News / Events

10th Annual Jerusalem Conference

Orthodox rabbis and physicians tend to be
suspicious of each other due to differences
about treating terminal patients, granting
approval for abortions, issues relating to lowerbrain
death and other sensitive questions that possibly
clash with halacha. Yet when leaders of the two
professions get together at the annual conference of
Jerusalem’s Puah Institute, the atmosphere is inevitably
cordial and respectful.
The 10th annual conference of the Puah Institute for
When religion and health meet,
answers may not be black and white
The annual Puah Institute conference continues to air the most intimate issues
from each perspective. Judy Siegel-Itzkovich reports (from the women’s section)

Fertility According to Halacha, held at the capital’s
Ulamei Nof with over 1,300 men and women strictly
separated by a cloth divider, always centers on subjects
related to reproductive health from the viewpoints of
medicine and Jewish law. It is always held during the
week before the reading of the weekly portion in Exodus
devoted to the story of the Hebrew midwives, Shiphrah
and Puah – who saved the male Hebrew babies from
Pharoah’s death sentence.
The 20-year-old non-profit organization founded and
headed by Rabbi Menachem Burstein originally focused
on helping infertile couples through the process of
building a family, has a staff of rabbis with expertise in
the field and women who carefully supervise in-vitro
fertilization to ensure that no mistakes are made. It
expanded its interests to training counselors for brides
and grooms, family purity experts, ritual bath attendants
and kashrut supervisors. Doctors, including totally
secular ones, are eager to be on good terms with Puah
(www.puahonline.org), as modern Orthodox and haredi
couples regard childbearing as an imperative. The
institute’s staff include 10 rabbis, and counseling sessions
are provided in Hebrew, English, French and Spanish.
Former Sephardi chief rabbi Eliyahu Bakshi-Doron said
he had much appreciation for ultrasound and other
advanced medical applications, “but as technology
advances, we have to be careful that knowhow does not
lead to dangers. God gave us the ability to know more,
but we mustn’t destroy the world with it. Just look at the
dangers of nuclear energy. Ultrasound has brought down
the abortion rate. The mortality rate of fetuses with
medical problems has also dropped, and many infertile
couples are helped to become parents. One can even
choose among embryos to see if they have diseases, or
choose a female for implantation if a male has
hemophilia,” the rabbi said.
But Bakshi-Doron added that the same technology
could theoretically be used to pick an embryo for blue
eyes and blond hair. “It’s a slippery slope.” He recalled
that during his Jerusalem childhood, his family had a
chicken coop. “The chickens lived their own lives,
moving around to find food. They had a social life, and
there was always a leader. Today, there is no such thing.
Twenty-thousand eggs are put in the incubator, and
20,000 chicks come out. The females don’t need a rooster.
They are all crowded into cramped cages, fed and
vaccinated. It is beneficial, because large numbers of
chickens and eggs are produced, but at the same time it
has made the short lives of chickens miserable.”
IVF, the rabbi said, can be a boon. It is expensive and
can pose risks now, but some day it will not be as
costly or dangerous. So one must be careful about
deciding what one should do, and not just whick
about what one can do. In Israel today, he concluded,
the Health Ministry can allow couples to choose the
sex of their child using pre-gestational diagnosis
(PGD) if they have at least four children of one
gender. “It is better to use IVF in an infertile couple
who want children, or in producing a healthy child
when there are genetic problems, but not for anything
else, for if we allow this, there will be no end to it.”
PROF. ARYE HARMAN, chairman of the Israel
Obstetrics/Gynecology Society and head of the
gynecology department at Assaf Harofeh Medical Center
in Tzrifin, enthused about new uses of ultrasound to help
produce a healthy newborn. Its most important function
during the first trimester, he said, is to allow the dating of
the fetus. “The older the fetus, the bigger the differences
according to age. Scans make it possible to know if it’s too
big or too small, if it’s in distress, is anemic or has a parvo
virus infection, if there are multiple fetuses, how to
deliver a baby and if there are two with only one placenta
or in one amniotic sac,” Harman said.
