Peninei Halakha

14. Multifetal Pregnancies

Sometimes, as a result of fertility treatments, a woman becomes pregnant with multiple fetuses. Carrying two fetuses is not considered especially risky, as some women have twins without medical intervention. Even carrying three fetuses is generally not considered especially risky, and triplet births occasionally take place naturally. However, if there are five or more fetuses, there is a significant risk that they will all die or be born prematurely, leading to terrible illnesses.

The vast majority of poskim agree that it is permissible to destroy some of the fetuses so that the others will survive. (The process is euphemistically called “fetal reduction.”) Some explain that each fetus is considered a rodef relative to the others. Others say that because fetuses are not yet considered human life, one may kill some to save the rest. Accordingly, in a triplet pregnancy, only in an unusual case of heightened risk may one kill a fetus. In a quadruplet pregnancy, the situation must be carefully assessed; most of the time it will be permissible to kill one fetus, and two if necessary. In a quintuplet pregnancy, there is a consensus that taking the lives of some of the fetuses is permissible in order to ensure the survival of the rest. Each individual case demands the opinion of a God-fearing doctor and then consultation with a rabbi.

Sometimes, in a twin or triplet pregnancy, one of the fetuses develops more slowly than the others. If the doctor feels that keeping that fetus alive will cause the loss of the other fetuses, it is permissible to take its life in order to save the others. This is both because the weaker fetus would likely not survive in any case and in order to save the remaining fetuses.[12]

[12]. R. Waldenberg writes that if a woman is pregnant with quadruplets one fetus may be killed, because the fetuses are not yet considered human life. Since the prohibition of abortion is because of ḥavala or hashḥata, when there is a great need, it is permissible to take the life of a fetus. He adds that he heard that his colleague R. Elyashiv permitted this (Tzitz Eliezer 20:2). R. Ḥayim David HaLevi is permissive as well (Mayim Ḥayim 1:61). Nishmat Avraham, ḤM 425:1 n. 30, records that R. Shlomo Zalman Auerbach permits reducing a quadruplet pregnancy by one or two, because each fetus is considered a rodef relative to the others. R. Naḥum Rabinovitch writes that in a twin pregnancy where one did not develop properly, it is permissible to take the life of that fetus in order to save the other twin’s life (Si’aḥ Naḥum §116). However, according to R. Moshe Feinstein (Igrot Moshe, ḤM 2:69), it seems that reducing a pregnancy would be permitted only when the danger is almost certain.

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