Abortion: A Jewish view

A practicing physician reviews the contribution of Jewish ethics, as it relates to the structure of Jewish law, to the issue of abortion. The topics approached include the status of the fetus, the relationship of fetus to mother, abortion and murder, therapeutic abortion, and the rights of the mother. The discussion describes rabbinic answers to abortion requests and is followed by a summary of the Jewish attitudes toward termination of fetal life. An appendix is provided, dealing with central aspects of Jewish ethics, the structure of Jewish law, their relationship, and a note on abortion legislation in Israel.     

A retrospective survey of community based utilization of Tay Sachs screening in Eight New Jersey counties

The purpose of this study was to determine the rate of utilization of Tay Sachs disease screening by the Ashkenazi Jewish population. Pregnant women who were referred to one of three genetic centers in New Jersey for amniocentesis unrelated to Tay Sachs screening were the study population. 4490 charts were reviewed retrospectively to determine the at risk population for Tay Sachs disease (Ashkenazi Jews) and whether or not patients and their spouses had elected Tay Sachs screening prior to referral. A group of 25 patients who did not elect screening were questioned as to their specific reason for declining Tay Sachs screening. Overall community utilization was 90%. Of the couples who did not elect screening, 64% felt that their risk to have an affected child was too small, 16% could not recall Tay Sachs screening being offered to them, 8% felt that screening was inconvenient. Tay Sachs screening as a voluntary preventive health care program has a high utilization rate in our study group.     

Breast feeding: religious influences

In Orthodox Jewish communities, mothers are expected to breast-feed their infants and this expectation is to some extent based on religious beliefs. The degree to which this expectation promotes breast-feeding success was assessed by comparing a group of 50 Orthodox Jewish mothers with a group of 50 secular Jewish mothers in regard to infant feeding practices. All of the women lived in the Yeoville suburb of Jahannesburg, South Africa. An effort was made to interview all Orthodox mothers with at least 1 child under the age of 5 living in the area and it was assumed that the 50 mothers in the study constituted all or most of that population. A group of 50 secular mothers, comparable in age, education, and general living conditions, was also interviewed. The 50 Orthodox mothers had a total of 155 children and the secular mothers had a total of 119 children. Despite the quasi-religious motivation of the Orthodox mothers to breast-feed, there were few differences in the infant feeding practices of the 2 groups. At the age of 1 month the ratio of breast-fed to bottle-fed infants was 2.5:1 for the infants of Orthodox mothers and 2.3:1 for the infants of secular mothers. At age 6 months the ratio was 1:3 for both groups. At age 9 months the ratio was 1:6.4 for Orthodox mothers and 1:6 for secular mothers. The children of Orthodox mothers were breast-fed for an average of 5 months while the children of mothers of secular children were breast-fed for 4-1/2 months.     

Pregnancy reduction in Jewish law

10% of infertile women who become pregnant with the aid of hormonal stimulation become pregnant with multiple fetuses. 20% of mothers of triplets experience preeclampsia and 35% risk serious postpartum hemorrhage. Risk increases with the number of fetuses for venous stasis, varicose veins, phlebothrombosis, thrombophlebitis, and embolic phenomena. Risk increases proportionally with increased number of fetuses for fetal morbidity and mortality. Selective abortion is often used as a method of reducing risk to both the woman and the fetuses, thus increasing the chance that 1 or 2 fetuses will be born healthy. A related issue is the selective reduction of fetuses in multiple pregnancies that may have a genetic defect like Hurler's syndrome, microcephaly, Tay-Sachs disease, spina bifida, hemophilia A, or thalassemia major. In cases where 1 fetus in a set of twins is so inclined, the reduction of the defective fetus increased the success of the remaining co-twin. Selective reduction should not pose a problem for Jewish women since the procedure does not violate any Jewish legal or moral rules. In Jewish law an unborn fetus is not considered a person until it is born. Until the 40th day of pregnancy it is considered as 'mere fluid.' In order to stress the positive aspect of selective reduction it should be called "enhanced survival of multifetal pregnancies."     

Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase

The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH’s clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, “marriageability,” the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.     

Patients’ Opinions on Genetic Counseling on the Increased Risk of Parkinson Disease among Gaucher Disease Carriers

Gaucher disease (GD) is an autosomal recessive disease caused by GBA mutations that is especially common in the Ashkenazi Jewish (AJ) population. The link between GBA mutations and Parkinson disease (PD), a later-onset neurodegenerative condition, is well established, and studies have shown that GBA carriers have an increased lifetime risk of developing PD. Carrier screening for GD is frequently offered to couples during or prior to pregnancy, especially to those of AJ descent. However, no studies have been performed to assess if prospective parents would want to learn about their risk of developing PD incidentally through carrier screening. It is also unknown if pre-test counseling on this topic would affect screening uptake. In order to answer these questions, a survey was administered to individuals who screened negative for GBA mutations. Of the 75 participants, 86.7% believed that patients should be informed about the increased risk of PD prior to having GD carrier screening, and 93.3% responded that this information would not have changed their decision to have carrier screening. These results indicate that healthcare providers should take into consideration patient preferences when determining how to counsel about GD carrier screening. Additionally, these results have implications for genetic counseling about other later-onset conditions that may be incidentally ascertained through carrier screening.     

