How Judaism differs in life-death issues

The boy was 17 years old and he urgently needed an operation.

As a Jehovah’s Witness, however, he would rather die than receive a blood transfusion, believing it to be a transgression of the biblical prohibition against eating blood. His parents, also pious members of the religious group, agreed with him.

The doctors of the UCLA Medical Center, however, would not agree to perform a blood-free operation. They were not willing to risk losing a patient’s life because of his religious beliefs.

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As a member of the medical center’s ethics committee, Rabbi Elliot Dorff was among those consulted.

Dorff, Conservative Judaism’s leading expert on medical ethics and chairman of the Rabbinical Assembly’s Committee on Jewish Law and Standards (CJLS), says that under halachah, or Jewish law, the case would be open-and-shut.

First, halachah does not consider a blood transfusion to be at all akin to the forbidden act of eating blood. Secondly, even eating blood would be permitted under Jewish law to save a life.

American law, however, presented the UCLA Medical Center with a more complicated picture. An adult has the legal right to refuse medical treatment. The patient, however, was a minor. And parents do not have the right to refuse medical treatment on behalf of their children.

This case was resolved by sending the patient to a hospital, affiliated with Jehovah’s Witnesses, that was able to offer a blood-free operation – and would be willing to let the patient die if necessary.

For Dorff, the case highlights one of the differences between the American and Jewish legal systems – one of three topics he will address this weekend as scholar-in-residence at Teaneck’s Congregation Beth Sholom.

“There are some very different presumptions in the two legal systems that lead to different results,” he says. “American law goes quite far in trying to guarantee patient autonomy. In the Jewish system, it’s your duty to save your life – and anyone else’s for that matter. You can look at the same case from two completely different viewpoints.

Dorff is a familiar figure to the many people in our area who have taken the Jewish Federation of Northern New Jersey-sponsored Florence Melton Adult Mini-School, a two-year program produced by the Hebrew University. Especially in the “Ethics of Jewish Living” course, Dorff’s writings appear and are discussed whenever a lesson focuses on issues of life, death, and health.

Dorff’s appearance here is being sponsored in part by Frieda Hershman Huberman, the local director of the Melton program, in honor of the 30th yahrzeit of her father, Isadore Asher Hershman.

Dorff’s career as a medical ethicist began almost accidentally in 1973. A friend who worked in the UCLA Hillel organized a lunch-time panel on abortion at the medical school, and asked Dorff to provide the Jewish perspective in 10 minutes.

“I had read exactly one article on the Jewish approach to abortion, but said that for 10 minutes, I could absolutely do it.”

Dorff read a lot more in subsequent years – and wrote a great deal, as well. He has served on three federal commissions on medical ethics, and is now on the California state commission on embryonic research.

One of the commissions was part of Hillary Clinton’s unsuccessful efforts to reform United States health care in the 1990s. In 1998, he co-authored a CJLS responsum on health care (available at http://bit.ly/js-dorff), a topic with renewed relevance given the debate over the current health care law.

“A Jewish perspective is much more communitarian than an American perspective,” says Dorff. “An American perspective is much more individualistic. From a community perspective, the community is obligated to ensure that its members receive health care. Nachmanides” – the 13th century halachic authority – “says that this is one of the implications of the commandment to ‘love your neighbor as yourself.’ If you could not afford health care, you would want others to provide for you.”

Dorff also authored a paper for the Rabbinical Assembly on poverty. This will be the topic for one of his talks in Teaneck.

“It’s pretty clear – if you had any kind of Jewish upbringing – that you need to take care of the poor. The letter talks about why you have to do that. What are the concepts and values in the Jewish tradition that underlie that? And then, what are the limits of that?”

Dorff will also be addressing contemporary Jewish medical ethics, examining issues such as cloning, stem-cell research, biologically engineered foods, genetic testing, and genetic engineering in humans. He is co-editing a book, “Jews and Genes,” dealing with some of these issues.

The biggest changes in his work at the hospital ethics committee since he joined in 1984, however, lie not in these clearly high-tech issues, which were totally in the realm of science fiction 30 years ago, but in the changes that have taken place in the mainstays of hospital work, the beginning and end of life.

“In 1984, the methodologies doctors had at their disposal to keep the body alive were less than they have now. The question is more acute, of when do you finally engage in hospice care, when do you understand that this person will not live, and that you try to palliate as much as possible, you try to keep the person comfortable when that person is dying,” he says.

This is a regular issue for the ethics committee, which has to navigate situations where, for example, grown children of an elderly parent cannot reach agreement on treatment.

“The patient is now comatose, and the question is what did the patient want. One child wants this, another wants that. Even if there’s an advance health care directive, there can be a question of how it is interpreted. Every now and then I’ll chime in and say, why are you so concerned about what the patient wanted. When he was alive you didn’t care so much! People around the table laugh and move on.”

New fertility treatments also raise issues.

“Twenty-five years ago, when a child was born prematurely at 27 weeks of pregnancy, the child would just die. Now there are cases where neonatologists are saving preemies who are at 23, 24 weeks, all of whom will have major deficits. Many will be deaf or blind. They will have lung issues. Many will have brain issues. It raises the question of, not can we, but should we?

“Emanuel Kant pointed out that if you can’t do something, you don’t have to ask if you should. If you can do something, you have to ask if you should, because there are all kinds of things you can do that you should not do.”