If the fetus has too little oxygen-rich blood, it can get an
infusion while in the womb, he explained. If there is
accumulated liquid near the liver or intestines, it could be
a serious but curable infection. A drain can be inserted
into the chest to allow lungs to survive. Harman recalled
a woman in her 32nd week of pregnancy whose fetus’s
chest had to be punctured just before a Cesarean birth so
he could be born with lungs that worked immediately. It
this had been done after delivery, he would have been
born in serious condition.
European doctors (but not yet Israelis) have treated in
utero fetuses with an abdominal hernia, which causes
the intestines to press on the heart and lungs. A
fetoscope is used to introduce a tiny balloon into its
mouth, inflate it and expand the lungs. “There is a good
chance that in such a case, the fetus will survive.” And
in a case of twins, if one fetus gets a strong flow of blood
at the expense of the other, causing premature delivery
and developmental problems, lasers can be used to
cauterize a blood vessel to stop this flow.
Harman showed images of a pregnant woman – the
daughter of an Assaf Harofeh doctor – carrying twins
whose umbilical cords were so tightly intertwined that
they would have been seriously defective due to lack of
oxygen. They fixed the situation in utero, and two
beautiful and healthy girls were born. “We fight for every
fetus and every child,” said Harman, as members of the
audience nodded. “There is no reason to abort a fetus
with a mild defect, especially if it can be fixed.”
DR. DAVID SORIANO, deputy director of gynecology at
Sheba Medical Center in Tel Hashomer, spoke about his
specialty – endometriosis, which is the subject of a
national center he opened in the hospital. He said this
“very common condition,” in which the reproductive
tract accumulates unnecessary tissue that causes
significant pain, especially during menstruation, can lead
to infertility. Untreated, the various abdominal organs
will eventually stick together, likely causing fertility
problems by damaging the ovaries. The woman’s
symptoms, aside from pain, include shortness of breath,
painful and urgent urination and elimination, short
menstrual cycles and long periods. It is the most
common reason for emergency visits in women under
25. “It is as if the body is screaming for help.”
Five to 10 percent of all women of fertile age have it,
along with one half of women who have strong
menstrual and pelvic pain. About 40% of sufferers will be
infertile. In families with a history of endometriosis, the
rate is seven times higher. Too often, when symptoms
first appear in teenage girls, they are given painkillers and
told it will resolve itself, but Soriano urged that any such
symptoms be checked early on.
Giving contraceptive pills or painkillers is the
conservative means of treatment. Laparoscopic
(keyhole) surgery is usually the solution, but it is best
if planned, and not performed as an emergency. “We
get about 50 women coming to our specialized clinic
each week. Ever hospital realized it needs experts to
diagnose and treat it.” Patients usually get relief when
they are pregnant, but obviously that is not the
solution, the doctor added.
Whether it is permissible to conceive a baby for the sole
purpose of curing its sibling who needs compatible bone
marrow was discussed by Ramat Gan Chief Rabbi Ya’acov
Ariel, who said he didn’t have a clear answer. Surely, if a
woman is healthy and can have a healthy baby, let her
have one. If she is not healthy, risking her life to produce
a baby just to cure an existing child is a problem. The
mother’s life comes first,” he said.
The importance of informing potential spouses
about one’s medical, psychiatric and other problems
before engagement was stressed by Tel Aviv Chief
Rabbi Yisrael Meir Lau. “There can’t be secrets that
one discovers after the wedding.” Rabbis consulted on
such matters have to deal with them on a daily basis.
It can involve the bride’s father not being Jewish or a
parent being an atheist. The most serious problems
are those that would prevent fertility or involve
inheritable genetic disorders. Some argue that one can
keep quiet about medical conditions that can be
treated, that if a spouse learns of a problem, he can
“always get divorced. But suppose the wife doesn’t
want a divorce?” Lau asked. “Suppose she refuses, and
the rabbis allow the man to get remarried anyway?
You ruin the life of a person. And what about deceit?”
He recalled when he was chief rabbi of Netanya three
decades ago, and a woman born without a uterus or
vagina wanted to get married. She underwent plastic
surgery to produce a vagina, but while she had ovaries,
could never get pregnant (although surrogacy would be
possible today). Lau consulted a leading rabbinical arbiter,
who said not to tell would be in violation of the halacha
against placing a stumbling block before the blind. It
would not be false gossip, said Lau, but it would involve
deceit; the woman’s family was obligated to tell the
young man so he could make an informed choice.
