"From Machon Puah"

Designer Babies - Final installments

PGD, as you may recall, is the process by which cells of an egg that was fertilized outside the woman’s body are screened for specific characteristics.

Fertilized eggs with undesired characteristics are discarded. The remaining eggs are used for IVF treatments. As we have previously reviewed, at the 10th annual PUAH conference in Jerusalem, Rav Yaakov Ariel spoke about using PGD to create a genetic match for a sick older sibling.

In another presentation at the conference, Rav Shlomo Amar, the Sephardi Chief Rabbi of Israel, discussed issues regarding another specific application of this technology; screening for genetic illnesses such as Tay Sachs disease. This application is actually the primary use of this technology within the religious Jewish community.

Until the advent of PGD, couples who were carriers of genetic disorders had no method of pre-pregnancy screening. Instead, they were faced with a range of difficult choices.

Should they get pregnant naturally and undergo prenatal testing during the pregnancy to see whether the child was or was not afflicted with the genetic illness? What if the child was found to be affected by the serious disease they carried? Would they be permitted to terminate the pregnancy? Even if it was allowed, would they want to undergo an abortion? The alternative to abortion would be having a sick child.

Some couples, faced with these incredibly difficult options chose not to get pregnant at all and miss out on the chance of having a family.
The advent of PGD represents a paradigm shift for these couples. They can now become pregnant without fear of their offspring being stricken with the genetic illness that the parents themselves carry in their DNA.

Rav Amar raised a fascinating question regarding these couples. PGD is an invasive process that requires a couple who have the ability to conceive children via intercourse to go through the process of In Vitro Fertilization (IVF). This process includes the administration of hormones and the extraction of eggs. Although it is considered a standard treatment today, there are still some health risks associated with the process. It can also be quite expensive.

Rav Amar spoke about the couple’s halachic obligations and how far they extend in having children. Is a couple with a known risk for genetic disorders obliged to undergo PGD in order to produce children? Although PGD’s existence can certainly prevent these dilemmas, is a couple obliged to use it or are they permitted to take their chances by getting pregnant naturally and praying that each pregnancy results in a totally healthy baby?

Rav Amar used a psak of Rav Moshe Feinstein regarding breaking Shabbat in order to save the life of a person who is not alive. This theoretical case is raised in the responsa of Rav Feinstein in discussing reattaching a severed head. Reattaching severed limbs and other severed body parts have become medical reality. Although we are not yet able to successfully reattach a head and give the person back their life, what if we eventually develop the skills to do so? Would such an operation be permitted on Shabbat?

Rav Moshe ruled that someone without a head is not considered to be “alive”, and thus we are not obliged to save him. As such, there is no issue of “Pikuach Nefesh” involved and the operation would not be permitted on Shabbat.

The potential child is not yet alive. Since there is no obligation to operate on a person who is not alive, we can deduce that there is no obligation to undergo PGD in order to save the life of a child who is not yet alive.

By contrast, the case we discussed in the past few weeks DID involve a sick older child who is alive and therefore, even according to this opinion, there may still be an obligation to have another child in order to save the sick child.

PGD - An Obligation?

In our continuing review of the uses of Preimplantation Genetic Diagnosis (or “PGD”), we have presented the case raised by Rav Shlomo Amar, the Sephardi Chief Rabbi of Israel, at the recent Puah Conference held in Jerusalem. Rav Amar raised the question that a couple with genetic disorders in their DNA may be halachically obliged to undergo PGD, which is an intensive and invasive procedure, in order to produce healthy children.

Above we discussed Rav Amar’s extension of a psak from Rav Moshe Feinstein that there is no obligation to save the life of someone who is not alive. Rav
Amar, citing the fact that any potential children created by this couple are not yet alive, argued that PGD would therefore not be obligatory.

In contrast, Rav Amar stated that there exist cases where this logic is clearly contradicted. Eliyahu HaNavi was a Kohein and forbidden to come in contact with a dead body. The Tanach states that Eliyahu revived a dead child who grew up to be the prophet Yonah ben Amitai.

The Tosafot ask how Eliyahu HaNavi, a Kohein, could become tamei to revive the child? One answer of Tosafot is that Eliyahu HaNavi was absolutely certain that the child would live (even though the child was physically not alive at the time) and therefore Pikuach Nefesh applied.

Rav Amar reasoned that according to this explanation there was an expectation that his interaction can and did save the life of someone who was not currently alive. By extension, we too are obligated to act in such a manner. While it could be argued that this permission is limited to Eliyahu who had clear knowledge of the future and knew what would happen, we could also say we would be permitted to break Shabbat to perform treatment for a person who is not considered alive so long as there exists a reasonable expectation of success.

There is no question that the use of PGD presents these couples with a reasonable expectation that we can provide them with healthy children. Therefore, these couples are obliged to undergo PGD in order to have healthy children even though those children are not yet alive.
Rav Amar then added further motivation to suggest that PGD is obligatory in this case. As we mentioned last week, a couple who learn that they are both carriers of a serious genetic disorder may choose not to have children. These couples do not want to bring unhealthy children into the world nor face the halachic problems of terminating a pregnancy of a child with such a disorder.

Using this as justification, Rav Amar ruled that such couples must avail themselves of this technology and not opt to remain childless. Rather than allow for the possibility that a couple not have children, we require all couples with this obstacle to use the scientifically proven and available means to overcome it.
Rav Amar’s ruling is a demonstration of a posek’s need to consider much more than pure halacha when making a psak. He must also consider the wider ramifications and how his psak will affect the Jewish people as a whole.

The Puah Institute is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Offices in Jerusalem, New York, Los Angeles and Paris. Contact: (02) 6515050, (Isr) - 718-336-0603 (US) puahonline.org

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