Jewish medical ethics, in terms of the application of halakhic (Jewish legal) and Jewish ethical principles to the solution of health-related problems, differs from secular medical ethics on four planes: (1) the range of discussions and attitudes; (2) the methods of analysis and discussion; (3) the final conclusions; and (4) the basic principles.22,23
The Range of Discussions and AttitudesHalakhah
addresses all the medical ethical questions which secular medical ethics raises, whether old or new. Halakhah
also addresses specific medical issues that affect only Jews who observe the precepts of the Torah
. The basic Jewish approach is the same for questions relating to the terminally ill, abortion, organ transplantation, and questions relating to the treatment of patients on the Sabbath, the laws of seclusion, or the laws of a menstruating woman.
Methods of Analysis and Discussion
Jewish medical ethics analyzes medical ethical questions with the same methods and halakhic
principles used for any halakhic
analysis using basic principles and sources enunciated in the Talmud, Codes of Jewish law, and the Responsa literature of all generations. The scientific or medical data are presented, and the relevant halakhic
sources are then applied to the data. It is not always easy to arrive at a halakhic
conclusion regarding a medical question. A far-reaching knowledge of Halakhah
as well as an expert and precise understanding of the relevant scientific facts is required in order to arrive at the proper halakhic
Judaism in general prefers the casuistic approach to resolve halakhic questions. This means that one must examine each situation according to the individual circumstances and develop the response according to the specific details, nuances, and characteristics of that situation, using many of the basic halakhic rules, regulations, and principles. This is the methodology of the rabbinic Responsa literature and is ideally suited for medical questions where the circumstances differ from patient to patient. By contrast, the current approach of Western secular medical ethics uses a limited number of ethical principles and applies them to all situations involving medical ethical questions.
The halakhic construct in resolving a medical ethical question is a tripartite one involving the patient and/or family, the physician and the medical team, and the rabbinic decisor. The patient is obligated to seek the best possible medical care. He has the autonomous right to choose his physician and his rabbinic decisor and has the right to make his personal wishes known. The physician is obligated to treat the patient and must offer the best diagnostic and therapeutic interventions according to his knowledge and judgment. The rabbinic decisor is obligated to understand all the facts of the medical questions, to consider the views presented by the patient and the physician, and then to decide according to halakhic principles and precedencies how to proceed in any given situation. His decision is binding both for the patient and for the physician. It is obvious that this construct applies only to medical situations which have halakhic ramifications. Pure medical decisions are decided upon by the physician and the patient. This construct can be termed a religious-paternalistic approach, which restricts the patient’s as well as the physician’s autonomy and requires acceptance of the halakhic decision, but it negates personal paternalism.
attempts to give final and operative decisions to questions posed to the rabbinic decisor. Since Judaism is not just an academic discipline, the goal of studying and teaching Jewish medical ethics, as in all other areas of Torah
learning, is to put Torah
law and ethics into practice. This is in contrast to secular medical ethics, which views its function as defining the relevant ethical dilemmas, sharpening the focus of the various views, but not necessarily arriving at final and practical conclusions.
Since time immemorial, however, Rabbis have differed in their opinions, and not always is the final decision unanimous. This situation is no different than any other normative legal matter. Mechanisms exist in Halakhah to decide among the various opinions. In this respect, there is no difference between a medical question and any other question in any area of Judaic practice or belief.
It is important to delineate the basic principles of Jewish medical ethics as compared to secular medical ethics.
Jewish ethics, including Jewish medical ethics, is based upon duties, obligations, commandments, and reciprocal responsibility. The word “right” in its modern sense, meaning “I am entitled to it,” does not exist in biblical or talmudic literature. By contrast, secular medical ethics is based heavily on the concept of rights and autonomy. This approach justifies human decisions that cannot be criticized as long as they do no harm to others. Judaism, however, requires self-fulfillment based on obligatory and binding moral requirements that are beyond the personal, temporal feeling of individuals but rather founded on values mutually beneficial to society.
Judaism recognizes absolutism only with respect to the Divine source of authority of Jewish law, the supreme authority of the prophets who speak the words of God, and the eternity of Torah. Judaism does not, in general, subscribe to a set of principles and values as absolute imperative categories but rather favors a middle-of-the-road approach, the “path of the golden mean,” which is a proper balance between different values or laws in any specific case, as stated by Solomon,24 by Maimonides,25,26 and by Rabbi Abraham de Boton.27 The ethical imperative for the average person is to conduct oneself properly with the appropriate balance between opposing values and to avoid extreme positions. Hence, for Judaism there is no definitive value that is absolute, such that takes precedence in every case or situation. Various values have different moral weight, and there is a system for ascribing priorities in specific situations where conflicting values exist. This view is based on the principle that “the Torah was not given to ministering angels”28 but to ordinary human beings who, by definition, are not perfect.
The physician–patient relationship in Judaism is not a voluntary-contractual arrangement but a Divine commandment and obligation on both sides. The patient is commanded to seek healing from the physician and to prevent illness if possible. The physician is obligated to heal and is considered to be the messenger of God in the care of patients. The patient is not free to decide autonomously to refuse treatment, which might be beneficial or save his life. He is prohibited from relying on miracles, but must do whatever is necessary to heal himself according to standard medical practice.
In Judaism, the value of human life is supreme; therefore, to save a life nearly all biblical laws are waived. This approach is in contrast to the secular ethical view that considers human life to be one of many values and often gives greater weight to “the quality of life.” Nonetheless, even in Judaism, the value of human life is not absolute, and in certain rare and well-defined circumstances other values may supersede it. This, however, does not in any way diminish the supreme value of human life in Judaism.
The four basic principles widely accepted in secular medical ethics nowadays are also accepted as important values in Judaism, but they do not receive the same weight in the Jewish tradition.
The principle of autonomy which is dominant in Western secular medical ethics is modified in Judaism. Judaism asserts that man was created in the image of God29 and that all people are, therefore, considered special and equal.30–32 Thus, Judaism requires that people must respect and help one another. Judaism also accepts a degree of patient autonomy in the physician–patient relationship. However, in certain situations in which autonomy conflicts with other fundamental principles of Judaism, such as the obligations to preserve one’s health and life, to avoid harming others, and to do good for others, Halakhah may be in direct conflict with autonomy.
In Judaism, man is said to have free will and choice. This does not mean that he is permitted to choose to live immorally or to violate Torah laws. A person is commanded to live within halakhic norms, and thus his autonomy and free choice are restricted. Decision-making in areas which do not involve Halakhah can be totally autonomous. However, in every life situation in which there is a clear halakhic position any observant Jew, be he the physician or the patient, must always act within the parameters of Halakhah and not on one’s own inclinations and desires.
The principles of beneficence and non-maleficence are clearly defined axioms in Judaism which prohibit the intentional harming of another person either physically, emotionally, or financially, or by defamation or by an attack on objects owned by others. In addition, Jewish law clearly requires not only the avoidance of harm to others but the active doing of good to others. Sometimes, punishment is inflicted for not doing so. This approach is in contradistinction to secular law and ethics which usually only require one to avoid harm to others but do not obligate one to do good for others. Acts of kindness are considered praiseworthy but not specifically required in secular law and ethics as they are in Jewish law. Thus, coming to the aid of a stranger (“good Samaritanism”), considered a supererogatory act in most Western societies, is obligatory in Judaism.