It is preferable for the doctor and rabbi not to tell
the relevant person, but for the family of the
prospective mate with the problem to reveal it, he
added, saying that if a person had cancer and was
cured by chemotherapy, the prospective spouse must
still be told, as cancer can, sadly, recur. “The person
must be told without exaggeration. Just give the
facts.” The Puah Institute is often consulted about
such problems, commented Burstein.
DR. ARYEH YESHAYA, a leading gynecologist at the
Rabin Medical Center-Beilinson Campus, gave a long
lecture on the various types of contraceptives
preferred by Jewish law if a rabbinical arbiter decides
that preventing pregnancy is required. The rabbi
noted that every case is different, and that a religious
couple should consult with a rabbi.
Finally, Rabbi Dr. Mordechai Halperin – an Orthodox
rabbi and trained gynecologist as well as a leading
medical ethics expert in the Health Ministry – disclosed
that many of the country’s most influential arbiters have
gradually changed their minds from recognizing a
woman who undergoes IVF with donor eggs as the baby’s
halachic mother, to regarding the donor of the ova – even
if she is not Jewish – as the real mother. This about-face
from two decades ago has developed recently.
The new opinion, he said, meant that the
government bill to regulate the donation of ova must
be passed immediately, even though it is “not
perfect.” Halperin, who headed the Health Ministryappointed
committee that prepared the bill 10 years
ago, said that because of the complete change of
opinion among leading rabbis, more “Jewish eggs”
must be donated so that infertile Israeli women will
not have to go abroad to purchase eggs.
The Puah Institute said it evaluates the particulars of
each case. “There are still numerous authorities who
maintain that the birth mother is indeed the mother and
that the child is Jewish regardless of the identity of the
egg donor. If a couple do not have a rabbinical arbiter, the
institute strives to provide advice consistent with their
ethnic and religious background and major authorities
they would identify with.”
The institute concluded that “as to whether a child
born from the egg of a non-Jewish donor is Jewish from
birth, we would assure couples who have previously
received a personal decision regarding their case that the
ruling they received remains 100% valid. We would also
advise any couple looking to undergo such treatment
that it is imperative that they consult with their rabbinic
advisor and/or a Puah rabbi.”


	News / Events 10th Annual Jerusalem Conference Orthodox rabbis and physicians tend to be suspicious of each other due to differences about treating terminal patients, granting approval for abortions, issues relating to lowerbrain death and other sensitive questions that possibly clash with halacha. Yet when leaders of the two professions get together at the annual conference of Jerusalem’s Puah Institute, the atmosphere is inevitably cordial and respectful. The 10th annual conference of the Puah Institute for When religion and health meet, answers may not be black and white The annual Puah Institute conference continues to air the most intimate issues from each perspective. Judy Siegel-Itzkovich reports (from the women’s section) Fertility According to Halacha, held at the capital’s Ulamei Nof with over 1,300 men and women strictly separated by a cloth divider, always centers on subjects related to reproductive health from the viewpoints of medicine and Jewish law. It is always held during the week before the reading of the weekly portion in Exodus devoted to the story of the Hebrew midwives, Shiphrah and Puah – who saved the male Hebrew babies from Pharoah’s death sentence. The 20-year-old non-profit organization founded and headed by Rabbi Menachem Burstein originally focused on helping infertile couples through the process of building a family, has a staff of rabbis with expertise in the field and women who carefully supervise in-vitro fertilization to ensure that no mistakes are made. It expanded its interests to training counselors for brides and grooms, family purity experts, ritual bath attendants and kashrut supervisors. Doctors, including totally secular ones, are eager to be on good terms with Puah (www.puahonline.org), as modern Orthodox and haredi couples regard childbearing as an imperative. The institute’s staff include 10 rabbis, and counseling sessions are provided in Hebrew, English, French and Spanish. Former Sephardi chief rabbi Eliyahu Bakshi-Doron said he had much appreciation for ultrasound and other advanced medical applications, “but as technology advances, we have to be careful that knowhow does not lead to dangers. God gave us the ability to know more, but we mustn’t destroy the world with it. Just look at the dangers of nuclear energy. Ultrasound has brought down the abortion rate. The mortality rate of fetuses with medical problems has