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Archive for the ‘Health’ Category

Judaism and Reproductive Science: Be Fruitful and Multiply. But How?

Monday, February 17, 2020 @ 11:02 AM
posted by Roger Price

Guest Essay by Prof. William D. Petok

Assisted Reproductive Technology.
Credit: wikigramas.org

The Bible and Fertility

The Biblical imperative is clear. “Be fruitful and multiply; fill the earth and tame it . . . .” (Gen. 1:28.) And God gives no description of how Adam and Eve are to do this. Again, after the flood, the same message comes from on high: “God then blessed Noah and his sons, saying to them, ‘Be fruitful and multiply, and fill the earth.’”(Gen. 9:1.) At least seven more times the commandment is given. This must be important!

Later in the text we are introduced to the problem of infertility. Sarah struggles and suggests that Abraham use the first known surrogate, Hagar, her handmaiden. After Ishmael is born Sarah conceives at the ripe age of 90. Tension between the two women increases and Hagar and Ishmael are cast out.

Infertility skips Isaac and Rebecca but plagues the next generation of the Matriarchs. “When Rachel saw that she was not bearing [children] to Jacob, Rachel came to envy her sister. She said to Jacob, “Let me have children; otherwise I am a dead woman.’” (Gen. 30:1.)

And finally, Elkahnah’s wife is stricken. Unfortunately, Elkhanah misses an opportunity to connect with his wife when he says “Am I not more to you than ten sons?” (1 Sam. 1:8.) Then, “In her deep anguish Hannah prayed to the Lord, weeping bitterly. And she made a vow, saying, ‘Lord Almighty, if you will only look on your servant’s misery and remember me, and not forget Your servant, but give her a son, then I will give him to the Lord for all the days of his life.’” (1 Sam. 1:10-11.) Miraculously, as in earlier texts, she conceives, and a son is born.

Modern Fertility Strategies

Today, we are less likely to rely on divine intervention for fertility problems. Reproductive medicine has developed an array of strategies for both men and women who are unable to create children “the old-fashioned way.” The most complex of these are considered Assisted Reproductive Technology (ART) and include In Vitro Fertilization (IVF) in which eggs and sperm join without other manipulation in a petri dish, Intrauterine Insemination (IUI), in which sperm is introduced to the uterus via a catheter, Intracytoplasmic Sperm Injection (ICSI), in which a single sperm is injected into a single egg under the microscope, the use of donor sperm or eggs, and the use of a gestational carrier when a woman’s is unable to carry a pregnancy to term for medical reasons. More recently, pre-implantation genetic testing (PGT) allows the determination of genetic problems with an embryo before it is transferred to a uterus. The process involves removing several cells in order to test them. Finally, egg freezing allows a woman to freeze her eggs for later use or donation at a later time.

As an added benefit of these technologies, same sex couples who wish to have children to whom they have a genetic connection can employ one or more of the above methods and build their families.

When Judaism Meets Reproductive Science

What does Judaism, the religion that brought us “Be fruitful and multiply,” have to say about these methods which did not exist when the biblical authors created the texts above? Many religions approach the problem of infertility with some amount of overlap. Judaism says that procreation is a religious duty, that infertility is imposed by God and may be seen as a punishment for wrongdoing. In fact, all the major religions take the view that infertility is a punitive response from the deity. As with most religions, Judaism has denominations ranging from the most orthodox to the most liberal. And the range of opinions on what is acceptable is significant. Generally, the more strictly one adheres to Jewish law, the more restrictive are the options.

Judaism in its most conservative forms is fairly flexible when it comes to ART. IVF is acceptable, particularly when the sperm and egg come from the individuals who will carry to term and raise the infant. IUI is acceptable if the sperm comes from the husband of the woman who will carry the pregnancy.

