Genetic Disorders


 

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The Jewish Take on Genetics: While the Center often provides the most halachically stringent information regarding topics such as genetic testing, assisted reproduction and cancer treatments, it is important to see how different denominations within Judaism address several halachic questions. Having an awareness of the various approaches towards complicated moral issues can be eye-opening and helpful when making tough choices. Remember that your local rabbi can be used as a resource to guide you in making such moral decisions. Keep in mind that rabbis and other religious leaders in your community may have varying, contradictory opinions regarding these matters, but they can be a useful source of knowledge. Also, various streams of Judaism view halachot in different lights—while some denominations see them as binding law, others may see them merely as advice.

Genetic Carrier Testing: Humankind has the obligation to heal, as is seen in various places throughout Written and Oral Torah. Also there is the obligation in Genesis 1:28: “G-d blessed them and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it. Rule over the fish of the sea and the birds of the air and over every living creature that moves on the ground.’” The phrase “subdue it” is understood as a directive for humankind to continue refining G-d’s creations to improve life: “Man is enjoined to protect the world and not harm it.”[vi]

With this thought in mind, it would be not only permissible to advance medical technology and then use it to screen for genetic disorders as a means of producing healthy offspring, but it would be recommended, especially because Rava said: “A man should not marry a woman from a family of epileptics or from a family of lepers.”[vii] Thus, the ability to prevent situations where genetic anomalies would result seems quite practical and important. Rav Moshe Feinstein feels that “failure to undergo the carrier testing would be tantamount to ‘closing [one’s] eyes [in order not] to see that which is possible to see.’ Rav Moshe seems to maintain that it is irresponsible to ignore the dangers involved in being a carrier. One is biblically obligated to take responsible measures to prevent and cure disease.”[viii] It is a common belief throughout Judaism that when medical technology is available and neither harmful nor sinful, it should be utilized. It is important, however, to use the technology in a constructive manner.

Reproductive Technologies, Abortion & Other Concerns: There are many concerns surrounding in vitro fertilization (IVF) and while not all of them pertain specifically to matters regarding genetic abnormalities and preventative procedures, a number of the concerns regarding IVF exist in conjunction with potential solutions in cases of genetic carrier couple status. Members of the Orthodox movement feel that while “plausible reasons are required before a couple is allowed to undergo IVF/PGD, most poskim would agree that in a case of infertility or of genetic abnormality, this procedure is permitted.”[xi] “In some cases, preimplantation genetic diagnosis with implantation of healthy embryos may be the only acceptable way according to Jewish law for a married couple who are both carriers of a serious recessive trait (such a Tay Sachs or cystic fibrosis) to have children born without a serious or fatal disease.”[xii] However, when undergoing IVF or using other reproductive aides, there are several issues that must be addressed.

Other topics in this section include: Preimplantation Genetic Diagnosis (PGD), Selective Abortion, Prenatal testing and Abortion.

Genetic Carrier Testing

Orthodox Movement
While the Orthodox movement supports genetic carrier testing, there are some parameters which are commonly suggested. The issue of anonymity is a primary concern, as it would be impermissible to stigmatize someone who is a carrier for a disease; while the person carries a gene coding for a disease, he or she is in no way an unfit parent or match, nor is anyone within his or her family. There is also the question of timing. If testing occurs before a shidduch (arranged marriage) and the dating period, there is no emotional attachment, so this is often the preferred time to be tested. Waiting until after a proposal causes a couple to question breaking up if they are found to be incompatible genetically, and that is often difficult. This would also leave a couple knowing private information about another person, putting both people at risk for stigmatization. Waiting until marriage raises further questions regarding reproductive technologies and waiting until pregnancy is problematic because at that point there is only the option of abortion. Because of these complex concerns and several others, a program called Dor Yeshorim based in New York was instated as a means of anonymously testing individuals within the Orthodox community. This program is the preferred method for testing as many of the complex questions and issues can be avoided. As a whole, the Orthodox community promotes early age screening so as not to deal with other more complicated situations and questions brought about by testing later in life.

