09. The Desirability of Prenatal Testing

As we have seen, some poskim prohibit abortion even when the fetus suffers from a serious illness. Many of them add that the mother should not do prenatal tests, as it would be pointless; even if the tests showed the fetus to be abnormal, these poskim would not permit abortion. Better to trust in God and His goodness rather than constantly worry about insoluble problems.

In practice, though, women should undergo the necessary tests. True, according to the restrictive opinion, even in a case where the fetus is clearly sick, abortion is prohibited. Nevertheless, there is a permissive view as well, and in a problematic case, the couple can consult a rabbi who will advise them as to which opinion to follow. Moreover, if there is a reasonable concern that the mother’s grief would jeopardize her mental health, abortion would be permissible even according to many who take the restrictive approach, as mental illness can be life-threatening, and when there is a conflict between the life of the mother and the life of the fetus, the mother’s life takes precedence. Even if the couple follows the restrictive opinion, conducting the proper tests will allow the parents to prepare themselves emotionally in the time remaining before the birth. Therefore, it is good to do prenatal testing. My rabbi and teacher R. Avraham Shapira ruled this way in practice.

It is still necessary to clarify which tests should be done. For example, it is known that the older the woman, the higher the odds that her fetus will suffer from Down syndrome. The question is: from what maternal age is it appropriate to test? Another question: For various reasons, some doctors recommend performing all types of tests during pregnancy. Some of them are very expensive, and many of them cause stress and worry. Is it best for a pregnant woman to have all these tests done? Or is it best for her to have a joyful, serene pregnancy, relying on God and His goodness?[9]

As a rule, tests to detect serious, common problems should be conducted, while tests to detect rare problems should not. This is consistent with people’s approach to life in general; most do not worry about minimal risks when it comes to car safety or dietary choices. A good rule of thumb to determine the importance of doing a particular test, at least in Israel today, is whether it is covered by the HMOs. When the cost of a test is covered, it means that the Ministry of Health, based on the mass amounts of data at its disposal, concluded that this test should be done. Thus, it is best to do it. In contrast, when a test is not covered by basic insurance, it indicates that it is not so important, and one need not do it. Nevertheless, if a trustworthy doctor follows this general approach yet recommends doing additional tests that he thinks are very important, it is best to accept the advice and undergo the tests.[10]

[9]. The odds that a 20-year-old woman will give birth to a child with Down syndrome are 1 in 1734 (0.05%), while for a 37-year-old woman the odds rise to 1 in 234 (0.42%), and for a 45-year-old woman to 1 in 31 (3.2%).

Some doctors recommend performing many tests because they want to cover themselves. If, God forbid, there are problems, the couple will not be able to blame them. This may be the reason that nowadays some doctors hesitate to take responsibility and make decisions; they are worried about being sued. Additionally, sometimes HMOs and the doctors make more money from extra tests than they do from regular ongoing care.

[10]. The interests of the HMOs and the Ministry of Health are clear: the cost of caring for a sick child is hundreds of thousands of shekels, so they will fund tests to detect serious problems that are common enough that they must be considered. In contrast, tests that are covered by supplementary insurance are to detect rare problems. The damage done by the anxiety these tests cause may outweigh their benefits. Of course, this rule of thumb applies to Israel in 2019, and may not be applicable in other contexts.

The test for CMV is a good example of present Israeli policy. The position of the Ministry of Health is that this test should not normally be performed, because its results are far from conclusive for the mother, and even less conclusive for the fetus. Performing this test or others like it as a matter of course would lead to great uncertainty, fear, and anxiety, which could lead to numerous unnecessary amniocenteses. Some people would presumably decide to abort because of the uncertainty. Therefore, the position of the Ministry of Health is that it is best to avoid these tests. Yet many doctors, who are either overly cautious or who fear lawsuits, encourage performing these tests in defiance of the formal guidelines.

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Translated By:
Series Editor: Rabbi Elli Fischer

The Laws of Shabbat (1+2) - Yocheved Cohen
The Laws of Prayer - Atira Ote
The Laws of Women’s Prayer - Atira Ote
The Laws of Pesach - Joshua Wertheimer
The Laws of Zemanim - Moshe Lichtman

Editor: Nechama Unterman