Medical Ethics

In contrast to general medical ethics, Jewish Medical Ethics, is based on halachic principles which generally provide clearer and more practical answers to the difficult ethical conflicts in medical practice. Jewish medical ethics in the sense of applying normative Jewish law and philosophy to practical medical issues is characterized and distinguished from general medical ethics in, at least, three spheres: Range, Underlying Principles and Methods of Analysis.

 

Ethics


Ethics deals with moral problems and judgments. It attempts to evaluate the propriety of human conduct, man’s desires and the results of his actions. Ethics (derived from the Greek ethos, meaning "manners" or "habit") deals with theory, while morals (derived from the Latin mos, meaning "custom" or "usage") deals with concrete aspects of conduct. These two terms are, however, often used interchangeably.

Medical Ethics

Medical ethics is the code which governs the physician’s conduct vis-à-vis colleagues and patients. Historically, such codes were formulated by physicians (e.g. the Hippocratic Oath, the Oath of Assaf ha-Rofeh, the codes of various medical associations). Today medical ethics deals with problems in clinical practice and medical research. 

Ethical Problems and Medicine

Moral problems relating to the practice of medicine have led to laws, edicts, guidelines and oaths formulated for or by physicians. Ancient codes of medical ethics are included in the Code of Hammurabi, Egyptian papyri, Indian and Chinese cultures, and the classic cultures of Greece and Rome. The ethical problems confronting us today are not entirely new; many of them have been the subject of debate for many centuries. What is new to our era, however, is the growth of these problems both in kind and degree.

Modern Medical Ethics

Modern general medical ethics is based on multi-disciplinary and pluralistic approaches to philosophical, sociological and legal perspectives which have developed over the past four decades, fueled by the horrors of World War II. Since then bio-ethical programs have rapidly developed in medical schools with the participation of ethicists in dealing with difficult moral decisions in hospitals. There is a constantly growing interest in the subject on the part of academic societies, as well as of the public at large, together with the development of both professional and popular books, journals, surveys and articles.

Medical ethics has several primary goals:

  1. Increasing the sensitivity and awareness of medical practitioners and researchers to the moral problems associated with treatment and research.
  2. Imparting basic philosophical and legal knowledge relating to moral problems.
  3. Advancing national analysis and debate regarding moral medical matters.
  4. Encouraging the combination of technical medical knowledge with human sensitivity, morality and justice.
  5. 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 made a normative consensus in many areas of medical practice impossible.

Jewish Medical Ethics

In contrast to general medical ethics, Jewish Medical Ethics, is based on halachic principles which generally provide clearer and more practical answers to the difficult ethical conflicts in medical practice. Jewish medical ethics in the sense of applying normative Jewish law and philosophy to practical medical issues is characterized and distinguished from general medical ethics in, at least, three spheres: Range, Underlying Principles and Methods of Analysis.
Of all the various spheres of science, medicine has occupied the most sympathetic, positive and exalted position within halacha (Jewish law). The goal of all medicine is the enrichment of human life and the enhancement of physical well-being. It is not surprising therefore, that throughout the generations, medicine and halacha have been finely interwoven in Jewish thought.
A mutually respectful relationship exists wherein medicine draws ethical principles and legal concepts from the halacha and conversely, halacha recognizes the sacred duty of healing and uses medical knowledge in the solution of halachic problems. Jewish scholars throughout the generations have held the greatest respect for the field of medicine and many of our spiritual leaders were crowned with scholarship in the areas of both Torah and medicine.
Within Judaism the field of medicine is accorded higher status than any other secular pursuit and its study and practice are regarded as duties and obligations. In the words of Rabbi Joseph ben Yehudah Ibn Aknin, "The study and teaching of medicine is a great mitzvah (meritorious act) and is an exemplary way of serving God."

The study of medicine has intrinsic value in that it enables one to fulfill the positive commandment to heal the sick.

