Topics in this digest: Vayera 5765
By Rabbi Dr. Barry Leff
And the Lord said, Because the cry of Sodom and Gomorrah is great, and
because their sin is very grave; I will go down now, and see whether they
have done altogether according to the cry, which has come to me; and if
not, I will know. …Genesis 18:20-21
The Torah tells us that the sins of Sodom and Gomorrah were so great that
God went down to judge them…and He judged them as guilty, and decreed the
cities should be destroyed.
We don’t really know what were the sins of the Sodomites. Many people
assume that since the word “sodomy” has the meaning which it has, the sin
of the Sodomites was homosexuality. That is actually NOT what the Jewish
tradition teaches. The closest to this teaching is a midrash which says
the people of Sodom stipulated among themselves as follows: “As to any
wayfarer who comes here, we shall have sexual relations with him and take
away his money.”
But most commentaries say the sins of Sodom had nothing to do with sex.
According to the prophet Ezekiel (Ezekiel 16:46-50), “This was the guilt
of your sister Sodom: she and her daughters had pride, excess of food and
prosperous ease, but did not aid the poor and needy. They were haughty and
did abominable things before me; therefore I removed them when I saw it.”
According to the prophet, the sin of Sodom was that they were full of
themselves, and they were prosperous, but ignored the needy.
The Talmud says their sin was being greedy and cruel. In tractate
Sanhedrin it says the Sodomoites would say “since bread came out of OUR
earth, why should we share it with travelers, who only come to deplete our
wealth? Let us abolish the practice of traveling in our land. In a case
which is reminiscent of some of our crazy modern lawsuits, like a burglar
suing for a homeowner for injuries sustained when we was braking into the
house, the Talmud records that in Sodom if someone wounded his neighbor
they would tell the victim that he had to pay the person who hit him a fee
for bloodletting, since bleeding was considered a beneficial medical
treatment in those days.
WHATEVER their sin was, it was clearly, in the eyes of God, a very grave
sin indeed since it merited the destruction of their entire city.
There are those who would put stem cell research in the same kind of
category as a very grave sin. There are those who say it is murder.
Dr. James Dobson, founder of the fundamentalist Christian group, Focus on
the Family, wrote: "In order for scientists to isolate and culture
embryonic stem cells, a living, human embryo must be killed. It is never
morally or ethically justified to kill one human being in order to help
benefit another. By requiring the destruction of embryos, the tiniest
human beings, embryonic stem cell research violates the medical ethic of
'Do No Harm.'"
Conservative former presidential candidate and staunch pro-lifer Gary
Bauer, called stem cell research "morally bankrupt."
The people who consider stem cell research murder do so based on a
fundamental belief of the Catholic church. The Catholic church has what
is called a catechism: a big book that tells Catholics EXACTLY what they
have to believe. Jews, of course, have no such book, we are great
believers in interpretation, and allow individuals a very wide latitude in
how they interpret Torah. However, good Catholics have no such choice.
They are told what to believe, and one of the statements in their
catechism says “From its conception, the child has the right to life.
Direct abortion, that is, abortion willed as an end or as a means, is a
"criminal" practice, gravely contrary to the moral law. The Church imposes
the canonical penalty of excommunication for this crime against human
life.”
The Pope has vigorously denounced stem cell research. "A free and
virtuous society, which America aspires to be, must reject practices that
devalue and violate human life at any stage, from conception to natural
death," the Pope said in a statement after meeting Bush in 2001. The
pontiff cited the creation of embryos for research purposes as an evil
akin to euthanasia and the killing of babies.
While most fundamentalists are NOT Catholic, they agree with the church on
this particular teaching. They say that life begins at the moment of
conception, and therefore using a morning after pill which which prevents
a fertilized egg from implanting is murder just the same as pulling
trigger on a gun and killing someone. Some believe this with such
intensity that they have murdered doctors and bombed abortion clinics to
prevent abortions.
Stem cell research is a huge issue, and it’s a huge issue in this
election. It represents a struggle between faith and science, between
ideology and technology.
Just yesterday (October 29) Newsday published an article which said that
Kerry has been trying to use stem cell research as a wedge issue to swing
some crucial undecided voters his way. According to Newsday, Kerry has
been endorsed by “actor Michael J. Fox, who has Parkinson's disease, and
Dana Reeve, the widow of paralyzed actor Christopher Reeve, who died
earlier this month from complications of an infection.”