Conservative Movement
The United Synagogue of Conservative Judaism endorses the following principles and actions:

  • Continue the national, community-wide discussion on the issue of genetic diseases including breast cancer, their causes, risks, facts and myths: continue to promote study of the usefulness of genetic testing and to increase research measures to identify prevention strategies and find cures.
  • Work with appropriate agencies to disseminate proper public health materials in order to combat misinformation and help individuals and families assess the risks and benefits of genetic testing.
  • Advocate for the inclusion of comprehensive genetic counseling performed by trained individuals, along with a detailed informed consent process (both written and interactive) as a part of any testing context prior to actually taking a sample.
  • Work with the various entities connected to the commercial genetic testing market and others, including the genetic testing companies and the oncological community, to combat fear-based and stigmatizing marketing techniques and inappropriate uses of genetic tests.
  • Emphasize that the current knowledge about genetic variations does not provide a mandate for broad scale testing of individuals outside the controlled research setting.
  • Continue its support of medical research aimed at ameliorating disease, including breast cancer, and including the identification of genetic mutations, which may be predictive of the onset of disease.
  • Support continued funding for research on the ethical, legal and social implications of genetic testing.

BE IT FURTHER RESOLVED, that The United Synagogue of Conservative Judaism encourages its affiliated congregations to educate its members about the benefits and concerns connected with genetic testing; and that The United Synagogue of Conservative Judaism calls upon the members of its affiliated congregations to communicate their concerns with their federal, state/provincial and local representatives.”[x]

Conservative rabbi, Rabbi Melman notes that it would be a mistake not to mention genetic testing during premarital counseling. At this point, it is financially unrealistic, as a movement, to require genetic testing before a rabbi will perform a marriage but pre-marital genetic screening is something to be strongly recommended. Genetic testing is a necessary part of pikuach nefesh. If one is a carrier for a disease, one has several obligations, specifically to their significant other and to their [unborn] children. “Knowledge,” he stresses, “is power.”

As a whole, Judaism promotes genetic carrier screening. While the timing and preferred processes may differ within each movement, the information provided by the results dictates a number of responses ranging from the ability to continue the relationship to exploring the ways in which a couple will be able to have children.

Reform Movement
The Reform movement also promotes genetic screening as mandated by an initiative written by the Union for Reform Judaism resolving to:

  • Join with the Central Conference of American Rabbis (CCAR), American Conference of Cantors (ACC) and Hebrew Union College-Jewish Institute of Religion (HUC-JIR) to work…to educate our members about Jewish genetic diseases.
  • Work with HUC-JIR to ensure that rabbinical and cantoral students receive appropriate and up-to-date training on Jewish genetic diseases.
  • Support the members of the CCAR and ACC in furthering their existing efforts to include the latest information on Jewish genetic diseases in their premarital counseling sessions, and to encourage couples to undergo carrier testing.
  • Encourage all members of our congregations who are of Eastern/Central European descent and are between the ages of 18 and 45 to consider screening for Jewish genetic disease carrier status.[ix]

While marriage is not discouraged within the movement if there is a possibility that offspring of a couple could be born with a genetic disease, preconception testing is encouraged during premarital counseling with a rabbi, in hopes of providing the couple with the knowledge necessary to have healthy children in the future. Reform rabbi, Rabbi Knobel notes that the Reform movement supports genetic testing and has made an effort to raise awareness both through marriage counseling and also through courses within the framework of the congregation’s adult education system that focus either on bioethics as a whole or specifically on genetic testing and its implications.

