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Medicine, Health Care and Philosophy
Published in: Medicine, Health Care and Philosophy 1/2021

01-03-2021 | Coronavirus | Scientific Contribution

Committing to endangerment: medical teams in the age of corona in Jewish ethics

Author: Tsuriel Rashi

Published in: Medicine, Health Care and Philosophy | Issue 1/2021

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Abstract

Doctors have been treating infectious diseases for hundreds of years, but the risk they and other medical professionals are exposed to in an epidemic has always been high. At the front line of the present war against COVID-19, medical teams are endangering their lives as they continue to treat patients suffering from the disease. What is the degree of danger that a medical team must accept in the face of a pandemic? What are the theoretical justifications for these risks? This article offers answers to these questions by citing opinions based on Jewish ethical thought that has been formulated down through the ages. According to Jewish ethics, the obligation to assist and care for patients is based on many commandments found in the Bible and on rulings in the Responsa literature. The ethical challenge is created when treating the sick represents a real existential danger to the caregivers and their families. This consideration is relevant for all dangerous infectious diseases and particularly for the coronavirus that has struck around the world and for which there is as yet no cure. Many rabbis over the years have offered the religious justifications for healing in a general sense and especially in cases of infectious diseases as they have a bearing on professional and communal obligations. They have compared the ethical expectations of doctors to those of soldiers but have not sanctioned taking risks where there is insufficient protection or where there is a danger to the families of the medical professionals.
Footnotes
1
A constantly updated list of doctors who have died can be found on: https://​portale.​fnomceo.​it/​elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/​.
 
2
Some medical associations have dealt with this only in the wake of the COVID-19 outbreak, but some addressed the issue several years ago during other epidemics. One of the associations that has updated its guidelines, for example, is the AMA. The American Medical Association (AMA) Code of Medical Ethics offered foundational guidance for health care professionals and institutions responding to the COVID-19 pandemic in Opinion 8.3, “Physicians’ Responsibilities in Disaster Response and Preparedness.” For further discussion, see: https://​www.​ama-assn.​org/​delivering-care/​ethics/​physicians-responsibilities​-disaster-response-preparedness.
On the other hand, the Israel Medical Association (IMA) addressed the question in 2008 as to whether there is a limit to the medical commitment in a pandemic following the SARS outbreak, and the main points were put into the IMA’s Code of Ethics. For further discussion, see: The Ethics Board: Rules and Position Papers, p. 50. Retrieved from: https://​www.​ima.​org.​il/​userfiles/​image/​EthicalCode2018.​pdf.
In a position paper published in 2008 the IMA dealt with question: Is there a limit to the medical obligation in pandemic situations? The Ethics Board: Rules and Position Papers, pp. 144–145. Retrieved from: https://​www.​ima.​org.​il/​userfiles/​image/​EthicalCode2018.​pdf.
 
3
This is not the only source that religiously justifies the duty to beware of unnecessary danger and not to harm others. For more on this subject, see Rashi (2020).
 
4
For more information, see: Neusner (2006) and Neusner and Avery-Peck (2005).
 
5
For further discussion of the constant obligation of a doctor to help others and to heal them, see Blaives (1999).
 
6
Practically, Jewish ethics follows the prevailing standards in the secular world. Especially when it comes to medicine and other areas of daily life, Halakha recognizes accepted professional and administrative standards as well as the norms adopted by civilized societies. Called “the way of the world” in Halakha, these criteria can include certain laws, regulations, and/or social norms (Barilan 2019, p. 6). Barilan showed that it is part of the religious rulings in several different cases, such as: What is the proper moral behavior in relation to kidnappers who demand excessive ransom for the hostages (Brailan 2019, p. 107)? What are the criteria for a doctor's professionalism and what are the moral expectations from him (Brailan 2019, p. 125)? And a further issue: What is the position regarding the sale of organs (Brailan 2019, p. 159)?
A most interesting contemporary issue concerned the fact that many women whose medical condition requires the use of contraception prefer the self-risk because of their desire for children. In light of the halakhic tendency to agree with “the way of the world,” Rabbi Shlomo Zalman Auerbach (1999, Chapter 82, Sect. 12) did not examine the reasons for these women's willingness to endanger themselves for the sake of having children and did not ask whether it is morally acceptable. This was a landmark ruling as Rabbi Shlomo Zalman Auerbach (1910–1995), the head of the Kol Torah Yeshiva in Jerusalem, was considered one of the most important of the twentieth-century Orthodox rabbis. An acknowledged halakhic authority on technological and medical issues, he wrote extensively on these subjects. Among his major initiatives were scientific studies to establish halakhic principles to determine the moment of death according to Judaism.
Rabbi Auerbach’s ruling is a telling example of the problematic aspect of the openness of Halakhah to professional and social standards. Rabbis generally prefer not to criticize a problematic practice and sometimes even rely on this practice to support an even more problematic custom. They do not try to critically examine the “way of the world”—public conduct and the biomedical establishment—but rather rely on common practices even if these have been subjects of considerable public and academic criticism, and they even relate to these problematic practices to render creative and bold halakhic extrapolations (Barilan 2019, p. 188).
 
