Abortion in Halakha: A Study Guide by Rabbi Dov Linzer

Ramban, Torat Ha’Adam Sha’ar Ha’Mechush – Inyan Sakanah

19. The Mishna in Ohalot however states (7:6), ‘If a woman is in hard travail, one cuts up the child in her womb and brings it forth member by member, because her life comes before that of [the child]. But if the greater part has proceeded forth, one may not touch it, for one may not set aside one person’s life for that of another’. Now this implies that beforehand [before birth] there is no concept of ‘saving of a life’. Similarly the Mishna states (Niddah 44a) that if a person murders a one day old child he is liable the death penalty – that is, only a one day old child, not a fetus – and the verse also states that one pays monetary compensation for [causing a miscarriage] of a fetus. Nevertheless, regarding the issue of mitzvah observance, we can violate Shabbat for a fetus. The Torah says: violate one Shabbat for him, for perhaps he might keep many Shabbats. Therefore, even to save a fetus less than 40 days old, which has no [current] viability, we would desecrate Shabbat according to Hilkhot Gedolot.
There are those who are of the opinion that we do not violate Shabbat for fetuses…

Responsa of Maharit, 1:97

Question. Regarding a fetus which is considered the thigh of its mother…
In the second chapter of Hullin… Tosafot wrote that while one is exempt from killing a fetus, it is nevertheless not permitted to do so… [The reason is] that it is forbidden on the basis of bodily injury.
The Mishna in chapter 7 of Ohalot states… And it is only because the mother’s life takes precedence that we can abort it, but were it not that there was a risk to her life, there is a matter of concern regarding [taking] the life of a fetus. So how then can we say in Arakhin that we would kill the fetus directly (lit., with our hands) because of concern of disfigurement of the mother? And an additional question, for in that very sugya in Arakhin, it quotes the case of the women who sits on the birthing stool on Shabbat… From this it is clear that it is considered a risk of life and it overrides Shabbat…. And Tosafot also wrote the a non-Jew is liable for killing a fetus, and a Jew is exempt, but although he is exempt, it is not permissible. We see that there is a prohibition in this matter.
And we can answer – that the case of being taken out to be executed is different, since the fetus will be executed together with the mother, since a fetus is a thigh of the mother…

23. Responsa of Maharit, 1:99

And from the fact that the Gemara (Arakhin 7a)says, “It is obvious!” [that we can abort the fetus of the woman who is condemned], it implies that as far as taking a [fetal] life is concerned, there is not the slightest issue of concern… Therefore, regarding a Jewish woman, in a case of the mother’s need, it would appear that it is permissible to assist them to have an abortion, since it is for the sake of the mother’s health.

Rabbi Jacob Emden, Responsa Shelat Yavetz, I 43

Question: Regarding what you asked – is there a violation to destroy a fetus in the womb of a mother who is pregnant due to fornication, both in the case of a single woman and the case of a married woman.
Response: In the book Havot Yair (following responsum 31) I have found that the author was asked about a married woman who became pregnant due to adultery, and after the act she had regret, etc., if she is allowed to swallow some medicine that will cause her to abort (lit., destroy the corrupt seed within her)…
Now it would seem to me that there is reason to be lenient since she has committed adultery and there is blood on her hands. Therefore, she is now deserving of death according to the Torah. Although her life is not in ur hands to execute her, nevertheless, by law of Heaven she is deserving of death… Although a mamzer once he is born has the status of a “kosher” person, for whom it would be murder to kill, nevertheless, now, that he is still a limb of his mother, and if her life were in our hands we would execute her with her unborn child… it is obvious to me that there is no prohibition in destroying it, even if his mother remains alive…
Now, regarding the author’s attempt to demonstrate in that responsum that there was there was an element of violation based on the sin of wasting of seed. This can be rejected, for one can say that this (wasting potential life) is not the reason for the prohibition, but rather because one “spills into the dung heep” and gives power to the demonic powers and weakens the supernal forces, as is known from the masters of Kabbalah… One can thus see that it is not considered to be “for waste” except when it is wasted on the ground (as a result of masturbation), based on the reason given above… Thus, regarding a fetus, since it is not a life it is a doubt if it will ever become a full life, as discussed, the matter is still doubtful. Thus even for a “kosher” fetus (not the result of adultery) there would be reason to be lenient for a great need, until the point when it has “become uprooted” (childbirth has begun). Even when the mother’s life is not at risk, but it is just to save the fetus from the evil that will befall it, that it will cause significant pain to the mother. And this requires further investigation.
Knowledge is easy to he who understands it, that there is nevertheless a prohibition at the outset to destroy a fetus based on the simple sense of the Talmud, although one is not liable for murder regarding fetuses. And similarly [it is prohibited] to destroy semen that has been absorbed into a woman’s body, although she has not yet conceived as a result. All of this is definitely forbidden without a reason, as is clear from the discussion that women who may not use a mokh, save for three special cases. In truth, however, for a (legitimate) purpose it is permissible, even to “waste seed” and to spill it on the ground, as we see in the case of the testing of the genitals (Yevamot 76a). From this we see that this serious prohibition is permitted in the case of the mitzvah need, as I have written elsewhere, and there is no need to write at more length.

