The importance of Centrist Orthodoxy: a case study in genetic screening

I was surprised and then annoyed with myself for not adequately appreciating the differences between Charedi Orthodoxy and Centrist (or Modern) Orthodoxy, in practical terms. Often, we try to understand the difference between these groups through slogans: eg. תורה לשמה and תורה עם דרך ארץ and תורה ומדע. In particular, when one identifies with Centrist Orthodox, unless they also have a deeper understanding of its approach to Yahadus, it can easily become a club or vehicle for those who promote left-wing, more compromising, approaches to Halacha,  or regrettably, boundaries outside of accepted Halacha.

Sadly, first steps are often after the fact. Individuals first assume an approach to Jewish Life and then identify themselves as Centrist (or Modern) Orthodox because they perceive more opportunity to mould that philosophy to accommodate their behaviours. Subsequent attempts to study Hirschian תורה עם דרך ארץ (a virulently anti-Zionist approach) or תורה ומדע (as described by Rabbi Dr Norman Lamm) are forays seeking to ascribe post facto legitimacy to existing behaviours and beliefs, some of which may well fall outside the Orthodox boundaries. There is much more to Centrist Orthodoxy than that, however. A failure to respect the solid foundations upon which Centrist Orthodoxy stands, is also an unfortunate, regrettable, hallmark of those who are identified with the right-wing.

It’s often easy to lose track of the importance of Centrist Orthodoxy because of the complex Weltanschauung it weaves and the friction it must deal with due to Centrist Orthodoxy not being an isolationist approach. Indeed, as a result, many who were Centrist become more Charedi, because the latter is actually simpler on the surface and perceived to be ‘more religious’. A seriously grounded and informed Centrist Orthodox Jew, however, is just as likely to have more fidelity to Halacha than a Charedi Jew! I won’t expand on this point in general terms; it’s pointless. Instead, I will reflect on a  burning issue which is being actively discussed. Through this issue, it is possible to discern an important difference in approach of Centrist versus Charedi, and, in my view, the superiority of the Centrist view is clearly manifest.

The Charedi community, influenced by a פסק from Rav Moshe Feinstein ז׳ל about testing for genetic markers, gave birth to the laudable and groundbreaking organisation Dor Yeshorim. The premise of Dor Yeshorim is not medical. Its aim is to

  1. construct and maintain a panel of genetic tests such that, based on Rabbinical advice, if two people are recessive carriers of a gene on that panel, they would be advised not to court each other.
  2. test two people, each of whom is identified by a secret unique number, and give a binary answer of yes or no, in respect of whether they may court each other (as defined by the particular panel of tests).

There have been two great achievements by Dor Yeshorim.

  1. Dor Yeshorim have been almost singularly responsible for removing certain genetic diseases from Jewish people. An example that is cited is Tay Sachs disease. I do believe this is true of the USA, however, in Israel there were and perhaps still are people who are ready to “roll the dice” and go out without knowing if they carry a deadly disease (this could be described as a misdirected exercise in תמים תהיה עם ה׳ אלוקך. [In this vein, when Rav Gavriel Holtzberg הי׳׳ד confided that his first son had Tay Sachs, I asked him whether he and his wife had been tested prior to marriage. Unfortunately, they had not. Their two eldest boys passed away miserably רחמנא ליצלן in a home for terminally ill children in Israel. The third son, the highly celebrated miracle Moshe Holtzberg, is a story in of itself and this post isn’t the place to discuss it. The point being though that (in my estimation) the more Charedi a couple is (unless they are Chassidim and their Rebbe has made a גזירה) the more likely they are to be חסידים שוטים and rely on תמים תהיה עם ה׳ אלקיך and שומר פתאים ה׳ and take easily avoidable and unecessary mortal risks, as Dor Yeshorim has demonstrated to date.
  2. Dor Yeshorim has managed to protect the privacy of couples, one or both of whom are carriers, and in this way engineered a much safer Shidduch environment. Indeed, if one loses their identification number, they will need be re-tested all over again. Since the testing regime is entirely anonymous, Dor Yeshorim cannot connect a person with their test results, were they to misplace their identification number.

