judaism bioethics essay

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The Bioethical Concept of Life for Life in Judaism, Catholicism, and Islam: Abortion When the Mother’s Life is in Danger

Rhami khorfan , ba, aasim i padela , md, ms.

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Correspondence should be directed to: Rhami Khorfan, 5209 Warwick Woods Trail, Grand Blanc, MI 48439, e-mail: [email protected]

Issue date 2010 Nov.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License ( http://creativecommons.org/licenses/by-nc-nd/3.0/ ).

Modern secular bioethics has focused on developing a set of universal principles to guide clinical decision making. However, this ignores the important role of religion in resolving bioethical questions. It is imperative that health-care providers understand these belief systems in order to traverse value conflicts and provide the highest quality care to a diverse population. This paper focuses on the process of bioethical deliberation in Judaism, Catholicism, and Islam. Abortion is normatively prohibited in each faith and through examining how each ethical code allows for abortion when the mother’s life is in peril due to the fetus, we highlight the value of unborn life in each faith. Orthodox Judaism uses the concept of rodef , or pursuer, to permit abortion in this scenario, Catholicism uses the moral concept of “double effect,” while Islamic law cites the maqāṣid , higher objectives of the law, to permit abortion in this scenario.

Keywords: Bioethics, abortion, Judaism, Catholicism, Islam

Introduction

Modern medical practice is becoming increasingly diverse. The various ethnic, racial, and religious identities within the patient population lead to a myriad of value systems being at play in the clinical realm. At times these value and cultural differences between the practitioner and the patient can lead to ethical challenges, and in order to find amicable solutions, understanding each party’s moral values and ethical constructs is of utmost importance.

Modern medical ethics, in its secular form, has focused on the establishment of values and principles that can guide physician-patient interactions within this multicultural context. The most popular model is that expounded by Beauchamp and Childress, which promotes nonmaleficence, beneficence, respect for autonomy, and justice as its four guiding principles. 1 However, religious beliefs do not fit easily within this four-principle model. As a result, various faith groups have tried to profess medical ethics based upon their own sacred law and ethical structure. 2 This paper discusses the way that Orthodox Judaism, Catholicism, and Sunni Islam approach medical ethics and examines their stance on issues of dire necessity relating to abortion whereby the clinical context is deemed substantial enough to overturn the normative prohibition against abortion.

Judaism refers to the religious system set forth by the Hebrew Scriptures of Ancient Israel (also known in Christianity as the Old Testament) supplemented by the rabbinic formulations and commentaries of the first six centuries of the Common Era (such as the Mishna ). Together the scripture and the rabbinic writings are called “the Torah,” the former transmitted in writing and the latter initially in oral form and later written down by a rabbinic sage. 3

The term “Torah” is used variably in Judaism and in a strict sense refers to the Five Books of Moses: Genesis, Exodus, Leviticus, Numbers and Deuteronomy (the Pentateuch ), but is also used to refer to the entire corpus of Jewish religious teachings. 4 For our purposes, the term “Torah” will denote the Hebrew scripture taken together with the rabbinic writings.

Jewish Ethics and Halacha

There are three primary streams in Jewish religious practice marked by their levels of adherence to the Pentateuch : Orthodox, Reform, and Conservative. The Orthodox movement is the oldest and most diverse form that follows a strict and literal interpretation of the Pentateuch as it holds it to be the exact word of God and subscribes to the belief that God’s laws are immutable. 5 This paper draws mostly from the Orthodox movement’s interpretation of Jewish law.

In Judaism bioethical inquiry is a subset of halacha (Jewish sacred law). As such it draws its principles from sacred texts and their commentaries, and utilizes an elaborate system of halachic reasoning. The three main sources of Jewish ethicolegal thinking are the Hebrew scriptures of ancient Israel, the Talmud , and the Responsa literature. The Hebrew Scriptures is the holy book of Judaism of which the Pentateuch holds the status of the highest source of law. 6 Simultaneous to the written text, an oral tradition of interpretation and commentary was composed by rabbinic sages during the first six centuries of the Common Era. Eventually this tradition was written down around 200 C.E. and is known as the Mishna . 3 The Mishna was amplified through further commentaries that came to be known as the Gemara (there are two: a Palestinian and a Babylonian). Together the Mishna and Gemara are known as the Talmud , which is the second source of law but whose influence on Jewish sacred law and moral codes is even greater than that of the Old Testament. 6 The Talmud is not just a book of rulings; it is a transcript of legal debates through the centuries and contains a multiplicity of recorded positions on any particular subject. The third source of legal authority is the Responsa literature. 7 These works are collections of opinions on contemporary matters as interpreted through the Hebrew Scripture and the Talmud . This literature spans centuries of thought and contains opinions of scholars from all over the world. In addition to these three main sources there are codifications of Jewish law that summarize the primary teachings, one of the most notable is the Mishne Torah , written by a noted 12th-century physician and scholar, Maimonides (Ibn Maymun). 7 ,a

Ethical legal reasoning starts with extracting the primary data on the subject from the Talmud , likely in the form of rulings in particular cases, or arguments about the validity of such rulings. Next, a hypothesis is formulated as to the general principle that explains the collections of rulings. Lastly, through deductive logic the principle is applied to new circumstances that are not covered explicitly by earlier rulings. 6 This process is undertaken by a trained rabbi in response to a questioner. In practice, because there are multiple codifications and manuals of Jewish law, a rabbi might consult a particular manual for rulings rather than labor through halachic reasoning anew. This process of halachic reasoning has allowed Jewish law to be dynamic, addressing issues on the basis of circumstance and precedent while allowing for enduring applicability.

The halacha puts great value on human life, and views every human life as having infinite worth. 9 However, the fetus is seen as a “prehuman” life rather than a full life. Only at birth are full rights given to the fetus. 10 Although a fetus is not equal to a full human life, the halacha still endows this potential life with certain rights and it is considered generally inviolable.

It follows then that abortion in the halachic view is prohibited. Different sources give several reasons, but the ruling is largely based on the verse, “Whosoever sheddeth the blood of man in man, his blood shall be shed” (Genesis 9:6). Here, “man in man,” is understood to be a fetus, and feticide is equated with murder. 9

The exemption to this prohibition requires an immediate and compelling necessity. Most authors note that Jewish law permits an abortion when the mother’s life is in peril. This danger to the mother’s life does not necessarily have to be definitive; it can be a probable threat to the mother’s life. 10 This permission is based on an interpretation of the halachic term rodef , meaning pursuer. This concept allows someone to kill a thief that is breaking into one’s house, because one may assume that the thief is armed and may kill him or her. The fetus is thus seen as a “pursuer,” which is threatening the mother’s life. This threat must be stopped, even if it means killing the pursuer. 9

Jewish bioethicists have developed four categories of illnesses to differentiate between different levels of necessity. The first is “discomfort,” including minor coughs and rashes. 9 The next category, “minor illness,” includes irritating coughs and headaches that are severe but not to the point of requiring bed rest. 9 Patients who “are severely but not fatally ill” and/or whose “limbs but not lives are in danger” comprise the third category. 9 This category includes illness that confines patients to the bed or illnesses that require preventative treatment. Finally, “a potentially fatal condition” is the fourth category. 9 For each of these categories, there are different restrictions on when and what type of normative prohibitions can be violated. These rulings range from no permitted violations for the first category, to all prohibitions being overturned for the fourth category.

Applying this four-category model to abortion leads to the same conclusion: that abortion of an unborn fetus is allowed if the mother’s life is in danger. This is because if a woman’s pregnancy is causing a “fatal” illness, the mother falls into the fourth category and everything must be done to save her life, including violating a command from the Torah. If this is not done, then whomever is responsible for the woman’s health is guilty of murder, because it is a much graver offense than abortion, which is not considered murder by Jewish law. 11

Catholicism

The Catholic Church is a federation of 24 churches that place authority in the pope regarding matters of faith and morality. The largest of these 24 churches is the Latin Church, also known as the Roman Catholic Church. The other 23 churches are known as “particular churches” or “Eastern Catholic Churches.” (Schweda, Phillip J (Chaplain, University of Michigan Hospital, Ann Arbor, MI). Conversation with authors. 2009-JUL-16. Unreferenced, see “ Notes ”) The pope (the supreme pontiff or Roman pontiff) is the head of the Roman Catholic Church and is a quasi-absolute monarch who rules from the Vatican City, also known as the Holy See. He is elected by an elite group of bishops known as the College of Cardinals, whose members receive their position through appointment by the previous pope. There is also a papal court known as the Curia , which governs all matters of the church. The pope’s authority stems from being the lineal successor to St. Peter and thereby is Jesus’ representative on earth. Further augmenting his authority, the doctrine of papal infallibility allows the pope to define Catholic teachings in all spheres of life, but in practice this is rare. The other 23 particular churches have limited autonomy but are still responsible to the Curia . (Schweda. Conversation with authors. See “ Notes ”)

Within the Catholic Church there exists an organized system of clergy of patriarchs, bishops, priests and deacons who minister to the needs of the church and its adherents.