Tzitz Eliezer 9: 51 (R. Eliezer Waldenberg)

Summary of the halakhot that emerge from the preceding section:

1. A Noahide is executed for aborting a fetus. There is an opinion that he is not executed.
2. A Jew is not executed for aborting a fetus.
3. When there is a need, and the law determines that it is allowed to arrange for an abortion, it is preferable to have it done by a Jewish doctor.
4. One should be stricter regarding arranging an abortion for non-Jews than for Jews, since they are prohibited regarding aborting a fetus and one would transgress putting a stumbling block before the blind if there is no one else to do the abortion… Similarly, when there is a need to arrange for an abortion for a non-Jew, one should attempt to have a Jewish doctor perform it.
5. Some are of the opinion that even though a Jew is not executed for aborting a fetus, there is nevertheless a Biblical prohibition against him doing such.
6. Others hold that there is no Biblical prohibition, only a Rabbinic one.
7. Still others hold that even Rabbinically, the prohibition is a weak one.
8. Kabalistically, the prohibition regarding aborting a fetus is very severe.
9. When there is a danger to the mother in continuing the pregnancy, one can allow an abortion easily.
10. Even when there is no danger, but the mother’s health is very delicate, and for the sake of her health or to relieve her of severe pain, it is advised to perform an abortion, even though there is no real risk of life, even here one can allow this, according to the judgment of the decisor, as he sees the case.
11. One can also allow, as above, when the woman is nursing.
12. A married woman who committed adultery or was raped and became pregnant, even from a non-Jew, where the child would not be a mamzer, and she has now repented (in the case of adultery), a number of great decisors are inclined to allow for an abortion, either because of her shame or because of desecration of the divine name, and the shame and stigma to the family [and other reasons, as mentioned above].
13. To have an abortion before 40 days from conception, and also before 3 months from conception, is much more lenient than to do so after these periods. It is thus preferable to arrange for the abortion prior to these periods, while the fetus has not begun to stir, when there is a well-based concern that the fetus that will be born deformed and beset by afflictions.
14. At the other extreme, to kill a fetus once the woman is in the process of giving birth and the fetus has already been “uprooted to emerge”, it is much stricter than before this moment, and one cannot allow in such a case, save when there is a direct threat to the mother’s life.
15. Even in cases where the law would allow for an abortion, nevertheless, one should get the husband’s permission, since it is his property.
16. It is also preferable to have an abortion by drinking a medicine than by direct surgical means.
17. A woman who has a terminal illness, and if she continues her pregnancy continues it will hasten her death, and the woman is beseeching not to have the abortion, and she does not care that the pregnancy will hasten her death, as long as she leaves behind a child, one can allow such a pregnancy to continue, on the basis of “sit and be passive.”
18. All Jews are commanded with a strict decree not to deal lightly regarding ending a pregnancy, and there is a great responsibility in such a case, both on the one asking to have the abortion and on the decisor being asked. Not to mention that there is in such decisions the fencing in of the breaches made by the wanton women and those who would fornicate after them , that even the nations of the world have fenced themselves regarding this, and established laws and strict punishments on the violators and those who assist them, and behold Israel are a holy people