Reproductive Technologies, Abortion & Other Concerns 

Orthodox Movement
When using IVF there is the necessity of collecting sperm, and for many people, the issue of hashchatatzera, spilling seed in vain, comes up, since not all sperm are used in the process. [xiii] For further discussion of the prohibition of spilling seed in vain, please consult your Halachic authority. Various debates in the Orthodox movement, have typically led to the permissibility of collecting semen through halachically appropriate manners, namely through intercourse with a special medical condom, preferably with a hole which could, in theory, allow sperm to pass through during intercourse. With the issue of spilling seed also comes the dilemma of how to deal with unused gametes and embryos. A fetus is considered mere liquid within forty days of conception; it is not considered a legal person. “Rav Zilberstein and other poskim allow one to discard unused IVF-derived pre-embryos, especially those with genetic abnormalities. Other poskim, like Rav Unterman, ruled that discarding unused embryos constitutes hashchatatzerah and should not be done.”[xiv] For help in the decision process, it is advised that one speak with one’s rabbi in order to receive appropriate guidance regarding acceptable uses—both reproductively and scientifically—and disposal methods for unused gametes and embryos or to consult the Puah Institute’s extensive resources.

Conservative Movement
The Conservative movement permits the collection of semen, and Rabbi Melman in fact makes an additional note reminding that the law not to spill seed is merely an interpretation of the Bible from many years ago. That being said, the interpretation may or may not be the correct interpretation and may need to be revisited. In a biblical story connected to the issue of spilling one’s seed in vain, the character named Onan may have been killed, not because he spilled seed, but, for example, because he refused to provide offspring for his late brother’s widow (Genesis 38: 6-9). These stories are interpretable, and do not necessarily offer total clarity. Regardless, Rabbi Melman does not feel that there is a halachic problem with collecting semen or in not using all of the male gametes when a couple undergoes IVF. Rabbi Melman notes that one never says, “Don’t throw your apple seed out because it was a potential tree.” Similarly, one should not say that about gametes because they are removed from human life in the eyes of Jewish law. Not only would it be permissible to let excess gametes go unused, but the same can be said for embryos. Now more than ever, embryos left over from IVF treatment should be used for scientific research, because there is so much potential to save lives with stem cell research and a number of other technological discoveries. The CJLS established that “after scientists have accomplished all that they can toward a given goal through animal experiments…frozen human embryos originally created for purposes of procreation not only may, but should be aggressively used for research into creating cures for a number of human ailments.”[xvi] Because there is room for interpretation and potentially challenging moral decisions, it may be helpful to consult your rabbi for further discussion.

Reform Movement
The Reform movement has a more unified approach regarding the disposal of unused reproductive matter. A response written by rabbis within the movement details the leniencies of the disposal of these products:

  • A human embryo or zygote is, like the fetus, a potential but not a legal person, and there is no explicit Jewish legal prohibition against its destruction.
  • In vitro fertilization is a legitimate medical therapy, offering realistic hope to many who seek to build families. Since the creation of multiple embryos is a necessary element of IVF, and since the preservation of “excess” embryos may constitute a serious impediment to the availability of this procedure, it is permissible to discard those embryos.
  • The embryo may be used for medical research, provided that it is handled with the proper respect and reverence.
  • The embryo may be offered to another couple. The child will be the biological offspring of the man and woman who donated the sperm and the egg. Those who raise the child are his or her “ultimate” and “real” parents….The child adopted by another couple has no legal or religious relationship to the donors of the egg and sperm, although for personal, medical, and genetic reasons the child or his/her guardian should be permitted to discover the identity of the biological parents at an appropriate time.[xv]

Rabbi Knobel cites that IVF is a permissible reproductive option and can be used for the fulfillment of pru u’rvu (commandment to be fruitful and multiply) when a couple is unable to have healthy children for any reason be it infertility, potential for genetic disorders, etc. There is no issue with cryopreservation of eggs or embryos and there are no problems with the disposal of gametes and embryos or even using them for scientific research, as Rabbi Knobel believes most Reform rabbis would recommend.

