Science qnd Ethics A Joint Perspective
Spring 2OO7 Vol I ll e2
Slern College for Women
Yeshivo University
q/( SCIENCE AND ETHICS A JOINT PERSPECTIVE
Editor in Chief: Miriam Ausubel
Associate Editor: Ariella Cohen
Editorial Assistant: Lcah Fried
Faculty Advisor: Rabbi Dr. Richard Weiss Science & Ethics: A Joint Perspective
TABLE OF CONTENTS
Three Responses to the Bodies' Exhibit...... 3 Rebecca Marmor AnimalExperimentation...... ll Ariella Cohen
Surrogate Motherhood ...... 38 Reena Gottesman
Ilelief and Medicine...... 50 Dalia Barenboim
How OId is Too Old, 66 Golda Stromer lluthanasia...... 75 Claudia Amzallag
Negligent Behavior and the Right to Medical Treatment...... 83 Rabbi Richard Weiss. M.D. Science & Ethics: A Joinl Perspective
Three Responses to the Bodies Exhibit Rebecca Marmor
Exhibitions such as "Bodies" in Manhattan and "llody World" in Lost Angeles provide what was once an runthinkable opportunity for the public: the chance to peer irrto actual human bodies which have been dissected to tlisplay organs, bones and other intemal structures of irttcrcst. For the price ofa movie and popcorn, any child or rrdrrlt can enter an exhibition hall and gaze at a number of hodics (structures from over two hundred bodies are often shown) which have been carefully posed and dissected to rcvcal brains, hearts, blood vessels, fetuses in utero, and various pathological stages of disease. Although the ctlucational power of such exhibits is undeniable (to understand why, one need only to see the faces of smokers standing close enough to touch a pair of preserved lungs liom a person who suffered from emphysema) the ethical issucs brought up by the exhibits are both pressing and cause for concem. With the rising popularity and acceptance of these exhibits across the world, the time has come to pause and reflect for a moment on the ethics of displaying the bodies of deceased humans, en masse. This
3 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective paper will briefly discuss the science behind the exhibits. llirgcns developed a preservation technique. His technique, Next, it will consider the Jewish ethical approach to the known as plastination, halts decomposition by depriving exhibitions. Finally, it will consider how Socrates, an early hirctcria of a hospitable environment to colonize, Greek philosopher might have reacted upon leaming of the gr[olif'erate, and metabolize. By replacing the water and fat exhibits. irr thc body with a synthetic polymer, von Hagens was able From the moment of death, the body begins the lo stop the body from decomposing, while simultaneously process of decomposition, which has two primary causes. grlcscrving its shape and structure.r Plastination differs One cause is that upon death, indigenous bacteria, which liorn other methods of preservation because it allows inhabited parts of the body such as the intestine while it lrssuos to maintain their natural shape and size. The was alive, are given free reign to consume the body. The leclrnique also allows for the display of specimens in the intestinal bacteria first begin to consume the intestine and o;tcrr air; as opposed to the murky bottles of formaldehyde then spread to other pafts of the body whiqh it can then go trrrrrry biology students have encountered. on to decompose. Decomposition can also be attributed to Now that we have leamed a bit about the science the enzymes found in the body. On a macroscopic scale, hchirrd the exhibits, we might have a greater appreciation of digestive enzymes contained in the intestine eventually lltc lirct that the bodies which are displayed are quite real. spread throughout the body. On a microscopic scale, 'l'ltcrc arc a plethora of ethical issues that arise from the enzymes contained within individual cells are released oxllihils. Can a person will her body for the purpose of upon cell death and break down the cell and its connections noril rnortcm exhibition? Should actual bodies of the with other cells and therefore also contribute to the lscd be displayed for the public? Is it permissible to decomposition of the body. lrry bodies of those who have not consented (e.g.,
To stop the decomposition process and preserve the sorcls)'/ And finally, is it ethical to display bodies fbr a bodies for public viewing, in the 1970s, Dr. Gunther von l'l 'l'his paper will only examine the question of
4 5 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective
