Ethics / An ultra-orthodox couple received permission to give birth to a daughter in order to humble a sperm donation
Tamara Traubman and Chaim Shadmi
The process carried out in "Hadasa"
For the first time in Israel, in a move that provokes medical and moral controversy, the Ministry of Health approved for a couple to choose the gender of their baby in advance - without a medical reason. The approval was given a few months ago to the Hadassah Ein Kerem Hospital, where the procedure was performed through in vitro fertilization and genetic testing. According to Prof. Neri Lauper, director of the women's division at the hospital, "the woman is now in the first month of her pregnancy." He explained that the couple wanted a daughter because they ran into "special circumstances" related to the fact that the couple is ultra-Orthodox and the father is a priest.
For about a decade, doctors have been using a method to determine the gender of the newborn, known as "pre-root genetic diagnosis". However, so far the process has only been approved in cases of hereditary diseases that mainly affect males, such as hemophilia. By preventing the birth of a male baby, the parents could ensure the birth of a baby that would not suffer from the disease. In Israel, the method is implemented in Hadassah, Ichilov, Rambam and Tel Hashomer hospitals.
But according to many doctors in the field of obstetrics and gynecology, many requests are already received from spouses to choose the sex of the fetus for non-medical reasons. Prof. Daniel Zeidman, an in vitro fertilization expert from the "Sheeva" hospital in Tel Hashomer, says that more and more couples want to choose the sex of their baby in advance without a medical reason; In most cases, they ask for a son. Also according to Lauper, "we constantly receive requests like 'I have four daughters - I want a son'".
The couple treated at Hadassah are ultra-Orthodox in their mid-20s. After they got married, they tried to have children - but in vain. They went to a fertility clinic, where they were told that the man suffers from a rare defect - there is no sperm in his testicles. The doctors explained to the couple that they could use a sperm donation, and use it to fertilize the woman's egg.
In Israeli society - and in the ultra-Orthodox community in particular - there is a reluctance to give birth to a child who is not a "biological child". In the case of the young couple, special circumstances were added to this, arising from the fact that the husband was a Cohen. The ultra-Orthodox parents strive to keep the matter of sperm donation a secret, but if they had a son, they would be forced to reveal the secret when he turns 13. The reason: when a priest's son reaches the mitzvot and goes up to the Torah, he is announced in the synagogue as a priest. But in this case, the announcement would be considered a halachic offense, since the child is not the father's biological son, and thus the parents would be forced to disclose the sperm donation. To avoid the dilemma, the couple decided they wanted a girl. A daughter, they explained, will never enter the Torah, the members of their community will not know that she is not their biological child, and they will not have to tell her that either.
Following their decision, Laufer turned to the legal advisor of the Ministry of Health, attorney Mira Hibner Harel, for permission to implement the method, even though there is no medical justification. Hibner Harel approved the request. According to her, her decision stemmed from consideration of the couple's plight. "In light of the fact that this is a person for whom Halacha and religion are a candle to his feet - and therefore there is a problem for him in having a child under the existing circumstances - but at the same time he is interested in having a child, there was a place to comply with his request", she reasons her decision.
"If we didn't allow them to choose the sex of the fetus, they wouldn't have children. Sometimes we have to adapt our decisions to the spirit and tradition of the people."
The laboratory team at Hadassah created embryos for the couple, through in vitro fertilization. After about three days, when eight cells had developed in the embryos, one cell was taken out of them and checked to see if it was a female or male embryo. The male embryos were not used, but the female ones were implanted in the woman's womb.
Many doctors estimate that in the future - and especially following the precedential approval - the number of requests to choose the sex of the newborn for non-medical reasons will increase. Dr. Anat Safran, director of the laboratory at Hadassah, says: "In my opinion, we are now standing at the threshold of an influx of people, who will ask themselves if their situation can also justify the choice of sex."
"Couples call and contact me and ask to choose the sex of the embryo," says Prof. Ami Amit, director of the in vitro fertilization unit at Ichilov Hospital in Tel Aviv. According to him, "The technology exists. In the current situation today, I do not agree to produce such a treatment for non-medical reasons. I am short of determining whether a family that has five sons and wants a daughter, is allowed to have the requested one. This is the role of the authorities.
The moral and social implications of the new approval have not yet been examined. So far, a clear line has been drawn between the use of the method for the purpose of preventing disease, and its use for the purpose of preventing the birth of babies with "undesirable traits". Prof. Zeidman does not rule out the use of the method, but according to him, choosing the gender of the baby without medical reasoning raises the question "To what limits can the choice be pushed? There is always the fear that it will not only be for sex selection, but will also continue to select tall babies, for example."
"I don't tend to easily adopt the 'slippery slope' arguments," says Dr. Ruth Halperin-Kadri, head of the "Center for the Advancement of the Status of Women" at Bar Ilan University's Faculty of Law, "but in this case, the reality they may deteriorate into is already present. You can't close your eyes." According to her, "in Israel's multicultural society, the danger of favoring one gender over the other is an existing danger." According to her, "the preference can sometimes stem from religious reasons, in the tradition where Kaddish can only be said by a son", but also in other population groups: "I remember when I was a student, when a son was born they clapped their hands, and when a daughter was born there was silence".
