BIOETHICS IN JUDAISM
"He has told you, O man, what is good. What does God require of you but to do justice, to love kindness and to walk humbly with your God?" Micah 6:8
Bioethics deal with the ethical questions surrounding the taking, giving or altering of human life. As Judaism’s focus is on life, bioethics are of prime Jewish concern.
For Jews, the ultimate question relating to all bioethical issues is how much we are allowed to tamper with life, the sacred gift granted to us.
In order to understand how Judaism deals with problems of bioethics we have to look at how ethical principles are formulated and how Jewish ethics can and does evolve to deal with dilemmas that arise from the rapid advances of science in general and medicine in particular.
The Sources of Ethical Principles
The famous verse from Micah quoted above epitomises the principles of Jewish ethics as the rules for a good and correct life, as Micah reminds us that the ethical life requires a spirit of justice, charity and humility.
Jews obtain their moral values from the Hebrew Bible, and the totality of the moral law is described as Torah. Torah values are similar to those of the other two great monotheistic religions which also claim Divine origin for their moral codes, as well as proclaiming that God's commandments are absolute for all times and for all situations.
Judaism complements the authority of the Biblical law with the concept that as well as the written Torah there exists alongside it the Oral Torah which has the same imprimatur as the written. Just as the written Torah was revealed at Mount Sinai to Moses it is traditionally held, the Oral Law was given at the same time. This enables Judaism to grapple with socio-historical changes, as the Oral Law is continually evolving through the labours of our rabbis (teachers) who use its authority to interpret the written Torah. The authority of particular rabbis as interpreters of the law hinges on their acceptance by their peers because of their outstanding knowledge and the excellence of their character, recognised both during their lifetimes and after their deaths.
The Oral Torah could not continue as a word-of-mouth system because of the sheer amount of data and rulings that have taken place over the centuries. It needed to be recorded and is continually being written down in such great works as the Talmud and collections of the rulings ('Responsa') of outstanding rabbis such as Maimonides. When faced with problems not overtly covered in the Torah, the written laws are interpreted and their essential meanings uncovered to arrive at conclusions in keeping with Micah's admonitions. For example the most misquoted verse in the Torah is Exodus 21:23-24, "an eye for an eye", which the rabbis teach has always meant the monetary value of the eye and not the actual eye.
From both the written and oral Torah we can formulate what I call the four golden rules of Bioethics:
1. Do not kill;
2. Each individual life is of infinite value and no one person's life is more valuable than another;
3. One's life belongs to God;
4. There is a duty on all to save life and heal the sick.
The traditional practice of applying principles of Halacha to ethical dilemmas and the evaluation of new technologies defines Jewish bioethics. This process attempts to identify the duties of physicians, patients and families faced with life, health and death decisions.
There are three main Jewish bioethical principles: that human life has infinite value; that aging, illness and death are a natural part of life; and that improvement of the patient’s quality of life is a constant commitment.
Other Jewish bioethical principles are that we are to act responsibly in preserving the wellbeing of our bodies, because they actually belong to God; and that any other law can be violated in order to save human life except murder, incest and idolatry.
The Jewish bioethical system is based on duties and responsibilities, as opposed to the secular model of rights.
The presumed right to withhold treatment, to commit suicide, to have an abortion when the mother's life or health is not at risk, and/or to perform euthanasia, are all overridden by the duty of Jews to treat illness, preserve health and life.
If we apply these rules to abortion we can immediately see that the adage "my body belongs to me and I can do what I like with it” has no place in Judaism. However Exodus 21:22 provides that compensation must be paid in cases where a miscarriage accidentally results from violence, and it has been suggested that this implies that foeticide, whilst morally repugnant, is not legally equivalent to homicide, since it does not give rise to the penalties which are imposed for accidental manslaughter. In Judaism the foetus is not characterised as an independent being until birth.
The general rule is therefore that the mother's physical and mental health takes precedence over the foetus, even, if in extreme cases it means that abortion is required. Nevertheless social abortion and abortion on demand are strictly forbidden.
The Torah forbids the defilement of a dead body, but it also states clearly the paramount necessity of preserving life. The stricture against defilement is therefore overturned if an organ such as a kidney is taken from a cadaver, transplanted into a sick person and could lead to the saving of a life. Corneal transplants are also approved, as sight is considered vital to an individual's well-being.
On the other hand, although saving a life is mandatory it should not be undertaken if there is a risk to the rescuer. The typical example is of a person who cannot swim and sees another drowning, and who is bound only to get a pole or rope and haul in the other.
This raises the issue whether a relative (ideally an identical twin) is allowed to donate a kidney, or part of his or her liver. There are two issues:
1.The immediate operative risk to the donor
2. The long-term risk of having one kidney
With modern surgical techniques and resuscitation the risk in removing a kidney is very low. However that is not the case where a part of the liver is removed. In Time magazine (28/01/02) a case was reported of a brother dying after donating half his liver. The report goes on to discus the ethical implications of this tragedy. The long-term risk of having one kidney is also not negligible and each potential donor must be assessed individually.
