit to the test, then he shouldn’t be allowed to do the procedure.
Beyond the health risk, metzitzah b’peh violates a baby’s right to refuse nonconsensual mouth to genital contact. In situations involving minors, the state has a particular authority and duty to place limits on religious practices that constitute clear and present dangers. First Amendment rights (for religion or speech) do not provide carte blanche, and the damage of metzitzah b’peh merits such intervention to limit the rights of some in order to protect the rights of others. There are some things that parents should not get to consent to on behalf of their children.
Some fear that the metzitzah b’peh controversy threatens to undermine not only this particular practice but the ritual of circumcision itself. If Jews take a stand against metzitzah b’peh, to what extent will such opposition open the door for criticisms of ritual circumcision more generally? That’s a different question, and both sides have arguments to make, but the possibility of such a debate should not distract us from the more pressing threat.
The case for metzitzah b’peh is weak. It’s not medically warranted or sound, and it’s not central to Jewish religious ideology. It is a custom that can, should, and has been modified by a range of observant adherents to Judaism. If a faction of ultra-Orthodox insists on doing this the old-fashioned way, then at the very least its mohels should submit to herpes testing beforehand, and those who test positive should be banned from performing the practice to ensure babies’ safety.
Elizabeth Reis is professor and chair of the women’s and gender studies department at the University of Oregon.