Spirituality and healing -
The "golden way" of jewish law and (Halakhah) rules and regulations
According to Jewish theology the true healer is God. This is clearly stated in numerous biblical verses, i.e.:
- And He said, if you diligently hearken to the voice of the Lord your God and do that which is right in His eyes and
give ear to His commandments and keep all His statutes, I will afflict you with none of the diseases with which I
afflicted the Egyptians, for I am the Lord, your healer [Exodus 15.-26],
- And I will remove sickness from your midst [Exodus 23:25];
- I kill and I make alive, I wound and I heal, and none can escape My hand [Deuteronomy 32:39];
- Who heals the brokenhearted and binds their wounds [Psalms 147:3];
- The druggist makes a mixture of the medicines God created, but one must also pray to the Lord that He will heal you
[Ben Sirach 38:7-8].
The human healer (i.e., physician) is merely God's messenger to help the sick, the handicapped, or the injured.
However, Judaism views the patient-physician relationship as covenantal, rather than a freely contracting relationship.
Hence, there is a specific obligation on the physician to heel and on the patient to seek medical help. The requirement
to seek medical help by the patient and to help patients with scientific-technological medical knowledge by the
physicians are not optional, noble moral recommendations; rather, they are obligatory, theological-legal binding
Judaism does not subscribe to absolute, imperative, and over-riding single values; rather, the choice is for a golden
path, middle way, balancing values.
This approach is manifested both in the principles and general rules as well in specific ethical issues.
As far as principles are concerned, the following examples are pertinent:
- Judaism sanctions the value of life as one of the most important ethical values; however, in well defined
circumstances the quality of life, as far as pain and suffering is concerned, is taken into account.
- Judaism subscribes to commitments, obligations, duties, and altruism rather than to rights, hedonism, and
selfishness. Hence, happiness and pleasure are only means rather than goals of their own. Therefore, autonomy is not
regarded as the only and overriding principle. Rather, a certain degree of paternalism is recommended, so that an
overall responsibility to halakhically accepted norms and regulations will be adhered to by the patient, the physician,
and society at large.
On specific issues the following are examples of the 'golden' middle way, without going into depth and details:
- Abortion can be dealt with morally in two opposing and extreme ways -- either a pro-life approach, which negates
any situation were abortion might be permissible; or a pro-choice approach, which negates any rights of the fetus, and
takes into account only the mother's wishes. Judaism subscribes to a middle way, whereby the fetus has inherent rights
and claims for life on the one hand, but the mother has priority over the fetus in life-and-death situations on the other
hand. Hence, in ordinary circumstances abortion is prohibited, but whenever the mother's life or health are
jeopardized abortion is permissible.
- The attitude towards the terminally ill is a complicated issue in current medical ethics. There are two extreme
positions in solving this dilemma. Ort the one hand, there are theologians and philosophers who regard the value of
life as an absolute value. Accordingly, every possible effort is demanded to prolong every life, no matter how short or
miserable that life is. On the other hand, there are ethicists who deny completely the value of life per se, and regard
only the quality-of-life as expressed by an autonomous patient to be the deciding value. Accordingly, lf a patient
views his life as worthless and requests active euthanasia, this wish should be carried out by the physician. Judaism
subscribes to a middle way, whereby the value of life per se is of utmost importance, although not an absolute
value. At the same time, unbearable and futile pain and suffering are undesired and should be avoided. Hence, life
should never be actively taken away, because killing is killing no matter what the justification for that action might be.
However, it is permissible to withhold treatment from a dying patient in order to avoid continues pointless and
unbearable pain and suffering.
- Disclosure of information to the patient is another specific example. Some advocate full and universal disclosure of
all information to any patient, based on an extreme interpretation of the notion of autonomy. Others are more
concerned with the potential harm to patients by disclosing to them bad news. They, therefore, promote the approach
of concealing bad news, and even lying to patients about their grave situation, in order to protect them from untoward
and ill effects upon their well-being. Judaism advocates a middle way by assessing carefully the coping capabilities of
every individual patient and stressing more the issues of How, Where, When and by Whom to disclose the
information. The aim of disclosure is to benefit the patient on the one hand, and to avoid harm on the other hand. This
can be achieved only by careful assessment of each individual patient, and by using appropriate communicative skills
by the health-care providers. In solving ethical dilemmas Judaism prefers an individual, case-specific, casuistic
approach, rather than a principled, regulated approach.
The Jewish model of decision-making in medical issues is based on a triad: the physician, who has the obligation to
treat and recommend the best medical advice; the patient, who has the obligation to seek medical help, and autonomy
to choose medical and galactic advisers; and the rabbi, who is required to solve any ethical/legal problem
encountered either by the patient or by the physician. The rabbi is expected to posses and comprehend all the relevant
data concerning the medical situation, as well as the psycho-social aspects of the case, and incorporate this
information into the halakhic framework. Obviously, the Rabbi's input is appropriate only where ethical dilemmas are
part of the decision making process.
Based on all these approaches an observant Jewish physician and patient can achieve more calming and comforting
solutions to ethical dilemmas.
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Jason Aronson Inc, New-Jersey, 19-3 0, 1990
Steinberg A, Jewish medical ethics. In: Brody BA, et al (eds), Bioethics Year Book, Kluwer Academic Pub,
Netherlands, 1: 179-199, 1991
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Netherlands, 271-279, 1993
Steinberg A, A Jewish pespective on the four principles. In: Gillon R (ed), Principles of Health care Ethics, John
Wiley & Sons, Chichester, 65-73, 1993
Steinberg A, Decision-making and the role of surrogacy in withdrawal or withholding of therapy in neonates. Clin
Perinatol 25(3):779-790, 1998
Prof. Dr. med. Avraham Steinberg
6 Shalom Aleichem Street
Jerusalem 92148, Israel