Your health: Examining medical ethics

Posted

The clash between secular and Jewish perspectives

By Dr. Leon Zacharowicz

Issue of Nov. 7, 2008 / 9 Cheshvan 5769

The amazing technological advances of the last century have created new solutions to medical and psychiatric disorders, but also have resulted in highly complex ethical and legal dilemmas.

Until about half a century ago, a physician could sometimes diagnose, often comfort and rarely cure his patients. He or she could offer empathy and some palliative measures, but little could be done to alter the course of most serious illnesses and disorders.

With the discovery of germs as the cause of disease and the advent of antibiotics such as penicillin, doctors could often cure patients. Subsequently, in the middle of the 20th century, psychoactive medications began to be used, enabling patients otherwise doomed to a life in a sanitarium to live, in many cases, productive lives in the community.

The last few decades have witnessed widespread use of machines such as CT and MRI scans along with rapid advances in other diagnostic and therapeutic tools. Genetic studies may soon enable people to know their genetic risks for various medical and psychiatric disorders, and enable a more targeted treatment approach.

The financial aspects of medical and psychiatric care have grown in importance over the past several decades. More could be done to help diagnose and treat people, so more was done (and sometimes, doctors leery of being sued ordered extra tests and procedures, a practice called “defensive” medicine). With the advent of HMOs, cost containment on patient care became a top priority, but this was presented to medical students and patients alike as “cost benefit analysis.”

Today, medical students and physicians are routinely taught to consider the costs of certain procedures and tests. Often, those professionals who order too many expensive tests or advocate too vigorously for their patients’ treatment find themselves removed from the HMO panel.

Secular ethics has grown as a field, in tandem with the growth of technology and concerns about costs. Secular ethics does not rely on biblical or religious sources, but rather on relatively modern, secular philosophies of mankind, such as the doctrine of personal autonomy, which has roots in the U.S. Constitution. Under this notion, supposedly a patient has the right to refuse even life-saving care if he or she is of sound mind and body. This view conceptualizes a person as the owner of his or her body and mind. No one is entitled to treat or even touch that person’s body without that person’s consent.

In traditional Jewish thought, a person is not viewed as being the owner of his body. To paraphrase Rush Limbaugh’s view of his talent, our bodies are on loan from G-d. With rare exception, a believing Jewish person is not free to do with his body as he pleases.

Not surprisingly, professional ethicists under the employ of hospitals often take the position most financially beneficial to the hospital center, but frame that position in philosophical and psychological terms which are appealing to the decision-makers — family members of a critically ill patient, for example.

Recently, the concept of “futile care” has entered the lexicon of ethicists eager to please their employers, as well as those whose world outlook differs markedly from a traditional Jewish perspective. This concept stems from the 19th century secular philosophy of utilitarianism, which posits that in some cases one should sacrifice the few to benefit the many. In the latest radical versions of “futile care” theory, a patient whose quality of life will not be much improved by modern medicine is not only expendable but a drain on our limited resources, and the only “humane” decision is one that results in the shortening of that patient’s life via withdrawal of care — even if this violates the notion of personal autonomy!

Such a view is anathema to traditional secular ethics and orthodox Jewish thought. In halacha, the overriding concern is the biblical prohibition against taking a person’s life, regardless of outside considerations, such as “cost benefit analysis,” the inconvenience or agony of family members, or the potential use of a patient’s organs — or respirator — to benefit others.

The case of the late Samuel Golubchuk, which pitted the family of a disabled orthodox “frum from birth” Jewish man against Canadian doctors who wished to end his life, is a classic example of what can happen when two different sets of ethics clash. Regrettably, the family and its supporters were unable to galvanize public support from major Jewish organizations, despite the clear-cut nature of the case and its implications (it was called “the Terri Schiavo case” of Canada). They fought a lonely and costly battle. As a result, there will be more such cases.

On a more mundane level, professionals whose allegiances are co-opted by healthcare and other systems may not represent your interests — or that of your child — to the extent you deem appropriate.

What can be done to protect your rights? Here are some suggestions.

— Make sure your physician is sensitive to your religious and ethical beliefs, and will advocate for you and your loved ones in your time of need. If your doctor will not respect your beliefs, switch doctors to someone who will.

— Talk to your rabbi soon, before the enormous stress of dealing with a serious illness clouds your thinking and legions of healthcare personnel descend upon you, insisting that “the only humane thing” to do is to “pull the plug.” (Be warned: even some yarmulke-bearing doctors may in their ignorance advocate this.)

— Convince your rabbi to occasionally discuss important but uncomfortable topics like end-of-life care from the pulpit.

— Prepare a “halachic living will.” A sample is available from Agudath Israel of America (212-797-9000) and designate a health care proxy to make decisions for you when you are incapacitated. Prepare a durable power of attorney whereby a loved one can access funds and make financial decisions.

—Go to lectures given on medical halacha. Our community is blessed with the presence of several academic ethicists, such as the world-renowned Dr. Fred Rosner and Rabbi Dr. Eddie Reichman, as well as rabbis who often speak about medical ethics (Rabbi Dr. Aaron Glatt, for example), and halachic authorities who specialize in this area (for example, Rabbi Tzvi Flaum).

— Attend seminars on end-of-life care and other topics of interest. (However, beware of who is sponsoring the seminar and what their hidden agenda might be, especially if the sponsor picks the speakers.)

— Realize that doctors may have special knowledge in medicine, but they are not necessarily authorities in medical ethics in general, nor in medical halacha in particular.

— Ask your doctor: When is the last time you attended a seminar on Jewish medical ethics? If he or she has not done so in more than a decade, your doctor may be as out of date in this rapidly advancing halachic field as a doctor who has not attended medical lectures in a similar period of time might be, and maybe that should factor into your choice of a doctor.

— Develop a relationship with a rabbi who is qualified to render life-and-death decisions and will be there for you in your hour of need.

By taking some of these steps, you can learn about the field of Jewish medical ethics and also help ensure that your values are respected in the “brave new world” of healthcare.

Dr. Leon Zacharowicz, a Far Rockaway resident, was the pro bono neurologist for the Golubchuk family in its legal battle, about which he lectured at a recent conference on end of life care at Yeshiva University. Co-founder of an international yarchei kallah series on medical halacha (www.j-c-r.org), he is currently helping to coordinate a Winter 2009 New York seminar on medical ethics. He can be contacted at DrZach007@aol. com.