Egg donation

There are rabbis who will reject the use of donor eggs while others allow it with the husband’s consent. A major concern, if the donor is Jewish, would be the “provenance” of the egg for future marriage of the child. Regardless of faith, it’s a bad idea to marry a half sibling. The genetic consequences could be problematic. In the most religious circles, a gentile donor is preferred, the assumption being that the child will only marry a Jew, thus removing concerns about gene lines and consanguinity. Many authorities would favor a full conversion to insure the Jewish heritage of the child.

Sperm Donation

The use of donor sperm from a Jewish donor is not allowed because it constitutes an adulterous relationship, at least metaphorically, because the donor creates a child with a woman who is not his wife. The child would then be considered a mamzer or bastard.

For men with male factor infertility, this option is removed. A non-Jewish donor, on the other hand, changes the equation. The child can’t unknowingly marry a half-sibling because in “proper” marriage arrangements there is only a Jewish option. If a donor is Jewish, accurate records must be kept to insure that the donor’s subsequent children are not potential marriage mates.

Seed Spilling

The issue of IUI, IVF, and ICSI are complicated by how the sperm and egg “get together.” Since these procedures all take place without intercourse, “spilling of seed,” or masturbation, is required. The original text from Genesis (38:9) and then again in Leviticus presents questions about emission of semen and raises similar questions about ritual purity. Jews who follow a strict interpretation of text will then have a problem with how sperm are obtained for the procedures above. Typically, a man provides a specimen for use by masturbating into a collection cup. But this violates the prohibition of spilling seed. In order to avoid the prohibition, special collection condoms have been created so the couple can have intercourse and the “seed is not spilt.” In the most observant situations, there is a small hole at the top of the condom, so it is “possible” for seed to escape into the vagina and it won’t be “wasted.” From a medical/scientific point of view these machinations are less than desirable, but acceptable.

Surrogacy

Some Jewish denominations allow surrogacy via gestational carrier. This a distinctly different form of surrogacy than the one Abraham employed. Today that would be referred to as “traditional surrogacy” in which the carrier is inseminated with the father’s sperm, carries the child to birth and the turns the infant over to the parents who will raise it. This practice is used far less today than 25 years ago because of advances in IVF which allow creation of a fetus outside the womb and subsequent transfer to a carrier. In the best case, the carrier would be an unmarried woman. However, some Halachic authorities raise the question of maternal identity. Is the carrier, who’s only contribution to the birth is her womb, a mother? It is possible to find Halachic authorities who make the case both for and against gestational surrogacy. Liberal Judaism, which has accepted patrilineal descent, finds gestational surrogacy acceptable.

Most gestational surrogacy arrangements today involve a woman who is done creating her own family. As with any pregnancy, one risk is future infertility due to complications of gestation or birth. Another reason for this guideline is that a woman who has her own children is more likely to turn over a child she has carried for someone else. Many carriers comment that they loved being pregnant and look forward to the process especially because they will be able to sleep through the night after the delivery!

Anonymity

While egg and sperm donors were initially required to be anonymous for reasons that don’t make sense today, there is a strong movement to create donor sibling registries. This allows donor conceived children to find their half-siblings, “diblings” in some circles, and obtain ongoing medical information about their donor which may impact them in the future. When donor sperm and later donor egg procedures became possible, no one could have predicted the impact of technology on reproduction. Today, with genetic testing from organizations such as 23andMe and Ancestry.com, it is almost impossible for a donor to remain anonymous. In the not too distant future, children who are not told about their donor conception could easily discover the “truth” when they take biology in middle school and bring home the DNA swab kit to learn about their own genetic makeup.

Egg Freezing

Egg freezing, a process in which a woman’s ovaries are stimulated in a controlled fashion to produce more eggs than are normal for one cycle, is gaining acceptance in the Orthodox community. The procedure allows eggs to be retrieved by needle aspiration while the woman is sedated. They are subsequently frozen and stored in cryopreservation tanks for later use. For an unmarried woman in her late 30’s, this is a significant development as it allows her to preserve some measure of fertility until she finds a mate. It is also significant for a woman who has a medical condition that requires treatment that can render her infertile, such as some treatments for cancer and other diseases. As striking a development as it sounds, it is an imperfect process. Not all frozen eggs will thaw properly and not all of those that do thaw will fertilize. Finally, not all those that fertilize will develop into embryos that can be transferred.