Preimplantation Genetic Diagnosis (PGD)

Orthodox Movement
Many equate the use of PGD to that of playing G-d because one is essentially choosing which embryos get to be brought into the world with a chance of achieving olam ha-ba (the next world) and which embryo will never have the chance to develop. “Professor Avraham Avraham, author of Nishmat Avraham, has reported that in principle, both Rabbi Yosef Sholom Elyashiv and Rabbi Yehoshua Neuwirth have granted permission for PGD to be performed for couples where both partners are carriers of a defective recessive genetic trait or have a child that has such a genetic abnormality. It is clear that the major poskim permit IVF and PGD only in order to avoid having a child with a disease or abnormality.”[xviii] To further justify the use of PGD, Rabbi Dovid Cohen “postulates that the prohibition of causing pain to another Jew includes a not yet conceived fetus. Just as one may not take an action that will cause tzaar [pain or grief] to another person, one may not perform an action that will create a child who will suffer.”[xix], While in most cases an Orthodox rabbi would allow for the use of PGD in hopes of preventing fatal diseases like Tay-Sachs, the choice between a carrier embryo and a non-carrier embryo is not a choice which one is typically permitted to make.[xx] When unsure about the halachot surrounding PGD, it is best to consult one’s rabbi.

Conservative Movement
The Conservative movement has two dissenting opinions regarding PGD. The CJLS takes the stance that “any Jew who has the ability to help someone avoid illness and fails to do so stands in violation of this precept [compelling individual Jews to actively work towards the health and well-being of others]. Parents who do not aggressively ensure the health of their children are especially culpable…Arguing strongly that we have an obligation to heal the sick does not necessarily imply that we have an obligation (or even permission) to actively intervene with the intention of preventing sick people from coming into existence…The embryo with the disease gene is not healed using PGD; rather, it is simply denied the chance to later develop into a fetus.”[xxi] Because there is so much debate surrounding the matter, the CJLS has approved the motion that “PGD should be permitted only to select against chromosomal abnormalities and genetic mutations which cause diseases that a) the fetus will very likely manifest should it be carried to term; b) are fatal or associated with a severely debilitating condition and; c) have no effective therapies at present.”[xxii] With this reasoning, one would be able to use PGD in selecting for healthy embryos without severe genetic disorders. This halacha, does not explicitly address whether one may also select against carriers of a specific disease even if the disease will not manifest in the future child.

The dissenting opinion to this halacha feels that it would be impermissible, “when already undertaking IVF and faced with a number of embryos, not to employ PGD in order to assure that the child born does not have those heightened risks that we are able to foresee.”[xxiii] Rabbi Melman elaborates on this point stating that it is permissible to select for non-carrier embryos even though a child won’t directly be affected by being a carrier because he too might need to go through the process, when in fact it could become completely unnecessary. Rabbi Melman feels that it would be great to just eliminate the genes for Tay-Sachs from our population. There is no need to have even carriers. Because so much benefit can be derived from selecting for non-carriers in cases where screening would be permissible, he feels there should be no prohibition against selecting only non-carriers when undergoing IVF with PGD.

Reform Movement
The Reform movement follows no formal halacha regarding PGD, and while Reform rabbi, Rabbi Stoller says, “Reform Judaism is open to innovations of technology when they are used ethically and to help Jewish families bring children into the world,” one must really strive to use these technologies for moral purposes. Rabbi Stoller stresses that ultimately the choice to use PGD or any other reproductive technology lies with the individual and not the rabbi. “Science is amoral,” he says. “Technology can be used for good or bad. I think it is important not to take the approach that just because you can, you should.”

Selective Abortion

Orthodox Movement
The Orthodox movement has no specific halacha regarding multifetal pregnancy reduction, selective elimination of one or more of the fetuses in a multifetal pregnancy, when the pregnancy is a result of IVF. A somewhat common opinion throughout the movement in regards to a naturally occurring multifetal pregnancy of four or more fetuses is that if there is grave danger to all of the fetuses, then a reduction may be performed.

In regards to IVF, a multiple pregnancy may result when more than one fertilized egg is implanted into the woman, and while this may provide for a higher rate of success, three or more fetuses growing in the womb could result in a high-risk pregnancy, and fetal reduction may be recommended. “Ending the life of a fetus is not considered murder by halachic definition, but it is not permissible either. This would only be permitted if the doctor has determined that some fetuses must be eliminated or they will all die. Even then, the decision is a very sensitive one.”[xxiv] As is the case with abortion in general, if the mother’s health is endangered, the procedure may also be performed; however, as a whole, this is a controversial matter and is dealt with on a case-by-case basis. It is best to avoid the need for a multifetal pregnancy reduction by limiting the number of embryos transferred during the procedure. If one finds oneself in such a situation where multifetal pregnancy reduction might be necessary it is important to consult with one’s rabbi.

