Medicine, Culture, and Ethics

Introduction

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Modern medicine creates many new ethical quandaries as it continually pushes the boundaries of what is possible. As medicine advances and life expectancy increases, almost all patients will, at some point, encounter an ethical dilemma in dealing with their own health or the health of a loved one.

Is it permissible, or perhaps even obligatory, to donate a kidney to save the life of a loved one?

May one pursue a dangerous experimental treatment that has the risk of shortening life?

Should children and teens have the autonomy to refuse potentially lifesaving treatment because of its arduous side effects, even when their parents disagree with their decision?

This series on Jewish Medical Ethics considers how modern medical dilemmas can be ethically resolved through thoughtful analysis of analogous cases that appear in the classical Jewish legal literature.

One of the central aims of this series is to help medical professionals develop greater sensitivity to how cultural norms affect patients’ interactions with the health care system. Western civilization as a whole is greatly influenced by Judeo-Christian tradition and there are undeniable Biblical underpinnings to American civil law. The concepts analyzed in this series will enable medical professionals to better attend to patients of all religious and cultural backgrounds.

In addition, such knowledge will contribute to a better understanding of religious Jewish patients and allow for greater sensitivity to their concerns. A further benefit of this course of study is that it provides physicians with a greater familiarity with the medical information needed by rabbis and Jewish clergy who wish to advise their patients on matters of Jewish medical ethics.

In this engaging series, we will examine some contemporary case studies, comparing common ethical and Jewish approaches as a means of developing ethical understanding.

Choosing Life: Patient Autonomy

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While a central pillar of medical ethics is the principle of patient autonomy, this is no guarantee that people will not make decisions that are capricious or unwise. If to be human is to have the right to choose, to be ethical is to make the right choice.

Learning Objectives

This lesson examines the ethics of issues involving patient auton­omy within the modern health care system.

  1. What is the Jewish perspective on pursuing medical care? Is it ever acceptable, or even preferable, to sim­ply rely on faith, prayer, and one’s own resources?
  2. How does Judaism justify medical intervention? And is it an obligation or a choice?
  3. How does this apply to terminally ill patients?
  4. May other family members force a patient to seek treatment that they may not want?

Flesh of My Flesh: Organ Transplants

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Hundreds of thousands of people find their lives hanging in the balance as they hope for the gift of life in the form of a vital organ such as a heart, lung, or kidney. By receiving an organ, they are literally given a new lease on life. Yet the shortage of available organs forces tough ethical choices.

Lesson Objectives

This lesson provides a nuanced and compassionate look at the sensitive ethical issues governing organ donation.

  1. Cadaveric Donation: Does Jewish law allow the donation of organs from one who is recently deceased? What of ethical concerns regarding desecrating a dead body or benefiting from a dead body?
  2. Heart Beating Donation: What does Judaism consider death? Is brain death sufficient to harvest key organs?
  3. Live Donation: Does one have the authority to give a body part away? Considering the great Mitzvah (good deed) of saving a life, might Judaism go further, actively encouraging or even mor­ally compelling one to donate under certain circumstances? What about carefully-regulated compensation to donors?

Rolling the Dice: Risky and Experimental Treatments

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Often, people with rare or incurable illnesses consider untested, experimen­tal treatments. Can we define the allowable odds? Does a patient’s personal preference hold any weight? Does it matter that participating in this experimental treatment will provide important knowl­edge that will be helpful in curing others?

Lesson Objectives

  1. While Jewish medical ethics lauds volunteering for a clinical trial that poses minimal risk, what is its advice regarding untested or risky, experimental treatments?
  2. May a terminally ill patient volunteer to participate in an experimental treatment with no guarantee of success that also has the dan­ger of shortening life?
  3. What about a patient with a poor quality of life? Can we justify shortening their lives for the sake of medical knowledge that will benefit others?
  4. How do Jewish ethical scholars assess whether it is in the best interests of a child to participate in an experimental medical procedure?
  5. What is the Jewish view on experimental research, such as stem cell research, that may lead to great human benefit?

New Beginnings:
Reproductive Technologies

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Many couples struggle with infertility. In their efforts to bear a child, they must navigate the complicated ethical web of the new reproductive technologies, many of which call into question the very definition of a parent. In the age of sperm donation, egg donation, and surrogacy, can a child have more than two parents? The unit also considers the ethical implications of using pre-embryos created for use in an ART cycle for stem cell research.

Lesson Objectives:

  1. How far must one go in the quest for biological children, and what recourse is there for those who are unable to bear children of their own?
  2. Does the Jewish responsibility to attempt to have children by natural means compel prospective parents to engage in medical interventions in pursuit of this goal?
  3. What is the perspective of Jewish law on the use of donor sperm in pursuit of a viable pregnancy?
  4. What is the purpose of Rabbinical supervision during Artificial Insemination and In Vitro Fertilization procedures and to what extent is it required?
  5. What is the best course for unused pre-embryos?
  6. How does Juda­ism look at “designer babies”? Can we pre-select the gender of the child to match parent preferences or to prevent genetic illnesses?

With You in Mind: Ethical Treatment of the Mentally Disabled

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Thousands of years before the rest of society, Jewish law recognized the essential humanity of the mentally disabled and while acknowledging their limitations of responsibility, encourages their maximum participation possible.

Lesson Objectives

  1. If reason and free choice are the heart of being human, what is the status of someone incapable of making responsible decisions?
  2. Who makes medical decisions for mentally disabled and what is the role of the community in protecting their interests?
  3. To what extent can children or mentally incompetent adults participate in medical research and trials? Can someone incapable of understanding be subjected to pain to help save lives?
  4. To what degree must the mentally disabled be integrated into society and what is the moral attitude toward them?

Secret Code: Genetics and Patient Confidentiality

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A basic presumption of modern medical practice is that patients have a right for their medical history to be kept confidential unless they explicitly waive those rights. What happens, however, when those records contain infor­mation that might impact the health decisions of other family members?

Lesson Objectives

  1. What is the ethical centrality of patient confidentiality as a necessary standard for medical care?
  2. What is a compelling reason to override this rule? What if keeping genetic test results confidential may cause harm to others or infringe on their right to know?
  3. At which point do Jewish ethical standards diverge from common law in this regard?
  4. Does Jewish law require physicians to risk financial loss or professional reputation to help others?
Brought to you by The Rohr Jewish Learning Institute and Touro College
in partnership with New York Medical College