Bioethicist pushes for autopsies in crib-death cases

Dr. Rabbi Mordechai Halperin says issue rests between doing work that may save a life, and desecrating a body.

The 1980 amendment to the Anatomy and Pathology Law that gives a veto to bereaved parents on whether an autopsy may be performed on their infant suspected of have died of Sudden Infant Death Syndrome (SIDS or crib death death) must be changed, according to Dr. Pnina Aviram, a senior lawyer and bioethicist at the Ono Academic College.
Aviram was speaking at an all-day seminar Tuesday attended by 400 doctors, nurses and families who have gone through the tragedy of SIDS.
She said that only a couple of autopsies are performed each year to determine the causes of death of seemingly healthy infants below the age of one year.
There is widespread opinion that it would be impossible politically for the Knesset to pass an amendment that would allow an expanded hospital ethics committee to decide if such a post-mortem exam were needed, but she strongly advocated this. The religious parties, as well as others, would resist changing the Autopsy and Pathology Law, she said.
But Aviram noted that there is a good reason why autopsies are permitted and carried out in many countries – not only when a possible crime has been committed but also when there is no suspicion of a crime, such as when a baby dies of apparently natural causes.
Knowing what caused the baby to stop breathing in its sleep could save the lives of future children in the family or other children, as there may be some medical problem which was not detected, she said.
“What I say sounds provocative and even a bit extreme. I am a liberal. But I have heard many of the medical lectures today on the causes of SIDS, and though all of them presented lots of data, nobody knows if the wrong conclusions have been reached. Why does SIDS occur?” She said she new knew only the statistical answer – going to sleep in a supine position, not exposing the infant to tobacco smoke and other chemicals, not heating the room and the child excessively and other factors.
But it is all guessing, she said, as autopsies in such cases are extremely rare.
Aviram added that when a child has to undergo any medical procedure, in many cases, parents cannot make an objective decision; a legal ethics committee must look at each case to determine what it is needed to learn the truth.
Dr. Rabbi Mordechai Halperin, the Health Ministry’s medical ethics expert and also a gynecologist, spoke by telephone to say that there must be reasons for something to be forbidden by Halacha; if not, it is permitted.
He said that autopsies on infants suspected of having died of crib death have been allowed by leading rabbinical arbiters if there is a very good reason, such as saving a life, but at the same time one must not desecrate bodies unnecessarily by dissecting them.
Halperin gave the example from 20 years ago, when a baby died soon after getting a hepatitis B vaccination. The ministry was concerned that there might have been something wrong with that specific batch of vaccine, in which case they would have to destroy the batch of vaccine to save other babies.
The late arbiter Rabbi Shlomo Zalman Auerbach said he would agree if Halperin was present when the autopsy, which could not be replaced by a scan or x-ray, was performed on the infant. In the end, the operation in Abu Kabir showed the baby had a rare fatal ear infection, and the vaccine was safe.
Saving a theoretical life is not enough to approve an autopsy, he added.
Halperin noted that Jewish law prefers a non-invasive way to make such discoveries. If a scan, CT or even an MRI can provide a good answer, it is much preferred. But if not, an autopsy can be approved by a leading arbiter.
The conference was organized by Dr. Anat Schatz, a pediatric respiratory expert at Jerusalem’s Shaare Zedek Medical Center, which hosted the conference and also houses the office of ATID, the voluntary organization founded a decade ago by Schatz to help SIDS families, increase public awareness of it and promote research.
A full Health & Science Page feature on the SIDS conference will appear on Sunday, March 27.