also dropped, and many infertile couples are helped to become parents. One can even choose among embryos to see if they have diseases, or choose a female for implantation if a male has hemophilia,” the rabbi said. But Bakshi-Doron added that the same technology could theoretically be used to pick an embryo for blue eyes and blond hair. “It’s a slippery slope.” He recalled that during his Jerusalem childhood, his family had a chicken coop. “The chickens lived their own lives, moving around to find food. They had a social life, and there was always a leader. Today, there is no such thing. Twenty-thousand eggs are put in the incubator, and 20,000 chicks come out. The females don’t need a rooster. They are all crowded into cramped cages, fed and vaccinated. It is beneficial, because large numbers of chickens and eggs are produced, but at the same time it has made the short lives of chickens miserable.” IVF, the rabbi said, can be a boon. It is expensive and can pose risks now, but some day it will not be as costly or dangerous. So one must be careful about deciding what one should do, and not just whick about what one can do. In Israel today, he concluded, the Health Ministry can allow couples to choose the sex of their child using pre-gestational diagnosis (PGD) if they have at least four children of one gender. “It is better to use IVF in an infertile couple who want children, or in producing a healthy child when there are genetic problems, but not for anything else, for if we allow this, there will be no end to it.” PROF. ARYE HARMAN, chairman of the Israel Obstetrics/Gynecology Society and head of the gynecology department at Assaf Harofeh Medical Center in Tzrifin, enthused about new uses of ultrasound to help produce a healthy newborn. Its most important function during the first trimester, he said, is to allow the dating of the fetus. “The older the fetus, the bigger the differences according to age. Scans make it possible to know if it’s too big or too small, if it’s in distress, is anemic or has a parvo virus infection, if there are multiple fetuses, how to deliver a baby and if there are two with only one placenta or in one amniotic sac,” Harman said. If the fetus has too little oxygen-rich blood, it can get an infusion while in the womb, he explained. If there is accumulated liquid near the liver or intestines, it could be a serious but curable infection. A drain can be inserted into the chest to allow lungs to survive. Harman recalled a woman in her 32nd week of pregnancy whose fetus’s chest had to be punctured just before a Cesarean birth so he could be born with lungs that worked immediately. It this had been done after delivery, he would have been born in serious condition. European doctors (but not yet Israelis) have treated in utero fetuses with an abdominal hernia, which causes the intestines to press on the heart and lungs. A fetoscope is used to introduce a tiny balloon into its mouth, inflate it and expand the lungs. “There is a good chance that in such a case, the fetus will survive.” And in a case of twins, if one fetus gets a strong flow of blood at the expense of the other, causing premature delivery and developmental problems, lasers can be used to cauterize a blood vessel to stop this flow. Harman showed images of a pregnant woman – the daughter of an Assaf Harofeh doctor – carrying twins whose umbilical cords were so tightly intertwined that they would have been seriously defective due to lack of oxygen. They fixed the situation in utero, and two beautiful and healthy girls were born. “We fight for every fetus and every child,” said Harman, as members of the audience nodded. “There is no reason to abort a fetus with a mild defect, especially if it can be fixed.” DR. DAVID SORIANO, deputy director of gynecology at Sheba Medical Center in Tel Hashomer, spoke about his specialty – endometriosis, which is the subject of a national center he opened in the hospital. He said this “very common condition,” in which the reproductive tract accumulates unnecessary tissue that causes significant pain, especially during menstruation, can lead to infertility. Untreated, the various abdominal organs will eventually stick together, likely causing fertility problems by damaging the ovaries. The woman’s symptoms, aside from pain, include shortness of breath, painful and urgent urination and elimination, short menstrual cycles and long periods. It is the most common reason for emergency visits in women under 25. “It is as if the body is screaming for help.” Five to 10 percent of all women of fertile age have it, along with one half of women who have strong menstrual and pelvic pain. About 40% of sufferers will be infertile. In families with a history of endometriosis, the rate is seven times higher. Too often, when symptoms first appear in teenage girls, they are given painkillers and told it will resolve itself, but Soriano urged that any such symptoms be