During my first year of medical school I went to a talk organized by our Jewish Medical Student Organization on the separation of conjoined twins. The talk focused on the 1977 Pennsylvania case of thoraco-omphalopagus twins born to an Orthodox Jewish family. These girls were born with a combined 6 chamber heart that would be incapable of sustaining their developing bodies. The case brought up the ethical debate of whether it is acceptable to separate the twins in order to save a single life, knowing that the other would die in the process. To sum of the full story, a unanimous decision was made on behalf of the medical team, rabbinical court, and American legal system that separation was justified. It is truly a fascinating case though and worth the read.
I was recently reminded of this case when a friend, a classmate, brought my attention to the this week's New York Times Magazine cover story: the two-minus-one pregnancy. Reading the article I realized that I have an arbitrary border placed between abortion and selective reductions. I fully support a women's decision to abort a pregnancy, and believe that it is not my place to judge such decisions. I believe that it is never an easy decision for any woman to make, it is never arrived at lightly, and that my role is provide supportive, quality health care to help her live her life in the way she chooses. Yet, as confident as I am that I WILL provide abortions as part of my career, I can't imagine that I will be comfortable providing selective reductions. Or at least not comfortable performing the procedure when there is not a medical indication behind it. Analytically, academically, I support a women's decision to reduce just as I support her decision to undergo an elective abortion but emotionally I feel very differently. When distilling this discomfort down in discussion last night, I realized that it stems from my religious doctrine. My understanding of Jewish text is that it is not for human's to decide whose life is of more value. It is one thing when comparing the life of a living mother to the potential life of a fetus, but seems to be a totally different matter when weighing equal-ish [potential] lives against each other.
I imagine this issue, and similar ones, will be revisited many times in my future. I have no idea what choices I will make if actually put in such a position. Yet, I imagine that these are the times I will turn to Jewish text. These defining moments in my career will be when I seek rabbinic advice and reflect on the precedent set in ancient text. However, I hope to be learned in the surrounding issues, comfortable in my own decisions, and cognoscente enough of my arbitrary borders that I will be able to support my patients regardless of where we both stand. If there comes a point that I am not comfortable performing a procedure, I pledge to help bridge the gap. I will refer them out to someone who can provide the comprehensive care and also to realistically help them access that care; much the same as I hope/expect from providers who refuse to provide abortion care.