Is metzitzah bapeh prohibited by Jewish law?

There has been a lot of controversy recently about the procedure of metzitzah bepeh, sucking away the blood orally after a circumcision, which some mohelim do instead of the alternative, using a pipette. The Department of Health has come out against the procedure, and in New York there has been a push to require informed consent for the procedure.
This has been heated by reports of the death of a baby in Brooklyn from herpes, who may have received it from a mohel. According to report in the orthodox newspaper Yated, which interviewed mother, the mother believes that her baby got herpes from another child through a pacifier which he had licked before giving it to the baby
The ultraorthodox community here has been up in arms against the proposal, seeing it as one step toward banning circumcision.
In fact, there have been health concerns for hundreds of years, and massive amounts of discussion on the issue. For centuries, there have been Rabbinic authorities who see metzitzah as optional or even forbidden.
Ramban (14th c) notes in the Yad Halevy, his commentary to Rambam’s book of Mitzvot, that in his time, doctors were against it. Already by his time as he puts it massive quantities of ink had been spilled over this issue. He says that it is not part of the mitzvah and certainly can be done with an instrument. Moshe Schreiber / Hatam Sofer (19c Europe) says it is not even a custom.
Avraham Borenstein/ Avnei Nezer (19c Europe): says it was only done because of safety concerns, not because it is part of the mitzvah. Milah consists of making the cut and uncovering, which together fulfill the double commandment of “hamol yimol,” you shall surely circumsize. The midrash says that the two words in that verse refer to cutting and uncovering, but no midrash says that metzitzah is implied by that verse, or by any other verse from the Torah.
On the other side of the controversy, Haim Hizkiyahu Medini /Sde hemed (19c Israel) argued that it is halacha lemoshe misinai—a law handed down to Moses at Sinai that needs no written source. That’s a pretty hard argument to disprove! Moshe Sternbuch, the current chief haredi rabbi in Israel, also came out strongly in favor of metzitzah as a required part of circumcision.
The roots of the controversy are in a passage in the Talmud, which I want to share with you.
BT Shabbat 133a-b
MISHNAH: WE PERFORM ALL THE NECESSITIES OF CIRCUMCISION ON THE SABBATH. WE CIRCUMCISE, UNCOVER, SUCK [Motzetz], AND PLACE A COMPRESS AND CUMMIN UPON IT. IF ONE DID NOT CRUSH [THE CUMMIN] ON THE EVE OF THE SABBATH, HE MUST CHEW [IT] WITH HIS TEETH AND APPLY [IT TO THE WOUND]; IF HE DID NOT BEAT UP WINE AND OIL ON THE EVE OF THE SABBATH, EACH MUST BE APPLIED SEPARATELY. WE MAY NOT MAKE A BANDAGE FOR IT IN THE FIRST PLACE, BUT MUST WRAP A RAG ABOUT IT. IF THIS WAS NOT PREPARED FROM THE EVE OF THE SABBATH, ONE WINDS IT ABOUT HIS FINGER AND BRINGS IT, AND EVEN THROUGH ANOTHER COURTYARD…
WE SUCK OUT, etc. R. Papa said: If a surgeon does not suck, it is dangerous and he is dismissed.
Isn’t it obvious: since we desecrate the Sabbath for it, it is dangerous?
You might say that this blood is stored up. Therefore he informs us that the blood makes a wound, and it is like a bandage and cumin: just as when one does not apply a bandage and cumin there is danger, so here too if one does not do it there is danger.

Rashi:
“suck” the blood, even though it makes a wound because the blood does not separate from the wound except through metzitzah
“you might say” our mishnah doesn’t teach us that it rises to [the level of] violating Shabbat, because the blood is stored and stands there as if in a vessel, and with metzitzah there is no wound or Torah prohibition, and there is no Torah prohibition [i.e. against metzitzah on Shabbat in general], and [you would think that] that is why it is permitted and not because of danger, [so] a surgeon does who not suck on the weekday, it is not dangerous and we do not dismiss him.
“therefore he informs us that the blood makes a wound”-when it comes out via metzitzah. Nevertheless it is permitted because of danger, since it teaches in the mishnah about a bandage and cumin.
The context of this discussion is a longer discussion of situations in which one breaks the normal rules of Shabbat. An earlier mishnah discussed taking care of a woman during childbirth, which overrides Shabbat because of danger. The Mishnah then discusses circumcision, which overrides Shabbat because of the Torah commandment to circumcise on the 8th day. This passage from the Mishnah is a bit of a hybrid: cutting and uncovering are permitted because circumcision overrides Shabbat, while the other are permitted apparently out of health concerns.
Now for the discussion in the Gemara. A little Talmud 101: the logical game here is a hava amina—what you might have thought, and then what someone came to tell us. According to Rashi, you might have thought that the blood that is sucked away was as if it was stored. Taking a liquid from storage is permissible on Shabbat, so sucking blood, circumcision or not, is permissible. This is why it’s permitted to do it—not because it’s a mitzvah that pushes Shabbat aside, as is the case with circumcision, but because drawing the blood is permissible in the first place.