The verse "And he shall surely heal" (Exodus, 21:19) teaches us that the Torah permits the physician to heal. The physician acts as an emissary of God in his work to heal the sick. Various Biblical sources have been quoted by our Sages in support of the mitzvah of medical practice. The halachic requirement of the physician is to attend to patients according to the principles of medical practice that he has been taught.

Further positive effects of medicine medical knowledge contributes to the understanding of many Torah laws. We find that the Jewish sages were well versed in anatomy, physiology, pathology, gynecology, fertility and sterility as indicated by various tractates in Jewish literature. Maimonides, himself a physician, mentions an important benefit of medicine: "Medical practice is an important introduction to intellectual and ethical pursuits, to the knowledge of God and to achieving true success; thus will their (the physicians’) study and ambition become one of the great occupations, unlike weaving and carpentry."

In the 20th century, we have witnessed a marked increase in medical knowledge and technology which has made ethical conflicts more salient and compelling. As a consequence of this development, we are witnessing an increase in halachic research that sifts, analyzes and decides practical approaches to these serious and formidable problems.

The Dr. Falk Schlesinger Institute for Medical-Halachic Research publishes several publications in both English and Hebrew on the subject of Jewish Medical Ethics.

Range

Jewish medical ethics deal with all the areas discussed in general medical ethics, such as those of abortion, organ donation, cloning and many more. The Schlesinger Institute is compiling an archive of the modern Halachic questions that arise within these areas, see IRP.

Jewish ethics also concern themselves with other Halachic topics, such as the question of medical treatment on Shabbat and Yom Kippur (the Day of Atonement), kashrut (dietary law), niddah (laws of the family purity), kohanim as patients or physicians, circumcision under specific conditions etc.

Underlying Principles

Current general medical ethics have shifted the locus of decision-making from the physician to the patient, thus accepting the primacy of autonomy in the patient-physician relationship. The principle of autonomy has become absolute, taking precedence over all other values such as life and beneficence.
This minimalistic view of ethics replaces the concern we should show for each other, neglects the model of beneficence, and most importantly, this supremacy of autonomy leads to the development of individual moral obligations while societal regard for the common good is discarded.

In contrast, Judaism subscribes to a higher order of moral conduct, which mandates the behavior of the individual as well as of society. Respect for others is highly valued. However, autonomous decisions that do not comply with the required moral standards are superseded by these higher moral values, which derive from the Divine Law and value systems which govern the life of each individual, be it patient or physician.

Being pluralistic, general ethics do not generally aspire to absolute, normative decisions. Jewish medical ethics, on the other hand, are essentially based on a halachic approach to medical problems. Their solutions are thus as binding halachic decisions as in any other field, such as the laws of kashrut (dietary laws), Shabbat or theft.

Methods of Analysis

Whereas general ethics are based on philosophical analysis, Jewish medical ethics are based on halachic (Jewish law) analysis. These two fields differ in their mode of discourse and in their cognitive backgrounds. These differences typify two divergent approaches to all areas of human endeavor.

The aspect common to both general and Jewish medical ethics is their application of general principles and theories to actual medical problems. The differences between the two arise from their respective sources of authority. General ethics are based on theories deriving from human thought and variable opinions, whereas Jewish ethics are based on halacha and Jewish thought which are of Divine origin and were interpreted and applied by the talmudic sages and subsequent authorities in the direct line of tradition.

This method of applying general halachot to specific medical problems is valid with regard to the allocation of scarce medical resources, defining the moment of death, and induced abortion, just as they are with reference to medical problems of the Sabbath, the kashrut (dietary laws) of medication, or niddah (laws of a family purity).

When asked about medical ethics, our leading rabbis (poskim) are guided by 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 whose decisions are reached on the basis on relevant halachic considerations. Nonetheless, familiarity with the halachic sources is, in itself, insufficient for halachic decisions. In addition, one must have a comprehensive grasp of all the relevant facts and their halachic sources which combined with a profound understanding of relevant personal and medical data can lead to the correct solution of moral problems.