Doctors and Matchmakers: A More Perfect Union?


Everybody wants the best for their children, especially when it comes to marriage. The choice of a spouse by a son or daughter is a validation of a life lived and a child’s upbringing. Moreover, it is an endorsement of the future of the family. Little wonder then that parents pay special attention to the future partner that their son or daughter chooses for themselves.

How does one go about this process to ensure the highest likelihood of success? Arrangement or romance? I will not claim special expertise in this charged area. However, I would like to weigh in on one aspect of the process that I think warrants reassessment for those who opt for arranged marriages.

Shadchanim, matchmakers, use an impressive array of criteria in judging potential marriage partners including family background, wealth, level of observance in all its minute manifestations, education, and even style of attire. Also on the list is the question of health status. And that is where there is a problem.

READ: Resources for Learning About Jewish Genetic Diseases

People entering adulthood who are beginning to plan for marriage are not immune from illness. Although it is not common, they may have genetic disorders or acquire serious diseases of wide ranging severity. For young men and women who are candidates for an arranged marriage, these conditions often become an insurmountable obstacle, a definitive deal breaker. In a culture where illness is often hidden because of social stigmatization, the prospect of marriage triggers intense scrutiny into medical diagnostics and prognosis.

I think this is tragic and I think this is morally wrong. First, in most cases the young person is in no way responsible for his or her illness. To hold their marriage hostage to their health condition seems profoundly unjust. Second, by focusing so heavily on these conditions, the person becomes commodified as a medical entity that loses sight of their rich humanity. To be sure, this is also the case when potential partners are graded based on wealth, education or the neighborhood where they live. But it is especially cruel when the classification is based on medical exigencies that are usually out of the young woman or man’s control. It fails to take account of the full scope of the individual and runs the risk of reducing them to a one-dimensional portrait. Third, none of us knows the future. The confidence we feel today about tomorrow can be shattered in a moment. Is it right to place such emphasis on the health problems we can identify today in the face of the huge uncertainty we all face looking to the future?

I suggest that it is a moral lapse, a lack of compassion on the part of parents and religious leaders to view pre-existing health problems as such a high barrier to arranged marriages. The notion of health problems as a pegam, a blot on the family name, need to be reconsidered. I speak from experience trying to help parents of some of my patients find partners who can comprehend and appreciate their medical problems in all their complexity and nuance.

One of the more common causes of hereditary disease that I treat as a pediatric nephrologist begins fairly innocuously in childhood but gradually worsens over time and dialysis or kidney transplantation are often necessary by early adulthood. While men tend to be more severely affected, women can also suffer from the disease. It often is associated with progressive deafness which only adds to the physical and emotional burden. Many cases are atypical and progress more quickly or do better than I anticipate. This unpredictability is probably related to the extent of the genetic abnormality but we are just learning how to make these correlations and predictions are far from certain. I have cared for a caring family with several affected daughters. The embarrassment that these girls experienced because they have to come to see me and wear hearing aids is understandable. But the added discomfort they felt as they watched their parents try to extract the most favorable assessment of their oldest daughter’s prognosis from me as they entertained marriage proposals only added insult to injury. I have cared for a young man for nearly twenty years. He learns full-time in a kollel (yeshiva for adults) and is a wonderful person. His parents are delightful and I enjoy every visit when the three of them come for his semi-annual assessment. He is doing as well as anyone with this disease could expect. Why should this family feel pressured to present the parents of a potential bride a definitive prediction of how he will be in ten or twenty years instead of having the confidence that he will be a loving husband for any young woman from his community?   

As I said before, I don’t consider myself an expert on marriage. The choice of matchmaking versus romance will be subject to religious world views and social convention. But regardless of which approach one adopts, I would offer two suggestions. First, our rabbis and educators should make it their responsibility and a priority to teach young people and their parents that illness is not the same as the person. Making such an equation is a moral failure. Second, parents will always want the best for their child. But whatever approach they take to marriage for a son or daughter, they should give the couple the final say. The future husband and wife will need to grow together over a lifetime if their marriage will be a success. It seems humane and prudent to let them decide how they want to deal with the potential adversity of health issues. We as caring communities should provide guidance. But ultimately we should support the decisions the future couple make without bias.       

Posted on May 2, 2016

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