From
Parshat Vayera Vol.11 No.8
Date of issue: 17 Cheshvan 5762 -- November 3, 2001
Modern Brit Milah Issues - Part Three
by Rabbi Howard Jachter
This week we will conclude our discussion of modern Brit Milah issues with a
discussion of Brit Milah on Shabbat for a baby that was conceived by artificial
insemination or in vitro fertilization and the use of anesthetics at a Brit.
Brit Milah on Shabbat, Bathhouse Insemination, Artificial
Insemination, and In Vitro Fertilization
The Gemara (Shabbat 130-134) teaches that we perform the Milah even on
Shabbat if that day is the eighth day of the baby's life. The Gemara (Shabbat
135), however, notes that this applies only to a baby born in a manner where the
mother is rendered ritually impure (as described in Vayikra 12:1-8). Thus, we do
not circumcise a baby that was born by caesarean section on Shabbat (see
Shulchan Aruch Yoreh Deah 266:10). A mother becomes ritually impure at birth
only upon a "conventional" birth.
The Gemara (Chagigah 16a) discusses the Halachic implications of a bathhouse
insemination. Commenting on this Gemara, Rabbeinu Channanel writes "this is a
miraculous act and a woman does not become ritually impure upon this type of
conception because it does not meet the specifications of the Pasuk (Vayikra
12:1) 'when a woman conceives and gives birth.'" Thus, according to Rabbeinu
Channanel, we may not circumcise the child conceived by bathhouse insemination
on Shabbat.
Rav Shlomo Zalman Auerbach (Teshuvot Minchat Shlomo 3:98:4) presents two
possible ways to interpret Rabbeinu Channanel. One is that since the conception
occurred miraculously the woman does not become ritually impure at birth. A
second interpretation is that the woman is not rendered impure because the
conception occurred in an unconventional manner. Rav Shlomo Zalman believes that
the second interpretation is the correct one.
Rav Shlomo Zalman notes that according to the second interpretation, Rabbeinu
Channanel would rule that a woman who was artificially inseminated does not
become ritually impure at birth, since the conception was unconventional.
Accordingly, Rav Shlomo Zalman suggests that one should not perform a Brit on
Shabbat on a boy that was conceived by artificial insemination.
Rav Hershel Schachter rules that we should follow Rav Shlomo Zalman's approach
and not circumcise the child conceived by artificial insemination on Shabbat.
Rav J. David Bleich (Tradition Summer 2001 - volume 35 no. 2 - pp.61-62) notes
that the same rule applies to a child that is conceived by in vitro
fertilization.
Parents for whom this is relevant should discretely inform the Mohel, as he is
unlikely to inquire how the baby was conceived. Rav Bleich writes that in order
to protect the family's privacy, parents may tell people that the Brit will not
take place on Shabbat because the baby was a caesarean section birth or
jaundiced. Rav Bleich rules that one may tell a "white lie" in such
circumstances (see Rashi to Breishit 18:13). We should note, however, that Rav
Ovadia Yosef (Yalkut Yosef, Kitzur Shulchan Aruch p.904) rules that one may
perform a Brit on Shabbat on a baby that was conceived by artificial
insemination or in vitro fertilization.
Anesthetics at a Brit
Poskim have debated for more than a century the Halachic viability of
general and local anesthesia for Brit Milah. Recently, Poskim have actively
debated the use of a topical anesthetic at a Brit. This debate remains
unresolved, as some Mohelim use an anesthetic and many do not. We will begin by
reviewing the classic debate regarding the use of anesthesia at a Brit Milah.
Three distinct approaches to this problem appear in Halachic literature. Rav
Yechiel Yaakov Weinberg (Teshuvot Seridei Eish 3:96) adopts an intermediate
approach to this issue. He rejects the idea that experiencing pain is an
integral component of the Milah process. On the other hand, he notes that many
Rishonim rule in accordance with the opinion that Mitzvot Tzrichot Kavannah. Rav
Weinberg argues that one cannot be placed under general anesthesia for Milah,
since an anesthetized patient is unable to have Kavannah to fulfill the Mitzva
of Milah. This argument is especially important in light of the Magen Avraham's
(60:3) ruling that Kavanna for a Torah obligation is indispensable. Rav Weinberg
is even more emphatic regarding the Milah of an adult convert. Rav Weinberg
writes "behold it is by the Brit that he enters into Kedushat Yisrael and if he
is sleeping during the Milah, who ushers him into Kedushat Yisrael?" Indeed,
Rabbi Yitzchak Fischer, a very active Mohel from Monsey, told this author that
Rav Moshe Feinstein permits only a local anesthetic for an adult convert but
forbids a general anesthetic for an adult convert.
Rav Weinberg's argument applies only to the circumcision of an adult. Rav
Weinberg does not object to the use of full anesthesia on a baby, but he does
not endorse it either, since its use constitutes a departure from accepted
practice. On the other hand, he permits using a local anesthetic even for an
adult. He explains, "We have not found anywhere that there is a Mitzva to
circumcise in a manner that inflicts pain."
On the other hand, the Maharsham (Teshuvot Maharshom 6:85) and Rav Ovadia Yosef
(Teshuvot Yabia Omer 5:Y.D. 22) permit full anesthesia even for an adult. Rav
Ovadia cites the celebrated responsum of the Maharach Ohr Zarua (number 11) who
asserts that the fundamental Mitzva of Milah is the state of being circumcised.
