Abortion

Dear Dr Halperin,

I am writing to you with a heavy heart with a question I was hoping you could consult Rabbi Waldenberg about.

Abortion in New York will only be legal for another 2 weeks so I need an answer quickly. My doctor told me waiting to do the procedure will increase my chances of complications.

I am 21 weeks pregnant. At 32 years old, I have had 4 unsuccessful artificial insemination attempts and finally became pregnant through in vitro fertilization. I have been manic depressive since age 17. A fetal anatomy sonogram this past week revealed enlarged ventricles in the brain (mild plus), I was warned about the possibility of hydrocephalus developing. A fetal echocardiogram done the same day revealed two leaks in the tricuspid valve. One leak in the center of the valve where where the flaps meet and the other in the septal flap where the examining physician suspected a cleft in the flap. In addition there is one confirmed ventral septal defect which may resolve itself over time or could require surgery at age 3 to plug the hole. There is also a possible second VSD closer to the tricuspid valve. This 2nd VSD could only be confirmed with later examinations.

Knowing about the Down Syndrome began when my OBGYN ordered a nuchal translucency test (it was not presented as optional). The result said I had a chance of 1 in 76 of having a baby with Down's. I later took a quad screen blood test hoping for better numbers and to prove the orginal test wrong. The result was worse

– a 1 in 21 chance of Down's. At 19 weeks with the guidance of our Rabbi we decided it would be too stressful to not know and had an amniocentesis that confirmed beyond doubt that the fetus has trisomy 21.

90% of people with or without psychiatric diagnosis chose to abort such pregnancies when Down's is confirmed because of the guaranteed challenge of mental retardation and the high probability of numerous associated health issues many of which can be life threatening.

I have a history of Bipolar disorder which includes lifelong medication, hospitalization and suicidal gesturing. This began at age seventeen with my first episode and I have diminished capacity for dealing with the extra stress of a Down's child.

I have been on Lithium since I was diagnosed, my

psychiatric history until 2002 is attached. Since

that time I have consulted with world experts who supervised an experiment, by my request, to take me off lithium to prepare for pregnancy. I did not want to take it during pregnancy. Despite intensive therapy at the time, I became symptomatic and had to be hospitalized, which is how we concluded I would need to take lithium throught pregnancy despite the dangers to the fetus. These include possible heart defects (Ebstein's anomaly – not seen in the recent

echocardigram) requiring surgery and hypotonia at birth. The medication did not cause the Down Syndrome.

Before the IVF, my genetic testing for the Jewish panel of diseases was negative. It took me years to find a husband willing to be in my life despite my illness and the potential for episodes that disable me from functioning in my family and outside the home.

The average Down's child has an IQ of 30-70. I cannot guarantee what degree of retardation or health problems the child will have or if it would be enough to give me an episode. I do know increasing stress is always a threat to my health. The stress will undoubtedly increase exponentially as the child ages and falls further and further behind in developmental milestones. There is also a greater liklihood for the child that it would die early on. This is devastating for any parent, I already struggle with mental illness, it scares me to think what the consequences of that experience would be for me. My husband has demonstrated willingness and ability to care for me and my illness. If he had to care for a bipolar episode and Down's syndrome simultaneously, he is certain he would be overwhelmed. In that instance, both me and the child would not have many of our acute needs met.

My Rabbi at the Young Israel is a good man and we went to him with this situation. He is trying to research and bring this question to Rav Waldenberg as well but in the busy Yom Tov season I fear he will not have time to get me the answer I need in time.

In summary, my husband is sad but wants to abort the pregnancy. I intellectually know this painful path is the lesser of two evils. Lesser stressors have resulted in hospitalization for me. Noone can guarantee a bipolar episode, but the extraordinary stress of being a Down's parent poses an undeniable threat.

Please tell me if halacha could allow abortion as an option under my circumstances.

Thank you,

העתק קובץ מצורף:

S. SHALOM FEINBERG, M.D.

104-20 QUEENS BOULEVARD

SUITE 1J

FOREST HILLS, N.Y. 11375

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(718) 275-2688