Ethicists debate issues about beginning of life

Infertility - not assimilation or inadequate education - is perhaps the biggest obstacle to Jewish continuity, suggests Rabbi Elliot Dorff, rector and professor of philosophy at the University of Judaism in Los Angeles. “We are in a great demographic crisis,” says the Conservative rabbi, an expert in medical ethics. “We Jews are not even reproducing ourselves, let alone growing.” Dorff understands how much education is required to take somebody born Jewish and transform that person into someone who knows a lot about Judaism and practices it. “But you can't educate someone who is not there,” he said in a phone interview with the CJN.

Infertility has hit Jews harder than other American populations because a higher percentage of Jews go to college and graduate school, Dorff says. These individuals often defer marriage and childbearing until after completing their education and establishing careers. Unfortunately for those planning to get pregnant in their late 20s and 30s, age is “by far the most important factor” in fertility for both men and women, says the rabbi. He'll address this topic Sun., Dec 10, as keynote speaker at Siegal College's conference on Bioethics and the Jewish Tradition. Participants will discuss “The Beginning of Life: Medical, Family and Ethical Issues.” The conference is sponsored by Case Western Reserve University School of Medicine and supported by a grant from The Mt. Sinai Health Care Foundation.

The optimal age to procreate is 22, according to the American Medical Association. Infertility rates rise for those between ages 27 and 35; about 30% of couples between 27 and 35 are infertile, Dorff says. Couples age 35 to 40 also see an increase in offspring with Down syndrome and other genetic defects. From ages 40 to 42, couples have only a 9% chance of delivering a healthy child. It's essential that organized Judaism take steps to try to reverse this demographic trend, the rabbi says. Parents and community leaders should encourage teens to apply to colleges with a large Jewish population to enhance their romantic opportunities as well as their educational and religious ones.

Second, young Jewish couples should be encouraged to marry and bear children younger, perhaps while still in graduate school, and to have three or four children, not the typical two. “Encourage means money,” Dorff adds. “Those of us beyond child-bearing years have to provide money for affordable day care and tuition for day schools and Hebrew schools and Jewish camps.” As a rabbi, Dorff frequently counsels those struggling with the “sheer ache” of infertility problems. “There's a lot of tension in the marriage. Every month is a final exam, and if you're infertile, you're going to fail a lot of those exams. Jews are not used to failing, especially something as personal as this.

“Marriages break up. People question ‘Who am I as a man?' ‘Who am I as a woman?' ‘Who are we as a couple?'” While many young Jewish couples think that modern science makes it possible to stretch their child-bearing years almost to menopause, Dorff says that is just not true. Assisted reproduction techniques, however, can help many Jewish couples have a child. Some of these procedures raise ethical questions. Having children with the parents' own egg and sperm, fertilized in a petri dish and then implanted in the womb, is not a problem ethically, at least not to Dorff. Rather, it's a problem financially. In vitro fertilization (IVF) costs $10,000 (and up) a try. Insurance doesn't cover the procedure, and couples have only a one in five chance of having a child with each IVF attempt.

Using donor gametes (sperm or egg) raises other issues. Among Orthodox Jews, very few would allow the use of donor gametes, Dorff maintains. The problem is there's always a possibility, no matter how remote, of unintentional incest in the next generation. This is especially true in closed communities that tend to intermarry. Couples are more likely to know the identity of egg donors than sperm donors. But egg donations pose questions about how to raise the child, Dorff points out. For example, an infertile woman desiring a child asks her sister to donate an egg. Is the egg donor the baby's mother or aunt?

Before even contemplating having a child, Jewish couples should be tested for the dozen or so Ashkenazi Jewish genetic disorders, the rabbi insists; these include Tay Sachs, Canavan's, and BRCA I and II genes, which carry a predisposition to developing breast and ovarian cancer. “Even if the news is bad, it's good to have the knowledge,” he says. “Not testing raises the ethical question, ‘Do you have the right not to know?'” A couple carrying affected genes can take steps to avoid having a child with a genetic disorder. In the case of recessive genetic diseases such as Tay Sachs, if both parents are carriers, they have a 1 in 4 chance of having a child with the disease. One way to avoid this is to do preimplantation genetic diagnosis (PGD) to determine if the embryo has the mutant gene.

In PGD, the father's sperm and several of the mother's eggs are fertilized in a petri test. The resulting embryos are tested for disease. Only a healthy embryo would be implanted in the mother's womb; the diseased ones would be discarded. As genetic testing and PGD becomes more routine, ethicists worry about the possibility of creating so-called designer babies. Parents could choose a child based on sex, and someday in the not too distant future, they could select for some other characteristic, such as height or eye color. Ethicists like Dorff ask, “What's the difference between therapy and enhancement?'' PGD is not an ethical problem for Jews, even Orthodox Jews, Dorff insists, even though it does involve destroying embryos, albeit diseased ones. Similarly, embryonic stem-cell research, which Orthodox rabbis support, requires the destruction of a days-old embryo.

“The Talmud says that for the first 40 days a fertilized egg is in the womb, it is simply liquid,” Dorff explains. “Throughout pregnancy, a fetus does not have the status of a full-fledged human being.” The moral watershed is whether we learn about a disease before or after it's a fact, he maintains. After the child is born, Jews have to see a person created in the image of God and make sure that individual has as full a life as possible. But before the child's birth, Jews have the right and duty to test for genetic diseases and to employ methods such as PGD to make sure they bring a healthy child into the world, Dorff says. That in itself raises ethical questions, too. “What diseases do you choose against?” the rabbi asks.

Dorff acknowledges that it's really hard for him to talk about choosing to bear a healthy child in the presence of people from the disabled community. With advances in science, he notes, the moral issues have to be re-examined.
“Once you can do something, you do have to ask whether or not you should do it,” he says. “Not everything you can do, should you do.” mkarfeld@cjn.org Bioethics and the Jewish Tradition will be held Sun., Dec. 10, at 7:30 p.m. and Mon., Dec. 11, from 7:30 a.m.-noon at Siegal College. It is open to the community and offers continuing education credits. Call 216-464-5827 or register online at http://siegalcollege. edu.

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