27. Tzitz Eliezer, 13:102 (R. Eliezer Waldenberg)

1975

The question is regarding terminating a pregnancy because of the Tay-Sachs disease… The technology today which allows testing for this disease cannot giver reliable results prior to three months into the pregnancy. Thus his question is if one can view such a disease with such severe and certain consequences, sufficient severity to allow for a termination of the pregnancy even after three months, or if the period of three months is absolute, and there is no justification, short of direct risk to the life to the mother, that would allow for a termination of pregnancy after three months.
Behold after investigation into the matter with great seriousness, and with consideration of all the relevant circumstances, it seems in my humble opinion, on the basis of the analysis that I wrote in my responsa, 9:51.3… that in a case such as this, in which the consequences are so grave if the pregnancy and childbirth are allowed to continue, it is permissible to terminate the pregnancy until 7 months have elapsed, and in a way in which no danger will befall the mother. Beyond 7 months the issue is more serious (and the stringency here is more based on how the matter seems and the “knowledge of the gut”, to use the phrase of the Havot Yair) since at the end of 7 months the fetus is often fully developed.
It is clear that capital punishment is not prescribed for abortion, and with the exception of a single opinion, the decisors conclude that there is nevertheless some form of a prohibition. But the opinion of most rabbis is that the prohibition is only of Rabbinic origin, or that it is in the category of the well-being of the world, but that there is not even the slightest element of destroying a life. Therefore, Maharit, in his responsum, permitted abortion for a Jewish woman whenever the matter was necessary for her health even when her life was not at stake.
Like this, and even to a greater degree, was it argued to be permissible in Responsa Yavet, 1:43… And therefore ask yourself where is there a great need regarding pain and suffering greater than the woman in our case which will be inflicted upon her if she gives birth to such a creature whose very being is one of pain and suffering and his death is certain within a few years… and added to that is the pain and suffering of the infant. This would seem to be the classic case in which abortion may be permitted, and it doesn’t matter what type of pain and suffering is endured, physical or emotional, as emotional pain and suffering is to a large extent much greater than physical pain and suffering…
(2) And you should know that in the words of Maharit and Yavetz, there is not mentioned at all that there should be a distinction between within 3 months and after 3 months. And the clear distinction given is only regarding once it has been “uprooted to emerge” and beforehand. To the contrary, Yavetz writes thusly: “As long as it has not uprooted to emerge,” and from this we can infer that as long as this is not the case, there is no distinction regarding what month it is in…
(4) Also in Responsa Havot Yair, 31, where he raises the possibility of distinguishing between before and after 40 days, or before and after 3 months, he expresses in passing his reservations about such distinctions, and he writes thusly: “Nevertheless, it is not our desire to make a decision based on what seems, and a knowledge of the gut”…
(6) Thus, as I have indicated at the outset, it would seem in my humble opinion that one can allow in a case such as ours to arrange for a termination of the pregnancy immediately once the test results are definitive that the child has this disease, even up to 7 months of pregnancy, provided that there is no risk to the mother…
(7) I will add that, to do it in the best possible way, it would be ideal if the operation could be performed by a woman doctor, for in such a case there would be another aspect of leniency, according to Havot Yair and Yavetz in their responsa. For they are of the opinion that the prohibition for a Jew to kill a fetus is because of wasting of seed, see there, and women are not prohibited in doing such according to most decisors.

