“If an ultrasound demonstrated conjoined twins,†a lecturer remarked during class, “the mother would be wise to terminate the pregnancy.â€
I don't think I fully heard anything else for the rest of the lecture. I wasn't shocked by the consideration of abortion itself. It was the certainty embedded in the recommendation that struck me – the implication that one path was obviously more rational, responsible, or humane than the other.
As a medical student considering a future in gynecology, perhaps in fertility or maternal-fetal medicine, I have increasingly found myself wrestling with the field's unique ethical tensions. Predictably, abortion sits near the center of many of them. But I am not here to debate the ethics or legality of abortion. Nor am I troubled by the fact that it is discussed openly with patients. My discomfort is something more subtle, and I think, more serious.
What concerns me is the way prenatal counseling can quietly shift from presenting options to steering decisions. And in doing so, it reveals an underlying assumption about which lives, and which futures, are worth continuing.
I want to be clear that this is not a religious argument either, though I find it worth noting that Jewish legal tradition approaches abortion with far greater nuance than is often assumed. Halachic discourse has long grappled with maternal wellbeing, fetal prognosis, and complex pregnancies in ways that resist simplistic categorization. Yet in some modern clinical settings, prenatal counseling can feel less nuanced, not more.
Part of what made the lecturer's comment so difficult to shake was how clearly it reflected a broader attitude I had already begun to sense within Israeli prenatal medicine – one that often frames disability, illness, and fetal anomaly through the language of prevention, optimization, and burden.
Let's start with the facts. Israel has the highest documented rate of invasive prenatal testing in the world. A 2022 sociological review comparing attitudes toward prenatal testing and selective abortion in Israel and Germany found significantly greater cultural acceptance (and far less public discomfort) surrounding these practices in Israel. The authors partly attributed this contrast to Germany's historical sensitivity to eugenics and deliberate effort to distance itself from that legacy, while describing Israel as placing a far greater cultural emphasis on genetic health and the idea of the “perfect babyâ€.
I wish these observations felt purely theoretical to me. Unfortunately, my own experiences within Israeli prenatal care have made the underlying patterns difficult to ignore.
I lived in the United States during most of my first pregnancy, where NIPT (a non-invasive blood test screening for genetic anomalies) is considered routine prenatal care. During my second pregnancy, after making Aliyah, I asked a physician why the test was not universally covered in Israel as well. She answered me matter-of-factly that she believed eventually it would be, because “it's cheaper for the country than having to care for children with disabilities.â€
I left that appointment feeling incredibly unsettled. Not because prenatal testing exists. Not because I believe by any means that families should be denied information or the ability to make informed decisions regarding their pregnancy. But because of how easily the conversation shifted from caring for patients to calculating which lives would be too burdensome to support.
That feeling deepened when another physician repeatedly pressured me to undergo amniocentesis despite my young age and lack of medical indication. When I declined, I was reprimanded for being irresponsible. And when I expressed hesitation about undergoing a procedure that carried a risk to the fetus, I was dismissed with reassurances that the risk was negligible, and certainly less devastating than the alternative.
What once again troubled me was not simply the recommendation itself, but the attitude surrounding it – the sense that the conclusion, and the implication behind it, were self-evident; that avoiding the possibility of disability was obviously the rational choice. The emotional and moral complexity of the decision seemed to be stripped down to a technical calculation, with little room for nuance, uncertainty, or the possibility that another person might weigh those factors differently.
And perhaps this is what frightens me the most: the ease with which the system and its practitioners begin simplifying what is profoundly complex and rationalizing what is, by definition, deeply emotional.
Prenatal screening is unquestionably one of modern medicine's greatest achievements. It allows physicians to diagnose and intervene earlier, and it offers families information that can guide the decisions they make. But somewhere within that process, I worry we have also become increasingly comfortable framing certain outcomes as absolute tragedies, and certain lives as quietly undesirable.
Conjoined twins are a striking example precisely because prognosis is not uniform. Outcomes vary enormously depending on anatomy, surgical feasibility, and evolving medical capacity. Some die shortly after birth. Some survive. Some are successfully separated and go on to live meaningful and fulfilling lives. To speak with certainty in such situations is to compress a vast spectrum of possibility into a single assumed conclusion.
I keep returning to that lecture – to the phrase “it would be wise.â€
Wise according to whom? Based on what understanding of suffering, disability, family, or quality of life? And when did medicine become so comfortable making those determinations with such confidence?
Physicians inevitably bring their own experiences and beliefs into the clinical encounter. We witness suffering, sometimes on a catastrophic scale, and many recommendations come from a sincere desire to protect patients from pain. I do not believe that physicians who lean toward termination in difficult cases are cruel or indifferent. Many are deeply compassionate people trying to help families navigate impossible situations.
But compassion cannot come at the expense of humility.
Israel is proud of it's medical innovation, and rightfully so. Our prenatal care system is among the most technologically advanced in the world. We invest heavily in early detection, genetic screening, and fetal intervention, often with remarkable success. But technological sophistication does not exempt medicine from moral humility. If anything, it demands more of it.
Because the reality is that medicine can describe prognosis, but it cannot fully determine the value of a future life. It can identify risk factors, anatomical abnormalities, chromosomal conditions, and statistical probabilities. What it cannot do is measure the meaning a child may hold for a family, the resilience people may discover within suffering, or the worth of a human life touched by illness or disability.
And that distinction feels especially important in Israel – a society deeply shaped by values such as the preservation of life, family, and collective responsibility. Our emphasis on prevention and genetic vigilance has produced extraordinary medical achievements. But perhaps this is the question Israeli medicine needs to ask itself more honestly: what happens when a society exceptionally skilled at preventing suffering becomes increasingly uncomfortable with the possibility of imperfection?
Perhaps prenatal counseling should leave more room for uncertainty, and more recognition that different families may arrive at different morally sincere conclusions. Perhaps physicians should be slower to present one path as obviously rational, responsible, or humane, especially in situations medicine itself can never fully predict or resolve. Perhaps patients do not always need medicine to resolve complexity for them. Perhaps sometimes they need physicians willing to sit beside them within it – with honesty, compassion, and humility.
And perhaps we should be more cautious about allowing the language of prevention and optimization to quietly shape how we think about the value of human life.
Perhaps that would be wise.
