Bioethics Glossary in vitro fertilisation A method of assisted reproduction that involves collection of ova (female eggs) and sperm, which are then fertilised in the lab, before implantation in the mother to be s uterus. foetus A baby in the womb. In medical terms, the human foetal period is from eight weeks until the baby is born. embryo In humans, the embryo is the organism developing in the uterus between the second and the eighth week after fertilisation. genetic screening testing groups of people to check for potential hereditary disorders. stem cell research utilising undifferentiated primitive cells that have the potential to grow into a range of different cells. Stem research is seeking to find cures for a broad range of human disorders. cloning The process of making genetically identical copies of organisms. pre natal screening Medical techniques of examining the foetus in the womb to detect potential abnormalities. pre implantation screening In in vitro fertilisation assisted reproduction, the screening of embryos for genetic defects prior to the implantation. gene therapy Medical treatment that seeks to correct genetic defects or diseases by replacing dysfunctional or missing genes with functioning ones. Therapeutic cloning Cloning of a person to the five day embryo stage only. At this point, the stem cells are removed from the embryo (which is thus destroyed), for use in stem cell treatments. This technology is currently at the research stage. Adult cloning The cloning of a person with the intention of reproducing a person with the same DNA as the donor of the original genetic material. Adult cloning is currently not being actively pursued by any reputable medical team worldwide.] Bioethics is a science that sets a system of medical and environmental priorities for acceptable survival. In practical terms, it is a branch of ethics A.J. Taylor 2004 Page 1
concerned with issues surrounding health care and the biological sciences. Such issues include the morality of abortion, euthanasia, in vitro fertilisation and organ transplantation. As suggested by the definition of bioethics above, there tends to be a spectrum of opinion about what is acceptable in bioethics, rather than a single, definitive answer. This is especially true of Judaism, a tradition that encourages, through its rabbinical teachers, interpretation of new life situations in the light of the halachah. As a living religion, Judaism will continue to dialogue with and respond to the moral dilemmas posed by advanced in science and technology. Jewish opinion can occupy the full spectrum. The mitzvah to procreate is strong in Judaism, and this would encourage support for the new technologies that allow married Jews who previously may not have been able to conceive children to have them. On the other hand, Judaism is inherently conservative: there is a Godgiven Law and it may not be right for people to have their every desire, as is seen above in Jewish sexual ethics. The slippery slope argument is sometimes employed in the discussion of ethics in Judaism. Some conservative authorities seek to build a fence around the Law, to avoid the slippery slope not permitting some behaviours which are not strictly forbidden according to the halachah, but which, if allowed, may lead to other prohibited behaviours. Generally speaking, Jewish bioethics operates within the tension created between the opposite ends of this spectrum. The appropriateness of any of the new technologies is considered on the merits of the individual case, dependent upon the motives of those using it and the insights gained by a reading of the halachah. A.J. Taylor 2004 Page 2
C Birth control and abortion As was noted in the previous section, Jews are required to be fruitful and multiply. Having children is therefore a mitzvah. There may be reasons for conception to be avoided, but it is also one s responsibility to participate in marital relations. For this reason, some birth control methods are not allowed in Judaism. Rabbinical opinion has generally approved only the use of female contraceptive devices, such as the diaphragm and the contraceptive pill. The reason is that as long as the male is attempting procreation with each act of sexual intercourse, the commandment to be fruitful and multiply is fulfilled. Jewish views on abortion do not fit neatly into the pro choice or antiabortion camps. Generally, it is the life of the mother that is seen as paramount. In the Talmud, the foetus is not considered a person until the time of the birth. At the same time, Jewish commentators realise the potential human being status of the foetus. Abortion presents Judaism with a moral dilemma. In the first forty day of the existence of the embryo, it is considered by the Talmudic authorities to be merely water and thus abortion, given the right motivations, is acceptable. The question remains whether, in any particular case, the human potentiality of the foetus becomes so compelling a factor as to make abortion morally unjustifiable. An equally important question is whether the life or health (including mental health) of the mother becomes so threatened as to morally justify abortion. Traditional Judaism has had a strong anti abortion message in Israel in recent years through the work of Efrat The International Organization for Saving Jewish Babies. Efrat also has offices in the largest Jewish community in the world, the US. A.J. Taylor 2004 Page 3
C Reproductive technologies Reproductive technologies such as in vitro fertilization, genetic screening, stem cell research and cloning are relatively new and as such, the responsa to them are still emerging. In vitro fertilization has majority approval among Jewish ethicists. Whatever other concerns might exist are outweighed by the greater mitzvot of being fruitful. As mentioned above, the embryo in the first forty days does not have strong status in the halachah. The same thinking applies to concerns about embryos that are fertilized for the purposes of in vitro fertilization treatments but never implanted. That is not to say that Jewish ethicists trivialise the status of the embryo. Always, the expectation with in vitro fertilization and other reproductive technologies is that it is being done within the context of marriage and with the intention of bearing children to loving parent(s). Genetic screening is general strongly supported by most authorities in Judaism. Tay Sachs disease, an affliction that causes death in early childhood, is confined mostly to Jews of Eastern European descent. Genetic screening for Tay Sachs disease has been highly successful in Israel, resulting in dramatic reductions in the number of children born with the disease. A significant part of the success of this program has been attributed to the support given to it by rabbis in their religious communities. The screening has raised the ethical question, though, of how far screening should go. Genetic screening is seen as preferable to pre natal screening, which would suggest the possibility of abortion. A technology for dealing with Tay Sachs disease that is in between genetic screening and pre natal screening is pre implantation screening. This A.J. Taylor 2004 Page 4
