In this week’s parsha we learn about the first bris milah that took place in the history of the world – the bris milah of Avraham Avinu. In regards to Avraham Avinu’s bris, the Medrash (47:9) writes:נמול אברהם אמר ר' אבא בר כהנא הרגיש ונצטער כדי שיכפל לו הקב"ה שכרו – “’Avraham was circumcised’ - Rabbi Abba bar Kahana says: He was acutely aware of the pain, and appreciated it in order that Hakodosh Boruch Hu would double his reward”. We see from this Medrash that Avraham Avinu appreciated and enjoyed the aspect of pain that comes together with bris milah.
The Reshash explains, that the drosha of the Medrash is based on the fact that the pasuk writes: נמול אברהם – “Avraham was circumcised” and not: נמול בשר אברהם – “the flesh of Avraham was circumcised”. From the fact the pasuk wrote נמול אברהם we see: דכל גופו הרגיש לו ונצטער כאלו כולו כרות וחתוך – “his entire body felt the pain, as if the entire ‘Avraham’ was being chopped and cut”.
Although the basic bris milah procedure has not changed much since the days of the Gemara, a number of contemporary innovations intended to help the mohel and protect the child, have been introduced over the centuries. This week we will address the use of anesthetics, general and local, when performing a bris milah, and we will discuss if the pain that Avraham Avinu felt was an integral part of the procedure, or if perhaps it was just a middos chasidus [pious act]? We will also discuss whether the age and circumstances of the child makes a difference? And finally we will discuss if perhaps a ger [convert] is different? Read on and be enlightened.
Local Anesthetic – Chiddush of R’ Meir Arik
We will start our discussion by mentioning a Teshuvah from R’ Meir Arik in his Imrei Yosher (2:140). R’ Meir Arik was asked a shailah about a thirty year old who wanted to convert and become Jewish. One of the things one must do to become Jewish is bris milah. R’ Meir Arik was asked:אם מותר לעשות המילה למשוח אותו מקום מקודם בסם שיצטנן הבשר למען לא ירגיש צער כ "כ בשעת המילה – “Is it permissible when performing a bris milah, to smear the area of the milah with a type of cream in order to numb the site (local anesthetic), so that one doesn’t feel too much pain during the bris”.
In response, R’ Meir Arik shows that anesthetics are not a new invention and that they have been around since the times of the Gemara. He cites the Gemara in Bava Kama (beginning of HaChovel) which talks about cutting ones hand off using a special cream which helps ease the pain, so we that already in the times of the Gemara they had anesthetics. If they had anesthetics to help ease pain when cutting off arms, presumably they had for helping ease pain when performing a bris as well. If anesthetics have been around for so long, why was it not standard procedure to use them whilst performing a bris? We see from here, says R’ Arik, that Chazal had a kabbolah [tradition] that feeling pain is an integral part of bris milah, and nothing should be done to stop it.
R’ Arik then cites proof from the aforementioned Medrash about Avraham Avinu, that we see that pain is an integral part of the bris milah.
He then concludes with something which the poskim say in many areas of halachah, which is that if a mitzvah has always been performed in a certain way, this is the mesorah [tradition] of how it should be performed, and chas vesholam for us to start changing the way the mitzvah is carried out.
We can perhaps bring further proof to R’ Meir Arik from a Gemara in Kesubos (8a). The Gemara says that when performing a bris milah we don’t recite the berachah of ‘shehasimcha b’meoino’ [in whose abode is joy], due to fact that the infant is in pain. Similarly, outside of Eretz Yisroel, the minhag is that we don’t make shehechayanu when performing a bris for the same reason. The question is, why not just apply local anesthetic, ease the pain, and then make the berachah? We see that pain is an integral part of the milah.
The Case of the Adamant Mother
There is an interesting Teshuvah from the Marchei Lev (53) in which he discusses a case of a five year old child who hadn’t yet had a bris. At the beginning the child wasn’t strong enough to have a bris, and once it was postponed it just didn’t end up happening. Eventually when the child turned five, they prevailed upon the mother of the child to perform a bris, and she agreed. However, she said there was one condition, which was that anesthetic had to be used to ease the pain.