Genetic Testing

Preimplantation genetic testing (PGT) was developed to diagnose genetically transmittable disorders. The process involves removing a single cell from a day 3 embryo and studying the genetic makeup of that cell. While the process is taking place, the embryo is frozen for later use. At day 3, the eight cells that make up the embryo are undifferentiated. Removing one will not affect the subsequent development of the embryo. The information obtained can prevent the transfer of embryos with Tay-Sachs, Down’s syndrome, and other disorders. It could also be used for sex determination, something that Halachic and non-Halachic authorities consider frivolous.

Additional Resources

This brief overview of Judaism’s approach to ART is by no means exhaustive. The reader who wants a deeper dive into both the Jewish approach and the broader field of ART is referred to several books and websites listed below.

Grazi, Richard V. Overcoming Infertility: A guide for Jewish couples (Toby Press, 2005). An edited collection by an experienced reproductive endocrinologist with contributions from rabbinic and medical experts.

Finkelstein, Baruch and Finkelstein, Michal. (The Third Key: the Jewish couple’s guide to Fertility (Feldheim Publishers, 2005). Contains halachic explanations of ART and what is and is not permissible for the most observant.

Cardin, Nina Beth. Tears of Sorrow, Seeds of Hope. Jewish Lights Publishing, 1999. Written by a Reform rabbi, this book, subtitled “A Jewish Companion for Infertility and Pregnancy Loss,” contains spiritual resources for those coping with infertility and pregnancy loss.

Jewish Fertility Foundation. https://www.jewishfertilityfoundation.org.  Headquartered in Atlanta, this organization provides financial assistance, educational awareness and emotional support to Jewish people who have medical fertility challenges.

Uprooted. https://weareuprooted.org.  A Boston based organization that offers advocacy and ritual creation. Uprooted educates Jewish leaders in assisting families with fertility challenges and provides national communal support to those struggling to grow their families.

Puah. https://www.puahfertility.org. Headquartered in Israel and providing services in the United States, this organization describes itself as “fertility, medicine and halacha.” In addition to information and events, it offers lab supervision to insure rabbinic requirements that Jewish parentage is established.

A Time. https://www.atime.org.  Headquartered in Brooklyn, this organization is focused on religiously observant Jews dealing with infertility and family building challenges.

RESOLVE. https://resolve.org/ The national patient advocacy organization. RESOLVE provides free support groups in more than 200 communities and is the leading patient advocacy voice.

The Society for Assisted Reproductive Technology. https://www.sart.org.  SART provides unbiased information and sets standards for in vitro fertilization (IVF). Member clinics provide data on success rates which are validated and available online. The website contains a wealth of patient friendly information in print and video form.

The American Society for Reproductive Medicine. https://www.asrm.org.  ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. Its patient information page, https://www.reproductivefacts.org, contains significant information about the medical aspects of infertility and its treatment

************

William D. Petok, PhD, is a Clinical Associate Professor of Obstetrics and Gynecology at Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA.

The views expressed by Prof. Petok are his own and not necessarily those of the Blogmaster. They are published in order to promote this blog’s mission to provide information and foster discussion about matters of faith and science. The Blogmaster thanks Prof. Petok for his contribution to this forum.

Rabbi Richard Address Explores “When Judaism Meets Science”

Sunday, October 27, 2019 @ 10:10 AM
posted by Roger Price
Rabbi Richard Address

RABBI RICHARD ADDRESS is the Founder and Director of www.jewishsacredaging.com. There he develops and implements the Sacred Aging project which has been responsible for creating awareness and resources for congregations on the implication of the emerging longevity revolution that has begun to impact all aspects of Jewish communal and congregational life.

