Cultural Concerns when Counseling Orthodox Jewish Couples for Genetic Screening and PGD.

There is a spectrum of attitudes within the Orthodox Jewish community towards genetic testing and PGD. Increased understanding of the belief systems of the Orthodox Jewish population will enhance the genetic counselors' ability to better serve this unique group of patients. By improving cultural competence, genetic counselors can help patients choose the testing options that they deem appropriate, while simultaneously respecting the patient's belief system.

Current Jewish perspectives on maternal identity.

Infertility counseling is a specialized field that will continue to grow in coming years as the impact of infertility and its treatment is documented more in terms of emotional, physical, social and life consequences. We report here on more recent developments in halakha (Jewish law and ethics) that are of importance to Orthodox Jewish infertile couple considering donor gametes or surrogacy. Counselors should anticipate issues that may arise in the future and assist couples in their efforts to address them. Good medical practice values the importance of understanding the patient's individual concerns and values, including the complex psychological, sociological and cultural context in which they experience their infertility. Good counseling anticipates and addresses future problems about which patients might not currently be aware, and requires up-to-date authoritative information.

Addressing the particular recordkeeping needs of infertile Orthodox Jewish couples considering the use of donated eggs.

Infertility counseling is a specialized field that will continue to grow in coming years as the impact of infertility and its treatment is documented more and more in terms of emotional, physical, social and life consequences. Counselors should anticipate issues that may arise in the future and assist couples in their efforts to address them. We report here on recordkeeping issues of possible future concern that should be addressed when Orthodox Jewish couples make use of donor eggs. Good medical practice values the importance of understanding the patient's individual concerns and values, including the complex psychological, sociological and cultural context in which they experience their infertility. Good counseling anticipates and addresses future problems about which patients might not currently be aware.

A note on eating disorders and appetite and satiety in the orthodox Jewish meal.

The relationship between religion and eating concerns is receiving increasing empirical attention; and because religion seems to be important to many women with eating concerns, there is an interest in investigating the role religion plays and ways that religion might be employed therapeutically. Research has indicated that women who feel loved and accepted by God are buffered from eating disorder risk factors. An aspect of religiosity that is unique to Judaism is Halakhah, the system of Jewish Law and Ethics which informs the life of a religiously observant orthodox Jew. In this note, we briefly describe how Halakhah approaches the issues of appetite and satiety in eating meals. These might well contribute to the protective influence regarding tendencies for eating disorders in a person whose culture demands an awareness of and commitment to halakhic norms. Some of the most significant characteristics of disordered eating-lack of appetite, disturbed satiated response, withdrawal from community and decreased spirituality-correlate inversely with the halakhic requirements of eating a meal. We suggest that future studies of orthodox Jewish women measuring eating-order symptomatology and its correlation with religiosity might focus not only on well-known indicators of halakhic adherence such as kashrut and Sabbath observance, but also on the specifics of how their kosher meals are eaten, including ritually washing one's hands before eating, saying the appropriate blessing before and after eating, eating the required two meals on the Sabbath, and fully participating in the Passover Seder meal.

Patient-centered Bedside Education and Traditional Jewish Law and Ethics.

BACKGROUND: Bedside rounds have long been a time-honored component of medical education. Recently, there have been various recommendations that residency-training programs further incorporate bedside teaching into clinical curricula. OBJECTIVES: To compare these current attitudes regarding bedside education with the position of traditional Jewish law and ethics. METHODS: Relevant medical journal articles and traditional Jewish sources were reviewed. RESULTS: Halacha (the corpus of traditional Jewish law and ethics) gives greater focus to a patient-centered rather than student-centered bedside education experience. CONCLUSION: Residency training programs should give greater consideration to the importance of a patient-centered bedside education experience.

Understanding culturally motivated requests from Orthodox Jewish women to delay ovulation.

We report here on the cultural reasons motivating some idiosyncratic requests from married Orthodox Jewish women to delay ovulation. Understanding and respecting the patient's individual concerns and religious values, including the complex psychological, sociological and cultural factors that they involve, is part of good medical practice.

Addressing the idiosyncratic needs of Orthodox Jewish couples requesting sex selection by preimplantation genetic diagnosis (PGD).

We report here on ethical considerations addressing the idiosyncratic needs of two Orthodox Jewish couples requesting sex selection through PGD. The patients' considerations stem from generally healthy concerns, are not based on any gender biases and have little chance of having any major societal impact, given the idiosyncratic nature of the situation. Halakhah, the legal and ethical system of rabbinic Orthodox Judaism, generally opposes sex selection through PGD for nonmedical reasons, but would approve the procedure in these cases. Meeting these needs within the context of the doctor-patient relationship necessitates reconsidering to some extent the ASRM Ethics Committee guidelines.

Jewish medical ethics: monetary compensation for donating kidneys.

The Israel Health Ministry is preparing legislation that would allow a person to receive monetary compensation in exchange for donating a kidney for a lifesaving transplant. Such a bill would be the first of its kind, and would seem to establish a policy that is in contrast with both existing international professional ethics and major Christian and Islamic religious ethics. In an attempt to investigate the extent to which such a bill would be consistent with traditional Jewish ethics, we reviewed the opinions of major traditional Jewish ethicists/halakhists, with emphasis on contemporary opinions, and found that compensating an organ donor for his or her time, discomfort, inconvenience, and recovery is fully consistent with traditional Jewish law and ethics. While non-altruistic sale of kidneys might be theoretically ethical from a Jewish perspective, ultimately its ethical status is inextricably connected to solving a series of pragmatic issues, such as creating a system that insures that potential vendors/donors are properly informed and not exploited, controlling and supervising medical screening and support of the donors to insure that their health is not permanently endangered, protecting minors and incompetents, and regulating payments so that they reasonably reflect compensation for pain and suffering.

Nonaltruistic kidney donations in contemporary Jewish law and ethics.

BACKGROUND: In 2000, the Consensus Statement on the Live Organ Donor reported that "direct financial compensation for an organ from a living donor remains controversial and illegal in the United States" and took note of the position of the Transplantation Society that "Organs and tissue should be given without commercial consideration or commercial profit." Christian authorities insist that organ donors must not accrue economic advantage, and "selling" organs deprives the donation of its ethical quality. METHODS: The writings of major contemporary authorities of Jewish law and ethics whose halakhic positions on bioethical issues are regularly considered by Orthodox, Conservative, and Reform ethicists were reviewed. Their positions on this issue were contrasted with those of various contemporary secular and religious authorities. RESULTS: These Jewish authorities reject the notion that generosity and charity, rather than monetary gain and greed, must serve as the exclusive basis for donation of functioning organs. CONCLUSION: Although nonaltruistic sale of kidneys may be theoretically ethical, ultimately its ethical status in Jewish ethics and law is inextricably connected to solving a series of pragmatic programs, such as creating a system that ensures that potential vendors and donors are properly informed and not exploited. Lacking such arrangements, ethical nonaltruistic kidney donations remain but a theoretical possibility.