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Multifetal Pregnancy Reduction in Halacha
Teacher’s and Student’s Guides
The focus of this presentation is to explore the Halachic permissibility of performing multifetal pregnancy reduction (MPR), by applying the teachings of the Talmud (Mishna and Gemara), Rishonim (medieval-period commentators), Acharonim (more recent commentators) and Poskim (Halachic decisors).
MPR is an interventional procedure performed by obstetricians in cases of multifetal pregnancies (for our purposes, we will characterize multifetal pregnancy as a triplet or higher order gestation) to reduce the number of fetuses in utero, thus increasing the survival probability of the remaining fetuses through a full-term pregnancy. Multifetal pregnancies are associated with several undesirable outcomes including complete pregnancy loss (miscarriage and stillbirth) and preterm birth which is often complicated by neonatal death and long-term disabilities. Reducing the number of fetuses in utero to a twin pregnancy leads to improved outcomes, as measured by lower rates of miscarriages, pre-term births and perinatal mortality.
It is understood that the goal of MPR is to optimize the survival chances of the remaining fetuses in cases where there is a high risk of total fetal death without intervention. Yet, since MPR by definition, terminates one or more fetal lives, contemporary Poskim and religious physicians have toiled to understand how Halacha views this predicament. This dilemma falls into the rubric of the universal question: can we end a life to save another life? Generally, taking a life cannot be justified even if it is the very (and only) means for promoting the survival of another life. This principle is described in the Mishna Ohalot as Ain Dochin Nefesh Mipnei Nefesh (אין דוחין נפשׁ מפני נפשׁ – we may not push aside one life on account of another life). Nonetheless, in very limited applications discussed in the shiur, we are instructed to save a life even if this will lead to the demise of another life. The shiur describes applications and limits of Ain Dochin Nefesh Mipnei Nefesh and the relevance to the Halachic permissibility of MPR.
In the course of the shiur, we will explore two different approaches that may open the door for permitting MPR in cases where the failure to intervene will lead to a high risk of total fetal death. One approach paradoxically is derived from the discussion in the Talmud concerning the ruling that one must give up his or her life not to violate murder (Yeherag V’al Yaavor). This is an application of the general principle of Ain Dochin. Perhaps the basis for the Yeherag V’al Yaavor ruling, which the Talmud describes as a logical reasoning that one may not presume one life is more valuable than any other life, may not apply in a case of multifetal pregnancy if all fetuses are likely to perish without intervention.
If this is true, perhaps Ain Dochin also will not apply under these conditions and MPR may therefore, be permitted. The second approach for permitting MPR is a derivation of the law of Rodef (pursuer), akin to the American legal concept of “justifiable homicide” where a person’s life is threatened by another, in which case, the life of the ”pursued” party may be saved even at the expense of the life of the “pursuer”. We develop this approach through the brilliant writings of Rav Moshe Feinstein, זצ״ל, (who was a leading Halachic decisor, Posek, over a half-century period in America; henceforth referred to as: “Rav Moshe”), in his magnum opus, Igrot Moshe. These approaches are built on two Talmudic sources about which prodigious commentary has been written, in particular, the “obstructed labor” and the “fugitive” cases, which will be explained below with the different interpretations and applications to MPR.
Please kindly dedicate the מִצְוָה of לִימוּד תוֹרָה involved in using these educational materials as a זְכוּת for a רְפוּאָה שְׁלֵימָה for my brother, יוֹסֵף אֵלִיָ־הוּ בֶּן בֵּילָא יִשְׂרָאֵ־ל
Note: This shiur it is not intended as a source of practical halachic (legal) rulings. For matters of halachah (practical details of Jewish law), please consult a qualified posek (rabbi).
Dr. Avi Lasdun attended Telshe Yeshiva in Wickliffe Ohio, graduated with a bachelors in Biology from Touro College in 1985 and a Ph.D. in Biomedical Sciences from City University of New York in 1990. Avi worked for over twenty years in the pharmaceutical industry as a scientist. He is currently adapting scientific analytical and writing skills gained during his career to help develop Torah teaching tools that he hopes will activate a fuller array of intellectual and emotional capacities to enable a more holistic learning experience for students.