Conservative Movement
The Conservative halacha aims primarily to eliminate the need for multifetal pregnancy reduction. The halacha states:

  • If a woman is pregnant with more than two fetuses, multifetal pregnancy reduction would be halakhically acceptable in appropriate cases—certainly in order to protect the woman from a serious threat to her health, and arguably with the independent justification of protecting the remaining fetuses. At the same time, this procedure may itself entail risks for the woman and especially for the remaining fetuses. From the standpoint of Judaism, it would be important to take reasonable steps to lessen the likelihood of the need for multifetal pregnancy reduction, as it would be appropriate to lessen the likelihood of recourse to abortion in other circumstances.
  • Many who have examined the practice of IVF have recommended limiting the number of embryos transferred to no more than three. The specific concern of Jewish law and ethics to minimize risk to the woman and fetuses provides us additional support for this limit. No more than three embryos should be transferred in a procedure. To the extent possible, transferring only two embryos would be preferable. [xxv]

Rabbi Melman says that this is a relatively firm policy and abiding by this halacha is in the best interest of the mother’s help—regardless of religious practice. Thus, there should be no need for a multifetal pregnancy reduction.

Reform Movement
The Reform movement has no formal opinion regarding multifetal pregnancy reduction. In situations where there are no other options either because the mother’s health or the survival of the fetuses are in jeopardy due to the high risk of the pregnancy, the procedure would be permissible. In cases with other factors, it may be helpful to consult a rabbi. It is best, though, to avoid the need for a multifetal pregnancy reduction by limiting the number of embryos transferred in the procedure.

Prenatal Screening Methods

Orthodox Movement
With effective premarital and preconception screening, there is often little need to undergo prenatal screening. While the Orthodox movement does not have a single opinion regarding prenatal screening, Rabbi Moshe Feinstein rules that “amniocentesis is forbidden if it is performed only to evaluate for birth defects for which the parents might request an abortion. Nevertheless, a test may be performed if a permitted action may result, such as performance of amniocentesis or drawing alpha-fetoprotein levels for improved peripartum or postpartum medical management.”[xxvii]

Conservative Movement
Rabbi Melman believes that amniocentesis and CVS, among other prenatal screening methods, would be permissible, and, especially in high-risk pregnancies, these procedures would be advised as a means of preparation for what is to come.

While prenatal testing is by no means the most advisable means of genetic screening, it is often permissible and can be used as a source of knowledge in preparing to become a parent.

Reform Movement
Rabbi Knobel explained that the Reform movement strongly recommends pre-marriage genetic counseling and testing, not as a deterrent to marriage but as a means of being prepared for the future. While a rabbi would not refuse to perform a marriage for a couple who has not undergone genetic testing, it is a topic that comes up in premarital counseling. If, however, a couple does not undergo some sort of preconception counseling and testing or prenatal screening is otherwise deemed necessary, it would be permissible. While abortion may not be recommended morally or halachically depending on the state of the mother in regards to both a physical and mental health, the knowledge provided by amniocentesis can allow for preparedness in raising a child.

Abortion

Orthodox Movement
The overall hope in every denomination of Judaism is that aborting a fetus with a genetic anomaly will become a non-issue given the various screening technologies presently available. Abortion is usually seen as impermissible within the Orthodox movement unless the mother’s life is directly endangered, as per the halacha bulletin written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l:

Abortion on demand is prohibited by Jewish law. Jewish law sanctions abortion only when continuation of pregnancy constitutes a grave hazard to the mother. Such hazards include psychiatric disturbances that may be caused or aggravated by the continued pregnancy, if these disturbances are genuinely feared to lead to risk to life…A serious medical threat to the mother's life…also constitutes an indication for abortion permitted by Jewish law. [xxviii]

Abortions would be permitted within the Orthodox community in several other cases, as well. While many genetic anomalies do not merit an abortion, some situations might arise where an abortion would, in fact, be allowed. These cases are very specific, and there are different opinions among halachic authorities. It is important to discuss the issue with one’s rabbi in order to understand one’s specific situation and its implications when determining the permissibility of abortion.