In winter 2018, Rabbi Address began hosting a weekly podcast, Seekers of Meaning. Rabbi Address’s interview of author Roger Price concerning the latter’s new book, When Judaism Meets Science, covers a wide range of topics, including creation, evolution, bio–ethics, fake news, the anthropic principle, a Jewdroid, and the Greenberg hurdle. Running about forty–five minutes, without commercial interruption, it can be heard here: https://jewishsacredaging.com/som-pod-roger-price-author-of-when-judaism-meets-science/

When Judaism Meets Science can be purchased from various etailers, including Amazon, and also from the publisher, Wipf and Stock.

Jews, Judaism and Genetically Modified Crops

Sunday, February 28, 2016 @ 10:02 AM
posted by Roger Price

Credit: USDA

Genetically modified (“GM”) crops are plant products which have been genetically altered for certain traits. Such traits include resistance to viruses, bacteria, fungi, nematodes, insects, herbicides and drought, as well as aspects of product quality like improved yield, nutritional value and longer shelf life.  (See here and here.)

The characterization is somewhat of a misnomer. Modification of biological organisms is not a new process. It has been occurring in nature for billions of years. Indeed, the natural selection of some traits over others is the driving force of biological evolution, the process by which a species over time secures a competitive advantage in its environment. Today, though, the label of GM foods is meant to identify those products that have been modified or engineered by human means.

And yet, the intervention of humans in an otherwise natural process is not new either. Humans have been actively engaged in plant breeding for up to ten thousand years. An Assyrian relief, dated to 870 BCE, illustrates pollination of date palms by man.

Similarly, the Torah tells of Jacob manipulating his flocks of goats and lambs so that he would increase his herd with the fittest among them. (See Gen. 30:31-31:13.)That the author ambiguously attributed Jacob’s success to both magical sticks and God’s miraculous power is irrelevant, for present purposes. What is important is that the story is testament to the reality that at least since the text was written some twenty-five centuries ago, humans have recognized the desirability of and have sought to guide the alteration of existing species in ways thought beneficial. This guided intervention has produced a host of useful and now common food products, but it is, or was, slow, unpredictable, unreliable, costly and inefficient. read more

A Nice Jewish Shot: Why Vaccinations are Kosher and Required

Thursday, June 19, 2014 @ 09:06 PM
posted by Roger Price

Let’s face it. Sometimes you can deny certain established scientific truths and it does not make much difference. You can, for instance, believe that the Earth was created about 6,000 years ago and life as we know it will still go on. OK, maybe Jon Stewart and certain professors and pundits will make fun of you, but as the little redhead Annie always reminds us, “the sun’ll come out tomorrow, bet your bottom dollar, that tomorrow there’ll be sun.”

If, however, you deny the safety and efficacy of approved medical vaccinations designed to prevent harmful, debilitating, even deadly diseases, such as polio, measles, hepatitis and tetanus, your belief may well make a great deal of difference to you, your family, your community and, indeed, all of humanity.

And yet, there are those who for a variety of reasons refuse to inoculate themselves or their children, or both, even when established governmental authorities require such action. While it is tempting to stereotype all such persons as undereducated or acting out of ignorance, some are not. Aside from the rare situations based on the medical condition of the child, some people object to a particular vaccine or procedure.  Others have broader religious, philosophical and personal beliefs that militate against inoculations. (See, e.g., here and here.) Some even may be part of an otherwise socially conscious community. read more

The Curious Consensus of Jews on Abortion

Thursday, January 10, 2013 @ 10:01 AM
posted by Roger Price

That different Jews have disparate views is not news. What is news is when most Jews agree on a particular idea or approach. And so it is with the curious consensus of Jews on abortion.