The Marchei Lev discusses the use of anesthetics when performing a bris and he writes, generally we shouldn’t come up with new ways to help deal with pain caused when performing a bris, however, he concludes that in our case: חלילה לנו להחמיר בהתנגדותנו אל דרישת האם הדואגת לחיי עוללה אישון עינה – “Certainly in this case one should be lenient and listen to the wishes of the mother who does so much for the child”.
The Marchei Lev holds like R’ Meir Arik that ideally bris milah should be performed without the use of anesthetic, and that the way bris milah is performed shouldn’t be changed, however, in pressing circumstances, such as the case of an adamant mother, we may be lenient. It may well be that R’ Meir Arik would agree in such a case as well.
Tzitz Eliezer
The Tzitz Eliezer (20:73) has a Teshuvah where he discusses the use of local anesthetic when performing a bris, he cites the Imrei Yosher, and the Marchei Lev. He also cites a Teshuvah from the Shevet HaLevi (5:147:2) who concludes, that certainly general, and even local anesthetic shouldn’t be used except in extenuating circumstances.
Special Time to Daven
The Olelos Ephraim (cited in R’ Eliezer Gutmacher’s hagaos to Shabbos 130) writes that a person should have his own troubles in mind while hearing a child crying during his bris, as “the child’s voice ascends without any impediment and his tefillos are included [with the child’s cry].”
The Tzitz Elizer towards the end of his Teshuvah writes: “This is a proof regarding the great significance of the child’s cry from the pain of the bris milah, that it rises to the heavens, unimpeded, and its strength is able to help others who are standing near him, that their tefillos should be accepted, and they should be redeemed from their troubles.” He attributes this idea to “Kabbalistic sources.”
He then concludes like the Shevet HaLevi: “That local anesthetic shouldn’t be used except in extenuating circumstances”.
The Other Side of the Argument
On the other hand, the Seridei Eish, R’ Yaakov Yechiel Weinberg has a Teshuvah (2:62) in which he rejects the reasoning of the Imrei Yosher, ruling that there is no fundamental objection to minimizing pain during a bris milah.
He writes: “We don’t find anywhere that there is a mitzvah to cause pain to the child whilst performing a bris milah. Avraham Avinu wanted to receive more reward, like we find ‘according to the pain is the reward’, however, we don’t see that in a normal case, the child must experience pain. Therefore, it’s ok to put local anesthetic on the child”.
Furthermore, Dr. Abraham S. Abraham, in his Nishmas Avraham (Vol. 2, pp. 309-310) writes that R’ Yaakov Hillel, a well-known expert of kabbalah and Rosh Yeshiva of Yeshivas HaMekubalim (Ahavas Shalom), insists that there is no written kabbalistic source for this notion. Furthermore, he notes that while the Zohar says the pain of a woman in childbirth “atones” for the sin of Chavah, it is common practice to minimize the pain of childbirth as much as possible.
The Nishmas Avraham also cites R’ Shlomah Zalman Auerbach and R’ Yosef Shalom Elyashiv, who told him that if anesthetics were proven to be safe, it would be permitted, even obligatory, to use them in order to reduce the child’s pain.
Tylenol
I have heard that although not as effective as anesthetic, some mohalim advise the parents to administer Tylenol and hour before the bris reducing the infant’s discomfort. It is also common to give the child concentrated sugar water during the bris, a known neonatal analgesic, which is commonly given in emergency rooms across America to ameliorate pain in infants.
However, I have asked a number of my friends who recently made brisim and they all told me that they used nothing at all, so before using any of the above please ask a shailah.
General Anesthetic
Until now we have been discussing the use of local anesthetic, we will now move on to discuss the more complicated question of the use of general anesthetic. In the case of an eight day old child, or even a five year old child, no one is contemplating using general anesthetic and it may even be dangerous, however, in the case of someone who is much older i.e. thirty, the question arises, as to whether general anesthetic may be used.
The Koreis HaBris deals with the above. First he discusses the aspect that feeling pain is an integral part of bris milah, then he goes on to say, feeling pain is just an inyan [a nice concept, but not halachically required] however, there is a halachic issue as well, as one must be awake when having milah performed. Many poskim rule that mitzvos tzerichos kavonah [a person must have intention in order to fulfill a mitzvah], especially when fulfilling a mitzvah de’O’raisa (see Magen Avraham 60:3) and a person under general anesthesia does not have “intention,” and therefore general anesthesia should not be used.