Conservative Movement
The Conservative movement’s halachic ruling states: “An abortion is justifiable if a continuation of pregnancy might cause the mother severe physical or psychological harm, or when the fetus is judged by competent medical opinion as severely defective”[xxx] Something that Conservative Rabbi Melman notes is that in today’s society, it is important that the father’s psychological wellbeing also be considered. A marriage is an equal partnership and the decision to abort a fetus affects both the mother and father almost equally when taking into account psychological impact. The Conservative movement’s CJLS highlights this fact, noting that “before reaching her final decision, the mother should consult with the father, other members of her family, her physician, her spiritual leader and any other person who can help her in assessing the many grave legal and moral issues involved [with abortion].”[xxxi]

Abortion, though not promoted within the movement, which is typically, as Rabbi Melman notes, “a pro-life religion—a religion promoting life, overall,” is at times permissible. Choosing to have an abortion is a weighty moral decision and a lot of factors go in to the decision. Keeping in mind that there are resources within the Jewish community that can be helpful when looking for moral guidance and support.

Reform Movement
The Reform movement notes “those who are within the broadest range of permissibility permit abortion at any time before birth, if there is a serious danger to the health of the mother or the child.”[xxix] Rabbi Stoller reiterates the breadth of this statement. The Reform approach focuses on the mother’s health, both in the physical and psychological sense. That gives significant room for leniency as one cannot doubt the mother if she believes she is psychologically unwell. Financial situations, family situations, and struggles caused by having a child with a genetic anomaly are all things that might cause the mother strife and could merit an abortion, within the framework of Reform Judaism. Rabbi Stoller also explains that while the Reform interpretation of halacha explicitly discusses the mother’s wellbeing, and it is the woman’s choice to have an abortion because the fetus is seen as a part of her body, such decisions should be made with careful consideration and the utmost respect for the fetus as potential life. Furthermore, it is important to understand that there are people involved in raising a child other than the mother. The family’s needs must also be taken into account.

A Conversation between the Movements

The main difference between Orthodox stringencies and Reform and Conservative opinions is that the Orthodox movement typically only takes the mother’s health into consideration, while the other movements also consider the father’s mental health and the future child’s wellbeing. However, Rabbi Melman says that one would be hard-pressed to find an Orthodox rabbi who would not permit aborting a fetus diagnosed with Tay-Sachs. While Tay- Sachs may be where some rabbinic authorities draw the line in permitting abortion, Rabbis Melman, Stoller, and Peter Knobel, another Reform rabbi, all commented on the difficulty of knowing appropriate circumstances for abortion when looking at the genetic health of the fetus. Some genetic anomalies are more severe than others and while all pose difficulties, abortion is not appropriate for the majority of minor, non-fatal anomalies. These situations, in theory, would be decided on a case-by-case basis. However highly recommended, it is nonetheless up to each individual to seek guidance from his or her rabbi before making any such moral decisions.

While lack of finances is not explicitly given as a reason for abortion in either the Reform or Orthodox movements, there are several opinions when approaching a couple that is not monetarily prepared to care for a child with additional special needs. Rabbi Knobel mentions that couples are encouraged only to have children when financially capable, so finances alone are not typically an acceptable reason for abortion. Rabbis Stoller and Melman bring up another side of the issue. Rabbi Melman conversely said, “I would probably lean to the side of ‘yes’ where termination would be acceptable and legal” because especially in today’s economic crisis, severe economic hardships can lead to severe psychological problems which could lend to the necessity of an abortion.

