CCAR RESPONSA

American Reform Responsa

57. Anesthetic for Circumcision

(Vol. LXXV, 1965, pp. 99-101)

QUESTION: A physician performing a circumcision insisted upon using an anesthetic. Should this be permitted or even encouraged from the point of view of Jewish legal tradition?

ANSWER: This question has been asked a number of times in recent years when the use of anesthetics (even for minor surgery) has come into general use. The question is asked usually with regard to adult converts. Sometimes a convert will not consent to circumcision unless an anesthetic be used. In one case the circumstances were reversed, and the convert insisted that no anesthetic be used because he wanted to feel pain, since he considered the pain to be sacrificial. Sometimes it is asked with regard to children. A Jewish child had not been circumcised in infancy (for reasons of ill health). Now, at the age of five, he is to be circumcised and the mother insists that a local anesthetic be used. Out of these various cases a general attitude has emerged as to the use of anesthetics in circumcision for adults and for children.

Perhaps the first discussion of the question was by Meir Arik, the great Galician authority in the past generation. In his responsa (Imrei Yosher II, 140) he decides definitely in the negative. His arguments are worth notice because they reveal the general mood of the authorities of the time to all new suggestions which may affect the ceremonial laws. He calls attention to the Talmudic debate (in Kiddushin 21b) which deals with the piercing of the ear of a Hebrew slave who refuses to be set free. The Talmud there speaks of sam (an anesthetic medicine). This provides, he said, that the Talmud was well acquainted with such medicines. Yet, since the Talmud does not mention the use of anesthetic medicines in circumcision, it clearly was opposed to their use. Furthermore, he says that the Midrash (Genesis Rabba47.9) tells that Abraham was in pain because of his circumcision, and it was for that pain that God gave him additional reward. Then he concludes with a general statement in the nature of a warning, namely, that we have never used anesthetics in the past and, God forbid, that we should introduce any novelties.

This firm and indignant negative is not shared by the majority of the scholars who have dealt with the question. For example, Bezalel Shafran (Responsa Rabaz, #125) refutes the prohibitory opinion found in the book Sefer Haberit, which insisted that the circumcised must be awake for the reason that the fulfillments of commandments require conscious intention (Kavana). Shafran proves that a child may be asleep during the operation and this fact would not impair the legal validity of the circumcision.

The strongest opinion in favor of the use of anesthetics comes from the famous Rabbi of Kishinev, Judah Lev Zirelsohn (who was murdered by the Nazis). It was he who dealt with the question of the five-year-old boy mentioned above. In his Ma-archei Lev, #53, after reviewing various arguments, he comes to the general conclusion that the Torahnowhere requires pain in the circumcision, and therefore, he agrees in the case mentioned to the use of anesthetics.

Gedalia Felder of Toronto, who has done yeoman service in collecting and organizing the Law and Customs in his four-volume work Yesodei Yeshurun, has now written a special work on adoption, conversion, etc. In this work (Nachalat Tsevi,p. 57) he summarizes the various opinions on this question and also doubts the negative opinion of Meir Arik.

In the light of the above, we may conclude that there is no objection to anesthetics. The law does not insist upon pain in the fulfillment of this commandment. However, to this extent Meir Arik is correct: that we should not introduce novelties unless there is a good reason for them. If the child is likely to be naturally asleep during the operation (as often happens), the law does not require that he be wakened (cf. the opinion of Bezalel Shafran). However, if the operation is done by a doctor, and he insists that an anesthetic be used, then we may assume that he has a good reason for it, and we should not raise any objections. In general, we should not institute the use of anesthetics as a regular procedure, but we should permit them when the surgeon or the parent asks that they be used.

Addendum

You now ask about the popular idea that the wine which is (sometimes) given the infant during circumcision is for the purpose of allaying the pain of circumcision.

It is customary for the Mohel to give a drop or a touch of wine with his fingertip after the two blessings, when the phrase from Ezekiel is used: "Live in thy blood." This custom is mentioned by Joseph Caro in Shulchan Aruch(Yoreh De-a 265.2). Of all the classic commentators, only the Spaniard Abudarham gives an explanation; but his explanation has to do with the sinful Israelites being given to drink the water into which their Golden Calf had been ground. A later commentator tries to connect it with the word "live" in the Ezekiel quotation, and attempts to have the drop of wine symbolize eternal life.

These explanations are obviously forced. One may say that no explanation is given for the drop of wine. Nowadays they sometimes give the child a bit of cloth or cake soaked in wine. This would lend itself to the notion that it was for the purpose of allaying pain. But the texts only speak of a "drop" or a finger touch. This could hardly have any pain-allaying effect, and therefore, this could not be the reason.

For the sake of completeness, it might be added that another taste of wine is sometimes given the child on fast-days at the blessing. The Mohel recites the blessing, but since it is a fast-day, he may not taste the wine. Therefore (in order that the blessing not be a "vain blessing"), a taste of the wine is given to the child (cf. Isserles to Yoreh Dea 265.4, Orach Chayim 621:3). But Abudarham quotes Ibn Gayyat and Maimonides, who object to the practice and who prefer that on fast days the wine blessing be omitted entirely. There is a wide variance in the minhagim about this practice. Some say: Give it to the Sandak to taste; some say: Give it to the young boys present to taste; some say: Give it to the mother; and some say: Give it to the child. Mishna Berura (The Chafets Chayim) to #621, says: It all depends on custom, and each custom has its basis. For a fuller discussion, see Edut LeYisra-elby Jacob Werdiger (Benei Berak, 1963), p. 127, #3.

The present custom of giving the child a wine soaked object to suck, which leads to the notion of allaying pain, is not authentic. Only a drop was used, and pain alleviation is neither mentioned in the sources nor possible.

Solomon B. Freehof

If needed, please consult Abbreviations used in CCAR Responsa.