Proof From Yevamos
The halachah is that if a man dies without any children, there is a mitzvah upon the deceased’s brother to perform yibbum with his sister-in-law. The only way to perform the kinyan [acquisition] is with biah [marital relations]. The Gemara in Yevamos (54a) teaches: לא קנה ביבמתו דאמר קרא יבמה יבא עליה עד דמכוין לשם ביאה ישן – “If one is sleeping (and managed to perform an act of biah) he doesn’t acquire his yevamoh, as the pasuk says, ‘the yevamoh should come on him’ from which we learn one has to have intention”. We see from the above Gemara, that if one is sleeping, he is unable to have “intention” when fulfilling a mitzvah. The Koreis HaBris proves from this Gemara, that one can’t use general anesthetic when performing a bris, as mitzvos tzerichos kavonah and one can’t have any kavonah [intention] when he is asleep.
Yabia Omer
R’ Ovadia Yosef has a Teshuva (Yoreh Deah 5:22) where he deals with the above question, and he argues on the rayah [proof] of the Koreis HaBris, and says that there is no comparison between the two cases.
In the case of an adult who needs to perform a bris milah, and the obligation is upon the adult himself, except for Avraham Avinu, most people are unable to perform the milah on themselves and they appoint a shliach [agent] to perform the mitzvah on their behalf. There is a machlokes haposkim if shlichus [appointing an agent] helps when it comes to the mitzvah of bris milah, but we maintain that it does, and through the principle of shluchoi shel adam kemoisi [when an agent acts on one’s behalf, it’s as if the one who sent him performed the act] the shlichus works.
In the case of yibbum, the only person that can fulfill the mitzvah is the deceased husband’s brother, and he must have kavonah, consequently, if he is sleeping, he can’t fulfil the mitzvah of yibbum. In the case of bris milah, however, the halachah is that one can appoint an agent, therefore, argues R’ Ovadia, as long as the mohel who was appointed as an agent is awake and has kavonah, there is nothing to worry about.
Does the Kavonah of An Agent Help, if the One Who Sent Him is Sleeping?
The halachah is, if a man makes a shliach to give a get [divorce document] to his wife, and he then turns crazy the shliach is no longer able to give the get. One of the rules by shlichus, is that the agent can’t be better off than the one who sent him, and if the one who sent him can’t carry out the act the agent can’t do it either. Consequently, if the sender turns crazy, since a crazy person can’t give a get, even if the agent is not crazy, he still can’t give over the get. What’s the halachah in a case of one who is sleeping, can an agent act on behalf of the sender if the sender is sleeping?
The Gemara in Gittin (70b) cites a machlokes [dispute] between R’ Yochanon and Reis Lakish about whether one who caught kurdeikus [a type of illness, where one is delirious and not fully aware of what he is doing] may appoint a shliach to give a get to his wife. R’ Yochanon maintains he can’t, as he is comparable to someone who is crazy. Reish Lakish maintains that he can appoint a shliach, as he is likened to one who is sleeping. Everyone agrees that if one is sleeping he can appoint a shliach, the only question is, if one who has kurdeikus is comparable to one who is sleeping or not. R’ Lakish maintains that one with kurdeikus is comparable to one who is sleeping, whereas R’ Yochanan maintains, that one with kurdeikus isn’t comparable to one who is sleeping. One who is sleeping will automatically wake up, whereas one with kurdeikus needs something to happen to him to make the kurdeikus go away.
We see from the above Gemara, that a shliach helps for one who is sleeping. Therefore, argues R’ Ovadia, if one is under general anesthetic and the mohel is acting as a shliach, as long as the mohel has kavonah everything is ok.
Perhaps Anesthetic Is Worse?
The obvious question is, however, how can we compare one who is sleeping to one who is under general anesthetic, perhaps one who is under general anesthetic should be likened to one who has caught kurdeikus?
To answer this, R’ Ovadia cites a Beis Shmuel. The Beis Shmuel discusses a case of one who appointed a shliach to give a get, and he then went to celebrate and drunk himself silly. The Beis Shmuel discusses if shlichus works for one who is drunk, and he concludes, even if one is in alcoholic stupor which is worse than one who is sleeping, the stupor will eventually ware off without any intervention needed, therefore, shlichus is effective.
