Law, medicine, and the right to decide
Symposium looks at pressing medical ethical issues through Jewish lens
Eleven years ago, in his quest to expose Jewish people to traditional Jewish values, a Chabad rabbi, Shalom Lubin, came up with a novel idea. He would organize a symposium geared for attorneys “to expose the legal community to the values of the Talmud.”
Fifty people showed up at the first Jewish Law Symposium in 2007, and since then the event has grown to fill a Birchwood Manor ballroom with 900 attendees. The 10th Annual Jewish Law Symposium, held on September 26, addressed bioethical quandaries related to the question of who makes the difficult decisions in medical practice. Attorneys, physicians, judges, and other professionals from dozens of prominent law firms, corporations, and medical centers attended the symposium to learn about “Law, Medicine and the Right to Decide.”
Sally Glick, a partner in the CPA firm Sobel & Co, credited the success of the event to “Rabbi Lubin’s personal magnetism. He has the ability to draw 900 attorneys, CPAs, and speakers to hear about the interaction between Jewish law and laws that govern our society,” she said. Ms. Glick, who lives in Livingston and is former president of Temple Beth Am in Parsippany, said that Rabbi Lubin’s talent is “showcasing the basis of our law. He seamlessly integrates Jewish tradition with the secular world.”
“The symposium is a fabulous opportunity for networking, and every year it gets bigger,” Ms. Glick said. Sobel & Co. has been a sponsor from the very first symposium in 2007, and now there are many secular Jews and non-Jewish professionals who attend the event, she added.
The featured presenter, Barry Ostrowsky, president and CEO of RWJ-Barnabus Health, launched the program. “It starts at the very beginning: Who is going to make the decision?” he asked. Mr. Ostrowsky said that when a premature baby is born at 25 weeks, the parents make the decisions. “In later years, finding the decision-maker is not as simple as you would have thought.” Even if a patient has a living will there can be complications. First, since “not all clinicians may agree with each other,” decision makers may be getting mixed signals about the patient’s prognosis. In addition, because medical fields change rapidly, living wills may not cover every situation. “You might be surprised how those documents leave gaps,” he said, recommending that living wills be updated on a regular basis.
Mr. Ostrowsky runs RWJ-Barnabus Health, a massive healthcare center that treats more than 3 million patients in four New Jersey counties annually. He reported that the government and employers are paying less than they used to for healthcare, and “if employers stop paying… and the government won’t pay, we will have to ration” medical services — and that will have a profound effect on decision-making in medicine. As it is, Mr. Ostrowsky reported, “New Jersey is the worst jurisdiction in the U.S. for end-of-life counseling and end-of-life palliative care. We underserve those who face end of life challenges in a significant way.”
Mr. Ostrowsky said that in a world where “the financial structure of healthcare is unsustainable, we need to be able to convince people to make choices that will keep them healthier.
“Some level of authority will have to say, ‘if you’re going to make bad health decisions you won’t get resources,’” he continued. By targeting such medical issues as obesity, which can lead to cardiac problems, diabetes, and cancer, we can keep people healthier, he said. Pediatric asthma could be reduced if the home environment would be modified to remove sources of allergens. And we can reduce healthcare costs for seniors if we make their homes safer, lowering the risks of falls and other accidents.
Rabbi Lubin moderated the panel discussion, first introducing the case of “an elderly father, who was starting to slip mentally” and had instructed his doctor not to discuss his medical condition with his children. “Who determines if the patient is competent?” asked Rabbi Lubin of the panelists.
“It’s up to the doctor to determine if the patient is competent,” said panelist Professor Sharona Hoffman, director of the Law-Medicine Center at Case Western Reserve University. “Hopefully there’s a durable power of attorney naming a decision maker,” she said, and by no means should it name all of the children as decision-makers. There should be one person designated, along with an alternate.
Panelist Dr. Kenneth Prager of Englewood, chairman of the Medical Ethics Committee at Columbia University Medical Center, recommended interviewing the patient to discover if “there’s some semblance of rationality. It can be very nuanced, and doctors may not agree.” He said it is more typical that the children will ask the doctor not to tell their parent what’s going on, to protect him or her. “But if it was clear to me that the patient wants to know, then I would tell him. In some cultures the norm is not to share bad news.”
Another discussion involved a patient with HIV who has not informed his partner. “The Talmud considers harming someone to be a sin,” said panelist Rabbi Michael Broyde, a legal scholar at Emory University School of Law. “Jewish tradition mandates that people do everything they can to prevent the partner from getting a lethal disease, not to stand by while someone is in danger of being harmed, even when the law of the jurisdiction requires it. If there is a choice between losing a license and being responsible for someone being harmed, then take a stand.”
“There are ethical dilemmas from cradle to grave,” Rabbi Lubin said, citing a case of deaf parents who wanted to use reproductive technology to ensure that they had a deaf child.
“These are true medical dilemmas,” Dr. Prager said. “There are no laws that govern this. With regard to reproductive technologies, on one hand “there are those who feel that parents have complete autonomy,” but on the other hand, “there are those who consider the rights of the child,” he added. “It is the Wild West of medicine — people can do pretty much what they want.”
“We always choose ethically challenging topics,” Rabbi Lubin said. “This is the first year with a medical theme.” He noted that these cases are not issues that every attorney deals with on a regular basis, but any could face these types of dilemmas at various points in life.
Mimi and Alvin Lakind of Wayne attended the event. “I’ve been going for years,” Mimi Lakind said. She works in the New Jersey Office of Attorney Ethics, where she investigates attorney compliance with ethical guidelines. She also teaches seminars on how attorneys “are supposed to take care of the money, and what they are allowed to do.” She said that CLE credits have become compulsory in the last few years, and many attorneys find the Jewish Law Symposium to be a good way to fulfill the requirements.
Dr. Israel Wahrman, a psychologist and attorney serving as administrative law judge for special education cases in New York State, said, “This was a wonderful way to fulfill the CLE requirement for ethics credits by addressing perspectives on how to face real life ethical difficulties.” He added, “Judaism as well as American law and legal ethics have much to say in this regard, and it is both useful and interesting hearing discussion of different perspectives side by side.
“And as a bonus, we got to eat excellent kosher food at this enjoyable event.”
The Jewish Law Symposium is a project of Chabad of SE Morris County in Madison. For more information go to www.chabadcares.com or call (973) 377-0707.
Dr. Miryam Z. Wahrman of Teaneck, the Jewish Standard’s science correspondent, is a professor of biology at William Paterson University where she has developed and taught courses in bioethics. Her recent book, “The Hand Book: Surviving in a Germ-Filled World” addresses how to stay healthy, and provides handy tips to reduce the risk of infectious disease. She is also the author of “Brave New Judaism: When Science and Scripture Collide,” which addresses cutting edge issues of biomedical ethics and Jewish law.
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