Editorial - September 2004
Rosh Hashanah 5765
• Self-Discipline – Respect - Hope
• Antisemitism in 3-D
• The Moment of Truth
• State and Nation
• Protection and Defense
• Gaza first ?
• Gideon Sa'ar
Medicine and Halacha
• Sex - Morality - Law
• Witness of his times
• Pinchas Tibor Rosenbaum
• Hungarian guilt
• Jewish Education in Hungary
Ethic and Judaism
• Whose mind is it ?
Dr. Mordechai Halperin. Photo by Bethsabée Süssmann
The image of Judaism is often that of an antiquated religion with medieval practices that preaches an austere and rigorous life style. Keeping Shabbat and eating kosher are often considered passé, and prevent those who respect these rules from “benefiting from the good things in life”. Defying culinary proscriptions and eating pork, frogs’ legs or seafood is considered being “young and with it”. It is superfluous to raise sexual issues: the opinion of those who do not know is already made up, since in this field as in others that determine our way of life, Judaism can only offer a list of don’ts. In fact, it is exactly the opposite! Judaism is at the cutting edge of modernity and offers a range of unprecedented responses, where morality, hygiene, religious ethics and Jewish law (halacha) come together. It certainly does not promote promiscuity or sexual deviation, but offers comfort to people faced with problems of infertility or sexual dysfunction, whether physical or psychological.
In the Bible and the Talmud, these issues are addressed in a direct and open manner. In the Treatise Chagigah (2a), where the people who should attend at the Temple are listed, there is also a list of those excluded: the deaf, the retarded, minors, people of indeterminate sex, hermaphrodites and others.
In order to discuss the place of these questions in Judaism and the answers it provides our society that considers itself so advanced, we met with Rabbi Dr MORDECHAI HALPERIN, a specialist in male and female infertility and of sexual dysfunction among men and women. Dr Halperin obtained rabbinic ordination at the famous Ponevesz Yeshivah in 1966 (after seven years of studies), his B.Sc. in Mathematics and Physics from the Hebrew University in Jerusalem in 1974, and his degree in medicine from that university and from the Medical School of Hadassah Hospital. Today, Dr Halperin is the Chief Officer of Medical Ethics at the Israeli Ministry of Health and a member of the Bio-Ethical Committee of the Israel Academy of Sciences and Humanities. Apart from his medical work, Dr Halperin runs the “Dr Falk Schlesinger Institute of Medical-Halachic Research” at Shaarei Tzedek Hospital in Jerusalem.
Your specialization, which is a very big area, touches the most intimate and deepest aspects of each of your patients. Since we do not intend to publish an encyclopedia on the subject, we will have to limit ourselves to a few elements of your work, of which the most important appears to be infertility. What are the main reasons for this disability?
There are four categories of infertility, three apply equally to men and women, and the fourth affects women only. The first three types are: the absence or dysfunction of the fertility cells (the sperm or the oocytes); dysfunction, absence or under-development of various organs that can cause anatomical or physiological transportation problems; and dysfunction of the sexual organs, the most common being problems of erection and non-ejaculation in men, and vaginismus in women, (a painful, instinctive contraction of the vaginal muscles preventing sexual intercourse). You should know that this is a very serious problem that leads to unconsummated marriages: in many cases, couples have lived together traumatically all their lives, just to keep up appearances. Many types of surgical interventions have been tried without success, but about fifteen years ago, an Israeli doctor from Tiberias, Dr Uri Levi, discovered a simple stimulation technique for a hidden reflex, that has to be activated by a medical procedure. Here is an easy solution to solve an ancient and unsolved problem. The fourth source of infertility, particular to women, is the absence of a uterus or the fact that, for medical reasons, it does not function.
How are these infertility questions perceived and approached by your patients, both the religious and non-religious?
I have patients from all groups, and they do not come to me for religious questions, but because they have a physical problem. It is true that in religious circles a lot of the information is passed on by rabbis, for whom we organize seminars. Incidentally, this was already the case at the time of the Talmud. We learn, for example, that Rabbi Yochanan suffered from a gastro-intestinal complaint, which was treated by Roman doctor in Tiberias. He did not just treat him, he also explained the method of treatment he was using. The following Shabbat, Rabbi Yochanan passed on his newly acquired knowledge to his students and to the members of his community. This teaches us that Jewish spiritual leaders did not only feel responsible for the spiritual well being of their flock but also for their health. Nowadays, many rabbis inform their religious audience of new medical techniques well before this type of information reaches the general public. In this regard, it is interesting to note that last May we organized a 32-hour seminar for young rabbis from the ultra-orthodox community in Israel, on the subject, “Medical information on infertility and the serious problems it poses for family life, particularly sexual dysfunction”. Leading doctors gave lectures on medical, physiological and clinical issues, as well as on halachic issues that arose. One of the aspects dealt with touched on the halachic implications that could result from family problems not being addressed or treated. By the end of the seminar, these rabbis were able to provide medical-halachic answers at first hand to the problems posed within their communities.
What you have said so far applies mainly to general medicine practiced the world over. However, you run an institute whose specialty is to synchronize the medical profession with the spirit of the Torah. How do halachic questions find their place in questions about sexual dysfunction and infertility?