In mid-2012, the Public Religion Research Institute (“PRRI”) published its findings from a 2012 survey of Jewish values (the “Jewish Values Survey”). The survey sought to measure the opinions of American Jews on a wide variety of political and economic issues, both domestic and foreign, as well as with respect to certain religious beliefs and practices. Some of those opinions were analyzed internally by Jewish denomination and externally by comparison to those of other faith or ethnic groups.

While Jews varied considerably in their views of a wide range of topics, on one – abortion – they were not only reasonably cohesive in their attitude, but strikingly different from other groups. Given the emphasis in the Jewish tradition on valuing life, on equating the preservation of one life with the preservation of a world and, conversely, the destruction of one life as the destruction of the world (Mishnah Sanhedrin 4:5), this result, on its face, seems as anomalous as it is clear. read more

Organ Donation: Holiest of Mitzvot

Tuesday, December 25, 2012 @ 10:12 AM
posted by Rabbi Shmuly Yanklowitz

When we pass from this world and our bodies enter the ground, do we merely wish to be remembered or do we wish to give the gift of life to others? For the medical, economic, and moral wellbeing of our society, the United States must change its policy on organ donation requirements.

Last week, we in my community were shocked and relieved when one congregant received a new kidney (a 100 percent perfect match, which is quite rare). After much pain and prolonged dialysis, she and her family are able to start a new life.

When my colleague and friend Robby Berman founded the Halachic Organ Donor Society, he sought to educate and inspire the Jewish community to save lives. Many had been confused by obscure teachings that Judaism was in some way opposed to organ donation, since, as some have told me, “I will emerge in heaven without that body part,” or that it is a violation of the dignity of the human corpse. Nothing could be further from the truth; organ donation is tantamount to pikuach nefesh (saving a life), one of the greatest of Jewish mitzvot. read more

Judaism and Nuts: Ethics and Allergies

Sunday, October 21, 2012 @ 12:10 PM
posted by Roger Price

Credit: USDA

It is one of the most dramatic moments in the entire Torah. There is no lightening or thunder, no plagues or parting of the sea, just an elderly statesman appearing before his people one more time, to teach one more lesson before they part from each other, the people to cross the river and the old man to enter eternity. Having led for so many years with the assistance of signs and wonders, now he simply speaks words, hoping to refresh their recollection and inspire them. He reminds them of their history in order to set the stage for their future. He tells them again what they should and should not do, emphasizing that they will have to make choices, choices that will lead to prosperity or adversity, choices that will enhance life or bring death. This leader, this teacher, this Moshe urges them: “Choose life, that you and your children should live . . . .” (See Deut. 30:19; see also Lev. 18:5.) Not for nothing is the Torah known as Etz Chaim,  a tree of life. (See Prov. 3:18; Ezek. 20:11.)

This reverence for life is more than some gauzy good feeling. Judaism at its best is grounded in experience, rooted in reality. Centuries after the biblical authors first put quill to scroll, the rabbis in the Talmudic period considered situations where observance of biblical ordinances on the sanctity of the Sabbath might adversely, perhaps fatally, affect real people – a wall that had collapsed on a child but could be removed, a fire that could be extinguished. (See  Yoma 84b, see also, Yoma 83a.) Referring to an obscure statement in the Holiness Code which seems to prohibit standing by or upon the blood of your neighbor (Lev. 19:16), the rabbis formulated the doctrine of pikuach nefesh (the preservation of human life), the principle that all of the laws, all of the rules, and all of the regulations which are in Torah can be abrogated to save a life. There are three major exceptions, essentially related to idolatry, murder and adultery, but the bias is otherwise comprehensive in favor of saving the life of another: “Whoever saves a life is considered to have saved the entire world.” (See Sanhedrin 37a.)  read more

The Big Bang: Science, Death and the Unknown

Thursday, December 15, 2011 @ 02:12 PM
posted by Robert Magrisso, M.D.