Catholic Moral Theology and Canon Law

Canon law refers to the body of laws and regulations developed or adopted by Catholic Church for the government of the Catholic organizations and the faith community. Canon law is at times referred to as ecclesiastical law; however, the former includes legislation borrowed from Roman law as well as those made by the Church, while the latter encompasses only those laws authored by the Church. 12 The sources of canon law are natural divine law and positive divine law (revelation). Both are contained in the scriptures and in tradition. Importantly, the New Testament of Jesus Christ is considered to abrogate most of the laws based in the Old Testament, save the Ten Commandments, and certain matrimonial regulations. 12

The author of canon law is the church that, as described above, holds supreme authority in matters of faith and morals and is charged with setting up a society running according to divine (canon) law. The bishops and pope taken together are the active sources of canon law as they decree regulations through ecumenical councils. The pope holds the power to set law by himself and the power to abrogate laws made by predecessors or by ecumenical councils. (Schweda. Conversation with authors. See “ Notes ”)

Along with law, Catholic ethicists also deal with another field in debating ethical issues, moral theology.(Schweda. Conversation with authors. See “ Notes ”) This is the theological study of what a human must do in order to gain the favor of God. It is defined and guided by natural ethics, Christian scripture, and the positive laws of the church. Catholic moral thought is a deductive process, starting from principles laid out in theology and applying it to cases through rational argumentation. We will see an example of this process in the discussion of abortion found below.

The guiding principle in Catholic moral thought’s dealings with abortion is the supremacy of the right to life. Catholic ethicists place the right to life above all else, because without life there can be no other good. 13 We will begin discussing abortion in the Catholic tradition with a summary given by renowned ethicist Daniel Callahan:

God alone is the Lord of life.

Human beings do not have the right to take lives of other (innocent) human beings.

Human life begins at the moment of conception.

Abortion, at whatever the stage of development of the conceptus, is the taking of innocent human life. The conclusion follows: Abortion is wrong.” 14

The distinguishing feature of Catholic ethics when dealing with abortion is the equality, from the very beginning, of the lives of the fetus and the mother. Pope Pius XII said, “Even the unborn child is a human being in the same degree and by the same title as its mother.” 14 This is distinct from the Islamic and Jewish view of fetal life as potential or pre-human life. Understanding this equality helps in understanding the seemingly strict stance on abortion taken by Catholic moral ethicists.

Necessity can only be used to override the Catholic prohibition of abortion if the fetus is not directly harmed. Catholic ethicists justify this type of abortion based on the principle of double effect, which states “An action that has both a good and a bad effect may be performed if the good effect accomplished is greater than the evil effect.” 14 Applying this to abortion, if a mother has a fatal medical condition that can be treated through surgery, only such surgery that does not directly harm the fetus is permissible. For example, if the mother has appendicitis an operation is permissible because the operation does not involve directly harming the fetus to save the mother’s life. Another example would be the case of an ectopic pregnancy when the embryo implants into the fallopian tube and a continued pregnancy would lead to rupture and the possibility of maternal and fetal death. In this scenario surgical removal of the fallopian tube is permitted even though it would cause the death of the growing embryo, here seen as a potential life of infinite value, because the process is indirect. In contrast to the indirect death of the fetus, procedures such as crushing the skull of the fetus are seen as direct killing and prohibited even if this is the only means to save the mother’s life. 14 The principle of double effect thus follows the rationale that the intended result of the procedure that indirectly harms the fetus is saving the mother’s life, which is good, and the death of the fetus is an indirect evil. Thus the good result outweighs the bad result and the procedure is allowed. 14 However in the direct case the moral impermissibility stems from directly ending one life, that of the fetus, in order to save another, the mother’s. Some Catholic moral philosophers explicitly state that in this case two natural deaths are better than one murder.

The Arabic word “Islam” carries meanings of “submission (to God)” and “to enter into the peace (of God).” Thus Islam is more properly defined as an action rather than a fixed entity. The term, however, has come to represent the monotheistic tradition of faith and practice that holds Muhammad ibn Abdullah ﷺ of 7 th century Mecca to be the final prophet from a long lineage of prophets including Noah, Abraham, Jesus and Moses (PBUT). Hence “Islam” represents a cumulative tradition spanning 14 centuries, which the Muslims, those who carry out the action of submitting to God, developed and adapted in diverse ways to varied times, places and contexts. Yet, despite the diversity of time and place, the Muslims of the world refer to a singular universe of meaning elaborated on and rooted in a certain number of fundamental principles. In succinct form, the root meanings of the word “Islam” imply Muslims believe that by sincerely and totally submitting to God inwardly and in external action, one can attain true peace within one’s self and manifest it outwardly in this life, and will find everlasting peace in the hereafter.

Shari’ah and Medical Ethics

Islamic medical ethics as a cohesive discipline is still in its formative stages. 15 Within Islamic medical ethics literature there are two dominant genres. The first is adab literature; writings related to character ethics both in the professional and personal realms. The other genre is more concerned with Islamic ethics as rooted in Islamic sacred law, or sharī`a . These writings aim at expounding the moral values attached to using certain medical technologies and interventions based on Islamic legal and ethical principles. 15 Indeed, as is the case with the Jewish halacha , the sharī`a encompasses all aspects of life and thus its scholars use sharī`a -based principles and formal techniques to find Islamic perspectives on all spheres of human activity from modes of banking to government.

Islamic sharī`a has two dimensions, the first being the physical corpus of legal rulings, precedents, and statutes, and the second being the intellectual and moral code of Islam. 15 In Islamic teaching the sharī`a is the source of Muslim existence as it represents “the correct path of action as determined by God.” The absence of a state authority enforcing the sharī`a in totality has relegated the sharī`a to a more theoretical sphere better thought of as “the collective ethical subconscious” of the Muslim community. 16 For this reason, Muslim patients and ethicists may refer to the sharī`a when making decisions about abortion, end-of-life care, and other biomedical issues.

Islamic legal reasoning and thought is very different from Catholic reasoning. Instead of reasoning from a general principle to specific situations, scholars of Islamic law take a normative example from the Qur’an or Sunnah and try to apply its spirit or their understanding of the reasons behind it to new situations.

Through the course of Islamic history, different methodologies and legal theories developed to reach a ruling from the Qur’an and Sunnah, some of these systems became extinct and others were codified and organized into schools of law. The four Sunni schools that have survived to modern times -- Hanafī, Mālikī, Shāfi’ī , and Hanbalī -- are all considered valid and orthodox interpretations. While it is beyond the scope of this paper to delve into the legal frameworks of these Sunni schools, all four schools accept four sources of law: the Qur’an, the ḥadīth , ijmā` and qiyās . 17 The Qur’an is held to be the literal word of God and “is a source of knowledge in the way that the entire corpus of legal precedent is for the common law tradition; not as much as an index of possible rulings (rather) as a quarry in which the astute inquirer can hope to find the building blocks for a morally valid, and therefore, true system of ethics.” 18 The ḥadīth encompasses collections of reports of sayings, actions and silent affirmations of the Prophet Muhammad ﷺ complied in book form. Ijmā` refers to consensus agreement about the moral and/or legal assessment of an act or practice. Its scope can include how a particular ḥadīth or Qur’anic injunction should be applied and interpreted, as well as a record of agreement on an issue that may not be explicitly covered by the two material sources. Differences exist within the different schools of law. The dominant opinion is that ijmā` is the agreement of Muslim-learned persons at a time, after the death of the Prophet ﷺ on a “legal matter.” 19 Qiyās is juristic reasoning by analogy. 19 In application it stands for applying a certain ruling from an established case if the predisposing conditions, which led to the ruling in the first case, apply to a second case. Thus the process of applying qiyas through inductive and deductive reasoning is strikingly similar to halachic reasoning in Judaism.

