Ethical issues in nephrology—Jewish perspectives

Abstract

Halakhah is the generic term for. the whole legal system of Judaism, embracing all the laws, practices, and observances of Judaism. The sources of authority in Halakhah are composed of two elements: (i) the written law, a composition of 613 positive and negative commandments of Sinaitic origin, which are included in the books of Pentateuch; (ii) the oral law, which includes the interpretation of the written law, as well as logical deductions, rabbinical positive and negative enactment, decrees and customs. These are included in the Talmud and in post-talmudic rabbinical sources, primarily codifications and responsa. Jewish medical ethics, in the sense of normative Jewish law and philosophy applied to practical medical issues, is derived from and based upon the halakhic sources and deliberations. In recent years, Jewish medical ethics has yielded an ever-growing body of discussion, writings, and research on relevant Jewish values and laws, so that a voluminous body of literature now exists in this field. Jewish medical ethics is characterized by and distinguished from secular medical ethics in its range, in its mode of application, in its methods of analysis, in its principles, and in its end point. With respect to underlying principles, many of the Jewish moral and legal principles and rules have significant bearing upon the practice of medicine. Obviously, they cannot be described in any detail in this article. It is, however, worthwhile to mention a few fundamental principles: • Judaism ascribes to commitments, obligations and duties rather than to rights and pure hedonism; beneficence and altruism are promoted over mere nonmaleficence. • Judaism, in general, is opposed to absolutizing any single precepts; rather a golden path, a middle way, is always advocated and encouraged. When conflicting values are encountered, each case must be considered individually, a casuistic approach is