Orthodox rabbis and secular (and even some observant) physicians are often on
opposite sides of the fence when it comes to medical and halachic
Regarding halacha as supreme law that must be obeyed, rabbis tend
to be on guard when controversial medical solutions are offered for health
problems, but they also need and respect doctors because Jewish law regards them
as God’s emissaries to heal and save lives.
Physicians may be suspicious
of the more extreme rabbis’ wanting to intervene in their practice, prohibiting
followers from donating brain-dead loved ones’ organs for transplant, refusing
treatments that are conventional in the Western world, and stressing technical
halachic matters that seem nonsensical. Yet cognizant of the fact that the
observant – and especially haredi – camp is growing by leaps and bounds,
physicians note their increased influence on Israeli society (as potential
private medical patients), while the observant always seek the best specialists
when they become ill.
THE TWO camps’ coexistence and even respect for
each other is always tangible at the annual conference of the Puah Institute for
Fertility According to Halacha, which recently convened for the 11th time in
Jerusalem’s Ulamei Nof hall, with nearly 2,000 men and women separated by a
Intimate subjects and sexual terminology that wouldn’t be
used in polite haredi society (its media won’t even use the words “breast
cancer”) are openly discussed at the conference.
It is always held during
the week before the weekly portion in Exodus devoted to the story of the Hebrew
midwives Shiphrah and Puah, who saved male Hebrew babies from Pharoah’s death
sentence. This year, the lectures continued as usual for 12 hours, but there was
a change – the absence of the late former Sephardi chief rabbi Mordechai Eliahu,
who was the spiritual and halachic adviser of the institute.
years ago and still headed by Rabbi Menachem Burstein, the non-profit
organization (www.puahonline.org) originally focused on helping infertile
couples. It has a staff of rabbis speaking Hebrew, English, French and Spanish
(who get an average of 150 calls a day) and women who carefully supervise
in-vitro fertilization to ensure that no mistakes are made. In recent years, it
expanded its interests to training counselors for brides and grooms, family
purity experts, ritual bath attendants and kashrut supervisors.
THE respect and cordiality, there are tensions. Rabbi Dov Lior, the chief rabbi
of Kiryat Arba who is national religious and not haredi, clearly disappointed
some listeners when he ruled in his lecture that young observant single women
who can’t find a suitable match may not have their eggs frozen – as permitted
recently by the Health Ministry – for later use when they marry, or using sperm
donation to produce a baby they will raise alone. The disappointment was
especially keen as just before the conference, a secular paper predicted that
Lior would endorse such a policy.
And Hadassah University Medical Center
endocrinologist Dr. David Zangen bemoaned the fact that some haredi rabbis
forbid single young men who had hormonal disorders from being tested for
fertility because the collection of sperm supposedly violates the prohibition
against “spilling seed.” A 17-year-old arrived at his clinic at the end of the
day, apparently so he wouldn’t be observed. “He had no secondary sexual
characteristics, adolescent-sized testicles or pubic hair. “Nobody in his
yeshiva told him that there was something wrong. But he compared himself to the
way his peers looked and came for help,” said Zangen, who noted that haredi
teachers and parents’ “ignoring such problems in boys as well as girls is not
“Tests have to be done,” he continued. If a boy in his early
teens does not show grown testicles and pubic hair, a brain tumor may be
interfering with his production of testosterone. It can lead to aggressive
behavior and even blindness. In this case, we did a scan and found no tumor. The
yeshiva student asked if he would ever have children. I told him we would give
him hormonal treatment. In some cases, such a patient will look sexually
developed but be infertile.
If treatment is delayed, fertility is less
Zangen said he could see that the boy was upset.
turns out he cried all night and said he didn’t want to live. Fortunately, a few
weeks ago, somebody had given me the phone number of Rabbi Ovadia Yosef. I
called him, and he asked to meet the boy with me present. He asked relevant
questions, and when the student left, he was smiling. I gave him hormone
treatment, and he developed normally.
When he began to meet young women
for marriage, he asked me what he should say about his fertility.
rabbis refused to let him undergo a fertility test. Rav Ovadia approved it. He
married, and just recently he and his wife had their third child.”
ADDED that the pituitary gland behind the eyes is responsible for producing
hormones. If there is a deficiency of estrogen in girls and testosterone in
boys, the child will not reach normal height or be fertile. The process of
biological adolescence must begin no earlier than eight years for girls and nine
for boys, and they should begin to show secondary sexual characteristics in
girls (breast buds and pubic hair) by 13.5 and 14.5 in boys (enlarged testicles
and pubic hair). The onset is different in each family, with premature or late
appearance running in families. If there is a problem, take the child to an
endocrinologist, he concluded.
