This is a series that usually appears on Torah Musings, but is for this one week appearing here, on The Times of Israel. Last week (28 Av, here), we saw a responsum in which R. Moshe Feinstein’s understanding of what Hashem guarantees us affected his recommendations regarding insurance. This week, again, we will see examples of his underlying ideas about what Hashem has promised us impact his view of when and how we should or shouldn’t strive to have children.

Although some of the discussion of how to balance reliance on Hashem with our own efforts is similar to last week’s, the question recurs almost incessantly in any life of service to Hashem, so I found the responsum worth our time. I hope to intrude as lightly as possible, to almost solely present R. Moshe’s views. But I will note where his conclusions leave room for different ones.

A Daughter with Leukemia

On the fifth of Elul, 1981, R. Moshe responded to his grandson, Yacov Tendler, whom the Internet identifies as a still practicing internist in Suffern. The first question regarded a couple whose three year old had leukemia. The responsum does not specify which kind, but ALL, the more common one, is a success story of oncology — from being an absolute death sentence eighty years ago, today as many as 80% of childhood ALL is driven into full and long-term remission.

But in 1981, even as progress was being made, it was certainly a disease where death was a realistic possibility. The couple had not yet had a boy, and wanted to postpone having more children to care for the little girl, who needed much attention at home and in the hospital.

The basis for any questions on contraception is a debate in Yevamot 110b, where R. Meir holds that three women may (or must, in some readings, but R. Moshe does not take it that way) use a contraceptive: a young girl, a woman who’s already pregnant, and a nursing mother. R. Meir was worried that a pregnancy might kill too young a girl and, in the other two cases, threaten the health of the existing fetus or baby.

The Sages disagreed, applying Tehillim 116;6, שומר פתאים ה’, Hashem takes care of the simple. For R. Moshe, the Sages were saying that the Torah’s silence on these concerns implied a divine promise to protect mother and child from harm should another pregnancy arise. He stresses that it is a guarantee, so that relying on that would not constitute a forbidden reliance on miracles.

That only applied to ordinary situations — an extraordinary danger, to child or mother, would move the Sages to agree with R. Meir, R. Moshe claims. That’s a huge leniency, inferred by R. Moshe with remarkably little textual support. It would be easy to read the Sages as requiring always relying on Hashem. His limiting that to ordinary life situations creates many, many possibilities for permitting contraception. As soon as a non-ordinary health issue arises, he has construed the Sages as allowing contraception. I would ask a competent halachic authority before applying that in practice, but that’s what he’s done, in theory.

Will a Pregnancy Threaten the Health of the Little Girl?

Unequivocally, then, if a pregnancy would endanger the couple’s ill daughter, R. Moshe is on board with contraception to prevent it. But would it? By the age of three, he notes, many children have babysitters. Some women (rich ones, in his view) have them purely for the convenience, and leave toddlers, let alone small children.

Even should this mother conceive right away, there would be five or six months to acclimate the daughter to a babysitter, to cover those hours when the mother’s pregnancy, childbirth, and need to care for the newborn would force her to be away from her daughter.

In reading this, I was reminded of multiple experiences I have had with people asking for charity, because they had left their jobs to care for an ill spouse or child. R. Moshe implies that they should have asked: granted that personal care is better, what are the costs in insisting on it?

Absent other claims on her time, the mother can choose to give all her daughter’s care. But here there was a significant competing value, the father’s obligation of פריה ורביה, procreation. It’s a reminder that life is often about the best response in this situation, to these circumstances, not the absolutely correct answer.

The Competing Value — Childbearing

To R. Moshe, the Torah obligation to have children needed to loom large. Even had they had a boy and a girl, he thinks the continuing obligation of שבת, of ensuring that the world is settled, might also be enough to say they should hire a babysitter to free up enough of the mother’s time and energy to have and care for another child.

This isn’t the place for the discussion, nor does R. Moshe go into it, but some have taken the obligation of שבת to mean that people have to keep popping out children, no matter how many. R. Moshe’s earlier comments about the health of mothers and children seems to me one simple response — while there is certainly an obligation of continuing childbearing (one to which too many Jews pay too little attention), other factors come into play. If having another child means one or both parents will not have enough time even to give the bare minimum necessary for the existing children’s physical and possibly mental health, there’s a good argument that those outweigh at least שבת. (That can be exaggerated the other way as well, defining the minimum as so onerous that one child is too many for both parents to handle).

