Written by: Erin Parfet

Jewish Medical Ethics

Throughout history, there have been various moral codes of medical ethics outlined by the Code of Hammurabi, Egyptian medical dictations on papyrus, various writings originating from early Greece and the Far Eastern Orient, and the various teachings of modern secular humanism. Jewish medical ethics, meanwhile, is based on the ancient, timeless teachings of the Torah and Talmud.

The Jewish model of medical ethics vehemently seeks to uphold the sacred value of God-created human life (Exodus 15:26, Deuteronomy 4:15, and Deuteronomy 30:19) and deems modern healthcare generally compatible with the current standards of care in allopathic medicine and palliative care throughout most of the modern world. As one might expect, Jewish medical ethics differentiates itself from secular medical ethics by combining the wisdom of the Jewish faith and sacred teachings of the Torah with nuanced, challenging medical decisions that will inevitably come up in healthcare situations for both physicians and patients alike.

Jewish medical ethics as we know it today largely evolved in the 19th century, with such scholars as Julius Preuss studying the intersection of the Talmud and medicine and rabbis such as Sir Immanuel Jakobovits publishing significant headways in the world of applying medical ethics with halakha (Jewish law) based on his exposure to Catholic medical ethics during his academic training in Ireland. Scholars and religious figures who have sought to build on Jewish medical ethics since then frequently use Rabbi Jakobovits’ work as a foundation for their positions and frequently cite his work.

Since then, bioethics has evolved with the latest scientific and medical breakthroughs in the 20th and 21st centuries (e.g., organ transplants, genetic screenings, and in vitro fertilization) that did not exist during the 19th century, as well as to combat issues that arose with medical experimentation that occurred during the Holocaust. What has remained constant over time, however, is that Jewish people strongly believe in the sanctity of life, even if that may be portrayed through a different perspective than the Christian definition of the sanctity of life, and seek to promote health, healing, compassion, and the alleviation of suffering.

Jewish medical ethics, in accordance with Jewish law, is based on four general principles that are generally compatible with secular medical ethics: autonomy, beneficence, non-maleficence, and justice. Jewish law primarily differentiates from secular medical ethics in that autonomy is limited by God’s law defined in the Torah and Talmud. The writings of the Talmud especially apply to situations such as suicide, assisted suicide, and euthanasia, all of which are forbidden under Jewish law. This differentiates Jewish medical ethics from secular medical ethics, which is based on principles of humanism, rational intellectualism, logic, and the concept of live and let live.

Furthermore, Jewish medical ethics also desires to uplift Torah scholars as their knowledge intersects with medicine, protect the weak and the vulnerable in society, love the stranger, widow, and orphan, not take advantage of people in pursuit of prestige or affluence, give charitably to the poor and those in need, uphold prohibitions against adultery and other forbidden sexual relationships, and promote other matters of moral behavior toward both humans and animals as specified in the Torah and the Talmud.

Generally speaking, Jewish physicians strive to uphold the Hippocratic Oath to do no harm and are dedicated to the cause of healing illness. However, unlike Adventist healthcare, Jewish physicians are less likely to mention lifestyle changes and are more likely to conform to textbook allopathic medicine (e.g., drugs and surgery). Meanwhile, Jewish patients are obligated under Jewish law to preserve their lives by seeking healing insofar as is possible.

Patients are commanded to seek healing if possible, and a physician is obligated to provide healing as much as is possible, upholding Torah and Talmud principles as far as possible, but those may be waived if that is what is needed to save the patient’s life. For example, kosher food is the ideal under scripture and Talmudic principles, but if, to save a patient’s life, non-kosher food is somehow all that is available, then this would be permitted. The doctor’s opinion reigns supreme on what treatments are best, and patients are generally not considered free under Jewish law to protest or decline a treatment that may save one’s life. Judaism recognizes free will, but not free will to violate God’s laws and commandments.

Jewish law permits nearly any required medical treatment needed for any given condition, as saving lives is viewed to be of vital importance in Judaism. Halacha requires doctors to apply the best medical advice and therapeutic interventions of the times that they are familiar with, while the rabbi advises on the principles of halacha and says that the medical intervention being provided is permitted under Jewish law. In emergency situations where there is no time to consult a rabbi prior to treatment, then Judaism permits any treatment being provided if that is what is deemed necessary to save human life. If there is not an emergency, often a rabbi is consulted prior to receiving any medical treatment. However, Jewish law views the medical doctor as the ultimate authority on the patient’s medical situation, not the rabbi or other medical professionals on the healthcare team.

