Genetic Screening and Judaism

Using modern medical technology a wide range of genetic maladies can be detected, but is that a good thing?

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The second method to prevent the birth of a Tay‑Sachs baby is to perform preimplantation screening of the in vitro fertilized zygotes if both husband and wife are known carriers and to only use the healthy ones for implantation. The discarding of the affected zygotes is not considered an abortion since the status of a fetus or a potential life in Judaism applies only to a fetus implanted and growing in the mother’s womb. This artificial method of conception is sanctioned by many rabbis for couples who cannot have a child in the normal way in order to enable them to have a child, albeit by assisted reproduction. The Jewish legal question of using artificial means of conception to screen potential fetuses for genetic diseases has yet to be ruled on decisively by modem rabbinic authorities. This seems to be an ethically acceptable option for couples where both husband and wife are carriers of a recessive genetic disease such as Tay‑Sachs or if one partner is a carrier of a dominant gene such as Huntington’s disease (an inherited degenerative disorder which affects both body and mind) or of a sex‑linked genetic disease such as hemophilia.

It is not clear whether Judaism sanctions genetic screening for diseases for which no effective treatment yet exists. Judaism is greatly concerned about the emotional burden (tiruf hadaat)that such knowledge may place upon a person found to have the gene for Huntington’s disease in the presymptomatic stage (symptoms most commonly appear between the ages of 35 and 50). Judaism would also not sanction the prenatal testing for Huntington’s disease if the only purpose is to abort the fetus if it is found to be affected. Preimplantation screening of Huntington’s disease and the choosing of only unaffected zygotes for implantation may be permissible to prevent the birth of an affected child as described above for the prevention of Tay‑Sachs disease. The same permissive view might apply to the prevention of hemophilia births by preimplantation screening.

Newborn screening for treatable diseases such as phenylketonuria and congenital hypothyroidism should certainly be done. Judaism subsumes such testing under the biblical and rabbinic mandates to patients to seek healing from the medical profession.

Judaism requires that confidentiality of test results for all types of genetic screening be maintained. The prohibitions in Judaism against talebearing (Leviticus 19:16) and evil gossip (Psalms 34:14) are discussed at length in the Talmud (Yoma 4b, Sanhedrin 31a) and in the codes of Jewish law such as Maimonides’ Mishneh Torah (Deot 7:2). An entire book was written on this subject by Rabbi Israel Meir Hakohen of Radin, popularly known as Chafetz Chayim. These prohibitions require that professional confidences between patient and physician be maintained. Whether the physician obtains such confidential information, genetic or otherwise, from the patient or from others, he is forbidden to disclose that information or share it with anyone including the patient’s family and even professional colleagues, if no benefit to the patient would result therefrom. However, if the maintenance of confidence might cause serious physical, financial, or emotional harm to another person, the latter may be informed. Thus, a person who is the carrier of a serious and potentially lethal genetic disorder is obligated to divulge that information to a prospective spouse.

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Dr. Fred Rosner

Dr. Fred Rosner is Director of the Department of Medicine of the Mount Sinai Services at the Queens Hospital Center and Professor of Medicine at New York's Mount Sinai School of Medicine. He is a diplomat of the American Board of Internal Medicine and a Fellow of the American College of Physicians.