Termination of Pregnancy and Neonatal Treatment – Synopsis of the Responsa
Rabbi Simcha Hakohen Kook
Chief Rabbi of Rehovot
Termination of Pregnancy and Neonatal Treatment –
Synopsis of the Responsa
The Prohibition Against Killing a Fetus
The verse “One who spills human blood, by a human being shall his blood be spilt (Genesis 9:6)” is understood by the rabbis as meaning “One who spills the blood of a human being within a human being, his blood shall be spilt.”
“A human being within a human being“ is interpreted as a fetus in its mother's womb (Talmud Sanhedrin 57b).
Does the Need to Save a Fetus Override the Sabbath?
The Early Authorities (Rishonim) disagreed as to whether saving the life of a fetus overrides Torah prohibitions. The decision in halacha is that one may override the laws of Shabbat to save the life of a fetus from the beginning of pregnancy. It follows that if there is any doubt about the status of a fetus, we must act to save its life.
Sources: Nishmat Avraham Vol. 1 (Orach Chayyim) 328:6 and other sources cited there.
Sacrificing One's Life to Save a Fetus
A person is required to sacrifice his life to prevent someone else from being murdered. If he is threatened with death unless he kills someone else, he must sacrifice his own life.
However, if the ultimatum does not demand that he kills another living person but a fetus, he is not required to sacrifice his life to save the fetus, and in such circumstances he may terminate the pregnancy.
Sources: Talmud Pesachim 25b; Minchat Chinnuch 296:24.
Abortion to Save the Mother's Life
Where the fetus threatens the life of the mother it may be killed before birth in order to save the mother's life.
Sources: Mishnah Ohalot 7:6
A Fetus that Endangers Its Mother's Mental Health
If a woman is mentally ill, and the illness is likely to worsen as a result of continued pregnancy, the pregnancy may be terminated if her mental deterioration is likely to threaten her life. Permission for abortion does not require a certainty that continued pregnancy will endanger her life. It is sufficient for the doctor to fear a possibility. In other words, if there is a reasonable supposition that continued pregnancy might increase the danger to her life, the pregnancy may be terminated.
Sources: Talmud Yoma 85b, also 85a (Tosefot).
Danger to the Health of the Fetus
The halachic authorities disagree as to whether a threat to the health of the fetus justifies an abortion. For example, rubella in pregnancy can adversely affect the fetus, the degree and type of danger depending on the stage of pregnancy at the time of infection. In the sources mentioned below there are detailed discussions of different authorities and further examples. In practice, wherever abortion is under consideration on account of danger to the health of the fetus, a halachic expert should be consulted.
When considering whether to do amniocentesis or chorionic villus sampling (C.V.S.), the danger of the test must be taken into account. These tests pose a serious danger to the fetus, which could result in harm and even death. The chance of a miscarriage caused by amniocentesis is one in three hundred, and by C.V.S. one in seventy.
Sources: Nishmat Avraham Vol. 3 Choshen Mishpat, 425:1:15-23.
A Fetus with Hydrocephalus
A fetus with hydrocephalus may necessitate a Cesarean operation, but the requirement for a Cesarean operation is not of itself sufficient to justify an abortion.
The damage of hydrocephalus to the fetus varies from case to case. Whether there can be cases where an abortion is justified is discussed in the sources quoted above.
Premature Births
A small baby born before the end of the sixth month of pregnancy with no chance of survival is regarded as if it were an aborted fetus.
The Sabbath laws are not overridden in order to prolong its “life,” and even on a weekday there is no obligation to prolong its short existence.
Until recently, this halacha was applied to small premature babies weighing 500-600 grams (1-1¼ lb.) born before the twenty-fourth week, i.e. before the end of the sixth month. However, Rabbi S. Wosner (in Shevet Halevi), Rabbi I. Weiss (in Minchat Yitzchak) and Rabbi G. Felder (in Yesodei Yeshurun) indicate that if incubators with intensive care can possibly save the lives of such small babies, they are no longer considered as aborted fetuses, and the Sabbath laws may be overridden to save their lives.
Rabbi S. Z. Auerbach issued a decision regarding tiny babies whose chances of survival are extremely small: initially only natural requirements such as oxygen, liquids and food should be supplied. At the same time their development should be watched, and only if there appears to be a chance of survival should they be considered as “alive” in all respects.
Sources: Shulchan Aruch, Orach Chayyim 330:7-8; Nishmat Avraham Vol.1 (Orach Chayyim) 328:6 and 330:19.
A Baby with a Hypoplastic Left Ventricle
A child with a hypoplastic left ventricle is in practice condemned to die within a few years. Today a complex operation may be performed in stages, with reasonable chances of life, but positive results have been obtained only at a limited number of medical centers in the world. The rabbis have been asked whether such a medical center should be established in Israel, bearing in mind the enormous cost, which would be at the expense of facilities to save the lives of other fetuses and babies with a better chance of survival. These rabbis consulted were not in favor of establishing such a center at the expense of saving other children, but recommended that a baby born with a hypoplastic heart should, if possible, be flown to an appropriate center overseas. Sources: “Considerations in Saving Human Lives” by Rabbi Isaac Silberstein (in Assia 55, Tevet 5755, pp. 43-56).
Conclusion
The principles raised in these responsa are to serve as a basis for halachic discussion and consideration, but in no way whatever are they to be regarded as obligatory halachic decisions. In practice a rabbinical expert should always be consulted.