Religious Perspectives on Abortion and a Secular Response

This paper concerns the medical, religious, and social discourse around abortion. The primary goal of this paper is to better understand how seven of the world’s major religious traditions (Roman Catholic, Lutheran, Jewish, Islamic, Buddhist, Confucian, and Hindu) address abortion ‘in the clinic’. We do not aim to critique these commentaries but to draw out some of the themes that resonate through the commentaries and place these within complex social contexts. We consider the intersection of ontology and morality; the construction of women’s selfhood; the integration of religious beliefs and practices in a secular world. We suggest that for many women, religious doctrine may be balanced with secular logic as both are important and inextricably linked determinants of decision making about the termination of pregnancy.     

Factors Influencing Uptake of Genetic Testing For Colorectal Cancer Risk in an Australian Jewish Population

There is a significant excess of colorectal cancer in the Australian Ashkenazi Jewish community. This excess can partially be attributed to inherited factors that are over represented in this population, such as the APC variant I1307K, which is associated with a modest increase in colorectal cancer risk. There is currently only sporadic clinical genetic testing offered for this variant, as neither the exact increase in cancer risk and therefore the appropriate screening strategies for I1307K carriers, nor the acceptability of such testing in Jewish communities have been determined. This study reports a high acceptability of such genetic testing within a community sample of 300 Australian Jewish individuals—94% of participants would have a test for predisposition to colorectal cancer and a majority would make this decision based on the desire for information for their families and to decrease their own cancer risk. Some concerns were noted about genetic testing for cancer predisposition, including insurance discrimination, test accuracy and confidentiality.     

Ethics and neonatology in Israel.

Israel is a country of controversies: with high-quality medical care available to all and a high antenatal detection rate of congenital anomalies followed by abortion, the incidence of infants born with malformations has been reduced dramatically in the last decade. On the other hand, religious and strong traditional ethnic attitudes on fertility have led to a world record rate of ARTs and multiple births, which have increased the incidence of VLBW infants and the long-term handicap that follows their survival.     

Jewish identity and intentions to obtain breast cancer screening

This study explored the associations between 2 dimensions of Jewish identity (cultural identification and religious practice) and intentions to perform breast cancer screening. Ashkenazi Jewish women (N = 220) completed surveys as part of an ongoing study of breast cancer risk counseling. Multiple regressions examined the relationships between the 2 identity measures and intention to follow routine recommendations for mammography, intention to perform monthly breast self-exam, and interest in genetic testing for breast cancer susceptibility. Cultural identity positively predicted interest in testing, whereas religious identity was inversely related. Religious identity was a significant predictor of intention to adhere to mammography recommendations. Findings show that culture and religion, although correlated, may have different associations with health attitudes.     

The consequences of abortion legislation

This article examines the consequences of the 1973 US Supreme Court decision legalizing abortion as well as potential implications of proposed legilation aimed at nullifying this decision. In addition to giving women the right to determine their own reproduction, legal abortion had had beneficial health effects for both mothers and infants. The partial reversal of abortion gains due to restrictions on public funding and limitations on how and where abortions can be performed has produced a slight increase in abortion mortality, but the impact has not been dramatic. Moreover, each year since 1973, women have been obtaining abortions earlier in pregnancy. Abortion may be experienced as a loss by the mother, but there is no evidence of serious psychological sequelae. In contrast, a large body of evidence supports the physical, psychological, and social benefits of legal abortion to women, children, and families. However, proponents of the proposed Human Life Amendment place protection of the rights of the fetus over all other considerations. Their antiabortion actions have challenged the medical tradition of privacy and the confidentiality of the doctor-patient relationship. Most supporters of legal abortion would prefer that there be fewer abortions; such a decrease is more likely as a result of better education and contraceptive methods rather than coercion.     

Performing and Declining PGD: Accounts of Jewish Israeli Women Who Carry a <Emphasis Type="Italic">BRCA1/2</Emphasis> Mutation or Partners of Male Mutation Carriers

To describe factors associated with preimplantation genetic diagnosis (PGD) decisions among Jewish Israeli BRCA1/2 carriers or spouses of a male carrier, we contacted all women who initiated PGD consultation for embryonic BRCA1/2 mutation detection at Sheba Medical Center, prior to March 2014. Applying a qualitative approach, we asked women to elaborate on the factors they considered in either opting for PGD or discontinuing the screening procedure. Participants were 18 Jewish Israeli women; 14 were carriers of one of the Ashkenazi founder mutations in BRCA1/2, and four were spouses of male mutation carriers, who underwent at least one cycle of PGD. Prior to seeking PGD, ten of the women had no children. At the time of the interview, all but three had at least one child. Three factors emerged as key motivators for PGD: having witnessed the disease in a close relative (n = 12); prior IVF treatment for infertility (n = 12); and having pre-existing frozen embryos (n = 6). Ten women withdrew from the PGD process due to clinical, logistical, and financial reasons. In conclusion, most women decided to withdraw from PGD instead of continuing until a successful conception was achieved. Those who opted for PGD attributed their discontinuation of further screening to the emotional burden that is greatly intensified by practical difficulties.     