In this case, the couple faced the more (halachically) pressing matter of baseline procreation. There, R. Moshe felt comfortable saying that instituting a babysitter (I assume barring some direct evidence that a babysitter in fact could not do what the mother did) did not constitute enough of a threat to the child’s continuing health to justify delaying that mitzvah.

Marfan Syndrome and Procreation

Next, he turns to the case of a 25 year old man with Marfan Syndrome, a genetic problem of the connective tissue, which can cause symptoms including a weakened heart, lungs, and eyes. The man had already had heart surgery and gone blind in one eye, and had a fifty percent chance of his children inheriting it. It’s not mentioned in the responsum, but at the time, life expectancy of sufferers was about two thirds of average; now, with improved treatments, it is about average.

He wanted to know if he was permitted or obligated to marry. Before I move on to R. Moshe’s answer, I want to make sure we remember the pathos in situations like this, and not mistake dry legal discussions for the entirety of a proper response to a person with this challenge. R. Moshe has no contact with this patient, so it’s not his role to reassure or encourage or cheer up the young man facing this difficult path. He will answer the question asked.

He takes for granted that if he finds someone willing to marry him — R. Moshe stresses that he has to reveal his condition; otherwise, it would be a fraudulent marriage, and hence likely null and void — he is allowed and obligated to marry and try to build a family. After all, a fifty percent chance is a statistical statement, not a specific prediction; all of his children might be spared.

Not only that, R. Moshe allows praying none of his children have Marfan, because that is not considered a miracle. (Remember that R. Moshe thought it was prohibited to pray for miracles). He doesn’t elaborate, but I think he means a miracle would be if science tells us that all or ninety percent of his children will have it, and he prays that they wouldn’t, or that a mutation occur such that they wouldn’t. But Hashem always arranges which genes are passed on to a child; the prayer would just be that Hashem arrange the genes to spare the children Marfan.

Even if his children do have Marfan, he will have fulfilled his obligation of piryah ve-rivyah — because, even back then, people with Marfan lived long enough to have a career, bear children of their own, make a contribution to the world. Even if they tended to pass away in their fifties, that’s still a life (more than one giant of Jewish history didn’t make it to fifty — the Arizal, the Shach, Ramchal, and Rema and the prophet Shmuel were fifty-two — but left an impact for generations to come).

Of course, it’s possible he won’t find anyone willing to marry him (a worthy topic of its own, how we deal with disabilities, whom we are or are not willing to marry), in which case he would be an אנוס, literally incapable of fulfilling his obligation.

Fertility Treatments Beyond the Bare Mitzvah

The third of the procreation questions — there’s also one about a doctor writing on Shabbat, but I’ve gone over my space limitations, so it’ll have to be another time — is about whether a couple with a boy and a girl, who want more children, should seek medical assistance (presumably, fertility treatments). For all that we’ve seen how seriously R. Moshe takes this obligation, here he rules that if the couple does not know of any illness preventing their having children (which, to me, implies that they’ve seen a doctor and s/he found no easily identifiable or easily solvable problem), they should assume Hashem does not want them to have more, has decided they would fulfill their bare obligation and no more.

Nor should they think of this as a punishment, he says; rather, it takes a special blessing to have many children, just like it does to be rich (R. Moshe speaks in terms of merits, but he may mean that certain goods come only for particular reasons, and if those don’t apply to this couple, they won’t get more children. I’m not sure, in other words, that he means that if they just added enough more merits, they’d get the children). The couple with “only” two children has not merited a greater blessing.

This couple should therefore daven to Hashem that they should be enabled to fulfill the mitzvah of shevet, of settling the world, and all the mitzvot connected to raising children. He contrasts this, by the way, to money, where he thinks that if Hashem wants us to have more, Hashem will give us more, and there’s no need to pray for it.

It is a final reminder, if we needed one, that for R. Moshe, much more of the course of our lives is set by Hashem’s decisions on what we do or don’t get (and what troubles we do or don’t face) than many of us assume.