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The course of the disease is progressive, and it is customary to riage. The other type of blemish is severe enough to cause a person
estimate the stage of the illness in the patient by ranking their abil- to seek a divorce once married. The blemish referred to in Sefer Chas-
ity to function alongside the decrease in their cognitive abilities (i.e. sidim was probably the latter kind. This severe type of blemish can
dementia): invalidate the marriage. The blemish Rav Yehudah was dealing with
Stage 1: The patient functions normally in his daily life, but the di- can be classified as the former kind. Although most Jewish women
agnosis has already been made. The patient can work at his profession would not initially marry the child of a gentile father, once married,
at the same level he did in the past. they are likely to accept the situation and not to seek a divorce. This
Stage 2: The patient’s work is at a lower level than normal, but he type of blemish would not invalidate the marriage and therefore, one
can still do the functions of of daily living. is not obligated to reveal it beforehand.
Stage 3: He cannot work anymore and needs help with housework In view of the above, it is clear that hemophilia is not as severe a
and handling financial issues, but daily living continues mostly as deficiency as the two previous cases. While most people would seek
normal. to leave a marriage so as not to bring Down’s syndrome or mentally
Stage 4: The patient becomes very dependent on those around retarded children, who may lose their minds and take their own lives,
him, but can remain with the family. into the world, hemophilia, on the other hand, is not a danger to life.
Stage 5: The patient is completely dependent and requires help in The patient can live a long and happy life, injecting his medications
all activities of daily living. He frequently requires hospitalization. when necessary.
There is no cure for this disorder. The average lifespan of patients, Therefore, the physician should try to convince the parents that as
after the diagnosis is made, is about seventeen years. Often the initial an act of piety, they should reveal the information to the brothers. It
manifestations of the disease are reflected in personality changes, a is also proper to reveal the information to those thinking of marrying
decline in starting and maintaining social ties, periods of depression, into the family. If the parents do not do so, the physician is not ob-
and more… all of which precede the diagnosis of the illness by a few ligated to say anything, and the parents probably did not violate the
years. (The most frequent causes of death are cardiosclerotic or pneu- prohibition of deception. This requires further study.
monia.)
Prof. S. Miklah, Geneticist 1 SuMMaRy and Conclusions

1 AnsweR to Question 1 1. The physician should tell the carrier and ask him to tell his
spouse the truth.
It seems to me that we are obligated to inform the sons who have 2. The physician should convince the carrier of the gene to tell his
reached adulthood and are in the midst of finding a spouse. They, relatives who are also carriers.
in turn, are obligated to tell a prospective spouse about their father’s 3. Hemophilia is a milder disease and does not endanger life. It
illness and its hereditary nature. However, one should not cause those is nonetheless proper to tell those who are about to marry into
sons who are not yet of marriageable age undue pain by informing the family. If the parents do not tell them, the physician is not
them before it is necessary. I will explain this further: obligated to do so.
A person who is sick with a serious illness is obligated to tell a
potential spouse about his illness for two reasons: 1) So that he does

56 1 Medical-HalacHic Responsa of Rav ZilbeRstein Hereditary Defects 2 77

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