September 30, 1999
The family gathers at the bedside. Sons, daughters and grandchildren ask each other, "What should we do for zedeh?" "Since his stroke he doesn't talk any more," laments a daughter. A brother adds, "I don't think he recognizes any of us." "It seems to me that he is suffering. I don't think he would want to live like this," interjects a granddaughter. Should he be transferred to a hospital or receive antibiotics if he develops pneumonia? Should a tube be inserted to feed him? Is it permissible to withhold fluids? Conservative Jews often direct these questions to their physicians rather than to their tradition. Perhaps this is because most sources on Jewish medical ethics in the past emanated from an Orthodox perspective and no comprehensive approach to the subject from a Conservative viewpoint was readily available.
Rabbi Elliot Dorff has filled this void with his new book, "Matters of Life and Death: A Jewish Approach to Modern Medical Ethics" (Jewish Publication Society, $34.95). This work melds original Jewish sources with clinical context, employing a Conservative legal interpretation that is balanced and compassionate. As Dorff states at the outset: "This book assumes that moral issues can be profitably treated by using Jewish law, but only if the law is applied intelligently -- that is, with attention to the difference between principles and policies, the nuances of specific cases, the historical development in the meaning of legal texts and the impact of the reader in discerning their meaning and applicability -- as well as with constant and full recognition of Judaism's moral and religious purposes." The reader may delve more deeply into the theory and method of this reasoning in the volume's appendix, a wonderful journey into how the essence of Conservative jurisprudence lends itself to the pursuit of morality -- and a rather compelling essay on why Jewish law should direct our daily lives. But an in-depth understanding of the methods is not necessary for untangling vexing clinical ethics issues by application of Conservative Jewish law.
The book tackles the most difficult issues facing today's American Conservative Jew, ranging from infertility treatments and genetic testing to organ donation and euthanasia. Each topic is approached from a clinical perspective, recognizing that the precise clinical aspects of the case must be understood before morally relevant considerations can be applied. For example, in the case presented at the outset: What precisely was this elderly man's neurological status? Had he discussed his wishes for life if he could not interact (or even recognize) loved ones? Had he completed an advance directive specifying who should make medical decisions for him when he could not? Was the family in agreement concerning whether he was suffering? These are the details that frame the cases that require the input from a reasoned interpretation of the Jewish sources.
The reader seeking advice concerning a particular clinical conundrum likely will find that issue directly addressed, while the explorer of Jewish medical ethics will learn the breadth and depth of the dilemmas patients and clinicians face. For instance, in the area of infertility treatments, Dorff confronts artificial insemination, ovulation induction, in vitro fertilization, selective abortion, surrogate motherhood and the costs of these procedures. Original sources along with well-recognized interpretations are presented. Then a detailed Conservative Jewish analysis of each particular issue guides the reader toward an understanding that should facilitate decision making and action.
Dorff's analyses advance the approach to tough cases from a Jewish perspective. An example is his consideration of withdrawal of nutrition and hydration from a terminally ill patient. The discussion springs beyond the restrictive Orthodox perspective to provide insights that can guide the Conservative Jew in making decisions that are firmly founded in Jewish law. Other analyses, such as the exploration of homosexuality, present a minority view among Conservative Jewish scholars. It is provocative in its richness, logic and compassion, though many readers may not find it completely convincing. The beauty of this text is that the reasoning is so clear that the point of disagreement with Dorff's interpretation can be articulated precisely.
Dorff, who is the provost of the University of Judaism, holds a doctorate in ethical theory and is vice-chair of the Conservative Movement's Committee on Jewish Law and Standards. His deep sense of the importance of medical ethics issues to individuals permeates this work. His rigorous rendering of Conservative thought presents a compelling sense of how "...Jews should live out their Jewish commitments in these matters." Matters of Life and Death should be a fixture in the library of each Conservative Jewish home. It should lead Conservative Jews to recognize the salience of Jewish thought to critical medical ethical dilemmas.
Dr. Neil Wenger is an associate professor of medicine and a general internist at UCLA. He also chairs the UCLA Medical Center Bioethics Committee.