Progress in detection of genetic diseases is spurring a new push for Ashkenazi Jews to get screened, but timeless questions of Jewish medical ethics are being raised anew.
Rabbi David Golinkin, the Conservative Jewish law expert, says the core issue has not changed since the days when screening was available only for Tay-Sachs disease.Golinkin will be scholar-in-residence at Temple Beth Sholom in Fair Lawn during Shabbat on Sept. 23-24.
“The main discussion vis-Ã -vis genetic disease is whether it justifies abortion,” Golinkin told The Jewish Standard in Jerusalem, where he lives and works at the Schechter Institute of Jewish Studies.
The Conservative approach adopted by the Rabbinical Assembly’s Committee on Jewish Law and Standards (CJLS) in 1983 concludes that there is a clear precedent in Jewish tradition “to permit abortion of a fetus to save a mother’s life, to safeguard her health, or even for a ‘very thin reason,’ such as to spare her physical pain or mental anguish. Some recent authorities also consider the well-being of other children, and the future of the fetus itself, as reasons to permit abortion.”
The responsum (decision on a matter of Jewish law) stipulates that the family’s rabbi should be involved in decision-making when a fetus is found to have “major defects which would preclude a normal life.”
The writings of Rabbi David Feldman, a noted Jewish medical ethicist and rabbi emeritus of the Jewish Center of Teaneck, are appended to the 1983 responsum. Feldman “insisted years ago that one can only abort for concern over maternal health and not the potential health of the fetus,” said Avram Israel Reisner, onetime rabbi of the New Milford Jewish Center and currently a member of the CJLS’ subcommittee on biomedical ethics. “That is the norm and the standard, but there are other voices asking about the economic and psychological well-being of the family.”
Reisner, who is rabbi of Congregation Chevrei Tzedek in Baltimore, said, “Judaism allows for abortion when necessary, but defining ‘necessary’ is all over the board.”
Even in the secular world, he said, controversy surrounds a new test to detect Down syndrome in the first trimester of pregnancy, which will inevitably lead to more abortions. While Jewish authorities generally permit termination of a pregnancy only for a fatal defect such as Tay-Sachs, the earlier test for Down is significant because Jewish law draws a distinction between the first 40 days of pregnancy and beyond.
“We don’t abort a Down syndrome baby after 40 days of gestation,” said Rabbi Dr. Moshe D. Tendler of Monsey, a renowned microbiologist as well as Jewish medical ethicist and a longtime dean of Yeshiva University’s rabbinic seminary. “If it is possible to detect it before 40 days, it becomes a halachic [Jewish legal] issue that has to be resolved.”.
Reisner believes that “earlier genetic tests [for additional conditions] will follow as the science gets better.”
All of Judaism’s religious streams agree that premarital genetic screening is a better option.
Tendler noted that American health insurance companies cover the cost of screening for a variety of common Ashkenazi genetic diseases, such as cystic fibrosis. This has been so effective that Tay-Sachs has been virtually eliminated in the Orthodox world, said Tendler.
Feinstein advised people to get screened before starting to date for marriage.
Many authorities allow pre-implantation genetic diagnostic (PGD) testing of fertilized eggs. Although this requires in vitro fertilization, which is expensive, Reisner added, “PGD can resolve a problem one step earlier than abortion. But it certainly may not be used for something like sex selection.”
Jewish medical ethicists are more united on questions of genetic engineering – specifically, human cloning. Golinkin outlined the concerns in his 2003 book “Insight Israel: The View From Schechter.”
“Who is the mother – the egg donor, the cell donor, the surrogate mother – or all three? Who is the father – the cell donor, the mother’s father, or perhaps the clone has no father? Or perhaps the clone is the identical twin of the cell donor? May we clone someone without their knowledge? May we clone a dead person? Does the nucleus donor fulfill the mitzvah to ‘be fruitful and multiply’? If a child is fatally injured in a car accident, may we take one of his cells and clone him? These questions show just how complicated human cloning is from a moral and religious point of view,” he wrote, concluding that “the [rabbinic] arguments against cloning human beings are much more convincing than those in favor.”
Feldman told The Jewish Standard that cloning humans “sounds exciting and promising, but there are so many things that can go wrong along the way.”