procedural risks versus theology: chorionic villus sampling for orthodox jews at less than 8...

Volume 189, Number 1 Letters 309Am J Obstet Gynecol

The new STAN method for intrapartum fetal surveil-lance is currently being used in 118 European maternityunits in 18 different countries with >1000 members ofstaff being certified. This development is based on havinga group of academic centers of excellence to support safedissemination of the method. The Antwerp unit is onesuch center, and it is of special interest to us that STAN,soon after its introduction to Dr Jacquemyn’s obstetricdepartment, has been shown to improve the detection ofadverse events in labor.

I. Amer-Wåhlin, MD, H. Norén, MD,and K. G. Rosén, MD, PhD

Neoventa Medical AB, Lilla Bommen 1, Gothenburg, SE 411 04, Swe-den; e-mail: kg.rosen@neoventa.se

REFERENCES

1. Amer-Wåhlin I, Hellsten C, Norén H, Hagberg H, Herbst A,Kjellmer I, et al. Intrapartum fetal monitoring: cardiotocogra-phy versus cardiotocography plus ST analysis of the fetal ECG: aSwedish randomized controlled trial. Lancet 2001;358:534-8.

2. Noren H, Amer-Wåhlin I, Hagberg H, Herbst A, Kjellmer I,Marsal K, et al. Fetal electrocardiography in labor and neonataloutcome: data from the Swedish randomized controlled trial onintrapartum fetal monitoring. Am J Obstet Gynecol2003;188:183-92.

3. Amer-Wåhlin I, Bördahl P, Eikeland T, Hellsten C, Norén H,Sörnes T, et al. ST analysis of the fetal ECG during labour—Nordic observational multi-centre study J Matern Fetal NeonatalMed 2002;12:260-6.

doi:10.1067/mob.2003.420

Procedural risks versus theology: Chorionic villussampling for Orthodox Jews at less than 8 weeks’gestation

To the Editors: The logistic analyses by Peleg1 andPetrikovsky2 of the article by Wapner et al3 no doubt rep-resent serious attempts at resolving the terrible situationin which Orthodox Jews find themselves with regard togenetic diseases such as Tay-Sachs. Unfortunately, thisproblem will never be solved medically. It requires scien-tifically knowledgeable Orthodox rabbinic authorities tolive up to their community responsibility and devise aworkable solution. As long as Orthodox rabbis instructtheir adherents that reproduction is a commandmentthat must be obeyed without regard to genetic makeup,as long as any form of birth control is forbidden to Tay-Sachs gene-carrying couples, and as long as abortion isdenied to women carrying Tay-Sachs children, affectedchildren will continue to be born. The best efforts of DorYeshorim, an organization that offers genetic screeningto Orthodox Jewish teenagers and tries to direct carriersof these mutations toward marriage to noncarriers, can-not prevent the birth of affected children without fullsupport from the Orthodox rabbinate.

Petrikovsky’s quote of the assertions by Orthodox au-thorities that “the fear that a child might be born physi-cally malformed or mentally deficient . . . does not . . .justify recourse to abortion”4 describes the problem, notthe solution. Anyone who has examined a child with Tay-Sachs disease at 2 to 3 years of age will have difficulty withthe phrase “fear that a child might be born physically mal-

formed.” A prenatal diagnosis of Tay-Sachs disease unfor-tunately constitutes not a fear of physical and mentalproblems but a certainty thereof; the term “physicallymalformed” is also a gross understatement of the seque-lae of Tay-Sachs disease. It is disturbing that Orthodoxrabbinic authorities have so far failed to exercise theirrights under Orthodox Jewish law to change laws that areno longer practical, that cause untold suffering and thatmost Jews regard as untenable.

I call specifically on our rabbinic authorities with med-ical/scientific training to critically examine, and if neces-sary re-examine, the current situation regarding theJewish heritage group of genetic diseases and to immedi-ately begin to provide leadership in this arena. The all-too-common situation in which a couple refuses to findout whether they are carrying a Tay-Sachs child, becausein any case they have no alternative but to allow the preg-nancy to go to term, must end and end quickly. There hasbeen far too much suffering already, and the problem re-mains a blight on the entire Orthodox Jewish community.

Joel Goodman, PhD, FCACBDynacare Laboratories, 20 Eglinton Ave W, Suite 1600, Toronto, On-tario, Canada M4R 2H1; e-mail: jgoodman@dynacare.com

REFERENCES

1. Peleg D. Procedural risks versus theology: chorionic villus sam-pling for Orthodox Jews at less than 8 weeks’ gestation [letter].Am J Obstet Gynecol 2003;188:299-300.

2. Petrikovsky BM. Procedural risks versus theology: chorionic vil-lus sampling for Orthodox Jews at less than 8 weeks’ gestation[letter]. Am J Obstet Gynecol 2003;188:300.

3. Wapner RJ, Evans MI, Davis G, Weinblatt V, Moyer S, KrivcheniaEL, et al. Procedural risks versus theology: chorionic villus sam-pling for Orthodox Jews at less than 8 weeks’ gestation. Am J Ob-stet Gynecol 2002;186:1133-6.

4. Rosner F, Tendler MD. Practical medical halacha. London: JAronson; 1990.

doi:10.1067/mob.2003.416

ReplyTo the Editors: Goodman’s comments are of general in-

terest but have very little to do with the content of the de-bate. We were discussing the usefulness of early chorionicvillus sampling (CVS) for the purpose of possible preg-nancy termination at less than 8 weeks for Orthodox Jew-ish couples. The suspicion of Tay-Sachs disease in thefetus is hardly ever an indication for early CVS, the bulkof which are to rule out chromosomal abnormalities,mostly trisomy 21. Regarding Tay-Sachs disease, Jewishcommunity leaders, including Orthodox rabbis, stronglysupport carrier detection in individuals who are ready toget married. It matches the American College of Obste-tricians and Gynecologists committee opinion that ideallyscreening for Tay-Sachs disease should be offered beforepregnancy if both members of the couple are AshkenaziJews or of French Canadian or Cajun descent.1 If thewoman is already pregnant, leukocyte testing must beused. Invasive procedures should be offered if both part-ners are carriers.1 Goodman’s statement that “as long asOrthodox rabbis instruct their adherents that reproduc-tion is a commandment . . . any form of birth control is