whether or not it is ethical to display the bodies of the I )cutl in Jcwish Law," Rabbi Jakobovitz remarks, in regards deceased for public consumption. However, in order to lu llrr: afbrementioned episodes, that "it is noteworthy that answer this question, it will be necessary to consider a few nrr voicc ofprotest was raised against these practices, a fact of the other questions which are raised. It is imperative to lll thc more remarkable since Jewish law in general note that this paper will not tackle the issue of whether or riporously upholds the inviolability of the human body in not it is ethical to display the bodies of those who have not tlcuttr as in life".2 In fact, it seems that Jewish law was consented. For the purposes of this paper, it should be lclirlivcly tolerant towards dissection of human bodies up assumed that we are only discussing exhibitions which rrrrlil thc eighteenth century. There is much evidence to display the bodies of individuals who have specifically nrrgg,cst that dissections were permitted for legal autopsies. willed their bodies for such a purpose. I f us attitude shifted in 1737, when a Jewish medical We continue with an examination of the how Jewish rtlt(lcnt wrote to Rabbi Jacob Emden to determine if he Law peroeives the exhibits. In order to understand the eorrltl participate on Shabbat in the dissection of dogs used Jewish perspective, it is necessary to consider how Jewish in lhc absence of human cadavers.3 Rabbi Emden's Law has ruled on the question of autopsies. We begin with rcsponse was twofold. First, he noted that participation on the Babylonian Talmud, Niddah 30b, which relates how thc Sabbath was prohibited and secondly, he explained that
Queen Cleopatra had the bodies of her pregnant female it was forbidden to derive benefit from a body, regardless slaves cut open for anatomical study to reveal the stages of ol wlrether the person was a Jew or not. It should be noted fetal development. In another episode, the Talmud, lhal although the student only asked in regards to dissecting Bekhorot 45a, describes how several disciples of Rabbi tlogs, Rabbi Emden used his question as a platform to voice Yishmael boiled the body of a prostitute, who had been thc opinion that dissection of humans is forbidden. This sentenced to death, to determine the precise number of lcsponsum marks the beginning of a decidedly anti- bones in a human. In his article on the "Dissection of the tlisscction attitude which permcated halakhic Judaism until
6 7 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective
present times. The only exception to this ruling which clctr violation of the halakhic mandate to bury the dead as
prohibits autopsies, regardless of the religion practiced by quickly as possible.a the deceased, is when autopsying a body might provide Next, we ask whether or not one can visit vital clues for the treatment of already existing patients, and oxhibitions of plastinated bodies. This question is a thus potentially could save lives. This ruling is yet another nllulil'cstation of the same tension which pervaded our manifestation ofthe general attitude in Judaism that saving lnvcstigation of autopsy. It is a tension between the desire life comes before all else. Attitudes conoeming both Iu lcarn, so that we might save lives, and the need to treat dissection and autopsy have shifted over the millennia and llrc body with utmost respect, bury it quickly, and not gain indicate that there is a range of acceptability and lrry bcnefit from it (as the halakha demands). In the case of pemissibility of the practice. cxhibits, various exit polls of visitors have demonstrated Equipped with both an understanding of the thc strong impressions the exhibits have made on the preservation technique which enables bodies to be placed visitors.5 Displays of lungs blackened with tar, blood on public display for extended periods of time and a basic vcsscls crippled with plaque and skin lesions caused by understanding of range of opinions Jewish commentators ovcrcxposure to the sun, are alatming and can potentially have held conceming autopsy, we are now able to delve prrvide inspiration for visitors to take better care of their into the questions raised by such exhibits. We begin by hotlics and possibly take measures which might save their questioning the preservation technique, plastination. livcs. Halakha, which has rejected all forms of embalming, However, this desire to save the lives of those who cremation and other unnatural means of interment, surely visit must be checked by other halakhic demands. In his forbids a Jew to speciflz that his body should be preserved rcsponsum from 173'1, Rabbi Jacob Emden clearly in such a manner. Also, it should be noted that the process cxplained that it is forbidden to derive any benefit from of plastination for an entire body can take weeks. This is a corpses, regardless of their religion.3 The benefrts granted
8 9 Science & Ethics: A Joint Perspective Science & Ethics: A Joinl Perspective by the exhibitions are of two types; the benefit for those Irrrrrsclf'as part ofthe grand tradition of anatomists, such as 'l who put on the exhibit and the benefit for those who attend l)r ulp, who was famously depicted by Rembrandt as them. Those who stage the exhibit are clearly benefiting wt'uring a hat while teaching an anatomy lesson to a cadre economically from displaying the bodies of the deceased. rrl students during the Renaissance.6 Finally, Dr. von Their profits are based solely on the corpses, because that is lllgcns has allowed his exhibits to be used for entirely what draws people to the exhibits. Besides for the potential rrrrorthodox purposes. For example, the website of his health benefits, as explained above, for those who attend ronlptny proclaims that part of a recent James Bond film the exhibits (which would, perhaps, make the exhibit trrkcs place in the Miami Body Worlds exhibit.T Dr. von permissible), there is another, much more disturbing benefit lllgcns began his life as an academic, but has since to be gained from them. Just as a family might eagerly rlcviated from that path. He understands the potential for anticipate its Sunday afternoon outing to an art gallery or his oxhibits to generate income, and is enjoying their movie, a family might anticipate its trip to see the display srrlging popularity in mainstream culture. His actions of human bodies. People who attend the exhibits surely do rrrtlicate that perhaps the primary purpose of the exhibits is so at least parlially in hopes ofbeing entertained, and thus to gcnerate dubious benefits a financial profit for himself