Under Jewish law, Jewish medical doctors are allowed to earn a decent standard of living but are not to pursue the medical field to gain wealth. Furthermore, the fees charged for a patient’s care are ideally to be determined by each individual physician and adjusted accordingly on a sliding scale to meet individual patient needs, not to exceed what is allowed by insurance companies. Jewish law recognizes the expense and time investment in pursuing the rigorous academic demands of aspiring to become a physician and does not want doctors resigned to poverty for the sacrifice of their education, career, or the utmost importance of healing here on earth, but wants doctors to pursue the profession for noble reasons of healing and not affluence.

Obviously, some doctors will pursue the profession for the wrong reasons, whether that be affluence or perceived prestige, engage in dishonest billing practices, or spend minimal time with patients in order to maximize profits. Jewish law also sees physicians as providers of services and not products, meaning that drugs and so forth meant to benefit one’s health should be provided if needed for healing but not to make a profit. Taanit 20b in the Talmud goes so far as to state that medications prescribed to a patient should not come at a financial cost to the patient.

Doctors are also not supposed to accept gifts from patients or third-party entities, such as pharmaceutical companies, suppliers, or vendors of any kind, for the purpose of remaining objective when interacting with patients and their healthcare outcomes. Ideally, honest, ethical doctors will gain a reputation through repeated business from satisfied patients and through word of mouth without having to advertise their medical practice. Jewish medical practices will also try to keep their offices clean, professional, and devoid of such things as cigarette advertisements in an effort to promote the preservation of human life.

Generally, Jewish patients will not undergo treatment on Shabbat or on dates corresponding with major Jewish festivals unless the condition is life-threatening and there is no other option to save one’s life. Anything to extend life is permitted under Jewish medical ethics; even moving a dying patient is prohibited as this may inadvertently cause death to a patient, and a rabbi must be consulted if a patient is moved or other actions are taken that may inadvertently hasten a patient’s death or deterioration of condition.

Terminally ill patients under Jewish law may be permitted to refuse treatments that may not cure their condition and often will not withdraw treatment that is already underway. Pain and suffering are to be minimized, but intentionally shortening or ending one’s life is not permissible under the laws of the Talmud despite patient autonomy, which may exist within the secular legal system. Halacha also permits rabbis to be involved in such things as advance directives and spiritual advice for their patients during the course of their medical treatment. Jewish tradition lends credibility to “educated opinion” and “legitimate authority” and thus is much less open to alternative treatments, dietary supplements, or nutrition having a place in a patient’s treatment plan.

Such things as Do Not Resuscitate orders may vary in permissibility, as there may be cases where such an order is deemed appropriate, and at such times, an order is deemed to violate Jewish law regarding the preservation of life. Dying patients will sometimes recite the Shema, the Psalms, and/or the Viddui (a confession one makes upon their death beds). Often, a rabbi will be in attendance if possible when a patient is dying, ideally one’s own rabbi if possible, but otherwise a local rabbi who is available. Judaism does not recognize any “last rites” or other special ceremonies.

Most rabbis will promote Genesis 1:28, and similarly, Isaiah 45:18, as a commandment to be fruitful and multiply, and thus medical interventions that help couples struggling with infertility are often permitted by the rabbis and Jewish law. This notion is also supported by the suffering of Sarah, Rebecca, and Rachel in Genesis as a result of their infertility and the desire to promote wellbeing and minimize suffering by providing what modern technology can provide as far as infertility issues.

There are some concerns about whether in vitro fertilization techniques are kosher under halacha, which vary among different rabbis. However, most rabbis bless the procedure if it involves the wife’s egg and the husband’s sperm and if steps are taken not to implant more than one fertilized egg into a woman to minimize the chances of high-risk pregnancies.

Jewish medical ethics seem to be open to a plethora of options when it comes to the controversial topic of genetic screening. Some may elect for genetic screening for any variety of conditions, while others may choose not to be screened and find more comfort in not knowing if they carry a particular gene. Medical professionals and rabbis seem open to the wide range of responses to genetic testing because some would prefer their patients vigilantly monitor their health and not be lulled into complacency by the results of a genetic screening.

For example, with breast cancer, which runs in Ashkenazi Jewish communities, some women may elect for mastectomy and ovarian surgery; others may prefer frequent screening; and others may prefer not to be genetically tested at all. Some doctors and rabbis may prefer that women actively screen for breast cancer throughout their lives rather than assume they do not have a high statistical probability of having breast cancer based on a one-time genetic screening test. With Tay-Sachs disease as another example, some may not be interested in any genetic screening until wanting to bear children, and then their perceptions may change. However, for those not choosing to bear children, there may be no reason or incentive to undergo genetic screening. Jewish law seems more open to a variety of responses and recognizes that some people are concerned about genetic discrimination if they undergo genetic screening.