            Suddenly, Einstein lifted his head, looked upward at the clear skies and said: “We know nothing about it all. All our knowledge is but the knowledge of school children.” “Do you think we shall ever probe the secret?” “Possibly we shall know a little more than we now know, but . . . .”
R.W. Clark, The Life and Times of Albert Einstein (Avon, 1971).

            One of the very few textbooks that remain from college is my Halliday and Resnick Physics for Students of Science and Engineering. On its side remain, in very faint but still readable pencil, the words “Physics is a fraud,” which I wrote as a freshman. It was the culmination of one of the first of a long series of ambivalent encounters that I have had over the years with science. I wrote those words as an act of blasphemy and liberation towards what was then, essentially, disillusionment with my first religion: physics. I majored in physics in college not so much for practical knowledge as under the presumption that I was dealing with truth, and not just simple truths, but ultimate Truth. To me, attending lectures, doing the experiments, learning the mathematics, reading the books and doing the problems was equivalent to Talmud study.Newton, Einstein, Bohr, Maxwell, Planck, Heisenberg, Galileo  . . .  these were the prophets. Feynman was our hero. read more

Five More Jewish Nobel Laureates: What Does it Mean?

Friday, October 7, 2011 @ 09:10 AM
posted by Roger Price

     This past week the Royal Swedish Academy of Science announced the award of Nobel Prizes for 2011 in, among other fields, physics, chemistry and medicine. Seven individuals were honored. Apparently five are Jewish. What, if anything, does that mean? read more

Proposed Ban Cut Off Ballot

Monday, August 1, 2011 @ 08:08 AM
posted by Roger Price

In a July 5, 2011 post, I discussed a ballot initiative proposed to prohibit and criminalize circumcision. See http://www.judaismandscience.com/on-leaving-more-than-your-heart-in-san-francisco/  The measure was scheduled for voting in San Francisco in November, 2011. Last week, California Superior Court Judge Loretta Giorgi ordered that the city remove the measure from the November ballot.

Judge Giorgi announced her tentative ruling last Wednesday, indicating that she would bar the proposed ban. After proponents of the initiative filed an opposition to her tentative ruling, the judge heard oral arguments and issued a final order on Thursday.

A lawyer for the ban proponents reportedly argued that the male circumcision was neither cultural nor religious. It was not even a medical procedure. Rather, he contended, it was mutilation and should be prohibited just like female circumcision is prohibited.

Judge Giorgi was not persuaded by such arguments. The debate, she said, was not about the merits of circumcision.  Rather, it was about whether “the proposed city ballot measure is preempted by state law.”

Concluding that the evidence presented to her was “overwhelmingly persuasive that circumcision is a widely practiced medical procedure,” she found in a narrowly tailored opinion that California state law expressly prohibits local regulation of medical procedures. Therefore, she ruled, “it serves no legitimate purpose to allow a measure whose invalidity can be determined as a matter of law to remain on the ballot after such a ruling has been made.”

Judge Giorgi did add that the proposed ban would also violate the Free Exercise of religion clause of the United States Constitution. But that comment, what lawyers call dicta, was not necessary to her ruling and, given the packed courtroom, may have been intended as additional comfort for the ban opponents and additional caution to the ban proponents.

Outside the courtroom, activists carried various signs which suggested a considerable lack of depth with respect to both medicine and the law. One asserted that “Circumcisers are child mutilating rapists,” apparently not understanding either anatomy, recent studies in pediatrics, criminal law or the English language.  Another claimed “My Penis (sic) is NOT your property,” but there was no information provided that suggested that anyone other than the sign bearer wanted anything to do with any part of his body (capitalized or not), much less own and control it.  Otherwise, the ban proponents vowed to consider their legal options.

While the good guys have won this round, only a momentary expression of satisfaction is warranted.  The real lessons here are that (1) there cannot be enough education, including science, and (2) there cannot be enough coalition building.

Roger Price