ix.     [i] (Orthodox Judaism)

x.     [ii](Conservative Judaism)

xi.     [iii] (Contemporary Halakhah: The Committee on Jewish Law and Standards)

xii.     [iv] (Artson)

xiii.     [v] (Washofsky, 2001)

xiv.     [vi] (Eisenberg, Judaism and Modern Technology, 2004)

xv.     [vii] (Yevamot 64b)

xvi.     [viii](Burns, 2006)

xvii.     [ix] (Jewish Genetic Diseases, 2008)

xviii.     [x] (Genetic Testing, Discrimination, and the Jewish Community, 1999)

xix.     [xi] (Pekar, 2008)

xx.     [xii] (Eisenberg, Altering Genes, 2007)

xxi.     [xiii] (Pekar, 2008)

xxii.     [xiv] (Pekar, 2008)

xxiii.     [xv] (In Vitro Fertilization and the Status of the Embryo, 2007)

xxiv.     [xvi] (Dorff, 2002)

xxv.     [xvii] (Pekar, 2008)

xxvi.     [xviii] (Eisenberg, Assisted Reproduction in the Conception of Babies with Disabilities)

xxvii.     [xix] (Eisenberg, Assisted Reproduction in the Conception of Babies with Disabilities)

xxviii.     [xx] (Eisenberg, Assisted Reproduction in the Conception of Babies with Disabilities)

xxix.     [xxi] (Choosing Our Children’s Genes: The Use of Preimplantation Genetic Diagnosis, 2008)

xxx.     [xxii] (Choosing Our Children’s Genes: The Use of Preimplantation Genetic Diagnosis, 2008)

xxxi.     [xxiii] (Reisnerm& Wind, 2008)

xxxii.     [xxiv] (Wahrman)

xxxiii.     [xxv] (Mackler, 1995)

xxxiv.     [xxvi] (Eisenberg, Assisted Reproduction in the Conception of Babies with Disabilities)

xxxv.     [xxvii] (Eisenberg, Abortion in Jewish Law, 2004)

xxxvi.     [xxviii] (Practical Medical Halacha)

xxxvii.     [xxix] (When is Abortion Permitted?, 1985)

xxxviii.     [xxx] (The Abortion Controversy: Jewish Religious Rights and Responsibilities)

xxxix.     [xxxi] (The Abortion Controversy: Jewish Religious Rights and Responsibilities)

xl.     Artson, R. B. (n.d.). Conservative Judaism: Covenant and Commitment. Retrieved July 27, 2009, from The Rabbinical Assembly: http://www.rabbinicalassembly.org/docs/Conservative%20Judaism%20Covenant%20and%20Commitment.pdf

xli.     Breast Cancer, Genetic Testing, and Health Insurance Discrimination. (1997, June). Retrieved July 28, 2009, from Central Conference of American Rabbis: http://data.ccarnet.org/cgi-bin/resodisp.pl?file=bc&year=1997

xlii.     Burns, E. (2006, June 17). The Jewish Woman's BRCA Screening Dilemma. Retrieved July 28, 2009, from YU Torah Online: DerechHaTeva: http://www.yutorah.org/lectures/lecture.cfm/724613/_Esther_Burns/The_Jewish_Woman's_BRCA_Screening_Dilemma

xliii.     Choosing Our Children’s Genes: The Use of Preimplantation Genetic Diagnosis. (2008, May 28). Retrieved July 23, 2009, from The Rabbinical Assembly: http://www.rabbinicalassembly.org/teshuvot/docs/20052010/Popovsky_FINAL_preimplantation.pdf

xliv.     Citrin, N. (2008, May 27). To Test or Not to Test – The BRCA Genes Explored. Retrieved July 23, 2009, from YU Torah Online: DerechHaTeva: http://www.yutorah.org/lectures/lecture.cfm/724206/_Nechama_Citrin/To_Test_or_Not_to_Test_–_The_BRCA_Genes_Explored

xlv.     Conservative Judaism.(n.d.). Retrieved July 22, 2009, from The Jewish Theological Seminary: http://www.jtsa.edu/Conservative_Judaism.xml