How does Dor Yeshorim decide what to test? Their website claims

Dor Yeshorim’s panel of tests therefore currently screens for debilitating and recessive genetic diseases most commonly occurring within the Jewish community. These specific tests have been painstakingly researched and chosen based on their frequency and severity of symptoms. The decision to add a disease to the Dor Yeshorim panel of tests is not a simple one. We are forever mindful of our mission to ensure healthy families. At the same time, we must employ a balanced approach to adding a test to the panel; just because a test exists for the disease, does not mean it warrants screening.

The issue of what can and should be tested has hotted up, of late. There are apparently some 39 life-threatening Ashkenazic diseases, (the number 39 and its connected to מלקות is chilling) made up of hundreds of mutations. Dor Yeshorim has chosen to focus on some 14 diseases. Since the diseases are life-threatening, one might assume that Dor Yeshorim has made the halachic call to screen for all 39. It should be noted, and this is important, that it is no more expensive for a testing laboratory to scan and report on 200 versus 39 versus 14. Therefore, there ought be no argument of cost vis-à-vis less prevalent carriers of disease. In the Dor Yeshorim system, nobody knows which of the two (or both) is positive for any particular marker. In addition, the set of tests is determined by Dor Yeshorim in consultation with its Poskim. The reality is that Dor Yeshorim has not extended to many more markers even though this ought be cost neutral. A result of Dor Yeshorim’s stance is that there is a new agency, known as JScreen.

JScreen looks at some 200+ diseases. The list is here.

The question now becomes, should one prefer JScreen as this is medically and scientifically a more expansive panel that will show up less prevalent diseases? Note, even if a disease is very rare, for example there is only a 1/10000 probability that a person is carrying the disease, then, for both the male and female to both be carriers, the chance of that occurring is, therefore, 1/100000000 (= 1/10000 squared=0.0001), nevertheless, it is a  25% chance! that the couple’s offspring will have the disease! This probability is constant and does not relate to the prevalence of the disease, and importantly does not impinge on the “Shidduch Crisis” because the chance of both people being carriers is 0.0001! I fear that some Poskim are simply not aware of the statistics and have an arcane notion that the more one tests the greater the effect on the Shidduch Crisis. This is not the case. Indeed, if a disease is incredibly remote (say one in a million probablity), but horribly destructive,  then

the chance of a prospective couple going on a Shidduch date both carrying this rare gene, is 0.000000000001 !!!

Should anyone be afraid that this will cut them out of Shidduchim? Not in my mind.

With the above in mind, I was listening to a fascinating podcast hosted by the impressive Rabbi Dovid Lichtenstein on this exact topic.

Rabbi Lichtenstein invited two world-famous Poskim to be live on his podcast. The first was מורי ורבי HaRav Hershel Schachter שליט׳׳א and the second was HaRav Binyamin Forst שליט׳׳א. Rav Schachter was gently firm and stated that there really ought to be no reason we aren’t finding out whatever we can to prevent a calumny. (It should be noted that it is estimated that couples who have a seriously ill child, have a 50% divorce rate, due to the incredible and inevitable pressure on a marriage).  In Rav Schachter’s eyes, it is the plain Halacha in Shulchan Aruch אבן העזר, סימן ב which determines practice:

לֹא יִשָּׂא אָדָם אִשָּׁה לֹא מִמִּשְׁפַּחַת מְצֹרָעִין וְלֹא מִמִּשְׁפַּחַת נִכְפִּין, וְהוּא שֶׁהֻחְזַק שָׁלֹשׁ פְּעָמִים שֶׁיָּבוֹאוּ בְּנֵיהֶם לִידֵי כָּךְ:

A man shouldn’t marry a women from a leprous family nor from a nekafim. If a family has three instances the next children will have the presumption of being this way.

Rav Hershel Schachter שליט׳׳א

Seemingly, the only counter-argument is that we should be careful not to ‘play God’ and if we use medical research to such an extent, it could be viewed as “interfering” with creation. (We do interfere with creation  though—we’ve basically eradicated Polio … is that a bad thing!?)

Rav Forst, who is a widely accepted Charedi Posek in the United States, was not happy about using JScreen over Dor Yeshorim, and advised that he cannot understand why one should look for such uncommon diseases, and that we should have more faith in Hashem. He goes as far as stating (I assume that he didn’t know Rav Schachter had been on before him) that no respectable Posek would suggest that couples undertake a larger panel of tests, per JScreen. Indeed, not only Rav Schachter but also Rav Dr. J. David Bleich are strongly in favour of wider testing. It could be argued that R’ Moshe Feinstein ז׳ל would also have agreed with that stance. Critically, I am not sure whether Rabbi Forst knew the מציאות that if the male and female carry the remote disease, that there is always a constant 25% chance (one in four!) that a child will inherit it.

