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I have recently encountered a number of non-Jews who were protesting circumcision in front of the U.S. White House. While I found most of their notions somewhat absurd, I was given pause to question what the differences are between Medical Circumcision and a Kosher Brit.
What is the minimum amount of tissue to be cut off? Is this the same in both Medical and Ritual Circumcision?
Besides the fact that a mohel is performing the bris in order to bring the baby into the covenant, and must handle it as a religious ritual, there are also differences in the medical procedure. The minimum amount required for a bris is more than that required for a surgical circumcision. There are also problems involved with the clamps that surgeons use. A "bloodless" circumcision is not allowed for a bris. Also there are discussions as to what clamps are allowed or forbidden for a bris, and specifically how to use them in appropriate ways.
A mohel’s technique is different from a surgeon’s: Clamps are forbidden; instead a butterfly-shaped shield protects the glans while the mohel removes the foreskin with a sharp scalpel. (In a bris, all membrane below the corona of the penis must be removed, which is not necessary in a medical circumcision.)
Milah in a forbidden fashion
We should begin by noting that milah comprises two elements: milah and priah. Milah is the removal of the orlah (the foreskin), and priah is the removal of the thin membrane which covers the flesh underneath.
The Shulchan Aruch rules, in accordance with the Gemara:
“If milah was performed but not priah, it is as if milah was not performed.”
The Rishonim and Achronim, in turn, wonder if milah and priah may be performed “as one”. In other words, may the mohel – either by hand or with a special instrument – hold the two skins together and cut them simultaneously? Many poskim are stringent in this regard, and most contemporary authorities hold that, l’chatchilah, milah and priah should be performed separately. However, Rav Moshe Feinstein zt”l disagreed, and many mohalim rely on his opinion. (A related question is whether or not the mohel may wear gloves during the milah.)
Nonetheless, there are a number of instruments which definitely invalidate the milah. For example, the so-called “clamp” essentially kills the orlah before the cut, and hence, no blood is involved. But the dambrit (the blood of the brit milah) is one of the main components of the brit, and therefore, mohalim may not use this instrument. Interestingly, several studies have shown that the baby endures more pain with this type of instrument. In any event, when such an instrument is used, the brachah is abrachah l’vatalah (“a wasted brachah”).
Note that there are discussions as to what a clamp means, what kinds of clamp are forbidden and what is allowed. This is only the most general statement. See Contemporary Brit Milah Issues for one such discussion.
Note that even if the child has been circumcised and sufficient skin removed to make it a kosher bris (something that is not guaranteed) a drop of blood must be taken as part of the bris. Adult males or older children who convert or who had lived in circumstances where it could not be done (such as the former Soviet Union) but had been circumcised can be examples of this. If an adult must have a full bris (something that is being done more and more according to various articles) then a specially trained surgical mohel must be consulted.
The Objective of the Ritual Circumcision
For this reason a person who underwent a medical circumcision, without intent to fulfill this commandment, should undergo a subsequent procedure performed with specific intent to fulfill this mitzvah. This subsequent procedure is relatively painless, involving only the drawing of blood from the reproductive organ, but done in the name of Brit Milah.
For further details, check with a mohel. You should also note that many times a mohel will be used even for a circumcision because of his expertise and the number of procedures that he has done compared to a regular surgeon.
Methods of Circumcision goes into gory detail on the medical procedures involved and the difference from a bris. It is too long to quote here but can be read at the link.
A Mohel performs a Brit using a Magen shield, and a Izmil (scalpel), which severs the skin safely, quickly, and efficiently --- within fifteen seconds, resulting in a minimum of pain. Doctors use a clamp, which takes several minutes, causes unnecessary pain, and can have serious health consequences. A letter from the Food and Drug Administration (FDA) issued in August of 2000 states,
“...although research suggests that circumcision is generally a safe procedure, we are concerned that some device-related complications have occurred. We have received 105 reports of injuries involving circumcision clamps between July, 1996 and January, 2000. These have included laceration, hemorrhage, penile amputation, and urethral damage.”
Note that it is precisely the clamps to which the FDA objects -- We at Brit Yosef Yitzchak couldn't agree more. Not only does the clamp not conform to the strictures of Jewish law, but it really isn't safe for any type of circumcision.
HATAFAT DAM BRIT FOR CONVERSION discusses what is done when a circumcision has been done but not a bris.
Brit Milah for an Adult discusses how uncircumcised adults can get a bris in Eretz Yisrael.
