"From Machon Puah"

Medical Secrets -Treatment for BRCA

Last week we started discussing the relatively common mutation of BRCA [in fact there are two types - Type 1 & Type 2 - but for the purpose of our discussion here we will call them both BRCA]. This mutation raises the risk of certain types of cancer: specific- ally, ovarian and breast cancer.
As we wrote last week, the best medical advice for such women is to undergo an operation - an oophorectomy - to remove the ovaries. This raises a serious halachic question as to the permissibility of such a procedure.
The Torah (Vayikra 22:24) prohibits sacrificing an animal that has been castrated, and then states “...and you shall not do so in your land.” These last words imply a prohibition not only against sacrificing such an animal but also against performing the castration itself.
While the Torah discusses this situation as it pertains to animals, the same Torah prohibition applies to human beings, with a difference of opinion as to whether women are included as well. While everybody agrees that there is a rabbinic prohibition, the Rambam (Hilchot Isurei Bi’ah 15:11) is of the opinion that there is no Torah prohibition, whereas the Gaon of Vilna holds that castrating a woman is a Torah prohibition as well. Most authorities follow the opinion of the Gaon of Vilna and therefore would only permit removing the ovaries or the uterus in a case where there was obvious and imminent danger to the woman - as in the case of a woman with cancer of the ovaries.
The case we have been discussing involves the removal of the ovaries in order to prevent the later onset of the cancer - a possible future disease - and not as a treatment of an illness that exists. Since it is not certain that the woman will get the disease if she does not have the oophorectomy, it could be suggested that one may not undergo preventative removal of the reproductive organs.
However, Rav Moshe Feinstein writes that even the Gaon of Vilna would permit it in a case of real need (sha’at had’chak). Thus, if a woman has been checked and found to be carrying the BRCA mutation it can be claimed that this is considered “great need” and may be permitted.
Rav Bakshi Doron also permitted the removal of the ovaries since even the Gaon of Vilna permits this procedure in the case of “danger”. Since women with the BRCA mutation are at a risk that exceeds 50% - and anything over 50% is considered “dangerous” -  he rules that even the Gaon of Vilna would permit it.
In addition, according to many opinions there is no prohibition against castrating a woman who is already infertile. Thus it is permitted for a woman who is post-menopausal to undergo the procedure to remove the ovaries when the doctors consider it to be necessary.
In our next column we will discuss the psychological aspects of these procedures.

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