Download What Is Jewish Medical Ethics

What Is Jewish Medical
Ethics?
from Jewish Medical Ethics/Assia, vol. 1, no. 1,
May 1988
German-born Avraham Steinberg
studied at Yeshiva! Mercaz Ha'Rav
Kook in Jerusalem before entering the
Hebrew University-Hadassah Medical
School. From 1973-76 he served as a
medical officer in the Israeli Air Force
and in 1976 became a resident at the
Department of Pediatrics at the Shaare
Zedek Medical Center in Jerusalem,
where he still works. Since 1988, Steinberg has directed the Center for Medical
Ethics at the Hebrew University-Hadassah Medical School in Jerusalem, where
he also teaches general pediatrics and
pediatric neurology .
The winner of five prizes, such as the
Abramowitz-Zeitlin Prize in 1976 and the
Katz Prize in 1990, Steinberg is listed in
the International Who's Who of Intellectuals (1987), the Dictionary of International Biography (1989-1990), and
Who's Who in Israel (1991-1992).
Steinberg edited the first four volumes of Assia (1976, 1979, 1982, and
1989), the Hebrew publication of the
Schlesinger Institute for Medical and Haiachic Research of the Shaa;e Zedek
Medical Center. He has authored and
coauthored a vast and profound range of
over 90 articles on neurology, general
medical ethics, Jewish medical ethics,
and medical history. His book titles include Chapters in Pathology in the Talmud (in Hebrew), Encyclopedia of Jewish Medical Law, volumes I and II (in Hebrew), and Neurologic Manifestations of
Systemic Diseases (in progress).
Steinberg lives in Jerusalem with his
wife and three children.
by A vraham Steinberg, MD
Ethics constitutes the branch of
general philosophy which deals with
moral problems and judgments. It
attempts to define human conduct in
terms of its property; it evaluates man's
desires and the results of his actions as
good or bad. Ethics (derived from the
Greek ethos, meaning "manners" or
"habit ") deals with the fundamental,
theoretical aspects of these values, while
morals (derived from the Latin mos,
meaning "custom" or "usage") deal with
the actual and concrete aspects of
conduct. These two terms are, however,
often used interchangeably.
Taken in their precise, historical
meaning, medical ethics form a code that
governs the physician's conduct vis-a-vis
colleagues and patients. Historically,
such codes were formulated by physcians
(e.g., the Hippocratic Oath, the Oath of
Assaf Ha'Rofeh, the codes of various
medical associations). In the accepted
modern meaning, medical ethics
constitute the application of general
ethical theories and principles to the
problems of clinical practice and medical
research. Medical ethics are the
systematic analysis of morals and values
in the medical and behavioral sciences .
Those principles and their application to
medicine derive from a wide spectrum of
14 Jewish Medical Ethics
knowledge of the humanities and social sciences, not exclusively from medicine itself.
Concern with the moral problems of
medicine originated early in history with
laws, edicts, guidelines, and oaths formulated for or by physicians. Among the ancient peoples exhibiting such concern we
find the Code of Hammurabi, Egyptian papyri, Indian and Chinese cultures, and the
classical cultures of Greece and Rome.
In its modern form , general medical
ethics are based on a multidisciplinary and
pluralistic approach to philosophical, sociological, and legal outlooks. This approach
was developed during the last thirty years,
starting with the publication of Joseph F.
Fletcher's seminal book Morals and Medicine (Boston: Beacon Press, 1954). Since
then the field has developed quickly, and
we have witnessed the forming of bioethical research and teaching institutions, the
introduction of bioethical programs in medical schools, and the involvement of ethicists in arriving at difficult moral decisions
in hospitals. There is a continually growing
interest on the part of academic societies,
as well as on the part of the public at large,
together with the development of specialized parallel literature - books, journals,
surveys, and articles in both medical and
popular frameworks.
It must be emphasized that from an
ethical point of view there is nothing special about medical ethics. Ethical theories
and principles are universal in nature. It is
their specific application to medical questions that gives rise to a special viewpoint.
