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Discussion on multi-fetal pregnancies highlights meeting of the new Jewish Institute of Bioethics

Miryam Z. Wahrman, Ph.D.

Multi-fetal pregnancy reduction discussed

At a recent parlor meeting in this township, about a dozen scholars: physicians, academicians and rabbis, met to discuss the problem of multi-fetal pregnancies. The main question pondered was "What are the options when a woman is carrying a multiple pregnancy?" Since fertility treatments have led to a high rate of multi-fetal pregnancies, the ethical questions relating to these high risk pregnancies have become more pressing.

That meeting was one of the first "learning sessions" of the Jewish Institute of Bioethics, a new organization, which, according to its mission statement, is "dedicated to the advancement of Jewish bioethical thinking in riposte to the rapid progression of medical and scientific change". A major goal of the institute is "to foster communication and cooperative partnerships among Jewish theologians and their medical and scientific counterparts."

Rabbi Dr. David Feldman, of Teaneck, introduced the major halakhic issues involved. "Fetal reduction - Is it murder? Is it abortion? Is it neither?" he reflected. It is clear, he explained, "if the woman's life is in danger, she doesn't have a choice. She must have an abortion."

Are you permitted to reduce the number of fetuses? According to Feldman, "If you do it for economic or convenience reasons, or sex selection, then that's all wrong. But if done for the health or life of the other fetuses, then it is permissible."

"The way the octuplets were greeted in the press, very few people appreciate what a tragedy this was." cautioned Dr. Charles Bacall, Assistant Professor in Obstetrics and Gynecology at Mount Sinai Medical Center. "Many fertility drugs are used by doctors not adequately trained to used fertility drugs." This, Bacall explained, results in a higher incidence of pregnancies involving four or more fetuses.

Dr. Richard Grazi, Director of Reproductive Endocrinology and Infertility at Maimonides Medical Center in Brooklyn, NY warned that any pregnancy involving more than two fetuses can lead to severe complications, and pregnancies with more than three should be considered unacceptable, because of the dangers to the mother and the fetuses.

New Bioethics Institute Introduced

Feldman, founding Dean of the new institute and an expert in Jewish bioethics, explained that the Jewish Institute of Bioethics is intended to be "nondenomenational, but strictly halakhic [pertaining to Jewish law]" in its judgements.

The mission statement of the organization declares, "The Jewish Institute of Bioethics seeks to provide ethical empowerment to the Jewish community through reference to Torah, the ultimate source of Jewish ethical dictates, and Talmudic and rabbinical commentary from every era, tempered by erudite, contemporary scientific and scholarly opinion."

"There are no other non-orthodox [bioethics] institutes that we know of," explained Maxine Dovere, Executive Director of the institute. "This is a universal Jewish institute."

"The mission of the institute," Feldman stated, "is to be a resource center of halakhic responses and Jewish values for the current and future medical ethics questions - the questions that seem to emerge daily from the front lines of medical and biomedical research."

"Problems come all the time." Feldman continued. "What's permissible halakhically? What's in keeping with the Jewish theological view of things? We'd like to bring scholars together and bring literary sources together, she-aylot u'tshuvot [questions and answers], and discuss these matters, and offer answers in keeping with this halakhic and theological approach."

"The institute was created in response to a need that I felt, after receiving many questions as to what to do in medical ethics crises." Feldman remarked. "What are the guidelines in many of these issues, like abortion, assisted suicide and pregnancy reduction? And other questions like treatment of the terminally ill...the general mandate to heal, and attitudes towards medicine and medical questions, proactive and reactive."

The institute further crystallized when Dovere hosted a radio program called "Connections: Linking Today with Tradition" which aired on WLIR (broadcast in Orange, Rockland and Westchester Counties, NY) for about two years. Feldman was her biweekly guest. "He discussed issues of halakhic comment on current medical practices ranging from, as we put it, pre-life to post-death, [including] the cloning issues, the infertility issues, the DNA issues." Dovere recalled.

"David Feldman is the rabbinical Dean. He will correspond and consult with other rabbis on a case-by-case basis." explained Dovere. "Our boards, and we will have two, will be made up of medical experts who are halakhically grounded and educated physicians. And those physicians, in conjunction with the rabbi and, where he designates, [other] rabbinical sources, will create the responsa that will respond to direct inquiry."

The next activity of the institute will be held in May in New York City. That session will involve a discussion of breast cancer screening and treatment in the Jewish community. "Where the genetic indicators exist, especially in Ashkenazic Jewish women, for the development of breast cancer, what is the position?" Dovere pondered. "Do you take off a breast, or do you wait? Do you take tamoxifen? How does halakha say you should work with this? What's the husband/wife position in such a situation?"

The institute plans to collect and publish the responsa, or position papers on bioethical issues, in the form of a semi-annual journal. "The journal, which is like the jib - or the forward sail - of a sailboat, will be called JIB, for Jewish Institute of Bioethics," explained Dovere. "And I hope that we will be able to sail forward in giving a calm presence in what can sometimes be choppy waters."

The Jewish Institute of Bioethics, headquartered in New York City, can be reached at (212) 535-1987

Dr. Miryam Z. Wahrman is Professor of Biology and Director of General Education at William Paterson University of New Jersey in Wayne.


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