28. Tzitz Eliezer, 14:102 (R. Eliezer Waldenberg)

Regarding checking the amniotic fluid to detect if the fetus has Mongoloidism (Down’s syndrome), and terminating a pregnancy under such circumstances.
March 19, 1978To his honor, haRav haGaon, Rabbi Eliezer Waldenberg, shlita, head of the Rabbinical Court, Jerusalem…
Among those who give birth over the age of 37, the frequency of such cases is approximately 1%, and amongst those who give birth over the age of 40, the frequency of occurrence is approximately 2%. The Ministry of Health will implement an amniocentesis screening program to be done at a time that will enable the detection of the embryos with this syndrome and the decision to terminate the pregnancy. This syndrome cannot be detected within the first three months of pregnancy. There is thus in this case a halakhic question similar to the one regarding pregnancy with a child who has Tay-Sachs disease.
As is known to his honor, a child who suffers from Down’s syndrome is completely different from one who suffers from Tay-Sachs. Down’s syndrome is a very undesirable disease accompanied by physical changes and mental retardation that sometimes requires institutional care and is linked to a shortened life expectancy. But, one should not compare a child with this disease to a child with Tay-Sachs who will surely die. It seems to me that the permission to terminate the pregnancy in a case of Tay-Sachs is based mainly on how such a case will impact the mental state of the parents, especially the mother, and it is for this reason that the rabbi (you) ruled that it is possible to terminate the pregnancy up through the seventh month of pregnancy. The harsh impact of a case of Tay-Sachs on the parents is clear and straightforward. On the other hand, although it is possible that Down’s syndrome will have such a negative effect, at the same time I am familiar with families who love their children who suffer from Down’s syndrome.
I am sure that I will soon be faced with inquiries from mothers of thirty-seven to forty years who will have two concerns: (a) Is it permissible to perform amniocentesis in order to discover cases of Down’s syndrome? (b) Requests for termination of pregnancy in such cases.Response. March 26, 1978. Jerusalem. To the honorable Prof. Dr. M. Meir, the executive director of Shaarei Tzedek Hospital in Jerusalem.
… Let us turn to second and main problem, if it is permissible to terminate pregnancy in the event that the examination shows 100% (as I was told in a verbal conversation) that the fetus suffers from Down’s syndrome, given that we are talking about doing this after three months of pregnancy.
Now, as his honor himself senses and emphasizes in his letter, one cannot compare the case of a child with this disease to a child with Tay-Sachs who will definitely die.
Similarly, a child who suffers from Down’s syndrome is very different from one who suffers from Tay-Sachs.
Therefore, it would seem that we cannot issue a general permission to terminate a pregnancy in a case of Tay-Sachs. However, when the results of the examination are known, the doctor must send the woman (and the hospital administration must issue an order in this regard) to a posek, providing the specifics of the results of the test, and the rabbi who is a posek will pay close attention to the emotional state of the couple in regards to this, and will decide with his halakhic judgment whether to allow the termination of the pregnancy. Only upon receipt of a qualified posek permit may the hospital management agree to do so in its facility.
I have emphasized that it is impossible issue a general permission… for according to the halachic sources and arguments that I have detailed and explained in my two previous responsa, in the course of my discussion of termination of pregnancy in the case of Tay-Sachs disease, there is a wide space (a strong basis) to conclude that it is permitted based on those same sources and reasons, even in the case of a fetus with Down’s syndrome. For in the final analysis, as his honor as described in his letter, it is also a very undesirable disease accompanied by physical changes and mental retardation that sometimes requires institutional care and is linked to a shortened life span. These realities have the ability, in many cases, to destroy the emotional/mental state of both the wife and the husband, including the ability to cause them to come down with a serious or not-so-serious illness, and also to destroy the health of the couple’s family life.
