Religious issues color reproductive advances in Israel

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JERUSALEM — Earlier this year, in Haifa's Rambam Hospital, Israel's first surrogate mother delivered twins, by cesarean section.

Several months later, on Israeli Independence Day, another surrogate mother delivered a healthy boy at Hadassah University Hospital at Ein Kerem, on the western edge of Jerusalem.

"To see the endless joy in the eyes of the biological mother, who cannot bear a child [because of] a congenital anomaly of the uterus, is the best advocacy in front of all contrary `authority opinions,'" said Professor Aby Lewin, who heads the in vitro fertilization unit at Ein Kerem.

However, on the other side of Jerusalem, at Hadassah's Mount Scopus Hospital, Professor Neri Laufer, chairman of the obstetrics-gynecology department, said he will not facilitate a surrogate pregnancy.

"I have ethical problems," said Laufer, who is also a specialist in IVF and assisted reproduction, as well as chairman of the Israel Infertility Association

Like the two physicians, Israelis are also divided about surrogacy, which is under attack from religious authorities on the right, feminists on the left and others in between.

On the one hand, Judaism places a high value on parenthood, and Israeli institutions have been leaders in reproductive technology. On the other hand, surrogate motherhood and in vitro fertilization raise ethical as well as religious concerns. As a result, Israel enacted a number of regulations to prevent women from bearing children who would be considered mamzerim, illegitimate under Jewish law.

The 1996 surrogacy law, out of consideration to halachah (Jewish law), specifies that only an unmarried woman can bear a child for a couple and she must be the same religion as the genetic mother. Sisters, mothers or blood relatives are prohibited from carrying children for one another to avoid halachic incest. As a result, the motivation of the surrogate mother is usually economic. Surrogate fees have not been set by law; however, $25,000, to cover health insurance, legal fees and "loss of time and suffering," has been deemed acceptable, according to a Hadassah spokeswoman.

The surrogate wmother who delivered the twins in Haifa was single and struggling economically, according to the Jerusalem Post. She had second thoughts about carrying the babies to term and was distraught after the children were born.

Rabbi Einat Ramon, who made history as the first Israeli woman ordained in the Conservative movement, says the Jewish state has legalized a system of surrogacy that exploits "women who are single or poor.

"That, I think, is a kind of slavery," said Ramon, who is a former Berkeley Hillel rabbi and a member of the Israel Women's Network, whose chair has also taken a strong stand against the Israeli system of surrogacy.

Rabbis, physicians and halachic scholars continue to be divided. At issue are not simply the contractual legalities and concerns about who is the mother, but concerns over what is viewed as extreme intervention in the creation of a child.

As a result, Ruth Halperin-Kaddari, who teaches family law at Bar-Ilan University, told the Jerusalem Post that among haredim "nearly all rabbinic authorities have forbidden surrogacy."

Meanwhile, as Israeli medical institutions pioneer and adopt advances in other areas of reproductive technology, religious considerations continue to play a critical role. Although the commandment to go forth and multiply is paramount, it's sometimes at odds with halachic concerns. The result is a patchwork of practices.

In Israel, said Lewin, donor eggs may be used for in vitro fertilization only if they have been donated by an infertile woman who has had more eggs removed from her ovaries than she needs for her own IVF treatment.

However, he added, fervently religious women are not allowed to use donor eggs at all, while religious non-haredi women will only use eggs from unmarried or non-Jewish women. In the case of a Kohen, eggs must come from non-Jewish donors.

Donor sperm is not permitted by haredi, Lewin said. Because masturbation is halachically prohibited, the husband's sperm for an IVF is collected after intercourse, in a condom that has not been treated with spermicide.

Non-haredi observant Jews, however, may permit the use of sperm from non-Jewish donors.

Among secular Jews, there is no restriction on the religion of the sperm or egg donor.

Other advances in reproductive technology pose further ethical dilemmas. Some physicians are concerned about the rising age of motherhood. Laufer at Mount Scopus said he will not employ heroic measures, such as IVF, to effect a pregnancy in women over age 45.

"I think it's madness to treat a 60-year-old woman," he said. "There's not enough knowledge about the effect on the heart. There's a limit to what medicine should do."

Professor Jacques Michel, director of the Mount Scopus Hospital, where 3,600 babies are born each year, has other concerns, including the increasing number of multiple low-birthweight babies born as a result of fertility drugs. While the birth of septuplets in Iowa last year was heralded as a miracle, he views allowing such pregnancies to continue unchecked as "bad medicine."

At Mount Scopus, he said, multifetal reduction would probably be performed, enabling the survival of "two or three embryos maximum." More than that is "dangerous for the woman and the pregnancy."

Although Jewish law clearly permits abortion if the mother's life is endangered, Michel said some Orthodox and some Muslims, including a number of Bedouins in the Negev, will not have an abortion. As a result, the neonatal mortality rate among these groups is higher.

At Hadassah's larger Ein Kerem facility, home of the famed Chagall windows, Lewin's IVF unit has achieved more than 1,000 pregnancies during the past 10 years. Forty percent of the patients achieve a clinical pregnancy and 33 percent take home a baby, twice the national IVF average in Israel.

In the unit, he said, "We perform on patients' request fetal reductions from triplets and more. In religious patients, rabbis usually allow reduction from quadruplets."

Lewin also pioneered a new technique that enables sperm to be extracted directly from the testes and injected into the vagina or an extracted egg, resulting in a 42.8 percent clinical pregnancy rate among patients who could not otherwise achieve a pregnancy.

While the Hadassah hospitals serve patients of all levels of religious observance, Shaare Zedek Medical Center in Jerusalem has strong ties to the Orthodox community. And the newly established Zir Chemed, a nonprofit, is reaching out to childless religious couples, offering fertility services under halachic supervision.

The organization is headed by an English-born fertility expert, Dr. Baruch Brooks, a fervently religious man who is a specialist in IVF and also has a doctorate in embryology.

"Judaism confirms life," Brooks told World Zionist Press Service. "This is one of the highest Jewish values. Thus, our views on fertility treatments and advances are very open and we put a lot of energy into finding creative solutions."

Janet Silver Ghent
Janet Silver Ghent

Janet Silver Ghent, a retired senior editor at J., is the author of “Love Atop a Keyboard: A Memoir of Late-life Love” (Mascot Press). She lives in Palo Alto and can be reached at [email protected].