In order to illustrate what I have to say, I will give you a concrete example that we were faced with and which raised many ethical issues. A few years ago, the manager of an Israeli bank telephoned me to say that his daughter wanted to marry the young man she loved, but that the boy had several medical problems. He wanted me to examine the young man to know whether or not they would be able to have children. If my answer was negative, the father insisted that his daughter marry someone else. I received the young man, who at first glance appeared quite normal. On closer examination, I realized that this look of normalcy was only because he had taken hormones. But he had a physical defect: his testicles were not developed and were the size of those of an eight-year-old boy. This meant that the testicles did not produce sperm. This was a well-known medical syndrome, hypogonadism, which we do not need to elaborate on here. I was able to treat the young man, and after eight months of marriage the wife became pregnant. This type of situation involves a large number of ethical and moral questions: can one recommend the marriage when it was not absolutely certain that the treatment would work (even though I estimated a 90% chance of success)? Could one use public funds from the national health insurance system for this type of treatment?
Even if the treatment was successful, could one know whether or not the problem was genetic and therefore transmittable? It is this type of ethical question that we have to answer to our own conscience, in accordance with halachic rules. The question of genetic transmission, a problem inherent to our age, well illustrates how in Judaism we find answers to burning questions of the day.
In the same spirit one could ask the question, can one use Viagra?
One of the main obligations of a husband is to provide pleasure and satisfaction to his partner. The Talmud (Treatise Shabbat 152) talks about erectile dysfunction, which it describes as “the organ which brings peace to the household is not functioning.” We regularly treat people suffering from impotence, entirely in compliance with halacha.
What are the biggest halachic problems of our times that you are faced with in your field?
There are many questions, which can occasionally take surprising turns. I was recently asked if one is permitted to take Viagra on Shabbat. In truth, this is not a medicine for illness. For many reasons that are too long to detail here, the answer is yes. But first and foremost we are faced by questions of infertility, which are extremely complex both in their immediate application and the consequences that may entail. We are often asked if using a donor’s sperm is permitted, if the transfer of oocytes is allowed, and similar questions. On this it is interesting to note that there is a fundamental difference between Jewish and continental civil law concerning the definition of the family. In civil law, the family is a legal issue, so there can be an illegitimate child. By the family being a legal concept, it makes adoption much easier, since it is sufficient to undo one legal connection in order to create a new one. However, in Jewish law, the concept of family is not legal but biological. A child who is born outside of marriage is not illegitimate, because it is the biological child of its father. Thus an illegitimate child does not exist. There is certainly a “Mamzer”, who is a type of bastard resulting from an adulterous relationship, but who has nothing to do with an illegitimate child as understood in civil law. According to Jewish law, the father provides the sperm and it is forbidden to create children from an unknown father. Despite this, in Israel there is still anonymity of the sperm donor, whereas in Great Britain a new law authorizes waiving it. The sociological father can adapt the child, but, according to halacha, the biological father retains his paternal status.
The whole issue of the mother’s status is much more complicated. Today, in vitro fertilization has become more accessible, and childbearing can be divided between two women, who share the two functions of oocyte and uterus, the one being genetic, the other physiological. As a result, determining the mother’s identity is no longer obvious. One of the consequences of a question that could occur, is whether a child born from such a conception may marry the son or daughter of his genetic or physiological mother, without being guilty of incest. This issue also affects the problems associated with a surrogate mother (which, on a case by case basis and after very careful examination by a specialist committee, can be authorized in Israel). The question is even more complicated in the Diaspora, where it is possible that the oocyte is from a non-Jewish mother, and where the determination of the mother’s identity will define whether or not the child is Jewish.
In your institute, do you also treat Arabs? Is the question whether one must treat the infertility of an Arab woman who potentially may give birth to someone who tomorrow will kill Jews?
According to Jewish law, every human being must be treated. In this connection, desecrating the Shabbat to save a life is obligatory. In emergency cases, care comes first, even if post facto it appears the treatment had not really been truly urgent, and that in fact it could have been deferred by a day or a week. In Jewish law there is no distinction between a Jew and a non-Jew, and in medicine any sort of discrimination is strictly forbidden. Incidentally, in Israel the Arab population receives many more organs that it donates. Anyone requiring a transplant gets one, as long as the organ needed is compatible and available. There is no calculation or correlation between the number of organs donated by a minority and the person who needs one. The country that makes that sort of calculation has a severe moral problem.
In conclusion, do you believe today we are witnessing in orthodox circles a new openness and awareness, where previously mention of sexual questions had the reputation of being taboo?
These questions have always existed in these circles. It is true that today rabbis are more alert, and they want to pass on correct, up-to-date medical information. We have more and more questions to which we answer to the best of our knowledge. We publish an international magazine, “Assia – Journal of Jewish Medical Ethics and Halacha”, we have a useful website [www.medethics.org.il] and a much used information line. When a medical procedure poses a moral or religious question that appears to contravene Jewish law, it is very important to have access to reliable information. We offer an international information service and supply answers worldwide. We also get many general and theoretical questions, but it is not rare to be asked about specific cases and technical or legal problems that are often complex. One of our Doctor/Rabbis makes every effort to answer as quickly as possible.