According to Halperin-Kadri, the adoption of the method may have negative consequences for women. "In vitro fertilization is a technology that is dangerous for women, and involves suffering and a difficult path physically and mentally. As soon as the possibility opens up and it is accepted as a social norm, we may reach a situation where women will be expected to undergo in vitro fertilization and genetic tests for sex selection or to prefer other features, just as today women are expected to undergo all prenatal tests."
According to Seidman, apart from the particular risk and discomfort associated with in vitro fertilization, it is still unclear whether the genetic diagnosis procedure has no long-term health consequences for the newborn. According to him, "There are couples who will say that in order to avoid a very serious illness, they are willing to take the risks. But is it also justified for choosing a boy or a girl?"
Prof. Binyamin Raubinoff, a fertility expert from Hadassah Ein Kerem, supports giving the option of gender selection in cases where this would greatly improve the well-being of the parents. However, he points out: "According to one of the counterarguments, the treatments are expensive and will not be available to everyone." Will, he wonders, only the rich will be able to choose the gender of their future baby, and others will have to "make do" with a baby of the gender they are lucky enough to have?
A librarian points out that although in the vast majority of cases the method provides an accurate diagnosis of the sex of the fetus, there are still a few percentages in which it gives incorrect information. "What will happen", she asks, "if it turns out to the ultra-Orthodox couple that they are carrying a healthy male?", since their faith forbids them to have an abortion.
Prof. Laufer is aware of the variety of questions raised by the use of the method for choosing the sex of the newborn. After receiving the approval in this case, he addressed a letter to Hibner Harel, clarifying the need to settle the issue, but received no response. "Lots of people turn to me, and that's why I demanded the Ministry of Health for the principle issue, not the individual one," he says.
According to him, "There should be a public discussion on the matter and not let things 'leak' by themselves, as happened with the couple who were treated by us. The time has come to face the question and decide, and not be dragged into things out of the box. This is not a medical question, but a social and public one." Laufer points out that the decision must consider not only the physical health of the fetus, but also the happiness and well-being of the parents.
Hibner Harel clarifies that, according to the existing legal situation, choosing the sex of the fetus other than for medical reasons is not prohibited, but it is also not allowed. According to her, a broad demand for choosing the sex of the fetus will require a public discussion. "If more than one request is received by the Ministry of Health, we will have to bring the matter first and foremost to the discussion of the Helsinki Committee (the committee that approves experiments and innovative treatments on humans) for genetics, and then there should be a joint discussion on this for ethicists, clergy and doctors," she said.
Choosing the gender of the newborn
The beginning of the 90s - the beginning of the world's use of "pre-root genetic diagnosis"
- 1993 In Israel, the use of this method for choosing the gender of the newborn began - for reasons
medical
- 2002 Permission was given to "Hadasa" Ein Kerem to implement the method without medical reasons
Coming soon: an Israeli study to examine the consequences of the possibility of choosing the sex of the newborn
The Gartner Institute for Health Policy Research and the Tel Hashomer Hospital are about to start a study soon, which will examine the consequences in Israel of implementing a method to determine the sex of the fetus. The study was initiated by Prof. Eil Schiff, director of the Department of Obstetrics and Gynecology at Tel Hashomer, and as part of it, it will be examined how many couples may request to use the method to choose the sex of the fetus, for what reasons and what their choice will be.
"Very soon, the ethical and social question will arise: is this type of intervention allowed," Schiff told "Haaretz" about a month ago. According to him, the Ministry of Health and the Knesset will have to decide the question through legislation. The results of the study, which will serve as a standard for the expected ratio between boys and girls who will be born as a result of the application of the method, will serve as an important tool in their hands.
"If the distribution of the answers we receive is that 80% of the couples prefer a certain sex, it is difficult to see the legislator allowing the implementation of the method for choosing the sex of the fetus," he said.
Haim Shadmi
China: much use of the method; USA: Controversy
In the world there is a controversy regarding the use of "pre-implantation genetic diagnosis" for the purpose of choosing the sex of the newborn.
In September 2001, John Robertson, chairman of the ethics committee of the "American Society for Fertility Medicine" approved the use of the method for the sake of "gender diversity", as he defined it. His intention was that couples who had already given birth to a child of one sex would be able to choose a baby of the other sex.
The decision provoked sharp criticism, both for its essence and for the manner in which it was made - a hasty telephone consultation of a limited team of committee members. In February of this year, the committee reversed its decision, stating that doctors should try to dissuade couples from creating embryos and then choose only those of the desired sex.
In India and China, methods for choosing the sex of the newborn are widely used. The methods mainly include planned abortions and in vitro fertilization, and have already led to a violation of the balance between boys and girls: in India, for every 1,000 six-year-old boys, there were only 927 girls last year.
Tamara Traubman
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