The next passage is talmud lomar, what we learn. We learn from Rav Papa that drawing blood is considered making a wound, and it is permitted at a circumcision on Shabbat because of safety, just as we are permitted to tend to a woman giving birth. The reason given is safety, not that it is part of the mitzvah and it takes precedence over Shabbat. If the Gemara thought it was a mandatory part of the mitzvah, the discussion would have been very different—it would have needed to justify breaking Shabbat, and found a prooftext for metzitzah.
The reason given in all sources is that it is an issue of safety, not that it is part of the mitzvah. What is the danger? According to an interesting article by Shlomo Sprecher, it is because the rabbis believed that blood causes decay. It is based on a Greek medical model which knew only of bodily fluids but not about pathogens, and which was thankfully overturned by modern medicine.
So in such a case, do we rely on the Talmudic assessment of what is safe or not, or on today’s doctors? I would argue, as do most posekim outside of the haredi world, that we should utilize the most up to date medical advice available, just like the rabbis of the Talmud did. Safety is a halachically relevant consideration, and we need to utilize the best information possible. If doctors say that it is unsafe, then metzitzah is actually prohbited by halachah.
And I’m not making that up—this is what Ramban said, 800 years ago. Here are his words: “If all the doctors of our day agreed that there is a safety concern in metzitzah in these days, then without doubt we would be obliged not only to cancel it, but also to forbid it [even on a weekday] out of concern for saving a life, and all the more on Shabbat…and the one who sucks is violating the Torah…
But the truth is that not all the doctors agree that with metzitzah in these days there is a concern for safety. Today there are also many doctors who say that metzitzah is helpful…It is known that with saving a life we don’t require a majority of opinions. If two say something is dangerous, and even a hundred or a thousand say it is safe, we listen to the two people because of saving a life (pikuah nefashot). And in the matter before us we don’t know how to rule, because whichever way we turn there are safety concerns. Many say that metzitzah is dangerous, but it is not a few who say that if we don’t do metzitzah the infant is endangered.
We only apply the principle of “not requiring a majority of opinions on a matter of saving a life” when the danger lies on one path. For example, on Yom Kippur, if two say that if he fasts he puts himself in danger, and a hundred say there is no danger to fasting, but everyone agrees thatif he eats there is no danger, then we say that on matters of saving a life we do not require a majority of opinions, and we feed him.”
So Ramban had a dilemma. You listen to safety concerns even voiced by a minority of doctors. In fact, safety concerns have the force of halacha: it is forbidden to put your life, or anybody else’s, in danger. But if some doctors say it’s unsafe to do it, and some say it’s unsafe not to do it, what do you do? So in the end he basically throws his hands up in the air and says: let them be, and God help them.
Today, however, no doctors say it is dangerous not to do it. So if only to doctors said that metzitzah is a health risk, and a thousand said it is fine, we are halachically obligated to listen to the two and play it safe. According to this logic, metzitzah with a pipette is merely unnecessary, and any mohel who does metzitzah by mouth is violating the Torah.
Moshe Sternbuch, the current chief haredi rabbi in Israel, wrote something very disturbing on the issue. He was asked: Can a Mohel refuse to do Metzitza BePeh –orally, as opposed to using a pipette- if he is scared that the child is sick with AIDS? He answered, in Teshuvos Vehanhagos, that as there have not been many cases of Mohelim getting sick from babies, one must rely on Shomer Mitzva lo Yodeya Davar Ra—one who is observing a mitzvah will know no ill. He argued that if one must suspect such risks as life threatening, then one would not be allowed to do a bris, ever. However, he says that if a mohel refuses to do metzitza bepeh due to fear of AIDS, the mohel is not called a sinner, but one should try to find a different mohel who will.
Rabbi Sternbuch’s approach of relying on divine protection is shocking. We do not rely on divine protection, even when doing a mitzvah. The Talmud discusses a boy who died when obeying his father’s order to send away a mother bird. He should have lived—he was fulfilling two mitzvot both of which promise long life! The Talmud says, he used a rickety ladder. We don’t rely on divine protection—we need to rely on common sense.
The deeper point here is also that Halacha needs to integrate medical knowledge, not compete with it. If doctors tell us we shouldn’t do metzitzah, then we shouldn’t. If medical information contradicts the Talmud, we should realize that the Rabbis were fallable, and doing their best to apply Torah values in their age, just as we need to do today. The Rabbis tried to learn from the best doctors and astronomers, integrating the most up to date scientific knowledge available. But they got some things wrong, because people didn’t really understand biology back then. Science has advanced tremendously over the last two millennia, and those advances need to be integrated into halacha and into our understanding of Torah, in order to create a vibrant and living Judaism.
Shabbat Shalom.