Islamic scholars have identified five essential goals, or maqāṣid , of the sharī`a . These are protection of religion, life, intellect, lineage, and property. A dire necessity ( ḍarūra ) that threatens one of these five values may be enough to overturn any normative prohibition based on the principle al-ḍarūrāt tubīḥ al-maḥẓūrāt . 21 In medical issues, the necessity is often left to be defined by Muslim physicians who can be trusted in both medical expertise and religiosity. 22

Abortion in Islam is understood first as an interference with God’s role as the ultimate owner and decider of life and death. Human life is valued because it is made by God. 21 As mentioned earlier, Islamic legal reasoning can lead to varying opinions on one issue, and abortion is no exception. The four schools differ in the moral culpability and legal permissibility of abortion before the 120 th day of pregnancy; whether it is prohibited categorically or simply morally discouraged and what conditions allow for its undertaking. 22 , 23 However, there is ijmā` among the Muslim scholars that abortion is prohibited after 120 days. 22 This is based on a ḥadīth of the Prophet ﷺ, which states:

The Prophet of God told us – and he is the one who speaks the truth and evokes belief – “Each of you is gathered in his mother’s womb for forty days; then [he is] a clot of blood for the same period; then he is a clump of flesh for the same period ... Then the spirit is breathed into it...” 22

Muslim scholars agree that after the moment when the soul is “breathed into it,” also known as the moment of ensoulment, the fetus is considered a human and gains almost full rights according to Islamic law and abortion is prohibited. The one necessity that overrides the prohibition of abortion after 120 days is when the mother’s life is at stake. This is because abortion is a ḍarūra to save the mother’s life, one of the five maqāṣid . At this point, the mother’s life is protected at the value of the potential life of the fetus. 22 The specific definition of what constitutes a potential-versus-actual harm to the life of the mother is left unspoken and subject to circumstantial consideration. All of the four major schools of law allow for the sacrificing of an unborn child even after 120 days of pregnancy to preserve the mother’s life, and they put this decision in the hands of a competent Muslim physician.

Religion is a very important source of ethical values and principles for many patients and physicians. In an increasingly multicultural environment, clinicians come in contact with many religious ideals, some of which may be alien to them. This cursory look at three of the most prominent religious ethical systems may help clinicians to understand and interact with different value systems, thus improving the quality of their care. Abortion is one example of an ethical question with significant religious implications, and a look at how each religion views the issue of taking one life to save another provides a useful illustration of their bioethical deliberation. Jewish halacha applies the concept of a rodef to allow abortion if the physician believes the fetus is endangering the mother’s life. Catholic moral theology values the sanctity of life above all else, and therefore only allows abortion through the concept of “double effect” when abortion is an indirect consequence of a necessary procedure to save the mother’s life. Islamic sharī`a views protecting life as one of the five maqāṣid , or higher objectives of the law, and therefore allows abortion to save the mother’s life through the means of the principle of necessity allowing the prohibited ( al-ḍarūrāt tubīḥ al mahzūrāt ), even after 120 days of pregnancy. Through this examination of abortion in each religion, we see one instance in which one life can be taken in order to save another and gain insight into the ethicolegal processes that were developed by each faith community to deal with the cases of life versus life.

Acknowledgments

We would like to thank Rabbi Sara Adler of the University of Michigan Medical Center Spiritual Services, Rabbi Rod Glogower of the University of Michigan Hillel, and Reverend Phillip Schweda of the Diocese of Lansing for contributing their time and expertise to help guide our research.

The authors interviewed Philip J, a chaplain at the University of Michigan Hospital, Ann Arbor, MI, on 2009-JUL-16. He reviewed a late draft of this article and permitted JIMA to publish the citation to his communication in this article.

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Bioethics in Judaism

“He has told you, O man, what is good. What does God require of you but to do justice, to love kindness and to walk humbly with your God?” Micah 6:8

Bioethics deal with the ethical questions surrounding the taking, giving or altering of human life. As Judaism’s focus is on life, bioethics are of prime Jewish concern.

For Jews, the ultimate question relating to all bioethical issues is how much we are allowed to tamper with life, the sacred gift granted to us.

In order to understand how Judaism deals with problems of bioethics we have to look at how ethical principles are formulated and how Jewish ethics can and does evolve to deal with dilemmas that arise from the rapid advances of science in general and medicine in particular.

The Sources of Ethical Principles

The famous verse from Micah quoted above epitomises the principles of Jewish ethics as the rules for a good and correct life, as Micah reminds us that the ethical life requires a spirit of justice, charity and humility.

Jews obtain their moral values from the Hebrew Bible, and the totality of the moral law is described as Torah. Torah values are similar to those of the other two great monotheistic religions which also claim Divine origin for their moral codes, as well as proclaiming that God’s commandments are absolute for all times and for all situations.

Judaism complements the authority of the Biblical law with the concept that as well as the written Torah there exists alongside it the Oral Torah which has the same imprimatur as the written. Just as the written Torah was revealed at Mount Sinai to Moses it is traditionally held, the Oral Law was given at the same time. This enables Judaism to grapple with socio-historical changes, as the Oral Law is continually evolving through the labours of our rabbis (teachers) who use its authority to interpret the written Torah. The authority of particular rabbis as interpreters of the law hinges on their acceptance by their peers because of their outstanding knowledge and the excellence of their character, recognised both during their lifetimes and after their deaths.

The Oral Torah could not continue as a word-of-mouth system because of the sheer amount of data and rulings that have taken place over the centuries. It needed to be recorded and is continually being written down in such great works as the Talmud and collections of the rulings (‘Responsa’) of outstanding rabbis such as Maimonides. When faced with problems not overtly covered in the Torah, the written laws are interpreted and their essential meanings uncovered to arrive at conclusions in keeping with Micah’s admonitions. For example the most misquoted verse in the Torah is Exodus 21:23-24, “an eye for an eye”, which the rabbis teach has always meant the monetary value of the eye and not the actual eye.

From both the written and oral Torah we can formulate what I call the four golden rules of Bioethics:

• Do not kill;
• Each individual life is of infinite value and no one person’s life is more valuable than another;
• One’s life belongs to God;
• There is a duty on all to save life and heal the sick.

The traditional practice of applying principles of Halacha to ethical dilemmas and the evaluation of new technologies defines Jewish bioethics. This process attempts to identify the duties of physicians, patients and families faced with life, health and death decisions.

There are three main Jewish bioethical principles: that human life has infinite value; that aging, illness and death are a natural part of life; and that improvement of the patient’s quality of life is a constant commitment.

Other Jewish bioethical principles are that we are to act responsibly in preserving the wellbeing of our bodies, because they actually belong to God; and that any other law can be violated in order to save human life except murder, incest and idolatry.

The Jewish bioethical system is based on duties and responsibilities, as opposed to the secular model of rights.

The presumed right to withhold treatment, to commit suicide, to have an abortion when the mother’s life or health is not at risk, and/or to perform euthanasia, are all overridden by the duty of Jews to treat illness, preserve health and life.

If we apply these rules to abortion we can immediately see that the adage “my body belongs to me and I can do what I like with it” has no place in Judaism. However Exodus 21:22 provides that compensation must be paid in cases where a miscarriage accidentally results from violence, and it has been suggested that this implies that foeticide, whilst morally repugnant, is not legally equivalent to homicide, since it does not give rise to the penalties which are imposed for accidental manslaughter. In Judaism the foetus is not characterised as an independent being until birth.

The general rule is therefore that the mother’s physical and mental health takes precedence over the foetus, even, if in extreme cases it means that abortion is required. Nevertheless social abortion and abortion on demand are strictly forbidden.

Organ Transplantation

The Torah forbids the defilement of a dead body, but it also states clearly the paramount necessity of preserving life. The stricture against defilement is therefore overturned if an organ such as a kidney is taken from a cadaver, transplanted into a sick person and could lead to the saving of a life. Corneal transplants are also approved, as sight is considered vital to an individual’s well-being.

On the other hand, although saving a life is mandatory it should not be undertaken if there is a risk to the rescuer. The typical example is of a person who cannot swim and sees another drowning, and who is bound only to get a pole or rope and haul in the other.

This raises the issue whether a relative (ideally an identical twin) is allowed to donate a kidney, or part of his or her liver. There are two issues:

• The immediate operative risk to the donor
• The long-term risk of having one kidney

With modern surgical techniques and resuscitation the risk in removing a kidney is very low. However that is not the case where a part of the liver is removed. In Time magazine (28/01/02) a case was reported of a brother dying after donating half his liver. The report goes on to discus the ethical implications of this tragedy. The long-term risk of having one kidney is also not negligible and each potential donor must be assessed individually.

Ethical problems arise when an essential organ (such as a heart or liver) cannot be taken from a cadaver as it must have a normal circulation right up to the moment of harvesting. The dilemma that this poses is: can a person be dead even though the heart is still beating albeit because of a life support system? If the person is still alive in some sense then these organ transplants contravene our first rule: we must not kill. If however a person is dead by virtue of their brain being dead despite their heart beating, then removing their vital organs is not tantamount to murder. This latter concept is accepted by most, but by no means by all, authorities, and so heart and liver transplants are usually permitted.