Let me give an example from a case that came before me in a couple of ultra-Orthodox Jews (from the old yishuv) who had already been born to them – it shouldn’t happen to us – two children who had Down’s syndrome who died a little more than a year after their birth. As a result, the wife was struck with an anxiety attack, and this expressed itself in her refusal to have marital relations with her husband for fear of becoming pregnant and again becoming pregnant with such a fetus. The husband waited a year, then two, and frequently implored his wife to return to a normal marital life, and the woman turned her back to him and remained adamant in her refusal. The situation came to my attention when they were already on the verge of divorce. When I saw what the situation was, I gave the woman permission to undergo the appropriate tests in case she got pregnant. She resumed martial relations with her husband, she became pregnant, she underwent the test, the test showed that everything was fine, and she gave birth to a sound and healthy child. Peace in their house was restored to its proper place, and they continue to live a happy life together.
In another case, I was asked by a certain Torah-scholar – scientist, regarding his wife, who was over forty and pregnant, and the doctor advised her to do the test. I tried to influence him that there was no need for an examination and to behave like our forbearers did who had faith in God that everything would turn out alright. He responded to me that from the moment his wife learned from the doctor about the concern (regarding Down’s syndrome) and the possibility to determine this through this recently developed test, she is not able to sleep at night, and she is deeply distressed to the point that he fears for her health. In this way, this knowledge has brought women into a state of “one who adds knowledge adds pain.”
Therefore, regarding such cases, and similar ones, it seems that we can certainly base a permission (for termination of pregnancy) one the rulings of the great poskim that we cited in our earlier writings (see Tztitz Eliezer, vol. 9, 13:102, and the previous responsum in this volume). In other words, whether based on the opinion of many poskim who hold that the prohibition against abortion for a Jew is only a rabbinic violation, for a fetus is not considered a life; or based on the opinions of the poskim who believe that it is not even an appurtenance to the sin of murder, but rather an offense like any other offense, add to this the fact that we don’t even violate Shabbat to save such a fetus (according to these opinions) as long as the woman is not in active childbirth; or based on Maharit and the many who are in his camp who permit an abortion whenever it is required for the health of the mother, even when there is no risk to life, and this is even if the prohibition is a Biblical one inasmuch as the fetus does not yet have a presumption of being alive; or based on the opnions that are mentioned in Havot Yair; or based on Yavetz and those in his camp who are of the opinion that there is a basis to be lenient as long as the child has not begun to leave the mother’s womb, even if there is no risk to life of the mother, but only to save her from the fact that the child will cause her great pain; or based on the author of Rav Paalim who is of the opinion that when dealing with these cases, a great need is defined not only in terms of one’s physical health needs, but also in terms of one’s spiritual and emotional needs, in accordance with how I explained and gave backing to this position; or explain and substantiate this; and so on, everything as I wrote and explained with great depth with God’s help in our earlier writings.
(D) I would also add that in a case where an abortion is permitted, in addition to the need and obligation to obtain the consent of the woman to terminate the pregnancy (as his honor wrote in his letter, which is included in the standard that you have prepared in this regard), there is also a need and an obligation to receive the husband’s consent, in accordance with the well-known halakha regarding damages when someone causes a woman to miscarry, that such damages are paid to the husband (Shemot 21:22, Baba Kama 42 and 49, Rambam, Hovel u’Mazik 5:1-2, and Hoshen Mishpat 423:1).
In conclusion:
(a) It is permitted to conduct an amniocentesis for the purpose of making a decision regarding termination of pregnancy due to mental retardation in a case of Down’s syndrome.
(b) In the event that the examination shows, with confidence, that the fetus has Down’s syndrome, a permissive ruling must be obtained from a qualified rabbi to perform a termination of pregnancy.
(c) An additional consideration to permit such an abortion would be if there was the possibility to terminate the pregnancy through drinking some medicine or through giving an injection (i.e., non-surgical means).
(d) In addition to the need to obtain the consent of the woman to terminate the pregnancy, the consent of the husband must also be obtained.With great honor and blessing, Eliezer Yehuda Waldenberg

