Genes and Jewish medical ethics

The anniversary of the death of Dr. Falk Schlesinger, after whom the world’s leading Jewish medical ethics institute was named, was marked by a Jerusalem conference. Judy Siegel-Itzkovich reports.

By JUDY SIEGEL
June 3, 2018 03:31
Genes and Jewish medical ethics

PROF. YECHIEL SCHLESINGER in front of a picture of his grandfather.. (photo credit: JUDY SIEGEL-ITZKOVICH)

 
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The Jewish Sages from the final 300 years of Jerusalem’s Second Temple until the 6th century of the Common Era had never heard of DNA, genes and chromosomes. But their wisdom is today adapted by experts in Jewish medical ethics to make decisions on issues relevant to the modern era.

The Dr. Falk Schlesinger Institute for Medical-Halachic Research in Jerusalem is widely recognized as the world’s leading center in the field. Founded in 1966 under the auspices of Shaare Zedek Medical Center, it was named for the hospital’s second director-general.

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Jewish medical ethics is based on the principles that generally provide clear and practical answers to the difficult ethical conflicts in medical practice. Experts apply normative Jewish law and philosophy to practical medical issues in a way that is quite removed from general medical ethics in their range, underlying principles and methods of analysis.

The institute’s first head was Prof. Rabbi Avraham Steinberg, a leading pediatric neurologist and winner of the Israel Prize for his original rabbinic literature who founded and in 1970 was the first editor of the institute’s Hebrew-language quarterly journal Assia, A Journal of Jewish Ethics and Halacha. The journal’s aim is to acquaint medical practitioners, academics and rabbis, as well as the public, with the important interaction among medicine, ethics and Jewish law and to provide a forum for the interchange of ideas.

The title of the journal is followed by the words asi chigratath, Aramaic for ‘heal yourself’, expressing the concept that the physicians start by healing themselves, not only physically but ethically, prior to treating their patients.

An event called “Gene Ethics and Halacha: Issues in Medicine and Jewish Law” was recently held in the Jerusalem hospital’s Steinberg auditorium to mark the 50th anniversary of the death of the German- born Schlesinger, who was director-general of the medical center when it was on Jaffa Road from 1948 to 1968.

The seminar on May 21 was attended by friends and relatives, including his son Rabbi Meir Schlesinger (the founder of Yeshivat Sha’alavim) and his grandson, Prof. Yechiel Schlesinger, director of Shaare Zedek’s Wilf Children’s Hospital. The pediatrician recalled that his grandfather died when he was 12 years old.

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“I remember that in the 1960s, he had a little beard and a Cadillac with a driver. If my grandfather had driven himself, he would surely have crashed into the wall.” The current director of the Schlesinger Institute is Dr. Rabbi Mordechai Halperin, a physician and ethicist who was the Health Ministry’s adviser on medical ethics.

So far over 80 volumes of Assia have been published, in which nearly 1,000 professional articles and bibliographies have appeared. These essays deal with a wide variety of topics, including scientific, legal, ethical and halachic aspects of cloning, determining time of death, heart transplants, the selling of organs, truth-telling to the dangerously ill patient, halachic and medical aspects of the AIDS virus, psychiatry and Jewish law, the cessation of medical treatment and euthanasia, smoking and life expectancy, coercive medical treatment, the surrogate mother, medical dilemmas of hospital nurses and practical halachic principles connected to the obligation to save human life.

One of those in the audience was Brooklyn-born Prof. Shimon Glick, an internal medicine and endocrinology specialist, Jewish medical ethicist and founding member and then dean of Ben-Gurion University’s Faculty of Health Sciences.

The 86-year-old emeritus professor told The Jerusalem Post at the conference that he had actually met Dr. Falk Schlesinger soon after his aliya to Israel.

“In fact, he suggested that I take over for him as director-general of Shaare Zedek, but I was a new immigrant and didn’t feel up to the job. He stressed that caring for elderly patients was more important than curing them.”

PROF. Yechiel Schlesinger began the event by joking that since it began at 6.21 p.m. and not at the scheduled time of 6.15 p.m., “my exacting yekke grandfather would have already regarded it as a failure.”

Incredibly, there have been only four permanent directors-general of Shaare Zedek since it was founded with 20 beds by German-born Dr. Moshe Wallach in 1902 (the building became the now-defunct Israel Broadcasting Authority when the hospital’s new premises opened in 1980. Falk Schlesinger ran the hospital from 1947 to 1967, followed by American-born Prof. David Maeir, who was bitterly criticized for initiating the building of the current hospital, now with 1,000 beds, at the foot of the Bayit Vegan neighborhood.

Maeir died tragically in a road accident, and his place was filled for a few years by temporary directors- general.

“The spirit of Falk Schlesinger remains at Shaare Zedek,” said Prof. Jonathan Halevy, who has masterfully run the hospital and guided its expansion for the last three decades. He didn’t know his predecessor, because he studied medicine at Tel Aviv University’s Sackler Medical Faculty and worked as an internal medicine and liver specialist at Beilinson Medical Center.

“I wasn’t a Jerusalemite then. But I know that Dr.

Schlesinger established the feeling of a dedicated team working together that continues today,” said Halevy.

“People who have previously worked in hospitals all over the world tell me that the feeling here is special and unique.

“Today, we stand on the shoulders of previous directors, including Dr. Schlesinger. He had vision. He said in 1963 that the Soviet Union would collapse.