There was a famous case in Israel when a 20 year student, Alisa Flatow, was killed when travelling in a bus blown up by a terrorist. Her parents gave permission for her organs to be transplanted. Bearing in mind our second rule that no one life is of more importance than another, two of her organs were transplanted into Palestinian recipients. This case stimulated the public’s interest in organ transplantation and led to more organs becoming available and being transplanted in Israel.

In-Vitro Fertilisation and Cloning

There is a positive commandment to procreate: “be fruitful and multiply” (Genesis 1:28) and so In-Vitro Fertilisation (I.V.F.) is encouraged to enable a barren couple to have children. Objections have occasionally been raised to the concept of fertilisation by a donor, in view of the danger of future forbidden relationships between children who are unaware of their genetic ancestry.

Traditionally it is held that the embryo does not take on human characteristics until the fortieth day after conception. If during that procedure some embryos are not needed, then research on those embryos and using their stem cells for therapy would not be an ethical problem as it could lead to the saving of life. Similarly the cloning of one’s own cells for future use would not raise any objections if used for reasons of health. The view that one can clone one’s self completely, including one’s own self awareness and memories, is currently a subject of science fiction; at best one could only create a physically identical twin.

“(There is) a time to be born and a time to die” (Ecclesiastes 3:2)

“Vex not his ghost. O, let him pass ! He hates him That would upon the rack of this tough world Stretch him out longer.” (King Lear, Act 5 Scene 3)

This topic is probably the most difficult to deal with as it is one that affects each of us in a personal way. Both Ecclesiastes and Shakespeare recognise that there comes a time when it is pointless and cruel to persist with life. Jewish tradition is replete with stories of not enduring with a life of suffering and anguish. However bearing in mind our golden rules, are we killing someone if we do not prolong a life which could, even in its last few moments, have some merit?

In essence Judaism is against active euthanasia. We cannot actively (knowing the consequences of our actions) administer a lethal dose to a person who is dying, to prevent their suffering. However passive euthanasia, where essentially nature is allowed to take its course, is permitted when death is inevitable. We need not embark on a course of treatment merely to gain a brief respite. We can even withdraw treatment if that treatment is not going to cure the dying patient.

Some bio-ethicists believe that, philosophically, there is no essential difference between active and passive euthanasia but Judaism does make that distinction. Judaism holds that one should never withhold sustenance from a dying patient. Controversy can arise as to the mode of deliverance of this sustenance. Judaism would not agree that Terry Schiavo’s naso-gastric tube (running from her mouth to her stomach) or the decision by the Victorian Supreme Court in a similar case (cited in The Australian, 30/05/03) should have been withdrawn, causing these women to die from dehydration. It would agree that nutrition given intra-venously would count as extraordinary and could be ceased. Whether it should be given artificially via a tube through the abdominal wall into the stomach is debatable.

Another vexed problem is the question of switching off a life support system and authorities have differed. Each case must be judged on its merits.

The Environment

The Jewish view is that the created world is not perfect and that man is carrying on the work of G-d in trying to improve it. We are not Luddites who believe that there should be no technical advances. But with that approach comes a responsibility that was realised nearly two thousand years ago in this rabbinic commentary:

“When the Almighty created Adam He led him round the Garden of Eden. ‘Look at my works’, He said. ‘See how beautiful they are; how excellent! I created them all for your sake. See to it that you do not spoil and destroy my world; for if you do there is no-one to put it right’. ”

I cannot think of any better way to sum up the Jewish attitude towards taking care not to pollute the environment, and the warning that there may be a stage when the situation becomes irreversible.

Orthodox Jewish bioethics is guided by the absolute morality of the laws of the written Torah which is believed to contain the word of G-d. The development of an Oral Law, which is continually being interpreted, enables Judaism to confront modern problems and solve them in the spirit of Micah’s message. In the words of a contemporary authority, Rabbi M.D.Tendler:

“Inherent in the Jewish point of view is an expression of confidence that decisions on these great issues do not reside in heaven . We don’t accept an infallible, irrevocable voice from heaven to clarify even these most complex issues. This of course is a disadvantage that we have compared with other religions. Using the biblical ethical principles…may help us all, while we study the problems with integrity and devotion, to surely reach the proper conclusion, one that is pleasing to us and to G-d”. (The Mount Sinai Journal of Medicine, 51:54-57, 1984.)

© Ian Kern 2006.

(Ian Kern is a paediatric surgeon with an interest in issues of medical ethics and Jewish studies.)

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Jewish Bioethics 101

By My Jewish Learning

What is Jewish bioethics? There is no simple answer to this question. The relationship between Jewish law ( halakha ), Jewish ethics, and the ethical principles of general society are navigated differently by different Jewish authorities. However, there is one principle that can be singled out for its prominence in Jewish bioethical discourse: the sanctity of human life and the duty to save and preserve it wherever possible.

Judaism does not categorically approve or disapprove of abortion. Jewish law does not consider a fetus to be a human being ; thus it actually requires abortions when a pregnant woman’s life is in danger. Jewish authorities disagree on whether to extend the permissibility of abortion to situations where the pregnancy or birth is psychologically but not physically dangerous. Those who allow for abortion in suchcases disagree on how far to extend this permissibility. Most of these authorities allow abortion in cases of incest or rape and cases where the fetus is affected with a terminal genetic disease such as Tay-Sachs. Other authorities extend permissibility further and may include cases where the fetus has a non-terminal genetic defect or even situations where the mere fact of pregnancy and anticipated childbirth is a threat to the mother’s mental health .

Organ Donation

A slew of ethical and halakhic questions arose when organ transplants first became viable. Ultimately, however, most of these problems were neutralized by a single legal and ethical concept– pikuach nefesh , the Jewish obligation to save lives . Except in those cases where one of two parallel organs, e.g. kidneys, can be donated by a living individual, it is imperative that an organ donor be halakhically dead before her vital organs are removed; thus, defining the moment of death is essential. Today, most rabbinic authorities accept brain stem death–as opposed to cessation of heartbeat–as halakhic death, thus allowing organ transplantation under Jewish law.

Genetic Issues

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According to the Talmud , a goses , a dying person, is considered no different than any other human being. Not only does the Talmud consider one who kills a goses to be a murderer, it prohibits any actions that may speed up her death. Thus, traditionally , euthanasia and physician-assisted suicide are prohibited by Jewish law. Nevertheless, most Jewish authorities object to any actions that impede the death of a sufferer. Additionally, modern authorities like Reform rabbi Peter Knobel support the termination of life in situations of extreme suffering, when a person’s tzelem elohim , or divine image, is compromised. Conservative rabbi Elliot Dorff has also questioned the relevance of the goses category, and in doing so comes to more liberal conclusions about end-of-life issues.

Fertility Technologies

A host of options now exist for couples and individuals who have difficulty conceiving through conventional means. “Artificial” insemination , in vitro fertilization (IVF), and surrogate motherhood all raise ethical and legal questions. Could insemination with donor sperm be considered adultery? Is the child born from such procedures illegitimate? What is the status of unused embryos after IVF is completed? Who is the mother–and what is the Jewish status–of a child born to a surrogate mother? There are few unanimous answers to such questions. However, procreation is a mitzvah , a fundamental Jewish obligation, and so these procedures are often permitted, particularly when the egg and sperm are those of husband and wife .

Pronounced: TALL-mud, Origin: Hebrew, the set of teachings and commentaries on the Torah that form the basis for Jewish law. Comprised of the Mishnah and the Gemara, it contains the opinions of thousands of rabbis from different periods in Jewish history.

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In This Article Expand or collapse the "in this article" section Jewish Ethics

Introduction, general overviews and anthologies.