29. Tzitz Eliezer 14:10 – excerpt on amniocentesis

Regarding the first matter (of the permissibility of undergoing an amniocentesis), there are two questions: (a) Whether it is permissible to conduct such an examination? and (b) Even if it is permitted on its own terms, is it permissible in cases where it will lead to a transgressing a prohibition? Because this will lead to causing the woman to stumble (in sin), for when she learns at that hospital the results of the examination, and when the hospital, which follows Torah law, will refuse to terminate the pregnancy, she will go to a different hospital or doctor who will agree to go against Torah law and carry out the termination of pregnancy.
Let me explain. The question regarding the intrinsic permissibility of the procedure, is because to do this test – as your honor has explained it to me in our oral conversation – it is necessary to insert a needle through the walls of the woman’s body and into her uterus (and this is done under local anesthesia) and the needle reaches the uterine cavity and draws a quantity of fluid from it … Sometimes it can happen (even if this is rare) that such an examination cause real harm and damage, such as bleeding and the like.
And examining the matter, it seems that despite this we can permit the act itself of performing a test … As far as the possibility that this will cause some injury to the woman as a result of this, behold this is it only a doubt (i.e., a small risk), and for this the woman’s consent suffices. For they do not perform such procedures without the woman’s consent to that, The permission to do this is certainly true given that they do not perform such a procedure for the purposes of inflicting injury, but for the sake of benefit.
The second question is that, as a result of the examination, the woman will be informed that the defect has been discovered in the fetus, and will arrange for the termination of pregnancy even in the case where the halakhic ruling is to forbid it. As a result of which, by administering the test we are transgressing the prohibition of putting a stumbling block before the blind, This can be an even greater concern if the woman who is undergoing the test is not religious, for in such a case the stumbling block is more real and anticipatable.
However, after looking into this matter, it appears that even the concern for this prohibition (of placing a stumbling block) does not exist, For we do not transgress the prohibition of placing a stumbling block before the blind except in cases where it is clear that the other person will transgress as a result of the first person’s actions. But wherever there is room to argue that the first person’s actions will possibly not lead to sin, then he does not transgress placing a stumbling block before the blind…
Now, in our case, we have all of these factors (of leniency regarding placing a stumbling block before the blind), and even more than them, For we are not handing the person the forbidden thing, for the test itself is not a violation, as stated above. It is also not clear whether this will even lead to a transgression, for in our case there are many many doubts regarding this. First, perhaps the test will be negative, which is what occurs in the vast majority of cases (the occurrence of Down’s syndrome in this population is only 1-2%), Second, who is to say that the woman will consent afterwards to undergo a termination of pregnancy. Thirdly, perhaps according to the circumstances of the case, she will receive a halakhic ruling permitting her to terminate her pregnancy from a rabbi who is a posek who will permit this according to Torah law…

30. Tzitz Eliezer 14:10 – use of kabbalistic or theological arguments

[Parenthetically, I understand that according to the Kabbalah it can be seen that everything is a decree from Heaven that these parents should have such children, either as a punishment for parents, or as a “fixing” (tikkun) of the soul, it is returned to the world of “action” (assiyah). And based on this, there are those who could say (and I imagine that there are already those who actually do say) that it is not our business to try to outsmart this decree, and therefore one should not perform any action that can get in the way of the process which is unfolding.
But, as is well known, one should not bring Kabbalah into Halakhah. As is written in Responsa Hatam Sofer, OH 51. Other poskim write similarly. Therefore, wherever there is a basis for permitting a certain action based on the Halakha, a counter-explanation of the situation based on Kabbalah should not act as any obstacle to performing the halakhically-permitted action, especially in cases where this kabbalistic explanation is not explicitly stated in kabbalistic sources.
I will also add that in general there is a way to reconcile (the decision to take such an action) with a kabbalistic approach which takes the perspective that “it is a decree that has issued from Me (and you may not question it).” This is based on what I saw in Hidushei Hatam Sofer of the Torah, (Tinyana) [Riviai], Parashat Mishpatim. Hatam Sofer states that “There are many who wonder about the Rabbis’ interpretation of “and he shall surely be healed,” (Ex. 21:9) that “from this you can derive that a doctor was given permission to heal.” (Berakhot 60a). People ask: what good does a doctor do? If a person’s merits or God’s mercy determine that the sick person will be cured, who needs the doctors? And if, Heaven forbid, the opposite is the case, then again, what good will the doctor do? To answer this, Hatam Sofer writes along the following lines. It is known that God created the laws of Nature, and it is His desire that the world should follow these laws of Nature. Now, consider a patient who, based on the doctor’s instructions, takes drugs which, according to the laws of the physical world, have the ability to heal and cure him, To alter the nature of such drugs so that they do not heal the person would be a miraculous act, and this person’s sins are not so great that God should perform a miracle to go against the laws of Nature and to prevent these drugs from being effective. Similarly, if someone does not merit that he should be healed via a miracle, nevertheless if he acts according to the laws of the natural world to heal himself, here his merits, and in particular God’s mercy, can help him to be cured. Moreover, as long as someone is operating according to the laws of nature, there is not such a need for his merits, and his reward for his good deeds will not be deducted from as a result of his recovering from his illness.” These are the amazing words of Hatam Sofer.
Therefore, according to these words of Hatam Sofer, one can explain the cases we are dealing with in a similar matter. We can say that if those who are “being punished” [the parents and the newborn] do not merit that a miracle should remove this suffering from them, and that the judgments that have been issues against them will be mitigated[, they can themselves, following the laws of the natural world, act to alleviate their suffering]. In this sixth millennium (from Creation) the gates of wisdom have been opened (as is known from the Zohar), we now have the ability to save them from their suffering, by following the laws of nature and the wisdom of medicine. When, in addition, doing such is not in opposition to halakha – because we find that according to halakha it is permissible to undergo a termination of pregnancy in cases of great need, and this permissive ruling is no different than that way we make permit other prohibitions in the case of a sick person and the like – then [there is a way for them to alleviate their suffering and] there is not such a need for a person’s merits to help alleviate and remove the punishment that was decreed against them… In this way it is permissible to remove the punishment against them through natural means, and Heaven will be satisfied (because it is permissible according to the halakhah) with the suffering that they already suffered from a pregnancy such as this in itself, and from the great sorrow (or “anguish”) that is attendant with it, both visible and not visible. Because they do so according to nature, that is, by following the wisdom that has been given to wise people to find a way to discover this condition before birth, then their merits, and in particular God’s mercy, will help them (to use the phrase of Hatam Sofer), that they will . , especially the mercy of heaven (in the language of the High Court of Justice) that they will not be punished any more than they have already been punished. And the One who is compassionate will atone for sin. There is no need to go on about this at any more length.]