Ethical problems arise when an essential organ (such as a heart or liver) cannot be taken from a cadaver as it must have a normal circulation right up to the moment of harvesting. The dilemma that this poses is: can a person be dead even though the heart is still beating albeit because of a life support system? If the person is still alive in some sense then these organ transplants contravene our first rule: we must not kill. If however a person is dead by virtue of their brain being dead despite their heart beating, then removing their vital organs is not tantamount to murder. This latter concept is accepted by most, but by no means by all, authorities, and so heart and liver transplants are usually permitted.
There was a famous case in Israel when a 20 year student, Alisa Flatow, was killed when travelling in a bus blown up by a terrorist. Her parents gave permission for her organs to be transplanted. Bearing in mind our second rule that no one life is of more importance than another, two of her organs were transplanted into Palestinian recipients. This case stimulated the public's interest in organ transplantation and led to more organs becoming available and being transplanted in Israel.
In-Vitro Fertilisation and Cloning
There is a positive commandment to procreate: "be fruitful and multiply" (Genesis 1:28) and so In-Vitro Fertilisation (I.V.F.) is encouraged to enable a barren couple to have children. Objections have occasionally been raised to the concept of fertilisation by a donor, in view of the danger of future forbidden relationships between children who are unaware of their genetic ancestry.
Traditionally it is held that the embryo does not take on human characteristics until the fortieth day after conception. If during that procedure some embryos are not needed, then research on those embryos and using their stem cells for therapy would not be an ethical problem as it could lead to the saving of life. Similarly the cloning of one's own cells for future use would not raise any objections if used for reasons of health. The view that one can clone one's self completely, including one's own self awareness and memories, is currently a subject of science fiction; at best one could only create a physically identical twin.
"(There is) a time to be born and a time to die" (Ecclesiastes 3:2)
"Vex not his ghost. O, let him pass !
He hates him
That would upon the rack of this tough world
Stretch him out longer." (King Lear, Act 5 Scene 3)
This topic is probably the most difficult to deal with as it is one that affects each of us in a personal way. Both Ecclesiastes and Shakespeare recognise that there comes a time when it is pointless and cruel to persist with life. Jewish tradition is replete with stories of not enduring with a life of suffering and anguish. However bearing in mind our golden rules, are we killing someone if we do not prolong a life which could, even in its last few moments, have some merit?
In essence Judaism is against active euthanasia. We cannot actively (knowing the consequences of our actions) administer a lethal dose to a person who is dying, to prevent their suffering. However passive euthanasia, where essentially nature is allowed to take its course, is permitted when death is inevitable. We need not embark on a course of treatment merely to gain a brief respite. We can even withdraw treatment if that treatment is not going to cure the dying patient.
Some bio-ethicists believe that, philosophically, there is no essential difference between active and passive euthanasia but Judaism does make that distinction. Judaism holds that one should never withhold sustenance from a dying patient. Controversy can arise as to the mode of deliverance of this sustenance. Judaism would not agree that Terry Schiavo's naso-gastric tube (running from her mouth to her stomach) or the decision by the Victorian Supreme Court in a similar case (cited in The Australian, 30/05/03) should have been withdrawn, causing these women to die from dehydration. It would agree that nutrition given intra-venously would count as extraordinary and could be ceased. Whether it should be given artificially via a tube through the abdominal wall into the stomach is debatable.
Another vexed problem is the question of switching off a life support system and authorities have differed. Each case must be judged on its merits.
The Jewish view is that the created world is not perfect and that man is carrying on the work of G-d in trying to improve it. We are not Luddites who believe that there should be no technical advances. But with that approach comes a responsibility that was realised nearly two thousand years ago in this rabbinic commentary:
"When the Almighty created Adam He led him round the Garden of Eden. 'Look at my works', He said. 'See how beautiful they are; how excellent! I created them all for your sake. See to it that you do not spoil and destroy my world; for if you do there is no-one to put it right'. "
I cannot think of any better way to sum up the Jewish attitude towards taking care not to pollute the environment, and the warning that there may be a stage when the situation becomes irreversible.
Orthodox Jewish bioethics is guided by the absolute morality of the laws of the written Torah which is believed to contain the word of G-d. The development of an Oral Law, which is continually being interpreted, enables Judaism to confront modern problems and solve them in the spirit of Micah's message. In the words of a contemporary authority, Rabbi M.D.Tendler:
"Inherent in the Jewish point of view is an expression of confidence that decisions on these great issues do not reside in heaven . We don’t accept an infallible, irrevocable voice from heaven to clarify even these most complex issues. This of course is a disadvantage that we have compared with other religions. Using the biblical ethical principles...may help us all, while we study the problems with integrity and devotion, to surely reach the proper conclusion, one that is pleasing to us and to G-d". (The Mount Sinai Journal of Medicine, 51:54-57, 1984.)
© Ian Kern 2006.
(Ian Kern is a paediatric surgeon with an interest in issues of medical ethics and Jewish studies.)