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Jewish Ethics by Jonathan Crane LAST REVIEWED: 30 June 2014 LAST MODIFIED: 30 June 2014 DOI: 10.1093/obo/9780199840731-0087

Jewish ethics investigates both theoretical and practical questions of what Jews can and should do in the world. It involves weaving together theology, philosophy, and law—the classic triumvirate for religious ethics—as well as lore, history, science, and sociology, among other facets of human knowledge and experience. With these tools in hand, some Jewish ethicists have wrestled with such questions as the relationship between law and ethics; the role of external, non-Jewish influences and thinkers; and the relationship between science, medicine, and revelation. Others contend with theories of the good and the right, with theology and ethics. And still other Jewish ethicists hone in on the minutiae of lived life, such as the pragmatics of behavior and policy. Though both ethics and morality can certainly be extracted from biblical and early rabbinic materials, it was not until the 9th century that Saadia Gaon discussed ethics as a subject matter worthy of distinct and extended consideration. For the next thousand years, only a few handfuls of volumes were exclusively devoted to ethics and morality, usually embedded in legal, philosophical, and theological texts. Increasing intellectual exposure to Western thinkers and society, especially to Immanuel Kant’s universal rationalistic philosophy and ethics, challenged and inspired Jews to clarify and explain Jewish ethics and morality. Hermann Cohen’s fin-de-siècle neo-Kantian revisioning of Judaism as ethical monotheism catapulted 20th-century Jewish ethical and moral thought from occasional meditations to central conversations across the streams of modern Jewry. Indeed, the last century’s incomprehensible tragedies and awesome technological advancements provided much fodder for Jewish ethical and moral consideration. Jewish bioethical discourse budded and bloomed after World War II; tracts on social, environmental, warfare, and political moral issues exploded in the 1960s and 1970s; first generations of feminist and covenantal ethics emerged in the 1980s and 1990s; a return to virtue ethics took root in the 1990s and early 2000s; and a renewed concern with business morality responded to embarrassing scandals and economic turmoil in the 2000s. Historically, Jewish ethics has been dominated by male voices and by contributors from North America and Israel, but the field is becoming increasingly diverse, as evidenced by the membership and leadership in the Society of Jewish Ethics, the premier, if not only, independent academic society devoted to this field. To be sure, Jewish ethicists will continue to wrestle with the most perplexing and enduring questions of human civility and creativity.

The first wave of anthologies in this field, comprising Fox 1975 and Kellner 1978 , included both theoretical and practical issues, and each focused on the ethics of military power—an understandable theme given the recent wars in Vietnam and Israel. The second generation is perhaps best exemplified by Dorff and Newman 1995 , which broadened the voices contributing to both methodological and practical debates. The third generation divides into the more pragmatic volumes of Dorff, et al. 2008–2010 , and the more comprehensive dual focused (theoretical and pragmatic) collection Dorff and Crane 2013 . Kolatch 1985 and Sherwin and Cohen 2001 reflect the emerging self-help ethos with a collection of short answers to or instructional essays on questions of ethical and moral concern. Newman 1998 surveys the breadth of the field and offers a taxonomy of its features.

Dorff, Elliot N., and Jonathan K. Crane, eds. The Oxford Handbook of Jewish Ethics and Morality . New York: Oxford University Press, 2013.

The most comprehensive anthology to date, complete with original essays from scholars throughout the Jewish world. The volume covers historical, thematic, denominational, and practical issues. Each essay includes suggested readings, and the index identifies classic texts, themes, and figures.

Dorff, Elliot N., and Louis E. Newman, eds. Contemporary Jewish Ethics and Morality . New York: Oxford University Press, 1995.

A diverse collection of previously published—and classic—essays (many edited for length) addressing metaethical concerns, methodological issues, virtue ethics, and sexuality and gender, as well as social, economic, and ecological issues, medical ethics, and the political exercise of power.

Dorff, Elliot N., Louis E. Newman, and Danya Rutenberg, eds. Jewish Choices, Jewish Voices . 6 vols. Philadelphia: Jewish Publication Society, 2008–2010.

This series of slim volumes, designed for college students, integrates case studies and questions with classic sources and contemporary essays. Each volume includes suggested readings. Volumes address Body ; Sex and Intimacy ; Power ; Social Justice ; War and National Security ; and Money .

Fox, Marvin, ed. Modern Jewish Ethics: Theory and Practice . Columbus: Ohio University Press, 1975.

Now considered a classic, the volume includes presentations and responses from a 1971 conference in Israel that wrestle with the legal and philosophical bases of Jewish ethics, in addition to essays on the political exercise of power. The index points to traditional sources as well as themes and names.

Kellner, Menachem M., ed. Contemporary Jewish Ethics . New York: Sanhedrin, 1978.

Perhaps the first collected edition in this field, its essays confront the questions of whether Kantian autonomy can countenance religious ethics, and whether Judaism and its legalism can countenance ethics beyond law. The volume includes classic pieces on political and medical ethics, capital punishment, business ethics, sexual ethics, and the Holocaust. Includes suggested readings and a brief glossary.

Kolatch, Alfred J. The Second Jewish Book of Why . Middle Village, NY: Jonathan David, 1985.

The second volume in this series is an introductory book using a Socratic method to cover social, personal, bioethical, gender, and dietary issues. The index is helpful.

Newman, Louis E. Past Imperatives: Studies in the History and Theory of Jewish Ethics . Albany: State University of New York Press, 1998.

Perhaps the best overall descriptive survey of the field of Jewish ethics, examining the tensions between ethics and law, ethics and theology, and methodological issues. One of the chapters, “Woodchoppers and Respirators: The Problem of Interpretation in Contemporary Jewish Ethics,” is now a classic in the field, especially for bioethics and euthanasia.

Sherwin, Byron L., and Seymour J. Cohen. Creating an Ethical Jewish Life: A Practical Introduction to Classic Teaching on How to Be a Jew . Woodstock, VT: Jewish Lights Publishing, 2001.

A creative “how-to” book integrating classic sources on the three fundamental relationships of Judaism: relations with God, relations to the self, and relations with others. Helpful notes, bibliography, and index.

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Bioethics in Judaism

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Bioethics and the Jewish culture ; Jewish bioethics

Jewish bioethics deals with major moral, religious, and legal issues for communal forms of Judaism in modern medicine. Each issue is described biologically and medically, related to issues in traditional rabbinic law, and then discussed by reference to leading contemporary rabbis in different contemporary Jewish religious movements, notably Orthodox, Reform, and Conservative (noting differences between the seven main groups of communal Jewish life – the Ashkenazi, Roman, North African, Kurdish, Near Eastern, Yemenite, and Ethiopian – as well as some numerically significant minorities – the Lemba of North Africa, the B’nai Menashe of India, and the Crypto Jews of South America).

The discussion of bioethics is guided at the most universal level by four general principles of western ethics and eight general principles of Jewish ethics. The western principles are (1) Maximize freedom of patient choice (Autonomy), (2) Cause no...

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Bleich, J. D. (1998). Bioethical dilemmas . Hoboken, NJ: Ktav Publishing House.

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Dorff, E. N. (1998). Matters of life and death . Philadelphia and Jerusalem: Jewish Publication Society.

Feldman, D. (1968). Birth control in Jewish law . New York: New York University Press.

Jakobovits, I. (1959). Jewish medical ethics . New York: Bloch Publishing Co.

Rosner, F. (1986). Modern medicine and Jewish ethics . Hoboken, NJ/New York: Ktav Publishing House/Yeshiva University Press.

Wahrman, M. Z. (2002). Brave new Judaism : w hen science and scripture collide . Lebanon, NH: Brandeis University Press.

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Samuelson, N.M. (2013). Bioethics in Judaism. In: Runehov, A.L.C., Oviedo, L. (eds) Encyclopedia of Sciences and Religions. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-8265-8_1518

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Judaism – 19/20 Essay

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‘In any society, ethics are vital for the enduring success and peace of the community.’ The Ethnics of our Fathers 1:2

Judaism is the core religion that is followed by Jewish adherents. The notion of primary ethical teachings is to ensure that success, peace and obligation is endured within the Jewish community. Withholding these central teachings provides a cohesive structure within the religious community of Judaism as it provides purpose, understanding of the religion and principles that must be followed by Jewish adherents. These core ethical teachings are The Commandments of the Torah, The Prophetic Vision and The Book of Proverbs. Moreover, each teaching has its own interpretation of ethical purposes which are vital for the enduring success and peace of the Jewish community. These core teachings provide a sense of prosperity and purpose which are obeyed by Jewish adherents.

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17 Jewish Bioethics: The Beginning of Life

Elliot N. Dorff (Ph.D, Columbia; Rabbi, Jewish Theological Seminary of America) is Rector and Distinguished Professor of Philosophy at American Jewish University and a Visiting Professor at UCLA School of Law. He has been awarded four honorary doctoral degrees, and he has chaired four scholarly organizations -- the Jewish Philosophy Association, the Jewish Law Association, the Society of Jewish Ethics, and the Academy of Judaic, Christian, and Islamic Studies. He has served on federal government advisory commissions on health care, sexual ethics, and the ethics of research on human subjects, and he currently serves on the California Advisory Commission on Stem Cell Research. Author of over 200 published articles and twelve books on Jewish thought, law, and ethics, he has edited fourteen other books as well. His books on ethics include Matters of Life and Death (on medical ethics), To Do the Right and the Good (on social ethics), Love Your Neighbor and Yourself (on personal ethics), and The Way Into Tikkun Olam (Repairing the World).

• Published: 28 January 2013
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This chapter begins with a discussion of fundamental convictions of Judaism that affect Jewish approaches to moral issues at the beginning of life, and then considers Jewish views about preventing pregnancy through contraception and abortion, and, conversely, assisting those with infertility problems. The analysis is also used to discuss embryonic stem cell research and genetic testing.

