Jewish Bioethics Research Articles

From Medical Halakha to Jewish Bioethics

ABSTRACT Scholars of applied Jewish ethics often describe the 1959 publication of Jewish Medical Ethics, by Rabbi Immanuel Jakobovits, as the birth of Jewish bioethics. The decades following its publication saw prolific scholarship, predominantly by Orthodox rabbis, that examined questions about medical practice and technology through the lens of halakha, or Jewish law. This article offers an alternative genealogy of Jewish bioethics, proposing that the field actually emerged around the 1990s, when academic ethics scholars began offering critiques of the earlier scholarship, which is better understood as medical halakha. This article outlines key features of medical halakha as compared with Jewish bioethics, clarifies differences between the two, and argues that drawing a distinction between these two genres will enable greater diversity and creativity in Jewish bioethics discourse. The article closes by discussing ways to incorporate Jewish philosophy into Jewish bioethics under this new framework.

Editor's Introduction

The issue before you features four articles, all of which were first presented orally at the Society of Jewish Ethics Annual Meeting in New Orleans in January of 2017. Thus, these articles (and their authors) have faced both the scrutiny and challenging questions from conference attendees and the rigorous anonymous review process that is standard for academic journals. I have no doubt that both kinds of responses—the immediacy of conference feedback, and the extended peer review process—have contributed to bringing these articles expeditiously to publication this summer.Broadly speaking, this issue includes two distinct thematic categories. The articles of Yonatan Brafman and Randi Rashkover focus on political ethics and legal theory, and the possibilities and challenges of conceiving of Jewish ethics and social norms beyond the model of ­regulation provided by the state. Brafman argues, therefore, that the work of rabbis Isaac Breuer and Mordecai Kaplan dually affirms a vision of Jewish life that “decenters the state by rediscovering the normative dimension of alternative social formations.” Instead of simply shifting Judaism to the realm of private religiosity, however, Brafman argues that Breuer and Kaplan both seek a “third way” of understanding how Jewish communal norms are constructed, regulated, and maintained—one that neither simply takes the state as a model for communal organization nor reduces Judaism's complex communality to “religion” in the private, ­modern sense.Rashkover, for her part, takes on the “secularization theory” of Thomas Luckmann and others, focusing on Luckmann's assumption that secularism must relegate religion to a sphere not only private, but largely devoid of the ability to regulate the lives even of its most devoted adherents. By way of rejoinder, Rashkover investigates the character of Jewish law and what she argues is its particular ability to maintain its powerful normative character and ethical force in the midst of secularism.In the second set of articles, Lital Abazon and Gavi Ruit take quite a different approach, with a narrative text serving as the basis for each piece; the resulting articles demonstrate yet again the fruitfulness of ethical reasoning that proceeds from literature. Abazon rereads A. B. Yehoshua's 1963 novella Facing the Forests through the lens of psychoanalysis, drawing evocative new conclusions about the Israeli protagonist's actions and motivations, and the implications of this reading for Israeli self-understanding. Ruit, meanwhile, takes on the ancient and disturbing biblical narrative of Genesis 34, a chapter that begins with Dinah, the daughter of the patriarch Jacob and his wife, Leah, going out “to visit the women of the region” and ends with Dinah's brothers destroying all the males of the city of Shechem. For Ruit, this ancient narrative—and the ensuing rabbinic commentaries on its significance—invites serious reflection not only on the ways in which rape and women's agency are discussed and debated in rabbinic literature, but on how rabbinic anxieties about power and gender are manifest in rabbinic reasoning.Thus, these two sets of articles are ostensibly quite distinct in their methods, assumptions, and conclusions. And yet I cannot help but see important points of overlap between them. Brafman's and Rashkover's essays, after all, consider some Jewish philosophical underpinnings for the construction and sustenance of Jewish norms outside of the state structure, and Abazon's and Ruit's essays provide vivid examples of the enduring power of literature to contribute—for better or worse—to this endeavor.JJE coeditor Jonathan Crane opens his 2013 study Narratives and Jewish Bioethics with a quote from Alistair MacIntyre that calls human beings “­story-telling animals” and asserts, “I can only answer the question ‘what am I to do?’ if I can ask the prior question ‘Of what story or stories do I find myself a part?’” There is no shortage now of theorization about the relationship between narrative and law, of course, but more particularly, perhaps the four articles presented here provide a fuller account of the means by which Jewish communal norms become compelling, become embedded, become troubling or stale, and require communal critique, discussion, and creativity. Such is surely part of the mission of this journal as well. We invite you to continue the conversation.