Stem cells is also clearly a big issue for Bush. Charles Colson, the
former Nixon aide, convicted felon (Watergate-related charges) and born
again Christian has a wide following among Christians. On October 22
Colson wrote “Prior to September 11, the defining moment of the Bush
presidency had been the president’s decision to limit embryonic stem-cell
research. And while that issue has been overshadowed by the war in Iraq,
it hasn’t gone away. In fact, it’s back with a vengeance, and that means
it’s time for Christians to understand the facts and what’s at stake in
the debate.”
Well, if it’s time for Christians to understand the facts, I suppose it
must be time for Jews to also understand the facts.
In August 2001, President George Bush gave a speech on stem cell research.
The President said as he thought through the issue he kept returning to
two fundamental questions: “First, are these frozen embryos human life,
and therefore, something precious to be protected? And second, if they're
going to be destroyed anyway, shouldn't they be used for a greater good,
for research that has the potential to save and improve other lives?”
Bush said he asked scientists, scholars, bioethicists, religious leaders,
doctors, researchers, members of Congress, his Cabinet, and his friends;
not surprisingly he found widespread disagreement.
What’s the disagreement? On the one side you have many scientists and
researchers who say that stem cell research from fetal tissues could lead
to cures for some really terrible diseases: everything from Alzheimers and
Parkinsons to spinal cord injuries to heart disease. On the other side,
you have some religious people saying that allowing researchers use
embryonic stem cells is murder, because they believe life begins at
conception. Bush’s conclusion weighed heavily on his “faith.” Basically,
he agreed with those that said destroying embryos is murder, and he banned
federal funding for stem cell research that would require the destruction
of any embryos. Which means the only stem cell research that can be done
with Federal funds must come from one of 22 existing lines of stem cells.
The $27 billion dollar annual National Institutes for Health budget is far
and away the largest source of funding for medical research in the USA.
While Bush’s decision does NOT outright ban stem cell research, it has a
HUGE impact on the progress that will be made.
My objective this morning is not to simply answer a single question—does
Judaism permit research using fetal stem cells—as it is to share with you
several principles that I believe Jews should know, which can be applied
in a variety of situations. After we’ve looked at the principles, we will
apply them to our question. It’s a complicated question: As Lawrence
Goldstein, professor of cellular and molecular biology at UCSD said,
"Everyone is looking for easy one-liners on this--but it's not a
one-liner."
The key question in this debates is what is life? When does life begin,
and when does life end? Some religions, like Catholicism, posit that life
begins at conception, and the soul enters the body at the moment of
conception. Many religions hold that life ends when heartbeat and
breathing cease.
Judaism acknowledges that life is more complicated than this. Life is not
a digital phenomenon, this instant alive, this instant not alive. We
gradually come into life, and we gradually fade out from life. For
halachic (legal) purposes there are certain defined transition periods.
We know from the Torah that a fetus is not a life with all the same status
of a person who has been born. In Exodus it is written “If men quarrel,
and hurt a pregnant woman, so that her fruit depart from her, and yet no
further harm follows; he shall be surely punished, according to what the
woman’s husband will lay upon him; and he shall pay as the judges
determine.” We know from elsewhere that the punishment for murdering
someone is death; therefore we see that causing a woman to miscarry is not
considered “murder” in the same way it is for killing someone who has been
born.
In the Talmud the stages of coming into life start at conception, at which
point the embryo is considered a potential person—the same thing many
scientists and researchers would say today. However, for the first 40
days the embryo is considered to be like “mere water.” At around 40 days,
the embryo, which is really just a cluster of cells, starts to take shape
and form—the cells start growing into their particular parts, and the
embryo becomes a fetus. After 40 days the fetus has more rights. For
this reason, many rabbis would say that if an abortion needs to be
performed for medical reasons, it should be as early as possible.
Up until the time of birth, the fetus has a lesser status than other
people such as the mother, as discussed above. Consequently, if in a very
difficult childbirth a choice must be made between saving the mother and
saving the child, the mother takes precedence.
All of this changes at the moment of birth, which the rabbis in the Talmud
defined as when the head emerges. The Mishnah in Ohalot says: "If a woman
is in difficulty during childbirth, it is permissible to destroy the fetus
surgically because her life comes first. If, however, the head of the
fetus
has already been delivered, then it is forbidden to intercede even though
it may cost the life of the mother. The fetus is now an infant with the
ability for independent life. Therefore, we do not sacrifice one life to
save another."