Fundamental Convictions

A number of Judaism’s fundamental convictions affect Jewish approaches to the moral issues at the beginning of life: 1. The body belongs to God. Unlike American secular ethics, in which each person’s body belongs to him- or herself, Jewish classical texts assert that God, as Creator of the universe, owns everything in it, including our bodies. 1 Close Therefore God can and does make certain demands of us as to how we use our bodies, demands articulated in Jewish law. It is as if we were renting an apartment: we have fair use of the apartment during our lease—and, in the biological analogue, during our lease on life—but we do not have the right to destroy the apartment (commit suicide) or harm it unnecessarily, because it is not ours. What constitutes “fair use”—that is, the risks that we may take—depends, according to Jewish law, on whether most people assume the risk. 2 So, for example, one may drive a car, even though it clearly raises the possibility of injury or even death, but whether one may engage in experimental medical procedures depends on the degree to which they have a chance of preserving one’s life or curing an illness or disability.

2. Humans may and should use medicine to prevent, mitigate, or cure illnesses. The Torah maintains that God imposes illness as punishment for sin 3 —although the biblical Book of Job strongly challenges this belief—and that God is our healer. 4 That idea might lead some to conclude that medicine is an improper human intervention in God’s decision to inflict illness, indeed, an act of human hubris.

The Rabbis of the Talmud and Midrash were aware of this line of reasoning, but they counteracted it by pointing out that God Himself authorizes us to heal. In fact, the Rabbis maintained, God requires us to heal. They found that authorization and that imperative in several biblical verses. Exodus 21:19–20 requires that an assailant must provide for his victim to be “thoroughly healed,” thus presuming that physicians have permission to cure. Deuteronomy 22:2 (“And you shall restore the lost property to him”), in their interpretation, imposes an obligation to restore another person’s body as well as his/her property. On the basis of Leviticus 19:16 (“Nor shall you stand idly by the blood of your fellow”), the Talmud expands the obligation to provide medical aid to encompass expenditure of financial resources for this purpose. And Rabbi Moses ben Nahman (“Nahmanides,” thirteenth century) understands the obligation to care for others through medicine as one of many applications of the Torah’s principle, “And you shall love your neighbor as yourself” (Lev 19:18). 5 God is still our ultimate Healer, and hence Jewish liturgy has Jews pray to God for healing of body and soul three times each day; but the physician, in Jewish theology, is God’s agent in accomplishing that task, and so use of the medical arts is not only permissible, but required. Jews, in fact, may not live in a city lacking a physician, 6 for that would mean that people could not take reasonable care of their bodies, which belong to God. This appreciation of medicine has led to a virtual love affair between Jews and medicine over the last 2,000 years, and it means that Jews trust medicine—and use it extensively—when they encounter medical problems, including those involving sex or procreation.

3. Sex has two goals, the pleasurable bonding of the couple and procreation. The Torah includes a number of sexual prohibitions regarding with whom one may have sex 7 and at what times during the woman’s menstrual cycle, 8 but it also includes two positive commandments. One, the very first commandment mentioned in the Torah, is “Be fruitful and multiply” (Gen 1:27). Although the command is given to both the first man and woman, and although both are clearly necessary to produce children, for exegetical and possibly for moral reasons the Rabbis of the Mishnah and Talmud asserted that only the man was obligated to fulfill this commandment. 9 Among the moral concerns were the facts that the man was going to have to support his children and so he had to be commanded to procreate against his economic self-interest, and that pregnancy endangers a woman and so it would not be fair to command her to have children. In any case, as we shall see, this rabbinic decision has important consequences for the use of contraceptives, for it makes it much easier to allow women, who have no duty to procreate, to use them than it is to justify their use by men.

A man fulfills his duty to procreate, according to Jewish law, when he produces one boy and one girl, 10 thus imitating the way that God created humans “male and female” (Gen 1:27). Because the Jewish tradition sees children as a great blessing, however, men were supposed to try to have as many children as possible, in fulfillment of two biblical verses—“God did not create it [the earth] a waste, but formed it for habitation” and “Sow your seed in the morning [that is, in your youth], and do not hold back your hand in the evening [that is, in later years].” 11

Sex, however, is not exclusively for procreation; it is also for the mutual bonding of the couple, emotionally as well as physically. The Rabbis derive this notion from Exodus 21:10, according to which a man owes his wife “her food, her clothing, and her conjugal rights.” 12 As they usually do with regard to any commandment, they then define exactly how this commandment may be fulfilled by determining how often a man must offer to engage in sexual relations with his wife. They maintain that it depends on the degree to which his job enables him to be home at night, and that consequently a man may not change his job to one that will bring him home at night less often without his wife’s permission. Conversely, men also have rights to sex in marriage, but, remarkably, the Talmud already prohibits marital rape, 13 which was not prohibited in any American state until 1975 and not in all American states until 1993. 14 If his wife repeatedly refused to engage in conjugal relations, then, the Mishnah’s remedy was that he could diminish what he owed her in divorce by a certain amount each week until he could divorce her without paying her anything and marry someone else, 15 for he too has a right to sexual satisfaction in marriage. This recognition of the role of sex in a couple’s physical satisfaction and emotional bonding, together with their respect for medicine, has made Jews quite willing to use medical and psychological interventions to overcome sexual dysfunctions, and to use artificial reproductive techniques to overcome infertility.

4. The status of the embryo/fetus. Exodus 21:9–10 says that if two men who are fighting hit a pregnant woman who miscarries, then if there is no other injury to her, the assailant must pay compensation for the lost fetus “to be based on a reckoning”—presumably depending on how far along she was in the pregnancy. But if there is other injury to the woman, then the remedy is “life for life, eye for eye, etc.” The Rabbis later interpreted “eye for an eye” to mean monetary compensation in lieu of physical retribution, 16 but the Torah is clearly distinguishing the status of the woman, who is a full human being, from that of the fetus, who is not. This fact leads the Rabbis to rule that if a woman is having difficulty in childbirth, those attending her must dismember the fetus within her (safe Caesarian sections were not available until the late 1940s), for she is a full-fledged human being and the fetus is not.

The fetus becomes a human being when its head—or, in a breach birth, its shoulders or, according to some, the greater part of its body—emerges from the vaginal canal. At that point, if doctors cannot save them both, the usual rules of triage apply—namely, that they should save the one whom they have the better chance of saving.

Before birth, the Rabbis divided pregnancy into two stages. During the first forty days, the embryo is “simply liquid” 17 ; from then on it is “like the thigh of its mother.” 18 Note that unlike modern obstetricians, who count from the woman’s last period, resulting in a forty-week pregnancy, and unlike modern geneticists, who count from conception, resulting in a thirty-eight-week pregnancy, the Rabbis were probably counting from the first period that the woman missed, so that their “forty days” is approximately fifty-four days of gestation. That is so because they could have known what the fetus looks like only from the miscarriages they witnessed. During the first month of pregnancy, a miscarriage is simply a heavy menstrual flow. During the second month it looks like a clump of cells. It is only after that—roughly at fifty-four days of gestation—that the fetus gains a bone structure, so that a miscarriage at that point has bone, flesh, and even hair. At that stage, given that it comes from the groin area of the body, it does indeed look like its mother’s thigh. Thus, unlike American law, which sees the fetus as part of the mother and therefore, with some limitations in some states, subject to her discretion until the moment of birth, and unlike current Roman Catholic authorities, who maintain that the fertilized ovum is already a full human being, Jewish tradition takes an intermediate, developmental position, in which the embryo over time emerges from “simply liquid” to “the thigh of its mother” to a full-fledged human being. As one might expect, this view will have significant implications for Judaism’s view of abortion and embryonic stem cell research.

Birth Control

Jewish sources from as early as the second century describe methods of contraception. A rabbinic ruling from that time prescribes the use of such methods when pregnancy would endanger either the woman or the infant she is nursing. 19 Subsequent rabbinic opinion splits between those who sanction the use of contraception only when such danger exists and those who mandate it then but allow it for other women too.