Jewish ethics and xenotransplantation

Although exclusively secular approaches to xenotransplantation are methodologically necessary to establish a fundamental verdict on its theoretical ethical acceptability, it is nevertheless pragmatically appropriate to take into account specifically religious positions, as religion is a factor relevant to societal acceptability. Apart from the aspect of societal acceptability, Jewish bioethics, like other religiously embedded ethics, may enrich the broader ethical discourse on xenotransplantation, as some of its principles-pikuach nefesh being the most prominent one-are plausible even in the framework of secular ethics. This paper first explores concepts of normativity in Jewish ethics before identifying specific ethical issues in Jewish bioethics and possible resolutions offered within the framework of Jewish ethics, and then finally examine the implications for the broader debate on xenotransplantation. Religions in general and Judaism in specific cannot and should not be systematically excluded from ethical debates, not only because they may provide helpful input, but also because religion, religiousness and the affiliation to a religion can be crucial factors regarding the societal acceptability of specific medical technologies and procedures as they may be important aspects of an individual's identity. The principles of Jewish bioethics may be compelling to those who do not necessarily share the specifically religious prerequisites on which Jewish ethics is established. Among these rather cogent concepts is the status of natural law and naturalness, which is far more open to medical technologies and procedures deemed as unnatural and thus morally wrong by other religious parties in public discourse. Jewish ethics has strong tendencies toward supporting xenotransplantation given a certain criteria is met. No categorical bans on xenotransplantation can be established on the grounds of Halacha.

Patient Autonomy in Talmudic Context: The Patient's "I Must Eat" on Yom Kippur in the Light of Contemporary Bioethics.

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge.

Jewish bioethics: rabbinic law and theology in their social and historical contexts

1. Introduction 2. An outline of 'Jewish bioethics' 3. Health and healthcare 4. Doctor-patient relationship 5. The human body 6. Fertility and very early prenatal life 7. Childbirth and abortion 8. Care for premature neonates 9. Organ transplantation and the brain death debate 10. Terminal care.

Initiating Palliative Care Conversations: Lessons from Jewish Bioethics

What are the ethical responsibilities of the medical staff (doctors, nurses, social workers, and chaplains) regarding the preservation of meaningful life for their patients who are approaching the end of life (EOL)? In particular, what is the staff's ethical responsibility to initiate a conversation with their patient regarding palliative care? By subjecting traditional Jewish teachings to an ethical analysis and then exploring the underlying universal principles, we will suggest a general ethical duty to inform patients of the different care options, especially in a manner that preserves hope. The principle that we can derive from Jewish bioethics teaches that the medical staff has a responsibility to help our patients live in a way that is consistent with how they understand their task or responsibility in life. For some patients, the best way to preserve a meaningful life in which they can fulfill their sense of purpose in the time that remains is to focus on palliation. For this reason, although palliative and supportive care are provided from the time of diagnosis, it is critical we make sure our patients realize that they have the opportunity to make a decision between either pursuing additional active treatments or choosing to focus primarily on palliative therapies to maximize quality of life. The Jewish tradition and our experience in spiritual care suggest the importance of helping patients preserve hope while, simultaneously, honestly acknowledging their situation. Staff members can play a vital role in helping patients make the most of this new period of their lives.

Prenatalny rozwój człowieka w Biblii hebrajskiej: perspektywa judaizmu

There are several references to the first stages of human life in the Old Testament Scriptures. Some of them are formulations of both descriptions of the creation of man in the Book of Genesis, fragments of Psalms, historical books and wisdom literature. These fragments do not create a coherent conception, which illustrates the development of prenatal humanity. They rather point to God’s involvement in human conception and birth, which remains for us hidden and unconceivable. This article discusses questions of human conception in the context of Hebrew Scriptures. They serve as a starting point for reflections of the state of the human embryo from the perspective of Jewish bioethics.