Jewish medical ethics generally opposes organ transplants on the basis that the deceased body is being mutilated (a violation of nivul hamet, or the mutilation of a deceased body), as well as the teaching of Deuteronomy 21:23. Within Orthodox communities, especially, organ transplants are often objected to because of a strict interpretation of Jewish law that the dead be buried in a timely manner.

The commandment to save a life, however, supersedes the general opposition to an organ transplant that may be helpful but is not occurring in the context of a life-and-death situation. Thus, there is a narrow range of exceptions within Jewish law for an organ transplant desperately needed to save someone’s life, and this life-saving procedure can then be considered to add glory and honor to the dead (kavod hamet). This is further justified by the Jewish principle of zeh ne'heneh vezeh lo chaser, which translates to “one party is helped and the other is not harmed.” In this context, some rabbis justify the practice by explaining that the transplanted organ is now in the body of the living and not the body of the dead, and therefore why bury an organ that is living in another individual when the organ will be buried in the future when the transplant recipient passes on.

Judaism generally permits contraception, especially with Reform Judaism and more liberal Jewish communities, generally citing the Beraita of the Three Women as their main Talmudic text to support their position. As one might expect, Orthodox Jews are more restrictive when it comes to contraception, however. Judaism does consider it a mitzvah to marry, procreate, and bear children, a burden Judaism seems to place more on the male than the female, and this is elaborated on in the Talmud, which states that being fruitful and multiplying equates to bearing two sons or a son and a daughter (Yevamot 6:6). Jewish law also forbids “wasting seed,” which refers to emitting semen without a purpose, based on Genesis 38:7–10.

The first circumstance would be negated by the use of contraception, and contraception would be seen as violating the second circumstance of wasting seed. Jewish law does permit contraception if it is needed in a circumstance that would protect someone’s life, such as a woman going through certain challenges with childbearing or being too young to safely become pregnant.

After the Holocaust, the Jewish people have been largely even more inclined to promote procreation to rebuild the Jewish community after so many lives perished in the concentration camps. Some Jewish people view women’s health and family dynamics as of paramount importance to the commandment to be fruitful and multiply.

Jewish doctors will promote nutrition insofar as it conforms with the Torah and current medical and clinical nutritional recommendations. Some Jewish doctors will go so far as to become vegetarians to be an example to their patients based on the teachings of Genesis 1:29 in the Torah while minimizing animal suffering and promoting the sanctity of life. Maimonides once mentioned that animals feel pain and suffer as well, and compassion toward animals leads to compassion toward our fellow man, while consuming animal products perpetuates violence not only toward animals but also toward humans. This is the basis that most Jewish people use when they justify a vegetarian diet, rather than the health message. Despite Maimonides once saying, "From a practical standpoint, knowledge of nutrition is of the greatest usefulness to the practice of medicine," nutrition is generally not viewed as much as a preventative means toward certain health conditions as it is viewed with Adventism.

Earnest prayer is also deemed to be significantly powerful as a healing remedy and is viewed as an essential component in healthcare settings, though Jewish law commands that one not rely on miracles. A faithful Jewish person is to pursue medical treatment if it is possible and not simply relegate the matter to prayer alone. Prayer (three times a day, ideally on weekdays, and special prayers additionally if the Torah is being read) and medical treatment, not merely prayer, are the ideals under Jewish law.

This article is not an endorsement of any particular line of thought, personal opinion, or philosophy, or the thoughts of every single Jewish person on the planet throughout all of history, nor does it touch on every moral issue. Rather, this article merely stands as a reflection of some prevailing themes throughout Jewish medical ethics that often guide patients and physicians in challenging healthcare situations.

Furthermore, this article does not constitute medical advice in any way. We encourage anyone struggling with healthcare issues to seek professional medical advice from a licensed physician or other appropriate healthcare provider. For any spiritual, ethical, or moral matters one may be grappling with, we encourage prayer and prayer-filled consultation with one’s own family, clergy, and/or church elders.

In the realm of Jewish medical ethics, the profound emphasis on pikuach nefesh, the preservation of life, resounds throughout the teachings of the various rabbis and Jewish scholars, even if there may be differing opinions on how practically to go about protecting life, reflecting on the value of empathy, and pursuing health and well-being for all in the various ethical and moral situations that inevitably come up within medical settings.

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