7

I ran into an article about a woman who died shortly after refusing cancer treatment in order to be able to carry out her pregnancy. This isn't an uncommon scenario — I can think of at least three different instances where this has been reported to happen.

Is there a general sense of what the appropriate thing to do in such scenarios when saving the mother's life is clearly opposed to preserving the potential life of the child? Does the viability of the child affect anything?

Disclaimer: I'm not Jewish, and most everything I know about Judaism has regrettably been things I learned from a Christian perspective, thanks to my education (something which I'd like to amend).

7

In Judaism (as codified in the earliest of sources - the Mishna Ohalos (7:6) (HT Double AA for the English link)) the mother's life comes first, no matter how late in the pregnancy. Only once the baby is out enough to be considered independent does another Jewish value kick in - we can't pick between the relative importance of one life and another, and can't act to favor one over the other, so we have to let nature take its course.

The reason why this is the case is somewhat of a debate in subsequent authorities. I'll give you the Rambam's reasoning (which many contemporary Halachic deciders view as controlling): The mother is acting in self defense, and self defense is always a justification for taking another life. Once the baby is out to a certain point, then they could be viewed as jeopardizing each other, so we can't pick one over the other. (That last sentence is a little bit of interpolation as the Rambam isn't exactly clear what changed, but that is one way to understand him).

A much more complicated question is can the mother choose to anyway forgo such treatments (i.e. is she obligated to save herself). As a general principle one is not allowed to refuse all medical treatment and just let a disease take its course, however in a real case like this there are a lot of competing factors (how effective will treatment be, the mother's mental state about the situation, the possibility that it won't be fatal to the baby but will be damaging, the fact that sitting back and doing nothing is easier to justify than acting in a specific direction, etc.), and that would require a real case-by-case analysis of the situation.

  • 2
    @Renia, one isn't allowed to kill another person unless that person is a Rodef (pursuer). What changes is that the the mother becomes a Rodef herself (they are both endangering each other) so everyone has to default back to taking no action to kill anybody. It is definitely a subtle distinction, and it is possible that the mother herself would be different - the presumption in this discussion is that we are talking about the midwives and doctors, as a birthing woman would not be in a position do much. – Yishai Dec 12 '14 at 16:08
  • 2
    Here's a possible scenario. There's a feud between two people and they are both taking active steps to kill each other. Can Person A sees Person B coming at him with a knife. Can he not kill him in self defense? – Daniel Dec 12 '14 at 17:27
  • 2
    @Daniel, if Person A can kill him in self defense (compare to the mother saving herself on her own) possibly [A discussion in Achronim that I heard in a shiur once, not applied to a birth scenario]. Can a third party just pick whichever side he wants? I highly doubt it. You could understand the Rambam the other way - no one is a Rodef anymore, or you don't know who is the Rodef for who, but that seems very hard to justify conceptually. I have definitely heard the Rambam explained the way I put it in my answer, don't remember the source. – Yishai Dec 12 '14 at 17:37
  • 1
    @Yishai But suppose you are in a hospital with a non-Jewish doctor who is completely willing to do whatever the mother says regardless of whether it is halachically appropriate for him to do so. Can the mother instruct the doctor to save her at the expense of the baby if it is self-defense from her perspective? – Daniel Dec 12 '14 at 18:25
  • 1
    @Daniel, I don't know. She would be violating Lifnei Iver (even if the Doctor isn't Jewish). Unless you say the heter is Pikuach Nefesh (at which point who cares about that?) instead of Ein Lo Damim. Or she tells the nurse to tell the doctor ... (but that would for sure be Halacha vEin Morin Kein even if all of these theoreticals lined up). – Yishai Dec 12 '14 at 18:28
0

@Yishai explained the practical course one should take. I want to fill in some alternative Halachik views.

According to some Halachik authorities, one is allowed to sacrifice one's life to save another's. The mother may therefore choose to decline treatment in order to save the life of her unborn baby. This, of course, would be contingent on the child being expected to survive.

More likely, the actual case contained uncertainties. The treatments may or may not damage or kill the fetus. The mother may or may not be able to deliver the baby and then commence treatments (I know of such a case; both survived). The mother's probability of survival with treatments might be very low. To quote, "The only certainty about the future is that the future is uncertain."

In such a case, one might find room to enable the mother to choose her preferred course of action. It is accepted that one may risk their life in order to save another's. This is subject to extensive debate on the mitzvah of lo saamod al dam reyacha - do not stand idly while another is killed. While the authorities disagree, they all permit one to take a risk to save another's life. How else could we allow security guards, life guards, or a host of other potentially dangerous jobs? The authorities disagree on the degree of risk one may take for another. Some permit even a major risk if one so desires to take it.

Just to be totally clear, ALL halachik authorities permit the mother to save her life at the expense of the fetus, even in case where the danger to the mother is uncertain. And of course, one should consult with a competent Rabbinic authority before making such major decisions.

You must log in to answer this question.