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מכון שלזינגר לחקר הרפואה על פי ההלכה

תגובה לשו"ת מס' 3587

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23 באוקטובר 2018

הרב המשיב: הרב ד"ר מרדכי הלפרין

שאלה:

Shalom,

in reply to your question (3540 , 3587), please read the objections in the attached .pdf file in English.

If for some reason you cannot open this file, please let me know.

I await your pertinent and credible answer – IN ENGLISH, PLEASE.

With best regards,


Shalom,

Recently, during a Shiur I attended at the Geneva Chabad center, the main Rabbi

mentioned a Talmudic ruling that it is permitted to pray for a son during the first 40 days of pregnancy but not thereafter.

I objected that the Talmudic Rabbis were mistaken, according to modern science, because it is now known that the sex of a child is genetically determined at conception. If the sex chromosomes in the first cell are XX the baby will be female, and if they are XY the baby will be male. This is the genetics of the first cell, which is reproduced thereafter in all cells.

The Rabbis could not know this, since genes were not discovered till the 19th Century, and fully understood till the 20th Century. There is no shame in ignorance or error, but of course to suppose that the Rabbis are not omniscient or infallible is contrary to Jewish dogma and very subversive.

Note that there is no “40 days” involved – nor less than 40 days, nor more than 40 days. If the Rabbis mentioned 40 days, it is possibly due to their observations of voluntary or involuntary abortions; they must have noticed that prior to about 40 days, the embryo is not morphologically sexually differentiated, whereas after that period (actually, many days later) sexual characters visible to the naked eye begin to appear.

A young Rabbi wrote this objection to you, and asked you for a rebuttal. You replied that the Rabbis had in mind the problem of “testicular feminization”. According to your reply, this allows for the possibility of a male fetus that would have abnormally taken on female characteristics to return to a normal male development in the first 40 days, thanks to ardent prayer.

However, this answer is logically absurd on several counts. First, it is scientifically unsound, in that the underlying problem here is not merely hormonal, but due to a genetic disorder, and this is inevitably operative since the first day (here again there is no justification for mention of 40 days, note). More on the scientific issues further down.

But secondly, it is dialectically inadequate, for if the Rabbis did not know about enetics, they could not know about a discrepancy between an embryo’s or fetus’ genotype (XY genetic makeup) and its phenotype (a female sex organ). To them, the fetus’ gender was simply identical with the physically visible character. They had no way to identify the genetic sexuality of a fetus or born child by medical tests.

If now you try to tell me that the Rabbis did know, by some sort of prophetic vision, about testicular feminization and about the genetic sexual status of actual individuals, I ask you to tell me where they mention it explicitly (do not confuse this issue with that of hermaphrodites, though – they knew about this disorder because it is visible to the naked eye).

Clearly, if they had known about testicular feminization, they would have iscussed this halakhically extremely important question in detail. By the way, the incidence of this disease is estimated at about 1 in 20,000 (according to some; others say much less); it is rare, but enough to be significant.

Is the child with such a disease (effectively, a malformation) to be regarded as a boy or a girl? If we go by the genetic makeup, it is a boy, and therefore he should be forbidden to have sex with or marry other boys (to avoid homosexuality) and he should do his bar mitzvah, etc. If we go by the physical appearance (sex organ), it is a girl, even though she cannot reproduce, and she is exempt from male mitzvas.

In view of the dangerous ambiguities involved, they would doubtless have dealt with these important issues directly (not just with reference to hermaphrodites, to repeat). To my knowledge, they never did, which proves that they did not know about testicular feminization.

Your reply was thus not a valid answer to the question posed. I suspect your reply was only intended as a smoke screen or manipulation; i.e. you pretended to reply, hoping your word would naively not be questioned further.

So much for the dialectics. Now to return to the scientific, factual issues. If you type “testicular feminization” in your Google search bar, you will find many sites that tell you about it. I recommend you to study at least the following page:

http://en.wikipedia.org/wiki/Androgen_insensitivity_syndrome#4._Infertile_male_syndro

me This page contains an instructive diagram of the genetic disorder. As you can see, a mutant gene (hereditary from the mother’s side) causes normal androgen hormone reception to be blocked. As a result, male sexual characteristics are inhibited from developing normally. This mutant gene is found supposedly in all cells of the organism, since all cells contain the X chromosome where this gene is imbedded.