Lior, speaking about fertility treatments,
said the majority opinion on artificial insemination in couples with fertility
problems holds that it is permitted, even though some rabbinical arbiters
prohibit it. The child who is conceived is, in the eyes of the majority, the
biological and halachic child of the husband if he was the source of the
“But a test-tube baby [produced by in-vitro fertilization (IVF)]
is much more complicated and a difficult question, because there is no physical
contact between the father and the fetus. It is important in Jewish life to know
who one’s father is.
There are problems with this technique,” he said,
countering the view of many leading rabbis. As for single girls who want to
freeze their eggs, the Kiryat Arba rabbi said women are not – unlike men –
halachically obliged to have children. “If a child is born without a father
figure, there can be negative characteristics; this is not the solution.” He
objected to the modern view that women have to have advanced college degrees and
good jobs before they marry. If they don’t find a proper match, they can always
adopt an existing child, Lior suggested, without addressing the problem that the
supply of decent religious men for religious girls in their 20s and 30s seems to
Rabbi Shlomo Daichovsky, who heads the Supreme Rabbinical
Court, tackled the problem of medical negligence and lawsuits, whose awards are
rising and which cause the cost of healthcare to spiral. He noted that it was
unnecessary to go to a “leading specialist” for ordinary conditions, such as
colds or flu. “But if there’s a serious disease, it is desirable to consult
leading specialists with good reputations. They have an angel accompanying them
at all times. According to Jewish law, such a physician has immunity from being
used. If he unintentionally made a mistake, it’s a matter for Heaven to punish
him, not a court.” Daichovsky continued that if the specialist believes a fetus
is defective, the problem “is not simple. Even imaging is not 100 percent
accurate,” he said, noting there have been scans showing a “defective” fetus
that was later born completely healthy.
More liberal was Holon Chief
Rabbi Avraham Yosef (son of Ovadia Yosef), who approved the use on Shabbat of
the handheld TENS electrical device that neutralizes pain from contractions
before delivery if a woman is unable to stand by herself. Women suffering from
such pain may be weakened during delivery. “They need a lot of strength; with
the device, they will be more relaxed during the early states and have more
strength to give birth successfully.” It can be used on Shabbat and holidays, he
says, even if the woman’s life is not in danger. A husband can take his wife to
hospital (by car or taxi) on Shabbat when she’s having regular
The problem of obesity in reducing the fertility of both
men and women was raised by Prof. Eyal Sheiner of the obstetrics/gynecology
department at Beersheba’s Soroka University Medical Center.
obesity is increasing the world over, and in Israel as well, causing fertility
problems, said Sheiner, who is writing an English-language book on the subject.
When body-mass index is over 29, “it is difficult to get pregnant.If a woman
loses even five kilos, she is likely to find it easier to conceive.” After
conception, obesity can cause gestational diabetes, riskier anesthesia and
too-heavy newborns. Obese women with fertility problems will find IVF less
likely to succeed, while very overweight men tend to have fewer sperm. “We
conducted a prospective study of 300 women, 80 of whom were obese, who needed
many more treatments than those of normal weight. They were more likely to have
hypertension and need a cesarean section.
The need to treat depression in
time and well is vital, said Prof. Eliezer Witztum, a leading psychiatrist at
Beersheba’s Mental Health Center and Jerusalem’s Herzog Hospital. Depression has
been known for 2,500 years and for a long time was known as melancholy (from the
word for “black liquids,” whose excess were thought to cause it). The great
medieval rabbi and physician, Maimonides, wrote about depression and was an
expert in his time on psychosomatic disease. Today, many sufferers go untreated,
and half of those who do get treatment don’t react positively to the first drug.
Then 30% fail to improve with a second drug. Other medications can help, along
with psychotherapy, exercise, nutrition, employment and cognitive behavioral
treatment, he said. A pill based on a natural herb, St.
(hypiricum) can improve the conditions of the lightly and moderately depressed,
said Witztum, with almost no side effects. Prescription drugs have to be taken
for a relatively long period, he concluded, noting that haredim often stop
taking medications on their own.
“We have learned how to deal with the
doctors; they’ve learned how to deal with us. We’ve learned how to accept each
other,” summed up Rabbi Gideon Weizman of the Puah staff. “We’ve also learned
how to work together because really it’s about creating relationships. The
doctors understand that we’re on the same side. We’re rabbis, not doctors. We
don’t give medical advice per se, but we give medical direction about new
treatments. Sometimes a doctor doesn’t know how to speak to a religious couple.
That’s where we come in.”