Legal and Ethical Considerations in Allowing Parental Exemptions From Newborn Critical Congenital Heart Disease (CCHD) Screening

Critical congenital heart disease (CCHD) screening is rapidly becoming the standard of care in the United States after being added to the Recommended Uniform Screening Panel (RUSP) in 2011. Newborn screens typically do not require affirmative parental consent. In fact, most states allow parents to exempt their baby from receiving the required screen on the basis of religious or personally held beliefs. There are many ethical considerations implicated with allowing parents to exempt their child from newborn screening for CCHD. Considerations include the treatment of religious exemptions in our current legal system, as well as medical and ethical principles in relation to the rights of infants. Although there are significant benefits to screening newborns for CCHD, when a parent refuses for religious or personal beliefs, in the case of CCHD screening, the parental decision should stand.     

Can Population-Based Carrier Screening Be Left to the Community?

As more genes and mutations are identified in diseases for which particular populations are at increased risk, it is becoming more important to address the social interface between communities and carrier screening. While disproportionately targeted in genetic research, the Orthodox Jewish community often shies away, due to social and religious constraints, from genetic testing and counseling offered by the public health system. The solution is provided by Dor Yeshorim—a program which has become for many a prototype for the successful merging of modern reprogenetic screening and traditional communities. My commentary focuses on the gaps between the rationale and practice of Dor Yeshorim, and the implications of these gaps regarding the trade-off involved in leaving carrier screening to the community. I conclude with a set of questions raised by the implications of the unintended consequences of community genetics.     

A pediatric screening instrument to detect problematic infant–parent interactions: Initial reliability and validity in a sample of high‐ and low‐risk infants

The purpose of this study was to determine the initial reliability and validity of a screening instrument developed to detect problematic interactions between infants and parents as part of a pediatric well‐baby exam. Participants included 117 infant–mother dyads (57 preterms and 60 full terms) assessed when infants were 6 to 9 months old. Mothers and infants were observed playing an interactional game such as peek‐a‐boo during the course of the pediatric exam. The game was scored for degree of interactional reciprocity using the Pediatric Infant Parent Exam (PIPE). Acceptable levels of interrater reliability were achieved. As predicted, higher risk infants and their mothers exhibited more problematic interactions than lower risk infants and their mothers. Results indicated that the PIPE was a reliable means of screening for interactional difficulties, that was sensitive to, but not synonymous with, neonatal health indices. ©2001 Michigan Association for Infant Mental Health.     

Denominational Variations Across American Jewish Communities

This article explores the Jewish identity of different Jewish denominational identification groups using the Decade 2000 Data Set with its 19,800 interviews of Jewish households in 22 American Jewish communities. We relate the Jewish identity of individuals in each denominational group (Orthodox, Conservative, Reform/Reconstructionist) to the denominational composition of the community. Communities are clustered via k‐means cluster analysis based on their denominational profiles. We examine the extent to which individual Jewish identification varies by the denominational composition of the community in which an individual resides, finding that considerable variation exists in Jewish identity measures depending on the type of denominational profile that exists in the individual's community. That is, Orthodox Jews, for example, behave differently in a community with a significant Orthodox population than in a community with few Orthodox, but many Reform Jews. Implications for Jewish communities, as well as for the broader interreligious community, are considered.     

Psychotherapy; Its Relation to Biblical and Rabbinic Judaism

Some facets of the relationship between psychotherapy and Judaism are analyzed. The issue of a framework for therapy that is congruent with Jewish biblical and rabbinic sources is examined in detail. The thesis advanced is, that the healing-helping model promulgated by psychotherapeutic theorists and practitioners is amenable to Jewish thought. Some implications of this model are explored. Attention is focused on the issues of inner conflict, self-knowledge, and complexity unique to human behavior. It is argued that these are basic premises fundamental to both depth psychology and Jewish thought. The Jewish and Christian variations of the healing model are compared and analyzed.     

Jewish Students and Christian Corpses in Interwar Poland: Playing with the Language of Blood Libel

This article focuses on the antisemitic discourse that surrounded the controversy over the provision of cadavers to medical departments in the Second Polish Republic. In the pages of the student press and at student rallies, activists argued that Jewish medical students should be barred from dissecting Christian corpses. They demanded that Jewish communities provide corpses for dissection on a regular basis as a condition for continued training of Jewish doctors. The discourse surrounding the cadaver affair combined nationalist language with religious vocabulary, suggesting that the affair was motivated as much by religious concerns as by nationalist ones. Drawing on notions of Jewish criminality and arrogance, allegations of a Jewish sense of religious superiority and disregard for Christian values, and fears of Jewish exploitation of Christians to fulfill their own collective needs, the cadaver affair played with concepts reminiscent of blood libel.