Guiding principles and standards of conduct in the practice of medicine which are based on the traditional religious and moral norms of Judaism. The subject became a distinct discipline only recently, and it is now beginning to have its own experts, literature, and specialized research institutes. Directives on medical questions are found in all sources of Jewish law---from the Bible to the latest rabbinic Responsa. These responsa constitute an appreciable part of the corpus of Jewish legal and ethical literature.
The belated "recognition" of Jewish medical ethics is strikingly illustrated by a comparison between the old Jewish Encyclopedia (1901-6), which included no articles on the subject at all, and the more recent Encyclopaedia Judaica (1972), which contains fairly extensive entries under abortion, artificial insemination, autopsies, birth control, castration, euthanasia, homosexuality, and transplants. Yet it still had no comprehensive article on medical ethics generally, and there were also other notable omissions (e.g., eugenics, experimentation, and faith healing, not to mention genetic engineering and cloning).
Publications
These books and articles are, however, only collections and discussions of the secondary sources. The primary source material chiefly derives from the massive output of responsa by great contemporary masters of rabbinic law such as Moses Feinstein, Eliezer Waldenberg, and Isaac Jacob Weiss. These multivolume works present the answers given by the authors to questions submitted to them for rabbinic decision. Their rulings are invariably based on principles enshrined as relevant precedents in the Talmud, the Codes, and earlier responsa within the constantly evolving process of Jewish lawmaking.
Among the many hundreds of individual responsa now published annually, a considerable proportion is devoted to questions on medical ethics. Opinions will often differ quite significantly owing to divergent interpretations or even conflicting assessments of the medical data---on the definition of death, for example, or the status of the embryo. As a consensus gradually emerges, however, that becomes the norm of Jewish law, it will generally be accepted as binding among those committed to the sovereignty of religious imperatives in their lives and to rabbinical mentors as the exponents of Jewish ethical values and standards.
Institutes
Scope
The enormously ramified decisions in all these areas are binding on doctors and patients alike. In most cases, particularly where they affect life-and-death decisions (such as pregnancy termination or transplant operations), the principles involved would be regarded as of universal validity, although Jewish practitioners treating Gentile patients would be expected to pay due respect to the teachings of their own faith as well.
Trends Naturally, ethical principles and guidelines rooted in a traditional code of laws, which in turn derive their authenticity from antecedents relying on earlier authority (whether Divine or human), are bound to be conservative in character. More often than not, therefore, the conclusions reached are restrictive rather than permissive. The area of personal choice by individual preference or conscience is frequently limited. Purely utilitarian motives are rarely sanctioned or encouraged.
The attitude reflected in traditional Jewish rulings is nevertheless often remarkably liberal, especially when contrasted with some other religiously inspired systems of medical ethics. For example, in Jewish law, there is no absolute ban on Birth Control or abortion, and the avoidance or mitigation of suffering ranks high among the considerations to be weighed where conflicting ethical interests require careful assessment to determine the verdict. Thus, where informing a patient of a fatal prognosis might cause a physical or mental setback, one should disregard the patient's possible desire for Confession---or even subvert the truth by outright denial -- because the patient's welfare and peace of mind should take priority over purely spiritual concerns.
Where some shift of opinion is discernible, particularly in relation to modern advances, it has usually been in the direction of greater leniency. Thus, while previously there was a fairly clear line of demarcation between abortions permitted to save the mother's life and all others which could not be sanctioned, quite a few judgments have lately veered toward permitting abortions even where the risk is only to the mother's health, or even where fears of grave abnormalities in the child are suspected or ascertained. A similar move toward greater permissiveness, albeit under carefully defined conditions, is apparent in regard to organic heart transplants. The former virtually unanimous opposition to heart transplants, condemned as "double murder" (of the donor and the recipient) by some, has thus given way to cautious endorsement, notably in a conditional agreement between the Israel Chief Rabbinate and Hadassah Hospital in Jerusalem. Other leading rabbis, however, continue to challenge this ruling; they insist on heart stoppage, not mere brain-stem death, before a vital organ can be removed from the donor.
Some Major Principles
(1) The sanctity of life or, more precisely, the infinite value of every innocent human life. Stemming from this cardinal rule are decisions concerning euthanasia, experimentation on human beings, the suspension of religious laws when these conflict with life, and the recourse to doubtful or unproven cures in any attempt to save life.
(2) The religious precept to preserve life and health. To apply medical skills by those who possess them for those who need them is never optional but always mandatory. Accordingly, a doctor must not refuse his services, nor is the patient's consent required for lifesaving operations, except where needed to secure his cooperation.
(3) The duty to procreate. This naturally affects in particular the attitude to abortion and contraception as well as sterilization, sanctioned only for urgent medical reasons and never on purely social or economic grounds, except when these may relate to the mother's health. The duty to procreate can also be seen as a factor in attitudes toward cloning where reproduction is otherwise impossible; some might sanction it, others would not, arguing that it violates God's ordering of the world and the creation of man in His image.
