Medical Ethics and the
European Academy of Sciences and Arts
Tolerance Prize 1998
Salzburg, August 15, 1998
Mr. chairman, colleagues, ladies and gentlemen:
I am grateful to the European Academy of Sciences and Arts for the opportunity to present today, within the framework of the Prize of Tolerance, a few general ideas about the interface between Medical Ethics and the most ancient Abrahamic religious traditions.
However, before I try to make a contribution to a discussion of Abrahamic religions, I would like to make a brief contribution to the dialogue between the Abrahamic peoples. The winner of the Prize of Tolerance 1998 is the first lady of the Arabic Republic of Egypt, Mrs. Mubarak. As an Israeli Jew, who was born in Jerusalem, it gives me much pleasure to be able to congratulate Mrs. Mubarak on this occasion and to praise her, as well as her husband, President Mubarak, for what they have done in pursuit of peace between our nations. I am not a formal representative, neither of my state nor of any party within it, but I assure you that I voice now the conviction of numerous Israelis, as held by the late PM Rabin, that lasting peace is possible. I assure you that I reflect now the belief of numerous Israelis, as held by associates and followers of the late I. Rabin, that mutual trust can be built between Arabs and Jews, on grounds of mutual respect and concern. And I assure you that I express the hope of numerous Israelis that the co-existence of the State of Israel and the neighbouring states of Egypt, Jordan, Lebanon, Syria, and Palestine brings and end to an epoch of hostility and bloodshed, enhancing viable peace and lasting tolerance in the cradle of the two ancient nations and the focus of three Abrahamic religions.
My brief presentation of the interface between Medical Ethics and certain Jewish religious traditions will be divided into three parts. In the first part, I will put forward what I would like to call "the fundamental formula of medical ethics", the major ingredients of the discipline. In the second part, I will mention some of the major elements of Jewish religion. In the final, third part, I will indicate some of the natural relationships between the two areas, medical ethics and Jewish religion, as portrayed in the previous parts.
Part I The fundamental formula of medical ethics: To be a physician, who practices medicine in the ideal ethical way is to be: (1) a professional, (2) a care-taker, (3) a person devoted to protection of human life and health, (4) a person whose activities are grounded on the relevant branches of science, and (5) a person whose activities are all performed within the confines of the moral principles of democracy. Every principle of medical ethics stems from one of these elements. Here are few examples: First, the norms of informed consent clearly stem from the moral conception of democracy, in which the human dignity of every citizen is protected by means of a system of rights and social institutions that guard them. Second, the norms of medical confidentiality are grounded not only on right of privacy, but also on responsibility to human life and death. Thirdly, the norms of clinical experimentation (of Helsinki declaration and the like), including the distinction between different phases of experimentation, reflect not only human rights but also the firm, scientific nature of the knowledge on which medical practice has to rest.
Part II General Properties of Jewish religious traditions (Actually, there has been a variety of Jewish denominations. In the spirit of tolerance one should have devoted attention to each of them in particular. However, since time in short, I will outline only general properties that appear to a significant extent in all of them.)
Every Jewish denomination is (1) practical, governed by rules: "thou shalt", "thou shalt not". (2) total, expressing its values in all domains: individual life, from cradle to grave community life, power and welfare. (3) general, in the sense of applying to all Jews (4) legal in nature: rules, interpreted by persons and courts, who set precedents. (5) constitutive, in the sense that such precedents can be binding, e.g., the definition of working on Saturday. (6) pragmatic: nature and society are given: Whether you try to change them or not, religious values are expressible: e.g., kingdom or democracy; freedom or slavery. (7) worship: Not having a binding theology, God worship is expressed mainly by self-restraint: e.g. Saturday (work); Dietary (food); ten commandments.
Part III The resulting interface between Medical ethics and Jewish religious denominations.
Put in a nutshell: Where one expects a clash, between the religious system of values and that of medical ethics, more often than not, the expected conflict does not emerge. Here is a couple of examples:
First, a possible clash between a certain conception of deity and the very idea of practicing medicine! Roughly put: If everything is a product of God's will, then a decease is also an expression of God's will. Consequently, medicine as such is acting against God's will! The Jewish practical reply has been to allow and even demand best possible medical treatment: on best scientific grounds, best treatments, by means of best medication and technologies. The legal reasoning rests on a biblical verse (Exodus 21:19): "In case men should get into a quarrel and one does strike his fellow... he will make compensation (only) for the time lost from the other one's work until he gets completely healed". Such a regulation, said the sages of the Jewish tradition, presupposes that permission had been given to human beings to heal. As a result, no "playing God" arguments have been enacted in that tradition, neither when scientific and technological achievements have been made, nor in particular when new forms of medical treatment have been introduced. Therefore, for most religious authorities, IVF and even cloning for medical purposes are not flatly rejected on grounds of any "playing God" argument.
Second example, not less important, pertains to human life. Again, a clash could be imagined between certain conceptions of human life under the reign of God, namely that human life cannot be of supreme importance given the humility required when human beings face God. And again, the Jewish practical attitude has been the opposite: Human life is of supreme importance in each and every medical situation. Therefore, whenever human life is at stake, religious regulations may be breached to the extent required to save life. Generally speaking, no work should be done during Saturday, however every work required for saving life is permitted. A dramatic example it that of IDF rescue units travelling to Kenya and operating there during Saturday, in order to save life. Notice it is not the life of one's family or fellow countryperson that should be at stake. Every human being's life should be saved, even if it involves violating major commandments. The same applies to food required as medicine, say, on Passover. More interestingly, if human life can be saved only by resort to activities of a secular physician, who is expected to violate commandments and regulations much more than is required for saving life, still he or she should be approached unhesitatingly, because human life is at stake. Such an attitude towards human life is expressed at both ends of life too. Roughly speaking, abortion is tolerated, though only where there are good reasons for performing it. Although the fetus is not a religious person until it emerges, since it is closely related to human life, it should be respected. Saving the pregnant woman's life is always considered a good and even compelling reason. Similarly, active euthanasia is forbidden as well as strict avoidance of passive euthanasia.
Given such attitudes, one can see where exactly could medical ethics be in conflict with some element of the Jewish religious traditions. The latter could have no objection to the conception of a professional care taker, devoted to protection of human life and health, on firm scientific grounds. Conflicts arise where the moral considerations require freedom that religious considerations do not tolerate, given their constitutive substance. For example, there is nothing wrong, from the point of view of medical ethics, in almost all forms of artificial insemination, whereas certain religious views, though not all, would not tolerate it. Or another example, there is nothing wrong, from the point of view of medical ethics, in harvesting certain organs from a cadaver for transplantation, whereas on some ancient religious criterion brain death is not actual death, and harvesting organs is tantamount to murdering.
Thus, one may reach the conclusion that to a significant extent, the major ingredients of the Jewish religious attitude towards medicine are the duty to consider human life, in each and every medical situation, as being of supreme importance, and the duty to practice medicine, in the best professional way possible.
It would now be only natural to draw the analogy, between medical situations in which human life is at stake and all other situations where human life is in jeopardy. We should consider human life of supreme importance, first in our hearts and our thoughts, and then in our actions. In other words, we should always pursue peace and tolerance.