The hierarchy of values in Jewish bioethics

This article describes how ethical issues in health are approached and resolved within the framework of Jewish bioethics. Its main purpose is to explore the range of sources and methodologies used to determine the appropriate hierarchy of values for various ethical scenarios. Its major thrust is to illustrate how a divinely based but humanly negotiated ethical code stands firm upon 'red flag' principles, while at the same time, allowing for 'shades of gray' flexibility informed by given contexts. It provides significant insights and practical tools that can be instrumental in decision making for nurses and other health providers of all faiths. The following ethical domains are addressed: respect for patient autonomy, truth-telling and allocation of resources.

Judaism and Health: Reflections on an Emerging Scholarly Field

This paper surveys the field of Judaism and health. The authors trace the history of discourse on health and healing within Judaism, from the biblical and rabbinic eras to contemporary research and writing on Jewish bioethics, pastoral care, communal services, and aging, including congregational and community programming related to health and illness and the emergence of the Jewish healing movement. The work of the Kalsman Institute on Judaism and Health is described, focusing on efforts to unite these various threads into a scholarly field emphasizing basic and applied research on the instrumental functions of Jewish religious life for health and well-being.

The Torah on life and death. Jewish bioethics in dialogue

Review of a book: Tomasz P. Terlikowski, Tora miedzy zyciem a śmiercią. Bioetyki zydowskie w dialogu , Wydawnictwo RHETOS, Warszawa 2007.

Book Review: An introduction to Jewish and Catholic bioethics: a comparative analysis

Book Review: An introduction to Jewish and Catholic bioethics: a comparative analysis

Book Review: Introduction to Jewish and Catholic Bioethics: A Comparative Analysis

Book Review: Introduction to Jewish and Catholic Bioethics: A Comparative Analysis

Aaron L. Mackler. Introduction to Jewish and Catholic Bioethics: A Comparative Analysis. Washington, DC: Georgetown University Press, 2003. x, 265 pp.

Comparative analysis, especially in the field of religious studies, is widely recognized as among the most difficult of intellectual tasks. How does one do justice to the complexity of both subjects? How does one set the terms of the comparison in a way that accurately captures both similarities and differences? How does one place those similarities and differences in a broader context so that their significance comes to the fore? And how does one present both halves of the comparison in a way that will be equally accessible to readers presumed to be familiar with only one or the other? These challenges are still more formidable when the subjects being compared are “Jewish bioethics” and “Catholic bioethics,” each of which draws on a long ethical tradition, encompasses a wide range of views, and continues to evolve.

Introduction to Jewish and Catholic Bioethics: A Comparative Analysis

Introduction to Jewish and Catholic Bioethics: A Comparative Analysis

Revisiting the problem of Jewish bioethics: the case of terminal care.

This paper examines the main Jewish sources relevant to end-of-life ethics, two Talmudic stories, the early modern code of law (Shulhan Aruch), and contemporary Halakhaic (religious law) responsa. Some Orthodox rabbis object to the use of artificial life support that prolongs the life of a dying patient and permit its active discontinuation when the patient is suffering. Other rabbis believe that every medical measure must be taken in order to prolong life. The context of the discussion is the most recent release of the "Steinberg Report," which proposes a law regulating end-of-life issues in Israel. It is argued that the Orthodox rabbis base their views on a strongly positivist concept of religious law. The rabbis deliberate the law as a manifestation of the will of God and try to stretch the law as much as possible in order to benefit the patient, even when it is good for the patient to die. Direct and active actions that kill are prohibited; certain forms of passive euthanasia and contrivances that terminate life support without needing direct human action are accepted.

Pellegrino, Edmund D., and Alan I. Faden, eds. Jewish and Catholic Bioethics: An Ecumenical Dialogue

Pellegrino, Edmund D., and Alan I. Faden, eds. Jewish and Catholic Bioethics: An Ecumenical Dialogue

Jewish Bioethics (review)