where in vitro fertilisation type techniques are used to separate out affected embryos and only implant healthy ones in the mother s uterus. Current Jewish ethical thinking sees this as less than ideal, but more acceptable than pre natal screening. Research Using the BBC Religion and Ethics: Ethics website, [http://www.bbc.co.uk/religion/ethics/index.shtml] compare and contrast non Jewish bioethical perspectives with those of Judaism that you have studied in this chapter.] C Stem cell research, gene therapy and genetic engineering Stem cell research that is derived from adult tissue does not present major ethical difficulties for Judaism. Among the greatest of the mitzvot is to save a human life. Stem cell research shows the potential to regrow human tissue and cure presently incurable human conditions. A.J. Taylor 2004 Page 5
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Diagram illustrating how stem cells can be harvested and used. This type of research is well advanced. There is less clarity about the acceptability of foetal stem cell research (although it still has considerable acceptance). To some, the embryo is not a human person, and the research is contributing to saving human lives, therefore the research is acceptable. To others, the issue is that some foetal stem cells may be derived from (prohibited) aborted foetuses, and thus the research is not acceptable. A major source of foetal stem cells is, in fact, embryos left over from in vitro fertilisations. Feature Box Cloned human embryos are stem cell breakthrough Scientists have demonstrated for the first time that therapeutic cloning in humans can be achieved. The researchers in South Korea created 30 cloned embryos that grew to about 100 cells in size further than any verified experiment so far. This meant they were able to harvest embryonic stem cells [ESC] from one of the embryos. They further showed that the ESCs could develop into a variety of tissue types. Their long term hope is that such a procedure would provide a source of perfectly matched transplant tissue for the treatment of diseases such as diabetes and Parkinson's All the experts contacted by New Scientist agreed, praising the experiments as remarkable. Cloning in primates has been regarded as especially challenging and perhaps even impossible. A.J. Taylor 2004 Page 7
Sylvia Pagán Westphal From New Scientist Online News 12 February 04.] Gene therapy is acceptable in the Jewish tradition for similar reasons to those outlined for stem cell research; that is, the potential to save human lives is great, and the embryo does not have the status of human person. Judaism is quite clear that gene therapy can and should be used in the investigation of a cure for diseases such as Tay Sachs disease. It is equally cautious about the slippery slope of genetic engineering the potential use of these techniques to do things other than save human lives, for example, to choose for or manipulate height, intelligence, eye colour etc. Did You Know? Gene Therapy: how do the doctors get the new genes into defective cells? They use carrier viruses. Viruses have the special ability to penetrate cell walls.] C Cloning In keeping with the principles that underpin the Jewish ethical approach to contraception, abortion, reproductive and gene technologies, there is no halachic principle that opposes cloning. Therapeutic cloning thus has broad support. Adult cloning is more problematic. Adult cloning is potentially of use to couples who wish to have a child where the father, perhaps through some tragic accident, has no sperm at all. In this case, cloning would involve, in the lab, removing the DNA from the mother s embryo and replacing it with DNA from samples taken from the father. Then using in vitro fertilisation, the embryo would be implanted in the mother s uterus and the child would develop and be born normally. The child would be a copy of the father, A.J. Taylor 2004 Page 8
although not an exact copy, because a small amount of genetic material is contained in the mother s empty egg shell (see diagram below). In genetic term, the clone is closest to (although not exactly) an identical twin of the father, albeit many years younger. The halachah, which operates on the human rather than micro scientific level, would consider the child the son of the father and the mother. Research Search How Stuff Works [http://www.howstuffworks.com/] to gain a better understanding of how biomedical techniques work and some of the implications of them. Key terms to search are cloning, stem cells, genetic engineering and designer children. These techniques are possible but not yet practised in the medical world due to ethical considerations; the odds of success are extremely low and the possibility of things going wrong extremely high and horrible to contemplate. The possibilities are so new that there are very few responsa to deal with them. In principle, the halachah is ethically neutral to the kind of (successful) cloning described above, but concern for the slippery slope that the potential copying of another human person creates, however, has caused great caution against adult cloning. Considering the issue here is interesting, though, because it points out the Jewish ethical approach of openness to new possibilities and dealing with situations on a case by case basis. A.J. Taylor 2004 Page 9
One potential use of adult cloning for profoundly infertile couples that might be acceptable according to the halachah. Note that human adult cloning is not yet possible and is banned by some countries. Efforts at the United Nations level to ban it worldwide have failed. Activities 1 Identify the foundation beliefs and documents that underpin Jewish ethics. A.J. Taylor 2004 Page 10
2 Clarify the principal ethical teachings in Judaism which determine sexual ethics. 3 Classify the various bioethical technologies referred to in this chapter. Give a brief description of each and make connections between them where appropriate 4 Assess one of the arguments offered in this chapter in favour of the use of a particular bioethical technology. 5 Discuss the Jewish ethical perspective(s) on the use of reproductive technologies 6 Identify a genetic dysfunction or disease of particular interest to the Jewish population and synthesise the Jewish ethical issues that arise from the application of biomedical techniques to address it.] A.J. Taylor 2004 Page 11