Sunday, November 9, 2008

Pikuach Nefesh & mental health II

Regarding the view that potential mental illness constitutes pikuach nefesh what do we do about pregnancy which carries the risk of post partum depresion & psychosis.

Igros Moshe(E.H. 1:65) Question: Concerning a woman who becomes psychotic after the birth of each of her two sons and the doctors prohibit her to become pregnant again – is it permitted for her to use contraception?… Answer: You are definitely correct that psychosis is considered dangerous – not only to herself but also to her young children. Even though her psychosis is not now concerned with causing harm, but it is possible to change so that she will want to cause harm to herself and to her children – G‑d forbid! It is impossible to guard against this. Therefore she is permitted to use contraception since she has established that she has this problem because twice she has become psychotic after giving birth and it was only with great difficulty she was cured through shock treatments. Even though the doctors have not specifically warned her about this but since the halacha is in accord with Rebbe that two times constitute a chazaka (legal presumptive condition). Therefore we have to be concerned on our own. Perhaps even if the doctors say that it is permitted to become pregnant and that it was just coincidence that she became mentally ill just prior to child birth – it is commonsense not to rely on them since she already has a chazaka from the two times she became psychotic after she gave birth. On the other hand if the doctors had said after the first birth that she became psychotic as a result of childbirth there needs to be concern about this possibility of psychosis even for the second birth even though she did not yet have a chazaka that she would become psychotic after childbirth. Nevetheless she should be allowed contraception because of the concerns of the doctors.

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