As in many cases of new questions prompted by new and cutting edge technologies, there is still a great deal of discussion around the topic. However, the majority analysis does seem to lean towards the notion that multi-fetal pregnancy reduction would be permitted in order to enhance the chances of survival for other fetuses, if medically deemed probable to save those other fetuses. Based on Exodus 22:1, the Talmud (Tractate Sanhedrin 72A) offers what is known as the law of the “rodef”, or “pursuer”. This principle teaches that one make take the life of a person who is posing a direct threat to the life of an innocent. Thus, if one sees a murder about to happen, one is obligated to save the victim even if it means killing the would-be murderer. Former Chief Rabbi of Israel Rav Mordechai Eliyahu permitted reduction on this basis, namely that each of the fetuses posed a threat to the survival of the others. Others argue with this position, suggesting that the law of rodef should only apply when there is a clear pursuer who threatens the clear victim. Here, each of the fetuses poses a risk to the others, but no one of them is the direct threat. Rather, each of them is concurrently a threat to the others as well as a potential victim of them. Instead, Rav Yitzchok Zilberstein (Av Beit Din of the Ramat Elchanan neighborhood in Bnei Brak) and Rav Chaim David HaLevi (former Sephardic Chief Rabbi of Tel Aviv) offer that reduction is permitted because these embryos have not yet been established as viable lives. One then does not need to employ the principle of rodef at all; we are not dealing with actual life but rather with potential life that is unlikely to survive without our intervention. The question of how many may be reduced is generally left up to the best assessment of the medical professionals involved and dealing with the case. All agree that it is better that the procedure be done earlier in pregnancy rather than later, best before 40 days if possible.

But in some cases embryo reduction can be necessary to sustain a pregnancy and to help a woman deliver healthy children. Often infertility doctors place multiple embryos into a woman’s uterus, to increase the likelihood that at least one will thrive. But sometimes they get too lucky. Ironically, a woman who has struggled with infertility may now carry five embryos. Multiple pregnancies have much decreased rates of successful delivery, much higher rates of fetal defect. Sometimes, it is medically directed to “reduce” – that is, selectively abort – some embryos so that others may survive.

 

While Jewish law forbids killing one person to save another – for as the Talmud says, “how do you know whose blood is redder?” – legal authorities across all streams widely agree that it is appropriate to terminate some fetuses so that others will make it healthily to birth. The point, after all, is to be fruitful and multiply and raise another generation of Jews.

 

There remain two hard questions, however. First, how do you choose which fetus(es) to abort? Is it ethical to use this as an opportunity to select sex or some other trait? Jewish ethics prohibit that kind of manipulation. Often doctors can identify that some fetus is genetically or constitutionally weaker, already less likely to survive. That fetus is the first candidate for reduction. If you cannot distinguish based on the strength of the fetus itself, the next candidate might be its position within the uterus. Some fetuses might be more accessible for the doctors to terminate with less chance of complication. But if there is no objective way to distinguish between fetuses, pure random chance – a coin flip, effectively – is the only fair way to select abortion candidates. Any other method of choosing who will live and die becomes a kind of playing God that is likely to diminish our reverence for each life.

 

Next, what number should be reduced to save what number of others? Couples face this hard problem all the time. No one would question the need to reduce five implanted embryos – people are not normally capable of carrying and delivering five babies. But the hardest cases and grayest areas come when reducing from three embryos to two, or from two to one. In principle, we should follow the expert advice of physicians. When doctors recommend aborting a third fetus to carry two, we should follow that advice without hesitation.

 

But doctors sometimes endorse carrying triplets, and rarely recommend reducing from twins. Understandably, parents might anxiously prefer singletons and not want twins or triplets. Nonetheless, medical indications are the principal reason to reduce. Absent doctor’s advice to abort for the sake of increased likelihood of successful delivery, I would argue against reduction. To avoid having to make such ambiguous decisions, couples might implant no more than two embryos at once. Although this could decrease the likelihood that any of the embryos would “take,” it would also keep you from having to terminate a potential life.

 

Jewish tradition would permit embryo reduction in the situation you describe. This is because, as you note, “Judaism takes a relatively more lenient position” on abortion than do some other religious traditions. But just how lenient that position is has been the subject of a long dispute among the halakhic (i.e., Jewish legal) authorities. Broadly speaking, these authorities have been willing to permit therapeutic abortions on the basis of either of two conflicting theories that justify the destruction of the fetus.

 

1. The first theory holds that the fetus may be aborted when its birth would pose a mortal or other grave danger to the mother’s life. This theory is based upon the legal doctrine of the “pursuer” (rodef) who endangers the life of another individual. Like other legal systems, Jewish law teaches that in such cases the “pursuer” must be stopped, even at the cost of his life, from threatening the life of his victim. According to this first theory, the fetus is defined as a “pursuer” and the abortion is permitted.

 

2. The second theory proceeds from the fact that, under Jewish law, the fetus is not a nefesh, that is, a full-fledged legal person who enjoys equal status with all other members of the community. Under this theory, an abortion is permissible precisely because its mother enjoys a higher legal and moral status. Halakhic authorities who adhere to this theory concerning the fetus and abortion – and this includes some Orthodox rabbis as well as most liberal rabbis – will likely be prepared to approve of abortion in a wider range of cases than those (primarily Orthodox) rabbis who favor theory #1.

With respect to your question, rabbis who support both theories have said “yes” to the procedure of fetal reduction.

 

a. The late Rabbi Shlomo Zalman Auerbach (d. 1995) is reported to have permitted fetal reduction in at least two cases (quadruplets and sextuplets) where the physicians judged that not all of the embryos would survive birth. Rabbi Auerbach based his permit upon the doctrine of the “pursuer”: since the embryos posed a mortal danger to each other, selective reduction was permissible in order to save some of them (A. S. Avraham, Sefer Nishmat Avraham, vol. 5 [1997], p. 234).

 

b. The late Rabbi Haim David Halevy (d. 1998), the chief Sefardic rabbi of Tel Aviv-Yafo, permitted fetal reduction on the grounds that the fetus is not a nefesh: the destruction of the fetus is not considered “murder” in Jewish law, so that abortion and fetal reduction are permissible for sufficient cause, even if that cause does not amount to mortal danger (Sefer Assya, vol. 47-48, 1989).

 

Mark Washofsky