He pushed the hospital into the new era of medicine and assembled devoted donors – the Stern, Jesselson and Bendheim families whose members remain active in Shaare Zedek today. We are very accessible, near the Begin Highway and the Jerusalem Light Rail. We offer compassionate medicine and advanced medical technologies, focusing on the patient and the family.”

PROF. EPHRAT Levy-Lahad, the celebrated head of the medical genetics institute who is responsible for many innovations and studies, went to medicine school at the same time at Prof. Yechiel Schlesinger.

“I remember our red eyes at night on the wards,” she said. The most exciting advanced in her field include genetics and identify; identification and ancestry; preimplantation genetic diagnosis (PGD); and gene editing.

The nucleus of each cell has DNA in the form of chromosomes, Levy-Lahad explained. In humans, each cell normally contains 23 pairs of chromosomes, for a total of 46. Of these pairs, 22, called autosomes, look the same in both males and females.

The 23rd pair, the sex chromosomes, differ between males and female. The genes are coded for proteins.

The chemical structure of DNA is four nucleobase pairs – adenine (A) is joined to thymine (T), and guanine (G) is attached to cytosine (C). In the three-dimensional structure of double-stranded DNA, the polymeric nucleotide strands whose complementary nitrogen bases are linked by hydrogen bonds form a helical configuration. As A is always connected to T and G to C, “one can know from the order in one strand the correct order in the other.”

Today, the entire sequence of DNA in an individual can be deciphered for just $1,000; a decade ago, it cost $1 million. There may be differences, but that doesn’t always have to pose a problem. Different base pairs could still produce the right protein. Two people who are not related could have three million different bases. Most of the differences are a polymorphism, such as mutations deciding what eye or hair color one has, but they don’t affect our health.

But significant mutations can cause a lot of trouble, said Levy-Lahad.

The two big revolutions in genetics in the last few decades, she continued, were the Internet and computerization.

She recalled that 25 years ago, a serial killer was finally caught in California using these tools. Investigators found tissue samples with the killer’s DNA at the scene of the crime, and his identity was confirmed from the FBI’s genetic database and samples from relatives. Many people also put their genealogies on websites.

As for ancestry, “Jewish genes” have been used to identify those in the Soviet Union who likely were of Jewish origin but did not have records. Enemies of Jews say we are a race, that we are not like them.

But while there are “Jewish genes,” not all Jews can be identified by them because of conversion, the geneticist said.

“If I have a book, I can try to copy it, but I will make errors. Someone could copy that version and then have more errors. If one looks at the genetic material, one can know what the original version was and what errors were made.”

Levy-Lahad noted that it has become very popular for people – and not only Jews – to be curious about their origins. They send tissue samples of saliva or cells from the inside of their mouths to companies to have their identity analyzed.

“I have relatives in New York who paid $300 to find out they were Ashkenazi Jews. I could have told them. The process is very accurate to identify people but looking into ancestry is not so accurate.”

Although most DNA is packaged in chromosomes within the nucleus, mitochondria – structures within cells that convert the energy from food into a form that cells can use – also have a small amount of their own DNA. This genetic material is known as mitochondrial DNA. Each cell contains hundreds to thousands of mitochondria, which are located in the fluid that surrounds the nucleus.

While the DNA in the cell nucleus is “inherited from all ancestors; the mitochondrial DNA is inherited only from a maternal lineage. As Judaism is passed down from a Jewish mother to her children, there are efforts to identify mitochondrial DNA if the family members did not convert to Judaism.”

At the same time, the Y sex chromosome comes only from the father. As the Jewish priesthood from the time of Aaron was handed down from father to son, Israeli studies have been able to identify members of the priesthood by using this chromosome.

As for PGD, the technique is used to prevent the birth of defective children in parents who are sick or carry a serious mutation. Such couples used to have an abortion, but if in-vitro fertilization is performed in couples who carry mutations, only healthy embryos can be chosen and implanted, Levy-Lahad said. “We at the hospital have made possible the birth of over 750 healthy children since 2004. A month ago, we took part in the bar mitzva of the first child of parents with muscular dystrophy.”

The “hottest” innovation resulting from basic research on yogurt that is now beginning is gene editing to repair and improve genes, she went on.

Using a technology known as CRISPR/Cas9, one can effectively and specifically knock out and replace genes to get rid of dangerous mutations. But it is tricky, said Levy-Lahad, as there are concerns that if not carried out carefully, new viruses could be developed that could cause great harm.

STEINBERG noted that genetics is routinely used to determine paternity mamzerut (a person born from certain forbidden relationships), identifying babies and mothers who may have been mixed up, identifying a body to determine if a woman is an aguna (“chained” to her marriage) and matching body parts.

“If Solomon’s judgment were heard now, we would not need the king to decide who the mother of the baby was; genetics would make it easy.”

There are still efforts to identify the buried remains of Holocaust survivors who fell in the War of Independence but had no known close relatives.”

Steinberg concluded that Catholics do not accept PGD because it regards every embryo from its first moment of existence, even before it is implanted, as a “human being” so discarding it is for them considered “murder.” Judaism, however, is much more liberal.

“Embryos who are diseased or even carriers can be discarded according to Jewish law. PGD is allowed even for genetic mutations that show up as diseases late in life such as BRCA and Huntington’s.

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