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Feb. 17, 2006
Wrestling with ethics
The Jewish tradition offers a unique perspective.
MONIKA ULLMANN
Imagine this: Your beloved daughter, all of 22 years old, is anorexic
and resisting the array of possible cures western medicine has for
this complex and potentially lethal disorder - psychological counselling,
family counselling, hospitalization and, most heartbreakingly, feeding
tubes.
It's been going on for some time and every time she's taken off
the tube, she stops eating. Her weight has dropped to below 80 pounds,
at which point her electrolytes, kidney, liver and heart function
are severely compromised. She is, in fact, dying. What should be
done? She won't eat because she believes she is "fat."
Is she mentally competent to make decisions for herself? If not,
who makes those decisions?
That's the kind of knotty issue with which a group of some 20 people
wrestled at a Philosophers' Café on Jewish Medical Ethics
presented at Or Shalom last week by Dr. Susan G. Albersheim, a neonatologist
in the special care nursery at B.C. Children's Hospital.
Part of an ongoing series of lectures on ethics, the evening started
slowly but gathered steam as other, equally difficult medical scenarios
were presented and discussed. What emerged was this: in the western
secular tradition,
personal autonomy trumps other concerns. It's largely up to the
individual to decide what to do, and difficult cases, like that
of the distraught father who helped his disabled daughter die, are
dealt with by the law, which clearly states that helping someone
to die is a crime.
But the autonomy of the individual is paramount. Doctors can only
advise – they cannot actually make decisions for the patients.
Doctors are bound by the ancient precept of "first, do no harm."
The Jewish tradition goes further – doctors are also bound
to "do good" and to consider issues of fairness and equality.
In fact, Albersheim said that the "client" role of the
patient doesn't work in the Jewish tradition, which sees the relationship
between doctor and patient as being a covenant of care. In other
words, it's not just about business – a dangerous trend in
modern medicine on which several people commented.
There can be conflict between what the doctor believes privately
and what she might advise, said Albersheim. According to halachah
(Jewish law), life is infinitely valuable and must be preserved.
In other words, a doctor should never stop trying to save a life,
even when it looks hopeless, as with our anorexic patient.
In Jewish tradition, autonomy is relegated to second place - there
are other concerns besides purely medical and personal ones. When
a Jewish patient seeks advice, said Albersheim, it is often in the
context of Jewish values and besides the doctor, a rabbi will be
consulted to provide a social and ethical perspective.
"The patient has the right to seek help and to make decisions,"
said Albersheim, "but he or she is bound to some degree by
what is recommended and to follow that path. You can't really 'shop
around' until you find a convenient solution; you have to abide
by what the rabbi and the doctor recommend."
It's a different story in the secular western tradition. When making
decisions for children, "it's the parents who make the final
decisions," said Albersheim. "All I can do is lay out
the medical choices for them, which in the end protects the doctor."
Albersheim gave a short overview of the changes that medical ethics
have undergone during the last century and then contrasted those
developments with the traditional Jewish approach.
She noted that before the 1950s, doctors and the medical profession
in general were regarded with universal respect and awe – the
doctor knew best and that was pretty much that. This began to change
due to the increased emphasis on individual rights and medical advances,
creating the need for bio-ethics.
For example, said Albersheim, when dialysis first became available
in the early '60s, the tricky decision of who would get what was
a scarce resource many people needed was handed over to an all-male
committee, the so-called God committee. Today, nobody would listen
to such a body, which shows how much our ethical norms have changed.
What hasn't changed is the Jewish perspective on life and death.
Many people in the discussion group felt that "the Jewish model
is better," because western medicine is increasingly dominated
by monetary concerns, something that should give everyone pause.
Monika Ullmann is a Vancouver freelance writer and editor.
She can be reached at [email protected].
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