7
For the text of Friedrich Wilhelm III’s letter published in the press, see Blum (1938). Rabbi Eger’s perspective regarding his actions to prevent the spread of cholera and his instructions to the Jewish public at that time, including detailed descriptions of the epidemic and actions for public hygiene can be found in Letters of Rabbi Akiva Eger, letters 146–148.
 
8
The source of this saying is in the Babylonian Talmud (Treatise Bava Metsia 62B), which discusses the hypothetical case of two on a journey, and one of them has a canteen of water. If they both drink, they will both die, and if one of them drinks, he will survive and reach a town. Two of the Talmudic sages of the first century CE disagreed among themselves: Ben Petora ruled it was better if both drank and then died, that one should not see the death of his friend. Rabbi Akiva disagreed and said “that they may continue to live among you”: Your life takes precedence over the life of your fellow. Clearly, from the rulings of the overwhelming majority of legal arbiters across the ages, Jewish law follows Akiva.
 
9
However, the verse in its biblical sense does not deal with protecting a person’s physical health. Having said which, over the years, various rabbis and foremost among them the Rambam have regarded the verse as a call to protect people’s health.
 
Literature
The Schottenstein Edition Talmud Bavli (1990–2012). New York: Artscroll.
Auerbach, Shlomo Zalman. 1999. Responsa Minchat Shlomo 2. Jerusalem: Otzrot Shlomo Institute.
Barilan, Yechiel Michael. 2019. Jewish Bioethics: History, Halakhah and Israeli Law. Jerusalem: Magnes Press.
Blum, Saul. 1938. Rabbi Akiva Eger’s Life: His Life and His Actions. Warsaw: Blum (in Hebrew).
David Ben Zimra Responsa. n.d. Venice: Meir De Zara Press (in Hebrew).
Eger, Akiva. 1994. Letters of Rabbi Akiva Eger. Jerusalem: Da’at Sofer Institute (in Hebrew).
Eger, Akiva. 1969. Commentaries on the Tractate Nedarim. Jerusalem: Igud Bnei Hayeshivot (in Hebrew).
Maimonides, Moses. 1954. The Code of Maimonides (Mishneh Torah). Trans. Herbert Danby. New Haven: Yale University Press.
Neusner, Jacob, and Alan J. Avery-Peck. 2005. Altruism in Classical Judaism. In Altruism in World Religion, ed. Jacob Neusner and Bruce Chilton, 31–52. Washington, DC: Georgetown University Press.
Waldenberg, Eliezer. 1984. Tzitz Eliezer. Jerusalem: Waldenberg (in Hebrew).
Wosner, Shmuel HaLevi. 2002. Shevet Ha-Levi. Bnei Brak: Wosner (in Hebrew).
Weiss, Asher. 2012. Minchat Asher. Jerusalem: Minchat Asher Institute (in Hebrew).
Weiss, Asher. 2020. Minchat Asher: Collection of Lessons and Responses, Letters and Articles Related to the Corona Epidemic. Jerusalem: Minchat Asher (in Hebrew).
Yosef, Ovadia. 1994. Yechaveh Da’at. Bnei Brak: El Hamayan (in Hebrew).
Zilberstein, Isaac. 1994. How Much Does One Have to Risk Himself to Save Others. Assia 7: 3–9 (in Hebrew).
Metadata
Title
Committing to endangerment: medical teams in the age of corona in Jewish ethics
Author
Tsuriel Rashi
Publication date
01-03-2021
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 1/2021
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-020-09983-y

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