When a person cuts or injures himself, proteins and particles in the blood known as platelets stop the bleeding by forming a blood clot. This process is called coagulation. Some people inherit a condition known as hyper-coagulation; their blood forms thick clots, which may cause some medical problems. Others suffer from an inherited disorder that impairs the body's ability to stop bleeding, such as hemophilia.
It’s dangerous to perform bris milah on such a person, and doing so may even put his life at risk. The Gemara in Yevamos (64b) talks about a child whose brother died due to bris milah (meisu machmas milah) and many poskim understand that the Gemara is referring to someone who died due to the above condition. In many cases the condition is inherited. The Gemara assumes, that if one’s brother died due to bris milah, it’s likely that that he may also have the same condition, therefore, he is exempt from the mitzvah of bris milah, as for him to perform a bris would be life threatening.
In recent years, with the major advancements in the medical world, it has become possible to perform surgeries using laser beams. Laser beams are used commonly in eye procedures, and they can now even be used to perform bris milah. The advantage of using a laser beam, is that it minimizes or even eliminates the concern of bleeding. This would seem to be the ideal solution for one who suffers from hyper-coagulation or hemophilia, and it would seem that it is now safe for such a person to have a bris, below we will briefly discuss if using a laser beam to perform a bris is a viable option, or if perhaps milah needs to be performed using a knife (izmal)?
The Use of A Knife to Perform Bris Milah?
Although when the Torah talks about the mitzvah of bris milah it makes no mention of the precise method of how to carry out the mitzvah, it is customary to use a sharp instrument. Indeed, the Torah relates that Tzippora used a "stone" to circumcise her son (Shemos 4:25) and later, Yehoshua used “knives of stone” (חרבות צורים) to perform bris milah for the Jewish males upon entering Eretz Yisroel (Yehoshua 5:2-3).
The Rambam (Hilchos Milah 2:1) and Shulchan Aruch (Yoreh Deah 264:2) rule: “Any utensil may be used to carry out bris milah, even a flint, glass, or any article that cuts. One should not perform bris milah with the sharpened side of a reed, because of the danger involved. The optimum manner of performing the mitzvah is to use an iron utensil – either scissors or a knife. Throughout the Jewish community, it has become customary to use a knife.”
The preference for a knife is mentioned by the Medrash (Medrash HaGadol, Shemos 4:25). The Targum Yonasan on the aforementioned pasuk understands, חרבות צורים, to mean, אזמלון חריפין – sharp knives.
The Prisha (264:7) cites a fascinating Medrash which also explains why we use a knife. In the famous fight between Dovid and Golias, Dovid threw a stone at Golias, and in spite of the fact that Golias was covered with a suit of armor, the stone managed to penetrate and cause Golias’s downfall. The question is, how did the stone manage to penetrate the armor? The Medrash says, a miracle occurred, and the armor changed its teva [nature], and decided to let the stone penetrate. As a reward for this, it was rewarded that it would be used in the performance of bris milah.
Double Edged Knife
The minhag is to use a knife which is sharp on both sides. The reason for this, is to ensure that even if the mohel accidentally uses the wrong side of the knife, no damage is done to the child. A remez [hint] to the above, is the pasuk: וחרב פיפיות בידם – “A double edged sword in their hands” (Tehillim 149:6).