(4) Sanctity of the marriage bond. This precludes the generation of human life outside Marriage, including by donor insemination or fertilization. Pre-marital and extramarital liaisons are also strictly proscribed in order to secure the uniqueness and stability of the marital relationship (see Sex).
To the same category belong the laws on sexual morality in general, including the prohibitions of Incest (by consanguinity and affinity), active homosexuality, and conjugal relations for about 12 days covering the menstrual period.
All these laws have some medical ramifications---for example, the need for certainty in establishing a person's paternity as well as maternity through accurate records of biological origins, particularly in cases of Adoption, artificial insemination, and in vitro fertilization (the latter two being restricted to husband and wife only).
(5) The duty to alleviate pain and suffering. Jewish law provides many exemptions from religious observances otherwise mandatory in order to secure relief from physical pain or distress. Conversely, the infliction of pain or injury, even on oneself, is an offense. A person does not own his body, but is merely its custodian, charged to preserve it from all harm. Accordingly, purely cosmetic operations would be sanctioned only if intended to promote some legitimate ends or superior value, such as marriage or employment prospects.
(6) Respect for the dead. This biblical principle, based on the human body's having once borne the incomparable imprint of God's image, governs the Orthodox Jewish insistence on speedy Burial, opposition to Cremation, and restriction of autopsies to cases in which the findings might help to save the life of a living person---by tracing a hereditary cause of death which may affect other family members, for example, or by establishing the effect of new drugs or treatments given to other patients as well. Since the saving of life invariably overrides other religious precepts (see Pikku'Aḥ Nefesh), there is also no objection to using cadaver organs for transplant purposes (including corneal transplants to preserve or restore sight, since blindness is deemed a potential life hazard), provided that the postmortem operation is limited to a minimum and all unused parts of the dead are eventually interred.
Gray Areas and Some Summary Conclusions
The inception of life. The infinite value of human life sets in only from the moment of birth. All authorities are thus agreed that the mother's life enjoys priority over that of her unborn child if it threatens her, as they are also agreed on the inadmissibility of any but medical considerations. However, where the threat is to the mother's health rather than her life, or where the child is suspected or known to suffer from some grave abnormality, rabbinic opinions continue to differ on terminating the pregnancy. This argument would, of course, also extend to amniocentesis with a view to an abortion if a genetic defect is discovered (see also "Trends" above).
Also still moot, however, is the establishment of maternity in cases of surrogate motherhood; some authorities would favor the genetic mother (the ovum or egg donor), although most would regard the host who carried the child for nine months---and gave birth to it---as the legal mother. This problem carries over into cloning as well, in cases where a woman other than the gestational mother might be the clonor. Which of the two is the "real" or halakhically legal mother is a moot question. In the case of a male clonor, "fatherhood" seems more clearly indicated. But it may also be asked who the clonee's real brothers and sisters are, or aunts and uncles, and so on. Few responsa have so far appeared about experiments on embryos, but it would be necessary to limit embryonic substances for such use to "spares" only, and breeding them for experimental purposes would be excluded. The entire question of genetic engineering becomes more urgent as more and more sophisticated techniques are elaborated, such as the creation of embryonic stem cells that could be differentiated into healthy replacement cells for the treatment of an entire range of maladies. While it is clear that procedures that alleviate suffering and prolong life are sanctioned and that gene manipulation or surgery at the level of the sperm, ovum or even the fertilized zygote might not be considered as tampering with existing life, the danger certainly exists that human beings will be assessed "by their potential value as tool parts, sperm donors, or living incubators," as one rabbi has put it.
The terminal stage of life. Patients should be advised that they suffer from a terminal condition only if such knowledge is not likely to aggravate their condition. It is never permitted to purchase relief from suffering at the cost of life itself, by deliberately hastening death. Several authorities are inclined to sanction the suspension of "heroic methods" to sustain a lingering life, provided no direct action is taken to this end (e.g., by "pulling the plug") through not applying or reapplying resuscitation machinery or other artificial means to prolong the dying process. The onus of decision-making in such cases, or in the choice of alternative lifesaving procedures (e.g., cancer treatment by surgery, chemotherapy, or radiation), rests on expert medical practitioners---where applicable, in consultation with competent rabbinical opinion---and not on the patient or his family. In contrast, Israel's Supreme Court has upheld the right of a terminal patient to discontinue life support under certain circumstances (extreme suffering, etc.).
Miscellaneous
Nevertheless, there is no objection to medical experiments on animals, provided every effort is made to reduce all pain to a minimum. In principle, the promotion of human health is expressly excluded from the biblical commandment to protect animals from suffering (tsa'ar ba'alé ḥayyim).
Alternative medicine and irrational cures, including faith healing, are generally frowned upon. However, even practices normally forbidden as superstitious may be permitted for patients who believe in them, so as not to disturb their peace of mind, provided that rational cures are not thereby avoided when necessary.
In various areas, Reform Judaism takes a more lenient position than some of the above-mentioned Orthodox attitudes, based on the halakhah.