This is a poignant example which amplifies a difference between Centrist Orthodoxy and Charedi Judaism. The Charedi approach appears to be reluctantly using Science as an ingredient in a kosher Jewish existence. When they do engage with Science, they are careful to limit this so that uncommon cases are not tested. There is a latent Charedi feeling (הרגש) that too much science implies that God is lessened in the equation of השגחה. Accordingly, they quote the verse of תמים תהיה עם ה׳ אלוקיך. It is important to be über pure in one’s relationship with God, and testing for “remote” diseases expresses a lack of faith in God’s choices and a lack of Bitachon!

Rav Binyamin Forst שליט׳׳א

Rav Schachter, however, uses the poignant example of a blind person who is playing near the seashore and is easily swept into the water. If we can see: that is, Science is able to help us, then there is no excuse to make oneself ‘blind’ and ignore what is easily found out. Rav Schachter is not challenged by Science. In his worldview, the Doctor has been given the Torah right to heal. Yes, they do interfere with the progression of illness! Furthermore, a Doctor who does not use the best medicine of his or her time is grossly negligent. Rav Schachter sees the advice of Tannaim in the Gemora in respect of Medicine, and the same applies to the Rambam, as being the best medicine of that time. We don’t follow that today! We also continue to follow the best medicine of our time. That is the Halachic imperative.

This chasm between the reality of medical-cum-scientific endeavour and the feeling that it is external to our Torah mandated Halacha (because its source is secular) is an important and critical distinction between Centrist (or Modern) Orthodoxy and Charedi versions of Orthodoxy.

Reb Moshe, himself, was never a predictable “all is forbidden” style Posek. This is one of the things that made him so very great. Reb Moshe would often rule in a lenient way and buttress his argument with prime sources, as opposed to later Acharonim. He is described as having ‘broad shoulders’. Consider this: even though Reb Moshe, for example, was stringent on himself not to use milk which was produced under the regulation of a Government, he had such milk at home, and his family partook of it. Indeed, his son Reb Dovid, who is a prominent Posek, still does. Reb Moshe was certainly not a ‘standard’ Charedi Posek. On this matter, Reb Moshe in a responsum on Tay Sachs balances these opposing concepts in his discussion about genetic testing before marriage (Igros Moshe EH 4:10). First, he writes, since the probability of both spouses being carriers is minute it may be included in the precept of “תמים תהיה according to Rashi, which instructs us not to delve into the future. However, he then writes, since the test is easily available and if an inflicted child is born it is devastating, the public should be educated about their options! Reb Moshe was the real deal, a truly great Posek, without fear or favour, and with a sensitive social understanding.

We close noting that Rabbi Forst advocates that women not test themselves for the BRCA gene, a gene associated  רחמנא ליצלן to breast and ovarian cancer, until they are 40+. The illness is not dependent on a husband. Rabbi Forst argues that the knowledge serves no real purpose since the women can have surgery at 40+ and remove the chances of cancer. I am not sure I understand. The surgery is radical and not at all easy for a woman. Rabbi Forst comes across as if it’s another (routine) surgery (Tonsilectomy?). Secondly, I would have thought that if we can aid medical and scientific research by attempting treatments on people before they are 40 (after finding out through a test) then we should do so! Imagine if they come up with a simpler treatment via some injection of specially designed stem cells. Would we not be involved in that from day 1? As I understand it, there is a higher incidence of problematic BRCA genes in Jewish people. Indeed, Rabbi Bleich suggests that we should, if possible, find out as much as we can by testing at birth. Of course, we do now test at birth, but only for those illnesses that can be treated.

In summary: one in four ought never be שומר פתאים ה׳ and the importance of Halacha engaging with the quality Science we have available, is critical!

Author: pitputim

I'm a computer science professor in Melbourne, Australia although my views have naught​ to do with my employer. I skylark as the band leader/singer for the Schnapps Band. My high schooling was in Chabad and I continued at Yeshivat Kerem B'Yavneh in Israel.

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