If couples are going to use contraceptives, Jewish law prefers those that prevent conception in the first place over those that abort an already fertilized egg, because, as will be discussed in the next section, in most cases Jewish law forbids abortion. The most favored form of contraception from a Jewish perspective is thus the diaphragm, for it prevents conception and has little if any impact on the woman’s health. If the contraceptive pill or implant is not counterindicated by the woman’s age or body chemistry, those are usually the next most favored forms of contraception. RU486 and any other means of retroactively aborting an embryo are, from this understanding, considered legitimate only when pregnancy would threaten the mother’s physical or mental health, as defined in the ways discussed in the next section. 20

The only nonpermanent, male form of contraception currently available is the condom. As was noted above, in Jewish law the male is legally responsible for propagation, and that fact argues against the man using contraception, at least until he has fulfilled that duty. 21 Condoms, moreover, sometimes split or slip off, 22 and even if they remain intact and in place, they do not always work. Nevertheless, condoms must be used if unprotected sexual intercourse poses a medical risk to either spouse, for condoms do offer some measure of protection against the spread of some diseases, and the duty to maintain health and life supersedes the positive duty of the male to propagate. 23

It should be noted, though, that rabbis from past centuries who permitted contraception for nontherapeutic reasons never anticipated that Jews would postpone having children as long as many Jewish couples now do. Even with modern medical advances, the late teens and the twenties are biologically still the best time for the human male and female to conceive and bear children. 24 Those who wait until after those ages to try to procreate often have infertility problems. 25 This means that even if young couples choose to use contraceptives for a time, they are well advised, both medically and Jewishly, not to wait too long.

There are, of course, good reasons why so many Jews wait so long. In addition to long-term schooling, in which Jews engage at far higher percentages than the general population, 26 most women in our society find that they must earn money to support themselves and their families, just as their male partners or husbands do, and so they often try to get their careers up and running before bearing children. Moreover, many people who would love to find a mate and get married in their early twenties may not be so fortunate, and once out of college it is often difficult for them to meet someone they want to marry. The painful reality of infertility and the increased likelihood of birth defects as one ages, though, argue strongly for seeking a mate and procreating earlier than most Jews now do.

Infertility is not only a great source of pain for the couples involved, it is also a demographic problem of major proportions for the Jewish people. Christians make up a third of the world’s population, Muslims about 22 percent. Jews, numbering just over 13 million, are only two-tenths of one percent. 27 Furthermore, because of the factors described above, the reproductive rate among North American Jews is only 1.8 (where 2.1 is required for replacement), 28 and among Israeli Jews it is about 2.0. Add to that the effects of intermarriage and assimilation, and there is a real possibility that Jews and therefore Judaism will not survive for many more generations. The contemporary, demographic problem of the Jewish people, then, must also be a factor that figures into the thinking of Jews using contraception.

As is true for other highly educated communities, Jews have been concerned about the world’s overpopulation since the 1960s, and sometimes that is another factor that convinces couples not to propagate altogether or to have only one child. Jews, though, constitute only two-tenths of one percent of the world’s population, and so even if the entire Jewish population were to be eradicated, that loss would do almost nothing to resolve the overpopulation problem. To do that, we need to raise the standard of living of poor populations, teach people how to use birth control and provide it to them cheaply, and change the policies of some groups that forbid artificial forms of birth control. Eliminating Jews and, with them, Jewish culture is not an effective or wise way of resolving the very real problem of world overpopulation.

On the contrary, given the demographic crisis of the Jewish community, rabbis are currently encouraging couples who can propagate to consider having three or four children. As Maimonides says, “If one adds a soul to the People Israel, it is as if s/he has built an entire world.” 29 In the current Jewish demographic crisis, doing so is all the more imperative. Thus although a couple’s first two children fulfill the commandment ( mitzvah ) to procreate, the Conservative Movement’s Committee on Jewish Law and Standards has approved a rabbinic ruling urging couples to have one or more additional children who are also “ mitzvah children,” both in the original sense of that word meaning “commandment” in that Jewish law requires couples who can to have more than the minimum number of two, and also in the sense of “ mitzvah ” as “good deed,” in that they are helping to make Jewish physical continuity, and therefore Jewish religious and cultural continuity, possible. 30

As Jewish communities have increasingly come to realize, the Jewish pattern of long-term education and the Jewish demographic crisis must also be factors in communal planning. Many adult Jews are now meeting each other through commercial dating websites focused on Jews, and Jewish communities are creating programs to help young adult Jews meet each other. To encourage young Jewish couples to have children, the family and community must share in the financial burden of raising them. So, for example, the Talmud imposes a duty on grandparents to educate their grandchildren in the Jewish tradition, 31 just as it obligates parents to do so, and so grandparents with the means are increasingly being educated to contribute to the tuition for their grandchildren’s Jewish education. Some Jewish day schools, camps, and youth group programs are giving discounts for each additional sibling. 32 Moreover, Jews, acting out of their own best interests and out of Jewish values are increasingly supporting profamily legislation such as laws that provide for family leaves for both mothers and fathers and for high-quality, affordable day care.

All this means, then, that young marrieds, especially those who marry in their late twenties or later, should use contraceptives for family planning purposes only for a very short time, if at all. In the end, the Jewish tradition thinks of children—and many people experience them—as a true blessing from God.

Because Jewish law perceives the woman as a full-fledged person and the fetus as not of that status, abortion is required when the woman’s life or health is at stake, with rabbis variously interpreting how serious a threat the fetus must be to the woman’s health in order to require an abortion. When the woman has a condition that puts her more at risk than a normal pregnancy would be—if, for example, she has diabetes—then she may choose to accept that risk and go ahead with the pregnancy (but consult her doctor much more often than usual), or she may choose to abort the fetus in order to avoid the risk.

What about mental health as a rationale for abortion? Rabbi David Feldman summarizes the evidence as follows:

Precedent for equating mental health with physical health comes from a late-seventeenth-century Rabbi…On the basis of Talmudic teaching, Rabbi Israel Meir Mizrachi argued that serious danger to mental health ( tiruf da’at ) is tantamount to risk to one’s physical wellbeing, and issued a permissive ruling…At least one Responsum (dated 1913), applied it specifically to the matter of abortion. 33

Mental health as a justification for abortion, though, has generally been construed rather narrowly, especially in the Orthodox community, so it would not justify abortion, for example, simply because the woman does not want to have another child. That would be a good reason to use contraception, but not retroactively to abort. (In the Reform movement, where individual autonomy is a major value, rabbis discourage abortion when it is contemplated for this reason, but they maintain that it is ultimately and properly the individual woman’s choice. 34 )

In modern times, with the advent of techniques to test embryos for genetic diseases, some rabbis in the Orthodox community, and most in the Conservative community, would permit an abortion when the fetus has a lethal genetic disease such as Tay-Sachs or Familial Dysautonomia. When the disease is debilitating but the child will have more or less normal life expectancy, some rabbis permit, and others forbid, abortion directly on the grounds of the disease. The problem with that approach, however, is that it inevitably involves sensitive and controversial judgments; when is a disease sufficiently serious to warrant an abortion, and when not? And which rabbi, if any, has the authority to make that judgment?

More commonly, then, rabbis use the maternal (and paternal) reactions to the fetus’s disease to determine whether it should be aborted. So, for example, Rabbi David M. Feldman, a Conservative rabbi who wrote the first comprehensive treatment of abortion in Jewish law, has written that if such a woman tells him that suffering from Down Syndrome will be terrible for her child, he would tell her that that may or may not be so, but in any case that is not a reason to abort. If the same woman, however, tells him that she is going crazy over the thought of bearing a Down Syndrome child, he would tell her that that is indeed an acceptable justification to abort. In the first case, she was talking about her child’s feelings and the future, neither of which she knows; in the second case, she was describing her own present feelings, and Rabbi Feldman would therefore invoke her mental health to justify an abortion. 35

This writer would instead ask the couple to talk to three other couples who are raising children with Down Syndrome so that they know what it is really like and not what they imagine it to be. Then, if the couple believes that they really cannot raise such a child, I would consider that a sufficient reason to abort the fetus, based on the mother’s and father’s mental health. (As we shall see in the last section of this chapter, couples with family histories of these diseases increasingly engage in preimplantation genetic diagnosis precisely to avoid the need for aborting a fetus with such a disease.)

In sum, the Jewish tradition requires abortion when the mother’s life or her physical or mental health is at stake. Judaism sanctions abortion when the mother’s physical or mental condition makes pregnancy more risky than it normally is. Abortion, though, is generally prohibited as an act of self-injury (not murder, because the fetus is not a human person who bears the legal protections against murder until birth), and the burden of proof is always on the one who wants to abort.

Embryonic Stem Cell Research

Stem cells are those cells that produce more than one kind of cell. Adult stem cells—called that if they come from any born human being from infancy through adulthood—are produced, for example, from bone marrow, which manufactures four different kinds of blood cells, and from skin, which produces three kinds of skin cells. Embryonic stem cells come from the inner cell mass of embryos that are five or six days old. At that stage, the embryo has produced a circle with cells inside it; if the embryo is in a woman’s womb, the circle will become the placenta, attaching the embryo to the woman’s body to provide the nutrients necessary for the embryo to develop, and the cells inside the circle (the “inner cell mass”) will ultimately become all the cells in the infant’s body. As such, these cells are “pluripotent”—that is, they are able to produce many different kinds of cells, including those that will ultimately become the infant’s heart and circulatory system, its nervous system (brains, spinal cord, and neurons), its respiratory system, its bone structure, and so on.