Reviewed by: Jewish Bioethics Edward Simon Jewish Bioethics, by Fred Rosner and J. David Bleich. Hoboken, NJ: Ktav, 2000. 454 pp. $24.95. Some books can be safely recommended just by looking at their cover. The editors (outstanding experts in medicine and Jewish law) and the publisher speak for themselves. Sometimes you will be fooled. This book falls in between. It is basically a reprint of a classic 1979 text which itself is a compilation of slightly updated older articles. In this “augmented” edition only three short articles have been added: “Pigeons as a Remedy for Jaundice,” “Sex Preselection,” and “Research on the Newly Dead.” Jewish law is not static. It evolves constantly as new problems arise and new insights are accepted. Not infrequently, modern science will raise not only new issues (microwave ovens, heart transplants) but new solutions to old problems (shabbos clocks, noninvasive procedures). On the other hand, the pace of innovation is not nearly as fast as that of scientific discoveries, so it is not surprising that a twenty-year-old work should still be a valuable reference. Furthermore, Jewish law is firmly rooted in classic texts (Torah and Talmud) and ancient commentaries (Maimonides), and those do not change at all. The contributors to this volume are internationally known experts in medicine, rabbinics, or ethics, often in more than one of them. If the essays are not quite “state of the art,” they will nevertheless illustrate the thought processes involved and show the reader the dimensions of the problem and the different points of view involved. “Autopsy in Jewish Law and the Israeli Autopsy Controversy,” by Fred Rosner, is a case in point. When the article was written in 1971, the problem of autopsies was literally ripping the country apart. Many people, religious and otherwise, were afraid to go to the most prominent hospitals in the country for fear that their body parts would be discarded. In more than a few instances this fear was well founded. By 1977 things had settled down, but the controversy was still simmering, since the original laws were [End Page 147] still in place. Today the furor is gone. But what, if anything, has actually changed? A page or even a paragraph updating the situation would have been most welcome. But the discussion of Jewish law (halacha) remains valid. The basic law is derived from Deut. 21:22–23: “And if a man has committed a sin worthy of death, and he be put to death, and you hang him on a tree, his body shall not remain all night upon the tree but thou shalt surely bury him the same day.” What does this have to do with autopsies? The Talmud (Sanhedrin 47a) explains that just as hanging on a tree all night is a disgrace to the human body, so too any other disgraceful action (such as dissection and destruction of organs) is prohibited. And if the Torah shows such concern for a murderer, how much more so for the rest of us. Other objections to autopsy are addressed elsewhere in the Talmud. A major concern is the need to bury the body as quickly as possible. (The current custom in the United States of delaying one or two days is to allow the family to gather and hence increase the honor paid to the deceased.) Another is the prohibition of deriving any benefit from the dead. For this reason it is questionable if one can even sit on a tombstone. What then about organ transplants? This is covered by two other articles, one by Dr. Rosner, the other by Rabbi Nachum Rabinovitch. The problem has been widely discussed. The key ruling is that the Torah states that it provides “laws to live by,” and therefore the prohibition against desecrating the dead is overshadowed by the sanctity of life and the need to preserve it. Similarly, autopsies in general can be performed only if they will be of immediate benefit to another patient. How does the age of the internet change these parameters? In fact, Dr. Rosner’s account touches on this issue, but it is left to the reader to extrapolate his conclusions twenty years into the future...

Duty and Healing: Foundations of a Jewish Bioethics (review)

Duty and Healing: Foundations of a Jewish Bioethics (review)

Is There a Unique Jewish Bioethics of Human Reproduction?

I thought of that quotation when I was asked to address the topic, Is There a Unique Jewish Bioethics of Human Reproduction? My general answer would be that, in some ways there is. Jewish bioethics on this topic is in some ways like all other religious ethical approaches, in some ways like some other approaches, and in some ways like no other approach. Comparing Jewish bioethics with the bioethics of other faith traditions is a complex matter. There are many differences as well as similarities among Jewish bioethical approaches to reproductive technologies. Also, many similarities as well as differences may be found in comparing Jewish approaches as a group with those of other traditions. Having said this, I believe that there are some distinctive (though on the whole not unique) characteristics that tend to establish a family

Human action and God's will: a problem of consistency in Jewish bioethics.

The religious legitimacy of medical practice was an issue of serious contention amongst medieval Jewish scholars. For Nahmanides, altering the patient's fate through manipulation of natural causality amounts to circumventing divine judgment. For Maimonides, however, human accomplishment is part of God's providential design; this view generally prevails in contemporary Jewish bioethics. But the doctrine of deligitimizing human intervention continues, even while unacknowledged, the underlie certain contemporary positions. These include arguments within Jewish bioethics about end-of-life decisions, which are therefore imbued with inconsistencies. It is suggested that, given the overall endorsement of modern medicine, the Nahmanidean approach must be explicitly confronted.