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 and Rav Daniel Feldman’s The Right and the Good, pp.75-94). We should note, however, that Rav Ovadia Yosef (see 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
For many decades Poskim have debated 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 (one must have intention to fulfill the Mitzvah in order to fulfill one’s obligation). 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 Mitzvah of Milah. This argument is especially important in light of the Magen Avraham's (60:3) ruling that Kavannah for a Torah level 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, Rav Yitzchak Fischer, a Mohel from Monsey, told this author that Rav Moshe Feinstein permits a local anesthetic only 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 Mitzvah to circumcise in a manner that inflicts pain."
On the other hand, the Maharsham (Teshuvot Maharsham 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 Mitzvah 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 Mitzvah 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 Mitzvah on a rock." Rav Ovadia Yosef concludes his Teshuvah by relating that the Beit Din of Jerusalem authorized the performance of a Brit on an adult convert to whom general anesthesia was administered.
Rav Meir Arik (Teshuvot Imrei Yosher 2:40), however, forbids even a local anesthetic. He argues that the experience of pain is an integral component of the Mitzvah 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 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 Mitzvah, 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 Etrog. Why then does the Midrash state that Avraham received reward for the pain he endured during Brit Milah? Rav Meir Arik's answer is that experiencing pain is not an aspect of the Mitzvah of taking an Etrog, but it does constitute an aspect of the Mitzvah of Brit Milah.
The Current Dispute - Topical Anesthetic
Recently, doctors have developed topical anesthetics such as EMLA, which 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. Rav 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 Chavah's sin, we make 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.
Rav 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 in part due to reports of medical complications caused by these anesthetics. My father-in-law Rav Shmuel Tokayer (a Mohel who resides in West Orange, New Jersey) reports that he has heard of incidents where the anesthetic cream caused the foreskin to become inflamed. Rav Tokayer told me that it is highly imprudent to perform a Brit on an inflamed foreskin. Rav Fischer told me that he has heard similar reports and expressed similar concerns. Rav Fischer added that anesthetic cream sometimes causes high blood pressure and increased bleeding 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.