(Story updated at 7:20 p.m. ET.)
The New York City Board of Health has relaxed its rules surrounding a controversial practice used by ultra-Orthodox Jews during circumcision.
The ritual, called metzitzah b'peh in Hebrew, involves the oral suctioning of blood from a wound following circumcision, which is traditionally done on the eighth day of a Jewish boy's life. Though most ritual practitioners use a sterile glass tube, a sponge or sterile gauze, the ultra-religious practice of oral blood suction has been a highly political issue in New York, which is home to America's largest orthodox Jewish population.
The city in 2012 enacted an ordinance under former Mayor Michael Bloomberg that required parents to sign a consent form for the practice, responding to the cases of 17 infants who contracted the herpes simplex virus following circumcisions that likely included the ritual. Two of those infants died. But on Wednesday, New York's board repealed the consent form ordinance, instead opting to educate ultra-religious Jews about the risks involved.
Educational brochures will be administered by doctors and health experts in appointments around the baby's birth at the hospital, the health department said in a statement Wednesday evening. Previously, consent forms with risk information were to be provided by the ritual circumciser, but the practitioners did not always abide by the ordinance.
“Protecting infant health is our main goal,” the department said. “We're confident that the right place to deliver sensitive educational information about medical risk is in a secular health care setting, either before or at the time of birth, where a health worker can deliver information to the mother and father.”
Jewish leaders will be responsible for identifying and permanently removing any ritual circumciser that infects an infant with herpes, as proposed by current Mayor Bill de Blasio in a compromise with Jewish leaders earlier this year. Nine board members voted in favor, one against and one abstained.
The consent requirement was impractical and did not have much "material impact," said health board member Pamela Brier, president of Maimonides Medical Center in Brooklyn, which has a heavily Jewish patient base and has been very involved in the issue.
A board member who abstained from voting, Dr. Lynne Richardson, countered that the consent requirement addressed "a very significant public health concern."
Rabbi Chaim Dovid Zweibel, executive vice president of Agudath Israel of America, a New York-based leadership and policy organization of ultra-religious Jews, lauded the administration's planned policy change in a statement last week. He noted that the Bloomberg rules marked the first and only time Americans had sought to regulate the Jewish circumcision ritual.
“It is to Mayor de Blasio's eternal credit that he recognized how profoundly offensive the regulation was to our community, and worked with us to undo the terrible precedent his predecessor had established,” Zweibel said.
Dr. Edward Burns, executive dean of the Albert Einstein College of Medicine at Yeshiva University, a Jewish institution in New York, has been a vocal critic of the practice. He called the de Blasio compromise “inadequate” in an op-ed with other Jewish physicians published in New York Jewish Week magazine in June.
“Behavior by (circumcisers) and local politicians that ignores fundamental principles of hygiene, and abrogates their responsibility to protect innocent children, is shameful and simply wrong, despite their express desire to maintain ancient religious tradition,” the op-ed states.
Though there are some doctors who serve as the ritual circumcisers, most are clergy or spiritual leaders trained in circumcision. Burns said in an interview with Modern Healthcare earlier this summer that ultra-religious Jews need to understand that circumcision is a medical procedure and therefore requires safeguards against infection.
To ultra-religious Jews, “It's not considered a surgical ritual, it's considered a ritual as opposed to a surgical procedure,” Burns said. “The tack that we took in our opinion piece is no matter what it is, it's akin to a surgical procedure and it needs to be treated as such.”
New York City has already distributed 20,000 printed copies and 22,000 e-mail copies of a new brochure in English and Yiddish, according to Health Commissioner Dr. Mary Bassett.