We know that we cannot sacrifice one person to save another from the
Talmud tractate Pesachim, where a person is told to kill another person or
he would be killed himself. He went and asked a great rabbi, Raba, what to
do. Raba told him to be killed, rather than transgress the commandment
against murder. Raba asked: “Why would you think your blood is redder
than his? Perhaps his blood is redder.”
There is however, also a principal that if someone is pursuing you to kill
you, you are allowed to kill them first in self defense. This principal is
used by rabbinic authorities today in Israel to permit killing terrorists
who are planning attacks in Israel. The Talmud in Sanhedrin poses the
question: "Why should you not sacrifice the infant even though the head
has already been presented, since this infant is endangering the life of
the mother? Is not the infant, then, a rodef [pursuer]? The law of the
pursuer should apply, which is to kill the pursuer in order to save the
life of the victim." The Talmud answers: "No, Heaven is the pursuer." In
other words, this is an act of God, and you should not consider the fetus
an attacker. While the child is in the uterine environment, totally
dependent on the mother's life yet threatening it, we classify the fetus
as a pursuer.
According to Maimonides while the child is inside the mother, it is
totally dependent on the mother. If the mother dies, the fetus would die
too. Therefore it makes sense to give the mother priority, because she is
the source of life for the fetus as well. Once the fetus is born, this is
no longer true and the infant has all the rights of any other person,
including the right to life.
The fetus in the mother’s womb is considered a limb of the mother, an
extension of her body. Another basic principle in Judaism is that you do
not own your body: God does. That is why suicide is forbidden under
Jewish, as is intentionally injuring yourself.
We can see from the preceding, that despite the fact that many Jews
support the liberal “pro-choice” agenda, Judaism itself would only allow
abortion when there is a threat to the mother. Most interpretations would
also allow abortions where the mental health of the mother would be
threatened by carrying the baby to term. The big debate in the Jewish
community centers on what constitutes sufficient threat to the woman’s
mental health to justify an abortion.
Just as we have stages in coming into life, Judaism recognizes a variety
stages at the end of life. When someone has an incurable illness, there
are termed a “treifa,” and they lose some of their “rights.” A person
within three days of death is termed a “goses” and you are not required to
work as hard to save their life, to do medical intervention. Some medical
intervention for a goses would be considered drawing out the death process
instead of extending life. Talmudically death was defined as
cardio-pulmonary death, cessation of heart and breathing. However, modern
Jewish scholars almost universally accept the idea of “brain death.” Even
the chief rabbinate in Israel recognizes brain death, and permits organ
transplants from brain dead people.
Judaism acknowledges advancements in science. In the days of the Talmud,
cardio-pulmonary death was the best technology available. Now that we
have more advanced technology, not only are we allowed to rely on it, we
are required to.
While we accept brain death as death, and support the idea that you don’t
have to do aggressive medical treatment for terminal patients, Judaism
still maintains that when life ends is a decision of the Creator—hence
under no circumstance would Judaism approve of active euthanasia, or
assisted suicide.
This reverence for life is one of the highest of values in Judaism. When
confronted with an opportunity to save a life, Judaism teaches that
“pikuach nefesh,” to save a life, takes precedence over everything. Any
ritual law—Shabbat, kashrut, Yom Kippur, whatever—can be set aside if
there is even the slightest danger to life. The only commandments that do
not take priority over saving a life are public idol worship, murder, and
certain sexual transgressions like incest; we are told to sacrifice
ourselves rather than do these things.
The Jewish values and principles that might apply to stem cell research,
therefore, are as follows:
1) Life does not begin at conception; rather we come gradually into life
2) An embryo less than 40 days old is considered in some respects “mere
water”
3) A fetus more than 40 days old is considered an extension of the mother,
and it is forbidden to destroy it, except for the health of the mother
4) Saving lives is the highest value in Judaism
To apply these principles to stem cell research, we have to understand
what stem cell research is. My apologies in advance to any doctors or
biologists present for my simplification of the subject. If you read the
three day series in the Blade, you may already be familiar with much of
this—please bear with me.
One of the miracles of how we develop from the moment of conception to
people is the transition from a blob of cells which are all identical to
each other, to an organism filled with different parts. Stem cells are
cells which have the potential to become different things. There are
different categories of stem cells. The fertilized egg is a totipotent
stem cell: it can become anything. As the egg divides, the outer cells
develop into cells that can form the placenta and other support structure,
and the inner cells for the most part become the fetus. These cells are
called pluripotent because they can no longer become absolutely anything,
they are starting to have some specialization. At the next stage we have
multi-potent stem cells, for example blood stem cells, which can become a
variety of different kinds of cells related to blood: red blood cells,
white blood cells, platelets, etc. While totipotent and pluripotent stem
cells are only found in embryos, multipotent stem cells are also found in
adults; we all have blood stem cells in our bone marrow that produce new
blood.