checked early on. Giving contraceptive pills or painkillers is the conservative means of treatment. Laparoscopic (keyhole) surgery is usually the solution, but it is best if planned, and not performed as an emergency. “We get about 50 women coming to our specialized clinic each week. Ever hospital realized it needs experts to diagnose and treat it.” Patients usually get relief when they are pregnant, but obviously that is not the solution, the doctor added. Whether it is permissible to conceive a baby for the sole purpose of curing its sibling who needs compatible bone marrow was discussed by Ramat Gan Chief Rabbi Ya’acov Ariel, who said he didn’t have a clear answer. Surely, if a woman is healthy and can have a healthy baby, let her have one. If she is not healthy, risking her life to produce a baby just to cure an existing child is a problem. The mother’s life comes first,” he said. The importance of informing potential spouses about one’s medical, psychiatric and other problems before engagement was stressed by Tel Aviv Chief Rabbi Yisrael Meir Lau. “There can’t be secrets that one discovers after the wedding.” Rabbis consulted on such matters have to deal with them on a daily basis. It can involve the bride’s father not being Jewish or a parent being an atheist. The most serious problems are those that would prevent fertility or involve inheritable genetic disorders. Some argue that one can keep quiet about medical conditions that can be treated, that if a spouse learns of a problem, he can “always get divorced. But suppose the wife doesn’t want a divorce?” Lau asked. “Suppose she refuses, and the rabbis allow the man to get remarried anyway? You ruin the life of a person. And what about deceit?” He recalled when he was chief rabbi of Netanya three decades ago, and a woman born without a uterus or vagina wanted to get married. She underwent plastic surgery to produce a vagina, but while she had ovaries, could never get pregnant (although surrogacy would be possible today). Lau consulted a leading rabbinical arbiter, who said not to tell would be in violation of the halacha against placing a stumbling block before the blind. It would not be false gossip, said Lau, but it would involve deceit; the woman’s family was obligated to tell the young man so he could make an informed choice. It is preferable for the doctor and rabbi not to tell the relevant person, but for the family of the prospective mate with the problem to reveal it, he added, saying that if a person had cancer and was cured by chemotherapy, the prospective spouse must still be told, as cancer can, sadly, recur. “The person must be told without exaggeration. Just give the facts.” The Puah Institute is often consulted about such problems, commented Burstein. DR. ARYEH YESHAYA, a leading gynecologist at the Rabin Medical Center-Beilinson Campus, gave a long lecture on the various types of contraceptives preferred by Jewish law if a rabbinical arbiter decides that preventing pregnancy is required. The rabbi noted that every case is different, and that a religious couple should consult with a rabbi. Finally, Rabbi Dr. Mordechai Halperin – an Orthodox rabbi and trained gynecologist as well as a leading medical ethics expert in the Health Ministry – disclosed that many of the country’s most influential arbiters have gradually changed their minds from recognizing a woman who undergoes IVF with donor eggs as the baby’s halachic mother, to regarding the donor of the ova – even if she is not Jewish – as the real mother. This about-face from two decades ago has developed recently. The new opinion, he said, meant that the government bill to regulate the donation of ova must be passed immediately, even though it is “not perfect.” Halperin, who headed the Health Ministryappointed committee that prepared the bill 10 years ago, said that because of the complete change of opinion among leading rabbis, more “Jewish eggs” must be donated so that infertile Israeli women will not have to go abroad to purchase eggs. The Puah Institute said it evaluates the particulars of each case. “There are still numerous authorities who maintain that the birth mother is indeed the mother and that the child is Jewish regardless of the identity of the egg donor. If a couple do not have a rabbinical arbiter, the institute strives to provide advice consistent with their ethnic and religious background and major authorities they would identify with.” The institute concluded that “as to whether a child born from the egg of a non-Jewish donor is Jewish from birth, we would assure couples who have previously received a personal decision regarding their case that the ruling they received remains 100% valid. We would also advise any couple looking to undergo such treatment that it is imperative that they consult with their rabbinic advisor and/or a Puah rabbi.”

Donate \| FAQs \| Rabbinical Endorsements \| Subscribe \| Volunteer/Join \| Contact