Iggrot Moshe, Choshen Mishpat, 2:69

Day after Sukkot. 1976.

Regarding Killing a fetus…
And in Maimonides it is even more explicit that killing a fetus is actual murder…
Therefore, regarding the law, it is prohibited under the prohibition of “Thou shalt not murder” to abort a fetus, with the single exception that one who kills it is exempt from the death penalty… And because of this I ruled that even if the doctors are saying that there is a possibility that the mother may die if the fetus is not killed – although for desecrating Shabbat and violating other commandments one would do so in such a case, even for a small concern of life – nevertheless, to kill a fetus it would be forbidden until the doctors assess that the likelihood of her death is almost definite…
And even if the doctor is being forced by threat of death to perform an abortion, it would appear that he must give up his life rather than do so [although an argument could be made to the contrary]… Therefore, this ruling requires greater thought, whether one must give up his life rather than perform an abortion…
I have written all this because of the great calamity in the world that many governments have allowed the killing of fetuses, among them political leaders in the State of Israel, and countless of fetuses have already been killed, and in these days the greatest need is to make a fence around the Torah, how much more so not to make leniencies regarding the prohibition of murder that is so severe. Thus, I was appalled by the responsa of a learned man in Israel written to the director of Shaarei Tzedek Hospital who permits the abortion of a Tay-Sachs fetus even beyond 3 months. And he ruled such by prefacing that the prohibition was, according to many decisors, only rabbinic… It is clear and simple as I wrote, the law which is made clear by the early rabbis and the decisors of Jew law, that abortion is prohibited as it is considered actual murder, whether the fetus is legitimate or illegitimate, regular fetuses or those which are suffering from Tay-Sachs. It is strictly prohibited, and do not err and rely on the responsum of that learned man…

34. Tzitz Eliezer, 20:2

1993.

The case is of a certain woman who is pregnant with quadruplets, and after a medical exam the doctors have determined that it is necessary to kill one fetus, and then the other three will definitely live, but without this, all of them will die. I was asked by her husband, who is a talmid chakham, if it is permissible by law to kill one of them so that his siblings live, or if this is similar to the law that is ruled in Rambam, Foundations of Torah 5:5, that if non-Jews tell you to give us one person to be killed, or else we will kill all of you, that you must let everyone die rather than giving over one Jewish soul…
Now, we have shown, that one who kills a fetus is not considered a murdered, and that this is not included in the three cardinal sins for which it is said that one must die rather than transgressing, one of which is murder, and on this point no one argues. The only debate is which negative prohibition applies to this case, whether the prohibition of wounding or that of wasting seed, or something similar, but that this is not even in the category of appurtenances to murder. And the majority of the decisors are of the opinion that it is only a Rabbinic violation, and some frame it merely as “a minor violation”…
Based on all the above, it appears to me, in my humble opinion, that the ruling regarding our question is, that it is permissible to kill one fetus so that more than three fetuses (each one of whom is in the category of a pursuer of the other) will survive…