International
Responsa Project
When a medical procedure raises
ethical, moral, or halachic questions, advice from a reliable source is needed.
The International Responsa Project provides this service to people all over the
world who send their questions – some general and theoretical, some specific
and technical – via e-mail (irp@medethics.org.il), website
(www.medethics.org.il), telephone, fax, and post. The questions are answered as
quickly as possible by one of the rabbi-doctors at the Institute. The
following are samples of recent questions and their answers. Please note that
these are answers to specific questions and no general halachic conclusions
should be drawn. A competent halachic authority should always be consulted.
Subject: reconstruction
(involving medical tatooing) after mastectomy
Answered by: Rabbi Mordechai Halperin, M.D.
I am a 46-year-old single (but looking) woman who had a mastectomy and
breast reconstruction after having been diagnosed with breast cancer a little less
than two years ago. The second stage of the reconstruction involves creating a
new nipple and then tattooing the skin around to match the areola of the other
breast using micropigmentation/medical tattooing. Is such a procedure
halachically permissible?
What are the halachic issues
involved? Is there a heter available for such a
procedure?
thank you very much
You are allowed to go through the tattoo procedure for the nipple
reconstruction.
See Nishmat Avraham, vol. II (Yoreh De'ah) 180:a3
(pp. 132-133) [Hebrew – new edition – 2007]; In the English translation of Nishmat Avraham (ArtScroll)
vol. 3, p. 302.
See also ASSIA vol.
87-88 pp. 35-42 (2010) For more references, please see ASSIA Book vol.
VII (Hebrew) pp. 273-303.
p. 13
International
Responsa Project
Subject:
Termination of Pregnancy
Date: January 2009
Answered by: Rabbi Mordechai Halperin, M.D.
Shalom rav,
I was just asked the following question, which I would like to present
to you. The lady who asked me is pregnant in the 9th week of
gestation. Two weeks ago, i.e. in the 7th week of gestation, an ultrasound
was performed. It demonstrated that the embryo has had a heartbeat and was
therefore viable. Now, two weeks later, a repeated ultrasound revealed absent
heartbeat. The gynaecologist declared that an intrauterine death of the embryo
has occurred and recommended the lady to let an abortion be performed:
1. Is it pertinent to rely on the opinion of only one gynaecologist
i.e., is there an obligation to consult another specialist?
2. Is the absent heartbeat a halachically sufficient proof of death of the
embryo? Or is only the case if proven on several occasions at different points
of time?
3. Should the death of the embryo be thereby proven, are there any halachically
specific features of such an abortion?
I would be very much obliged for an answer before Shabbos, since the
lady in question is under considerable emotional stress.
Thanks in advance / kol tuv
Shalom,
1. It is recommended to perform
another ultrasound elsewhere before reaching a decision.
2. If the lack of a pulse has
been confirmed in the second scan, taking into account the existence of a pulse
in the past – it is a conformation that the embryo expired around the 9th
week.
3. When a dead embryo is present in the womb, the main considerations
for its extraction are medical, not Halachic.
p. 39
International
Responsa Project
Subject:
Nurse Working on Shabbat
Answered by: Rabbi Meir Orlian
Hello
I am graduating from nursing school. I have received a job offer from
The Methodist Hospital in the Houston, Texas Medical Center.
I will be working as an RN on the cardiovascular intensive care unit. I have
run into a dilemma though. It is The Methodist Hospital Policy (and most) to
work weekends: Friday, Saturday, and Sunday. The rule is four weekend days out
of the month in this form: 1 Friday, 2 Saturdays, 1 Sunday. I asked the manager
of the unit during my interview if they allow people to work just Sundays and
she told me no. I have a friend that works for the same hospital and has been
turned down from jobs because she will not work Shabbat and Chagim.
She wrote the hospital saying it was discriminatory to not hire based on
religious practices and of course they told her that was not the reason for not
hiring her.
I would like to know if the halacha that allows doctors to work on
Shabbat and Chagim may also apply to nurses as well?
I'm very worried about this and have worked very hard to get this job. I have
spent a lot of time and money studying to be a nurse and there is no chance of
relocation. Especially because I am from Texas I cannot get around the system.
There are not enough Jews to make it a concern. Please let me know if you have
any advice and insight on this matter.