Because embryonic stem cells are more flexible than adult stem cells, they hold out more promise for producing cures for a variety of serious and even life-threatening illnesses. If we could figure out how cells “decide” to differentiate into the specific cells they become, we might be able to produce cardiac cell lines, for example, that could cure the damage brought on by a heart attack or stroke, or neurological cells to cure a spinal cord injury or Alzheimer’s. Embryonic stem cells also turn off, so that we get one head and not more, and if we could determine the mechanism that turns them off, we would have the ultimate cure for cancer, which is precisely the production of too many cells of a given type. Thus while research using adult stem cells holds out some promise and certainly should be pursued, embryonic stem cell research is even more promising, as demonstrated not only by the pluripotency of the cells, but by a number of animal studies in which they actually did cure some diseases. 36

The embryos used for such research are donated by couples who created them in an effort to overcome infertility through in vitro fertilization (IVF) but who have now had as many children as they want or have given up on having their own biological children. The choice, then, is either to discard the remaining embryos or to donate them to research. (Creating embryos for purposes of research might involve other objections, but that has not been the question at issue because of the availability of embryos created for infertility treatments.)

The problem with embryonic stem cell research is that in order to carry on such research, one must remove the inner cell mass from an embryo, which kills the embryo. The question, then, is the status of the embryo. Although Church Fathers as important as Augustine and Aquinas viewed the fetus developmentally, 37 very much as the talmudic Rabbis did, Roman Catholic doctrine over the last several centuries has classified the embryo in a woman’s uterus as a full human being, as a result of the invention of the microscope, and Catholic authorities construe embryonic stem cell research as murder. In recent years they have extended that concept even to embryos in a Petri dish, where there is no chance whatsoever for the embryos to become a human being unless they are implanted into a woman’s womb.

As we saw above, on the basis of Exodus 21 and their own observation of miscarriages, the Rabbis of the Mishnah and Talmud instead viewed the fetus developmentally, with embryos less than forty days old—and certainly those at five or six days of gestation—classified as “simply liquid.” They were clearly well aware that in a woman’s womb some of that “liquid” may become a human being, but to classify it as such so early in pregnancy is to confuse a potential state with an actual one. In fact, we now have good hormonal studies to indicate that as many as 80 percent of fertilized egg cells in a woman’s womb will miscarry, 38 and so even there one has only a one in five chance that the embryo will become a human being. In a Petri dish, that chance is zero. At the same time, the Jewish tradition includes a strong mandate to seek to cure (or at least mitigate the effects of) diseases, and the embryos in question would otherwise simply be discarded. Therefore, rabbis across the denominations have ruled that until and unless embryonic stem cell research proves to be unsuccessful in producing the cures it promises, engaging in such research is not only permissible, but desirable. 39

Infertility

A surprising number of biblical figures had fertility problems. Abraham and Sarah, Rebekah and Isaac, Rachel and Jacob, and Elkanah and Hannah (who ultimately bore the prophet Samuel) all had difficulties. 40 No other culture’s sacred scripture focuses so extensively on infertility.

What can we learn from this? First, that children are precious. Indeed, the Jewish tradition sees them as a great blessing. In part this is so because of the psychological growth and joy they bring to their parents. In addition, of course, the future of Judaism and the Jewish people depends on procreation. But the very difficulty that so many couples have in conceiving and bearing children is itself a mark of how precious they are when they come.

Second, the biblical stories amply indicate that infertility causes immense tensions in a marriage. Infertile couples begin to question who they are individually as a man or woman and what their future together holds. Worse, couples seeking to become pregnant have the equivalent of a final examination each month, and if they are having difficulties conceiving, they will fail many of those examinations. Nobody likes to fail, least of all in a matter as important and personal as childbearing. Some couples break up over this issue, and those whose marriages survive must revise their hopes and dreams of their lives together.

In our own time, Jews are especially troubled by this problem, in part because of Jewish genetic diseases but primarily because Jews have adopted the American ideology that makes work the fundamental source of one’s identity and pride. As was noted earlier, this situation leads Jews to engage in extended education and to postpone marriage until the late twenties or later, producing low birth rates and problems with infertility.

Another factor that contributes to infertility is that men commonly believe that infertility is only a woman’s problem¸ that only women have a biological clock for procreation. Actually, about a third of infertile couples are so because of a problem in the woman; a third because of a problem in the man; and a third because of a problem in both or for reasons that are unclear. 41 Age is not the only factor in infertility, but it complicates all the rest in both men and women and makes it harder to fix.

Yet another part of the American milieu that deceives Jews is its emphasis on technology as the cure for all that ails us. Jews have greatly honored medicine for the last two thousand years, and many young Jewish adults now trust that at whatever age they want to bear children, medicine will enable them to do so. Although infertility specialists have made great strides in making it possible for many couples to bear children, they cannot do that for everyone, and the younger the couple is, the greater the chance that the new techniques will work.

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Bioethics essay

Bioethics is the branch of ethics that arises from issues relating to life and death. The response of Jewish adherents to issues such as IVF, abortion, euthanasia, stem cell research and suicide expresses the teachings of Judaism on bioethics. For adherents of Judaism, the most significant principle driving bioethical decisions is to follow the will of God. This demands a great reverence for human life. With close reference to Euthanasia and Abortion in the context of variant responses, we will be able to witness how the bioethical teachings of Judaism are expressed.  

The basic guideline to follow the will of God will guide bioethical decisions made by the Jewish adherent. They will make a decision that they believe is protective of human life and maintains the covenant with God. All variants agree that life belongs to God and is a sacred gift, created in the God’s image. This equal value for every individual life drives a responsibility to protect life and heal the sick. Such claims are supported theologically, in the Decalogue; the 6 th  commandment “thou shalt not kill” suggests the protection of human life. In every bioethical issue, Jews seek to preserve the dignity of life and maintain their covenant with God.

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However, actual Bioethical teachings may differ based on each variants source of ethical guidance. Varying responses stem from levels of reliance/adherence to the Torah (first 5 books of the Hebrew bible), the Halakhah (oral law that interprets torah and its ethical teachings) and the Rabbinic Responsa Literature (Commentary on arising cultural/ethical issues by Rabbi’s. Orthodox Jews view the Torah & Talmud as God’s direct revelation to Moses and a strict adherence to their doctrine influences bioethical decisions. Reform Jews Consider view the Torah & Talmud as ethical guidelines but emphasise a much greater role for the conscience. Conservative Jews have modernistic and liberal beliefs like Reform, yet tend to be conservative in practice.  

After viewing the ethical sources from which bioethical teachings are derived, we can analyse how these principles translate into modern life by looking at the responses to Euthanasia & Abortion.

Abortion is the deliberate termination of a foetus. The circumstance around which it is acceptable depends on the variant and revolves around the life of the unborn baby being equal to the life of the mother. While in some cases Abortion is accepted, Judaism does not condone the act, and merely acts in the best way to fulfill God’s will.

Orthodox Judaism accepts termination if the life of the mother is endangered. As the unborn baby is considered a “rodef” (pursuer of mothers life), the life of the foetus has less value than the mothers life until the head is delivered at birth. In cases of disability, rape or incest, Orthodox Jews seek to continue the pregnancy. Regardless of situation, Orthodox Judaism values the life of the unborn child and wishes to preserve it. Reform Judaism also values the life of the child but the conditions to which it can be terminated are more flexible than those of Orthodoxy. While the decision is not a light one, Reform Judaism accepts abortion in cases of severe disability, rape or incest. Rabbinic Authorities justify abortion when the mother’s physical and mental health is at risk.

Conservative Judaism has a similar stance to Reform in that it justifies abortion if pregnancy might cause the mother physical or psychological harm. Conservative Judaism does suggest that the woman should consult the biological father.

Euthanasia is the intentional ending of a person’s life. Even with developments in medicine and technology, the Jewish bioethical teaching on Euthanasia has remained constant. All variants of Judaism condemn Euthanasia because they believe only God has the right to take a life. Even in extreme desperation and suffering, Jews are instructed to preserve the dignity of life. This pro-life stance by adherents reflects the teaching that humans are made in God’s image (Gen 1:27) and all life is equal. Rabbi Apple of the Great Synagogue in Sydney described the prolonging of life as an unnecessary impediment on the natural process of death and God’s will. Also, Halachic literature states that a Gosses does not require any means to prolong their life. The equality of life and its nature as being created in God’s likeness encourages them to take an anti-euthanasia stance.

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• Level AS and A Level
• Subject Religious Studies & Philosophy

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