Much more is involved. But my conclusion is simply that no amount of prayer in he first 40 days (or less, or more) can change that condition, since it is genetic and therefore pervasive from conception onwards. One can suppose that genetic medicine will one day prevent this disease perhaps by some genetic manipulation in vitro on the first cell – but once the embryo/fetus/baby is allowed to develop, there is nothing to be done about it. Do correct me if you think me wrong; I have an open mind.

Moreover, note, I wonder why you only mentioned testicular feminization. There are other “intersex” syndromes. Notably, a female genotype may develop as a male phenotype. So if people pray that their genetically male child does not turn out looking like a female, they should also pray that their genetically female child does not turn out looking like a male. For in either case, serious halakhic complications ensue. Nowadays, it seems to me, genetic males who develop abnormally as apparent females ought to undergo masculinization therapy or sex change towards male features. Similarly, female genotypes with male phenotype might legitimately be treated or operated on (femininization). This would be a practical solution to the halakhic difficulties. But I am no expert or authority, of course.

With regard to the issue of 40 days, if you type “fetal development” in your Google

search bar, you can learn a lot about that subject. See for instance:http://en.wikipedia.org/wiki/Fetal_development

According to my reading of these sources, sexual characteristics begin to be visible well

after 40 days – some seem to suggest after the 8th, 9th or even 10th week of prenatal

development. In that case, where did the Rabbis get the 40 days (6 weeks) figure, I wonder? Do tell me if you know.

Note in passing that I have nothing against prayer. The issue about prayer only rises because of the Rabbinic principle that you should not pray in the case of a known fait accompli. But the truth is, we could always pray in the way of a conditional statement rather than a categorical one. Instead of saying “please give me a boy” just say “if the matter is not settled, please give me a boy”. In that case there is no danger of a prayer in vain.

The truth is, people always pray when they do not personally know whether the facts of the matter are settled or not. If they know the case is closed, they won’t bother praying anyway. Prayer surely cannot be characterized as “in vain” when one does not know it is in vain; otherwise, one would almost never pray, fearing to pray in vain. So this aspect of the discussion seems to me much ado about nothing – just pilpul.

I await your pertinent and credible replies to all the above objections.

With best regards,

A.S, Ph.D.

תשובה:

It seems to me that some of translation difficulties are at the root of our misunderstanding (as my original Responsa on the subject were in Hebrew). I shall therefore start with some clarifications:

1. I have no qualms to withdraw when I make a mistake. As a human being that is not so rare.

2. In my responsum I never stated that the rabbis knew modern genetics fifteen hundred years ago. I only wrote that the Babylonian Talmudic conclusion may be in accordance with some genetic phenomena known today, such as Testicular Feminization or Swyer syndrome.

3. In my last responsum to your young Rabbi I asked for a reference to show that the defect discussed exhibits a full or at least very high penetrance.

"Penetrance is a term used in genetics that describes the extent to which the properties controlled by a gene, its phenotype, will be expressed."

This is the definition given in wikipedia – not the fully reliable source needed, but enough for this correspondence. Later on the article asserts that:

" However, relatively few of the genes in the genome show high penetrance. Most genes make their little contribution to a very complex milieu of biological interactions, to which many other genes are also contributing.

As a result, most genes and their effects and mechanisms of action are very difficult to fully understand, because the required observations and experiments are complex and difficult to devise. Even if such observations and experiments were conducted, however, some theorists would still hold that because all traits are influenced by non-genetic factors as well as by genetic factors, no trait can be determined strictly by genes."

4. Therefore, if you can supply a confirmed evidence that both syndromes (Testicular Feminization & Swyer syndrome) are determined solely genetically with no environmental component, I shall have to withdraw my suggested statement, and I shall do it without any hesitation..

Otherwise, there is merit for prayer before some unknown environmental component may cause a significant effect, and my early reply is a valid one, as a different conclusion has no scientific backup.

5. According to Halachah, the sex of a newborn is determined by its phenotype.

So with both syndromes, the baby is considered fully female in Halachahic terms.

6. If you are interested in the Halachik considerations employed in dealing with severe ambiguous genitalia, please see Prof. Steinberg's Encyclopedia of Jewish Medical Ethics (English version- Feldheim Publishers., 2003), Vol I pp. 50-54

I would be glad to hear from you again on this and other subjects.

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