There are several primary declared
goals of medical ethics: first , increasing
the sensitivity and awareness of medical
practitioners and researchers to the moral
problems connected with ·treatment and research; second, imparting basic philosophical and legal knowledge related to moral
B'Or Ha'Torah
problems; third, forwarding national analysis and debate regarding moral medical
matters; fourth , encouraging the union of
technical medical knowledge with humane
sensitivity , morality , and justice; and fifth,
improving the moral conduct of medical
practitioners and, perhaps, improving their
moral character.
Noble though these goals be, the pluralistic and multidisciplinary nature of medical ethics has proven unable to achieve a
normative consensus in many areas of
medical practice.
The first to speak about the specifically
Jewish aspects of medical ethics was Rabbi Immanuel Jakobovits in his Jewish Medical Ethics (New York : Bloch Publication
Co., 1959). There are, however, three factors that characterize and distinguish these
Jewish aspects, as compared with general
medical ethics.
I. Range
General medical ethics deal with diverse subjects, including the patientphysician relationship, confidentiality, informed consent , disclosure of information,
attitude toward the patient's family , public
medicine policy, limited medical resources,
triage decisions, labor strikes , biomedical
experimentation on human and animal
subjects, attitude toward the terminal patient, congenital defects, abortion, artificial
insemination, in vitro fertilization, organ
transplants, definition of death, and involuntary hospitalization .
Jewish medical ethics deal with all
these as well as many more subjects that
are no less important from the point of
view of halacha (Jewish law), for example:
medical treatment on the Sabbath and
Yom Kippur, gynecological examination,
B'Or Ha'Torah
the laws of family purity and kosher food,
kohanim (members of the priestly class) as
patients or physicians, circumcision under
specific conditions.
II. End Point
Being pluralistic, general ethics does
not generally aspire to absolute, normative
decisions. Jewish medical ethics, on the
other hand, are essentially based on a halachic (Jewish legal) approach to medical
problems. Their solutions are thus as binding as halachic decisions in any other field,
such as dietary laws, the Sabbath, or theft.
Ill. Method of Analysis
Whereas general ethics is based on philosophical analysis, Jewish medical ethics
are based on halachic analysis. These two
fields exhibit differences in their mode of
discourse and in the relevant cognitive
background pertaining to the medical problem under analysis. These differences typify two divergent approaches to all areas of
human endeavor.
The common aspect of both general
and Jewish medical ethics is their application of general principles and theories to
actual medical problems. The differences
between the two fields arise from their respective sources of authority. General ethics is based on theories deriving from human thought and variable opinions, whi e
Jewish ethics are based on halacha and
Jewish thought , which are of Divine origin,
as they were interpreted and applied by the
Talmud Sages and subsequent authorities
in the direct line of tradition. Let me emphasize again that Jewish medical ethics do
not profess morally possible or desirable
Jewish Medical Ethics 15
modes of conduct. Rather, they profess halachically normative, obligatory conduct.
The same halachot (Jewish laws) which
determine the parameters of prohibited
gossip may be applied in medical contexts.
This method of applying general halachot
to specific medical problems is just as valid with regard to the allocation of rare medical resources, defining the moment of
death , and induced abortion as it is with
reference to medical problems of the Sabbath, the kashrut of medication , or nidda
(family purity). When asked about medical
ethics , our poskim (leading rabbis) are
guided by exactly the same modes of
thought and analysis, the same considerations which guide them in responding to
any other halachic problem. It is therefore
impossible to solve moral problems in
medical practice on the basis of the patient's or the physician's proclivities or personal feelings. Rather, it is essential to be
guided by an authoritative rabbi (posek),
whose decisions will be reached on the
basis of relevant halachic considerations.
Familiarity with the halachic sources is, by
itself, insufficient for halachic decisions . In
addition, one must have a complete grasp
of all the relevant facts and their ramifications . Only the combination of thorough
comprehension of relevant halachic sources with profound understanding of relevant
data can lead to the desired solution of
moral problems.
In summary, proper use of the term
"Jewish medical ethics" is limited, requiring
an awareness of the factors which distinguish it from general medical ethics. Used
properly, it refers to the halacha governing
physicians and medical practice. In effect,
Jewish ethics is halacha and it is only in
this sense that the term should be used
with respect to actual medical problems,
just as it is used in all other fields.