Accordingly, he argues, it is irrelevant that one lacks Kavannah while he is
anesthetized. One fulfills the Mitzva simply by being circumcised. Rav Ovadia
adds, "The Kavannah of the Mohel suffices for the one being circumcised,
especially since the Mohel is the latter's Shliach (agent)." The Maharsham
emphasizes (based on Gittin 70b) that agency does not expire when the
Meshaleiach (principle) sleeps. The Maharsham equates an anesthetized patient
with a sleeping individual. Rav Weinberg, on the other hand, believes "an
anesthetized person is the Halachic equivalent of a rock, and one does not
fulfill the Mitzva on a rock." Rav Ovadia Yosef concludes his Teshuva by
relating that the Beit Din of Jerusalem authorized the performance of a Brit on
an adult convert to whom general anesthesia was administered.
At the other extreme, Rav Meir Arik, who lived in Tarnow, Galicia, (Teshuvot
Imrei Yosher 2:40) forbids even a local anesthetic. He argues that the
experience of pain is an integral component of the Mitzva of Brit Milah. He
notes that Bava Kama 85a demonstrates that anesthetics were available to Chazal.
He points out that despite the availability of anesthetics, Chazal chose not to
use anesthetics at a Brit. He infers that Chazal oppose using anesthetics at a
Brit because pain is an essential component of a Brit.
The Imrei Yosher argues that this idea is reflected by the following Midrash
(Breishit Rabbah 47:9, commenting on Breishit 17:26) that states "Rav Abba said,
'He suffered pain so that Hashem will double his reward." Rav Weinberg, though,
counters that this Midrash merely demonstrates that Avraham Avinu desired the
reward for the pain he had to endure for Brit Milah. It does not prove that
there is an obligation to inflict pain on baby boys who do not intend to be
rewarded for their pain.
Rav J. David Bleich (Tradition Summer 1999 - volume 33 number 4 - pp.56-60), in
turn, explains the argument of the Imrei Yosher. Rav Bleich notes that if one
experienced pain in the process of a performing a Mitzva, such as obtaining an
Etrog that was ensconced in thorns, he would not receive any additional reward
for the pain he endured in order to obtain the Etrogs. Why then does the Midrash
state that Avraham received reward for the pain he endured during Brit Milah?
Rav Meir Arak's answer is that experiencing pain is not an aspect of the Mitzva
of taking an Etrog, but it does constitute an aspect of the Mitzva of Brit
Milah.
The Current Dispute - Topical Anesthetic
Recently, doctors have developed topical anesthetics such as EMLA, that
reduce the pain that babies experience during a Brit. There has been a mixed
reaction by Poskim regarding its use at a Brit. Rav Eliezer Waldenberg (Teshuvot
Tzitz Eliezer 20:73) forbids its use based on the Imrei Yosher. Rav Wosner of
Bnei Brak (Teshuvot Shevet Halevi 5:147:2) also forbids the use of a local
anesthetic on a baby except in case of great need. Rabbi Yitzchak Fischer told
me that Rav Wosner told him that one may use a local anesthetic when
circumcising an adult because of the great need to do so. Rav Wosner believes
that absent great need one should not tamper with the traditional character of
Brit Milah, which includes experiencing pain. He cites the Gemara (Gittin 57b)
that explains the Pasuk (Tehillim 44:23) "For Your sake we are killed all of the
day", to be referring to Brit Milah, as proof for his assertion.
On the other hand, Dr. Abraham S. Abraham (Nishmat Avraham 5:83-84) reports that
Rav Yaakov Hillel, a Rosh Yeshiva of a prestigious Yeshiva for Kabala studies,
investigated the matter and found no source in the Zohar and other Kabalistic
works that teach there is any special value attached to the suffering of a baby
during his Brit. In fact, the Rosh Yeshiva remarked that despite the fact that
the Zohar teaches that birth pains atone for Chava's sin, we make all efforts to
reduce the pain a woman experiences during birth, and no rabbinic authority
objects. Indeed, Dr. Abraham reports that both Rav Shlomo Zalman Auerbach and
Rav Yosef Shalom Eliashiv told him that if there is no medical problem
associated with the use of a topical anesthesia, then there is an obligation to
use it at a Brit to reduce the suffering of the baby.
Conclusion
Rabbi Fischer reports that an injection of a local anesthetic is administered at
almost all circumcisions of adults. He reports that a general anesthetic is used
for an adult born Jew only in case of great need. He relates, though, that
Poskim do not permit general anesthesia for an adult convert in virtually all
cases.
Some Mohelim have begun to use topical anesthetics at a Brit of a baby. However,
many Mohelim decline to use them due to reports of medical complications caused
by these anesthetics. My father-in-law Rabbi Shmuel Tokayer reports that he has
heard of incidents where the anesthetic cream caused the foreskin to become
inflamed. Rabbi Tokayer told me that it is highly imprudent to perform a Brit on
an inflamed foreskin. Rabbi Fischer told me that he has heard similar reports
and expressed similar concerns. Rabbi Fischer added that anesthetic cream
sometimes causes high blood pressure and increased blee-ding at a Brit.
Interestingly, Rav Moshe Feinstein (Teshuvot Igrot Moshe Y.D. 4:40) writes that
we do not use anesthetics at a Brit because of the danger associated with
anesthetics. His concern might apply to the topical anesthetic creams.
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