People with Down syndrome have an extra chromosome, which leads to intellectual and physical disabilities of varying severity. They have distinctive builds and facial features, and are at increased risk for certain illnesses and defects, including heart defects and duodenal atresia, infection, and leukemia. Nevertheless, due to advances in medical care, their life expectancy has increased in recent years, and they can live to age fifty and beyond. Their intellectual disabilities generally mean that they cannot live independently, but rather require assistance and support, like young children. Recently, educational methods have been developed which improve their abilities to learn and to function. Some are even able to get married and live in their own homes. (Men with Down syndrome are almost always sterile.) However, even in the best of circumstances, people with Down syndrome require the level of care and support afforded to older children. The question is: is it permissible to terminate a pregnancy when the fetus has Down syndrome?
Those who adopt the restrictive approach maintain that just as one may not take the life of a child with Down syndrome, so too one may not destroy a fetus with Down syndrome. True, someone who kills a child commits a capital crime, while someone one who kills a fetus does not. Nevertheless, since these poskim view the prohibition against killing a fetus as an offshoot of murder, a woman carrying a Down syndrome fetus may not abort.
Even though R. Shlomo Goren permits aborting a fetus with Tay-Sachs, because the child would suffer and die within a few years, he does not permit the abortion of a fetus with Down syndrome. Only when there is a concern that the birth will disrupt the family’s equilibrium and endanger the mental health of one of the parents would an abortion be permitted (Torat Ha-refu’a, p. 192).
Those who adopt the more permissive approach maintain that if it would be difficult for the parents to cope with the hardships involved in raising a child with Down syndrome, and it would cause them great pain, an abortion is permitted. This is because these poskim maintain that abortion is prohibited as a form of ḥavala or hashḥata, so to prevent great suffering on the part of the child and its parents, they would permit an abortion (Tzitz Eliezer 9:51:3; 13:102:6; 14:101-102; Amud Ha-yemini §32). As we said in section 3, under pressing circumstances one may rely on the permissive opinion. However, here we are talking about a problem which does not always justify an abortion. There are families which, despite the tremendous difficulties involved, successfully meet the challenge of raising a child with Down syndrome, and sometimes even grow as a result. Therefore, greater discretion must be exercised, taking into consideration the state of this family, and an outstanding Torah scholar must be consulted.