Thank you for your time,
sincerely,
Hello
We sympathize with your circumstances. The great halachic decisor of the previous generation, Rabbi Moshe Feinstein zt"l wrote about non-Shomer Shabbat
residencies that a person should take the residency that will afford him the
best training, even if less conducive to a Shabbat environment. However, he
stipulated that this is only if he can avoid violating Shabbat with work
unnecessary for the patient's real medical care (See Practical Medical
Halacha, Rabbi M.D. Tendler & Dr. Fred
Rosner, Raphael Society of the Association of Orthodox Jewish Scientists, p.
150, 1980&1998).
You need to check whether the nurses' responsibilities include work not
directly related to the patients' medical care, such as signing in/out, filling
out standard forms (e.g., insurance), cleaning the unit, etc. It seems that it
is unrealistic to be able to serve on Shabbat without having to do any such
work.
Furthermore, while in a cardiac intensive care unit all the patients
would be defined as life-threatened, in that hospital almost all will be
non-Jewish. When a doctor or nurse is already found in this situation, great
contemporary halachic authorities have ruled not to differentiate
nowadays between treating Jews and non-Jews (See Iggrot
Moshe, O.C. vol. IV #79 and Nishmat
Avraham 330:8). However, in regards to accepting such a position, see Lev
Avraham 13:147 citing Rabbi Sh.Z. Aurbach zt"l and Rabbis Y.S. Elyashiv
and Y.Y. Neuwirth shlita.
We understand that you have invested much time, money and effort in
earning your degree. However, this does not allow putting yourself in a
circumstance that will cause you to desecrate Shabbat in a prohibited manner. I
am sure that there are smaller, albeit less prestigious, hospitals and clinics
that would be happy to have you cover the Sunday slot on a regular basis. This
will allow you to heal and help lives while preserving the precious sanctity of
Shabbat.
With best wishes,
p. 42
International
Responsa Project
Subject: Ovum
Freezing
Answered by: Rabbi Meir Orlian
Dear IRP:
I am researching the issue of egg freezing for social purposes. I would
like to know what the halachic issues are, if any, for an unmarried woman who elects
to freeze her eggs. I understand that supervision (of the
lab) and procedure would be necessary, but are there any other issues or
concerns?
Thank you,
Shalom,
Additional issues of concern and discussion include:
1. The
general risk of any unnecessary invasive medical procedure and the accompanying
risk of sedation under anaesthesia. This is weighed based on the risk factors
and the potential benefits of the procedure.
2. It
was not clear in your question what you meant by "for social
purposes". If the purpose is to enable her to have children with her own
eggs more easily if she gets married late, there maternity is clear. However,
if the purpose of the eggs is to donate to others, there is a further question
of maternity, whether the mother would be determined by the egg donor or the
host mother. See:
·
http://www.jewishfertility.org/egg-donation.php
·
http://www.eggdonor.com/blog/2010/02/01/the-child-is-jewish-or-not-jewish-that-is-the-question-the-israeli-rabbis-just-answered-for-now/
3. The
standard technique of egg removal involves hormone treatments to release the
eggs and collecting them with the aid of a needle inserted through the vagina.
There is a newer technique that involves freezing ovarian tissue. This
introduces another potential issue of sirus,
the prohibition of maiming the reproductive organs. This might only be allowed
if there is a clear fertility concern for the women herself. See: article
(Hebrew) in Assia 81-82, pp. 62-63
(http://www.medethics.org.il/articles/ASSIA/ASSIA81-82/ASSIA81-82.04.asp#).
B'Hatzlacha,
p. 64
International
Responsa Project
Subject: Fertility
Answered by: Rabbi Meir Orlian
Is a woman allowed to put herself through surgery for the sake of her
husband's fulfilment of Pru Urvu?
Why?
What if she is single and
faces radiation/chemotherapy – is she allowed to undergo oocyte retrieval
procedures in order to freeze her eggs?
Shalom,
A woman is permitted to put herself through surgery for the sake of
having children with her husband if the risk is not high, for a number of
reasons: First, the woman also benefits from having children. Second,
although she does not have a formal obligation of Pru
Ur'vu, according to many authorities she is
included in the human responsibility to populate the world (shevet)
and fulfils a mitzvah by bearing children. (Tosfot
Gittin 41b s.v.
lo; Otzar Haposkim,
Even Ha'ezer 1:13:84) Thirdly, she has
a responsibility to enable her husband to fulfil mitzvot according to
her ability, certainly in the area of fertility.
If she is single and faces radiation/chemo, it is recommended that she
undergo oocyte retrieval to allow her to conceive with her own eggs.
All the best,