A woman who had taken fertility treatments became pregnant only to learn that she was carrying four embryos. Her doctors suggested multifetal pregnancy reduction, a process to eliminate some of the embryos so that the remaining ones would have a better chance of normal development. What does Jewish medical ethics advise her to do?
The above incident was one of the hypothetical scenarios put forth by Valley Beth Shalom's Rabbi Ed Feinstein, who along with Dr. Judith Partnow Hyman, VBS congregant and psychotherapist, convened a panel of experts -- a rabbi, a perinatologist and a medical ethicist -- to discuss conception issues for the first of three Medical Ethics Beit Dein programs, "A Time To Be Born: The Creation of a New Life," examining modern medical issues from a Jewish perspective. (The second program, "Healing the Body, Soothing the Soul, The New Role of the Physician," took place on Nov. 21.)
Human beings are now called upon to make choices once considered "decisions that only God has the wisdom to make," Feinstein said. The series addresses the moral conflicts people face today as a result of advanced fertility technology.
Jews often face dilemmas surrounding conception because they generally marry and start families later in life, said Rabbi Elliot Dorff, a University of Judaism professor and panel member who serves as vice chair of the Conservative movement's Committee on Jewish Law and Standards. This makes them more likely to need such procedures as fertility treatment or in vitro fertilization in order to conceive.
The instance of multiple fetuses has grown dramatically with increased use of reproductive technology. The more fetuses present in the womb, the less likely each is to survive, said panel member Dr. David Braun, regional director of perinatal care for Southern California Kaiser Permanente. Those that make it to birth are prone to experience serious long-term health problems. In addition, having multiple fetuses increases the mother's chances of experiencing life-threatening complications. "Because of that, we tend to recommend seriously considering reduction of the pregnancy to fewer babies," Braun said.
If the parents' goal of undergoing these procedures was to have a healthy baby, "very quickly one reaches the question: How can they not do multifetal pregnancy reduction?" said the panel's third member, Dr. Neil Wenger, chair of the UCLA Medical Ethics Committee and a professor of medicine. At the same time, Wenger said, couples and their doctors should clarify their goals and values ahead of time, discussing the likelihood of multiple pregnancy and how it would be handled prior to facing the situation.
"In Jewish tradition, God owns our bodies," Dorff said. "We have them on loan for the duration of our lives and we have a responsibility to take care of [them]." This means we are forbidden from mutilating our bodies, and at the same time we are obligated to take action to save our own lives, even if it means sacrificing a part of our body.
Thus in the case of the multiple pregnancies, Dorff said, "It seems to me from a Jewish perspective [the mother] would have the requirement to reduce the number of fetuses in her womb in order to save her own life and health as well as the [remaining] fetuses. There are stages in coming into life and ... in leaving life. Your halachic status depends upon what stage you're in in that process." Our tradition, he said, does not recognize the fetuses as full-fledged human beings.
In vitro fertilization presents its own set of ethical challenges. Dorff pointed out that potentially there can be up to five individuals involved in the conception -- the couple wanting the child, an egg donor, a sperm donor and a woman to carry the fetus to birth. (To which Feinstein commented, "Practically a minyan.")
More problematic is the issue of screening the embryos for gender, disease or -- if it ever became possible -- personality traits. Dorff said that because the commandment to "be fruitful and multiply" is only fulfilled once a couple has both a boy and a girl, there may be religious grounds for allowing gender selection.
Wenger suggested looking at the broader picture. "There is something called a communal ethic, where each individual or couple has a responsibility to the rest of its social network." Selecting by gender could harm the community by ultimately swaying the population in one direction or another.
As for selecting for traits such as athletic ability or musical talent, Wenger said we have a responsibility "not to use science in such a way that our whim gets satisfied [at the expense of] society as a whole."
"Jewish tradition respects the power of human intellect and human imagination and human judgement," Feinstein said. "We've always been a pro-science community because we respect the power of human beings to make the right judgments."
The final program "A Time to Live, A Time To Die, Accepting the End of Life," will take place Dec. 5, 7:30 p.m at VBS, 15739 Ventura Blvd., Encino. For more information, call (818) 530-4093.