R’ Ovadia maintains that general anesthetic is no worse than one who is drunk, and the anesthetic will wear off by itself, therefore, as long as the mohel has kavonah everything is ok.
Chiddush of the Ohr Zarua
There is a big discussion in the poskim if the mitzvah of bris milah requires kavonah. A number of poskim suggest that this may depend on whether the mitzvah of milah is the ma’aseh [act] or the totza’a [result]. If the focus of bris milah is the result, i.e., that the child should be nimol [circumcised], then there appears to be no requirement to have kavonah (see Beis HaLevi 2:47, Pri Yitzchok 2:30 and Minchas Asher, Sefer Bereishis, siman 21).
There is a famous Maharach Ohr Zarua (11). The Rishonim ask why we need a special drosha to exempt women from the mitzvah of bris milah, as surely the mitzvah is time bound. Various answers are given. The Maharach Ohr Zarua answers that the mitzvah of bris milah is to ensure that that the child is no longer an arel, i.e., that merely being circumcised is itself a mitzvah, consequently, the mitzvah applies constantly and is therefore not considered a time bound mitzvah.
The Maharach Ohr Zarua cites a Gemara to proves this point. The Gemara (Menachos 43b) relates: When Dovid HaMelech entered the bathhouse and saw himself naked, he exclaimed: “Woe is me! I am no longer clothed with Your mitzvos.” When, however, he remembered that he was circumcised, he regained his calm.
The Maharach Ohr Zarua proves from this passage that one fulfills the mitzvah of bris milah merely by being circumcised, and not through the act of circumcising.
We see that the Maharach Ohr Zarua clearly understands that the mitzvah is the totza’a.
R’ Ovadia’s Conclusion
After citing the above chiddush of the Maharach Ohr Zarua R’ Ovadia concludes, that performing a bris milah even under general anesthetic is ok. As we see from the Maharach Ohr Zarua that the main aspect is the totza’a therefore, even if one is asleep it’s ok, as in the end of the day he has the totza’a. And even if the mitzvah is the ma’aseh, the mohel is a shliach and the mohel is awake and is able to have kavonah.
The Other Side of the Argument
However, many poskim disagree with R’ Ovadia, and maintain that even if local anesthetic may be used under pressing circumstances, general anesthetic should be avoided (see for example, Seridei Eish 2:62, and Shevet HaLevi 5:147:2).
The Use of General Anesthesia for a Convert
Much of the halachic literature regarding bris milah under general anesthesia relates to adult converts. A number of poskim note that the halachic considerations concerning an adult convert may differ from those for an adult Jewish male.
For example, R’ Ya’akov Yechiel Weinberg, in his Seridei Eish (2:62) emphatically prohibits performing bris milah on an anesthetized adult male in the process of converting. He argues that since the person is meant to enter into the covenant and kedushas Yisroel through the act of milah, it is inconceivable he can do so while unconscious.
He cites the Chasam Sofer (Yoreh Deah 300) who proves that the milah of a convert, unlike the milah of a person born Jewish, requires that it be done with specific intention (lishma).
This question of whether a convert must be conscious during the bris milah, may depend upon whether bris milah is an integral part of the conversion process, in which case the convert might need to be awake, or only a preparatory phase (hechsher), in which case he may be fully anesthetized.
R’ Moshe Sternbuch (Teshuvos VeHanhagos 3:308) suggests that this debate may be dependent upon another disagreement regarding whether bris milah must be performed in the presence of a Beis Din. If the bris milah must be performed in front of a Beis Din, this may indicate that the bris milah is part of ikkar geirus [the essence of conversion], and subsequently we may also conclude that the convert must have the proper intention during the bris. Alternatively, if the milah is merely a hechsher, and not an inherent part of the conversion process, we would not require any specific intention.
R’ Sternbuch concludes that since the milah should lechatchilah [preferably] be performed in the presence of a Beis Din, it therefore follows that the milah should be performed without general anesthesia. However, since, in his view, bedieved [after the fact], if the bris milah was not performed in front of the Beis Din, the conversion is valid, then bedieved an adult male may undergo bris milah while anesthetized, as the bris milah is not perceived as an integral part of the conversion process requiring intention lishma. R’ Sternbuch concludes, however, that a child may be fully anesthetized, as he does not have da’as (halachic competence) in any case.