xlvi.     Contemporary Halakhah: The Committee on Jewish Law and Standards. (n.d.). Retrieved July 28, 2009, from The RabinicalAssembally: http://www.rabbinicalassembly.org/law/contemporary_halakhah.html

xlvii.     Dorff, R. E. (2002, March 13). Stem Cell Research. Retrieved July 23, 2009, from The Rabbinical Assembly: http://www.rabbinicalassembly.org/teshuvot/docs/19912000/dorff_stemcell.pdf

xlviii.     Eisenberg, D. M. (2004, May 29). Abortion in Jewish Law. Retrieved July 31, 2009, from Aish.com: http://www.aish.com/ci/sam/48954946.html

xlix.     Eisenberg, D. M. (2007, August 18). Altering Genes. Retrieved July 23, 2009+, from Aish.com: http://www.aish.com/ci/sam/48959046.html

l.     Eisenberg, D. M. (n.d.).Assisted Reproduction in the Conception of Babies with Disabilities. Retrieved July 27, 2009, from Dr. Falk Schlesinger Institute for Medical-Halachic Research: http://www.medethics.org.il/articles/BrachaLeAvraham/Eisenberg.asp

li.     Eisenberg, D. M. (2004, October 15). Judaism and Modern Technology. Retrieved July 23, 2009, from Aish.com: http://www.aish.com/ci/sam/48949821.html

lii.     Genetic Testing, Discrimination, and the Jewish Community. (1999). Retrieved July 28, 2009, from The United Synagogue of Conservative Judaism: http://www.uscj.org/Genetic_Testing_Disc6690.html

liii.     In Vitro Fertilization and the Status of the Embryo. (2007). Retrieved July 16, 2009, from Central Conference of American Rabbis: http://data.ccarnet.org/cgi-bin/respdisp.pl?file=2&year=5757

liv.     Jewish Genetic Diseases. (2008, June 1). Retrieved July 23, 2009, from Union for Reform Judaism: http://urj.org/Articles/index.cfm?id=21408

lv.     Mackler, R. A. (1995, March).In Vitro Fertilization. Retrieved July 28, 2009, from The Rabbinic Assembly: http://www.rabbinicalassembly.org/teshuvot/docs/19912000/mackler_ivf.pdf

lvi.     Orthodox Judaism. (n.d.). Retrieved August 3, 2009, from Jewish Virtual Library: http://www.jewishvirtuallibrary.org/jsource/Judaism/Orthodox.html

lvii.     Pekar, M. (2008, May 27). Sex Pre-Selection. Retrieved July 23, 2990, from YU Torah Online: DerechHaTeva: http://www.yutorah.org/lectures/lecture.cfm/724217/_Marina_Pekar/Sex_Pre-Selection

lviii.     Practical Medical Halacha. (n.d.). Retrieved July 16, 2009, from Association of Orthodox Jewish Scientists: http://www.aojs.org/pmh.asp

lix.     Reisnerm, R. A., & Wind, D. M. (2008, June 12). PGD: Preimplantation Genetic Diagnosis – An Ideological Dissent. Retrieved July 23, 2009, from The Rabbinical Assembly: http://www.rabbinicalassembly.org/teshuvot/docs/20052010/reisner_PGDdissent.pdf

lx.     The Abortion Controversy: Jewish Religious Rights and Responsibilities. (n.d.). Retrieved July 28, 2009, from The United Synagogue of Conservative Judaism: http://www.uscj.org/The_Abortion_Controv5481.html

lxi.     Wahrman, D. M. (n.d.).Assisted Reproduction and Judaism. Retrieved July 28, 2009, from Jewish Virtual Library: http://www.jewishvirtuallibrary.org/jsource/Judaism/ivf.html

lxii.     Washofsky, M. (2001).Jewish Living: A Guide to Contemporary Reform Practice.New York: UAHC Press.

lxiii.     When is Abortion Permitted? (1985, January). Retrieved July 20, 2009, from Central Conference of American Rabbis: http://data.ccarnet.org/cgi-bin/respdisp.pl?file=16&year=carr

lxiv.     Yevamot 64b.In Babylonian Talmud.



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