Given their unique characteristics, pluripotent stem cells are incredibly
valuable in research, and potentially could revolutionize the treatment of
many illnesses, including many of which are currently considered
incurable.
Some of the diseases and conditions which could possibly be treated by
pluripotent cells stimulated to grow into specialized cells include
Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns,
heart disease, diabetes, osteoarthritis and rheumatoid arthritis. There is
almost no realm of medicine that might not be touched by this innovation.
Failing hearts could be strengthened with heart muscle cells grown from
human pluripotent stem cells. Preliminary work in mice and other animals
has demonstrated that healthy heart muscle cells transplanted into the
heart successfully repopulate the heart tissue and work together with the
host cells. A report published in the October 8, 2004 issue of Science has
revealed a previously unknown power of stem cells: a congenitally
defective
mouse heart was repaired with embryonic stem cells. The stem cells seem to
have been able to “nurse” the flawed cells into fitness.
Pluripotent stem cells potentially offer a true cure for Type I diabetes.
Type I diabetes results from a disruption in the production of insulin by
specialized pancreatic cells called islet cells. Islet cell lines derived
from human pluripotent stem cells could be used for diabetes research and,
ultimately, for transplantation.
For some of these innovations, tissue rejection is a possible issue; one
way of solving this problem would use a technique called somatic cell
nuclear transfer, which to this lay person seems to be a combination of
stem cells with cloning—you would end up with tissues identical to your
own.
There have been two different approaches to isolating pluripotent stem
cells. In one approach cells are taken at the blastocyst stage from eggs
that were embryos that were created in a test tube. The blastocyst stage
does not last long; the fertilized egg becomes a blastocyst at around 4-5
days, and is only a blastocyst for another few days before becoming an
embryo. The second approach involves extracting cells from fetal tissue
from terminated pregnancies.
You may have heard in the debates that we should only use adult stem
cells; others support stem cell research only from embryos that were
created for other purposes and would otherwise be destroyed.
The scientists involved say that while adult stem cells hold promise,
there are many limitations to them, and embryonic stem cells could almost
undoubtedly bring us cures to many diseases much faster.
Given what we now know about the halachic principles and technology
involved, what would Jewish law say about stem cell research?
There is substantial support throughout the Jewish community, including
from strictly Orthodox poskim (rabbis who write decisions on Jewish law),
for stem cell research that does not involve creating new embryos for the
purpose. If we use cells from aborted fetuses, or from excess embryos
created in fertility clinics it’s comparable to organ donation, where you
give your cells to help someone else live.
It would be more difficult to justify intentionally fertilizing eggs in a
test tube simply to grow blastocysts and extract the pluripotent stem
cells. While under Jewish law, creating blastocysts for research purposes
in no way is an “evil akin to euthanasia and the killing of babies,” from
the moment of conception there is a potential for human life, which is of
significance.
One could argue that under Jewish law, the blastocysts, being less than 40
days old, are not considered much more than water. They are certainly not
considered in remotely the same category as babies. Not only are
blastocysts not viable on their own, if left in the test tube without
being implanted in a woman, they will not develop into babies, or into
anything else.
One could argue that until the cells are implanted in a woman, they are
not even the kind of “potential life” that the Talmud uses to describe
embryos less than 40 days old.
Given the enormous potential that stem cell research affords to save
lives, we clearly should support stem cell research from excess embryos in
fertility clinics or aborted fetuses. If there was a great scientific
need, creating blastocysts for research purposes would be in a grey area,
where some principles could be applied to permit it, and others to forbid
it.
The current Administration’s policy on stem cell research is far more
restrictive than is necessary. Lives almost undoubtedly would be saved if
we pursued embryonic stem cell research more aggressively. I respect the
President as a man of faith, and I support his right to make policy
decisions informed by what his religion teaches. However, the Jewish
approach to understanding the origins of life makes much more sense to me
than the Catholic approach. If you were in a fertility clinic where a
fire broke out, and you could either save the life of a sleeping four year
old child, or you could grab an armful of test-tubes filled with embryos,
is there a single one of us who would even think twice before taking the
one child to safety? Opposition to embryonic stem cell research is
largely based on a belief system that would have you grab the test tubes.
Shabbat Shalom
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