derive a forbidden benefit from them. rurrtl cntertainment for the public. The educational ability of Perhaps we can best ascertain the purpose of the thc cxhibits apparently has taken a backseat to these other exhibits from Dr. von Hagens, himseli Known in bcrrcfits. scientific circles as a flamboyant personality, who wears a If the primary purpose of the exhibits is to entertain fedora hat even into the operating theatre, Dr. von Hagens visitors and generate profit for a company, it seems rather left his post teaching anatomy at a German medical school, clcar that the halakha would forbid a Jew to attend them. lt to found and run the company which organizes the Body sr;oms that members of the Catholic clergy have come to Worlds exhibits. His hat is a nod to the fact that he sees thc same conclusion about the exhibitions. While Catholics
l0 1l Science & Ethics: A Joint Perspective .\t ittn'a & Ethics: A Joint Perspective also acknowledge the potential for the exhibits to educate I rrrrtl consider how secular ethicists might justify visitors, they, too worry that "by objectifying the rirrlr;xrll of the exhibits. In the Phaedo, Plato relays unidentified corpses, the exhibit might lead to a lack of t's' Lrndcrstanding of the mind-body connection. respect for the human body or the human person."' While rvus thc first dualist, who viewed the soul and the protests against the exhibits have been rather subdued in xrtirl sclf as two entirely separate entities. Unlike the United States, they were much more dramatic in lprorrs philosophcrs, who saw the body itself as Europe, where Catholic clergy attempted to block the tlrirrg holy (albeit less important than the soul), exhibit opening in Germany.l0 Because the Judeo- rrrtcs did not see the body as anything more than a 'l-his Christian tradition places such emphasis on the notion that scl. is a belief that he died by; when sentenced to humans are created with divine help, it is difficult to tlr hy the state and given the opportunity to go into exile imagine that either religion would be comfortable with the ntcl(|, Socrates refused, insisting that his body was, for exhibits. However, it should be noted that whereas lht rnost part irrelevant. This might be the earliest Judaism might object to plastination on the grounds that it lirrnulation of this type of thinking, which is so common is an "unnatural" treatment of bodies, Catholics might not lurongst secular humanists today. It is this line ofthinking, harbor this reservation. Catholicism has a long-standing pcrhaps, which emboldens people to donate their bodies to tradition of preserving various body parts of saints for he prcserved and displayed. For people who see their postcrity. While Judaism could object against the very act physical selves as having significantly less value than their of plasting a body, the primary objection for Catholics rrrirrds, the opportunity to give their bodies as a "gift" for about the exhibits is that displaying real bodies for the othcrs to leam from might be tantalizing, especially if they masses is simply inappropriate. russume their bodies will have no further use once they've
Because we have considered two arguments against tlicd. the Bodies exhibit, it is necessary to shift focus for a
t2 13 Science & Ethics: A Joint Perspective ,\t irnt'e & Ethics: A Joint Perspective
Those who support the exhibitions usually offer or tunrly. While Jews and Catholics acknowledge the three primary reasons for their support. Most compellingly, rrtrirl lirr cducation at the exhibits, they are concerned they cite the studies which have demonstrated that the rrt tlrt're is too much oi a spectacle being made of the exhibits are moving and inspiring for visitors, encouraging lrlrlr,:, rvlrich ultimately disrespects and cheapens them. them to take better care of body, etc. They would argue Acknowledgments: that providing this inspiration is paramount. Next, there is 'lhc author acknowledges Rabbi Yehudah Sama, a spirit of egalitarianism that pervades the exhibits. [rrrrirltcl of religious lil'e at the NYU Bronfman Center, and ll llirrvey Babich, chair of the Stem College Biology Supporters often believe that the intimate knowledge of the I)r'pru trncnt, for their help writing this article. human form should be open to all people, not just medical Works Cited students. The exhibits provide the chance for the lalperson lll llohannon, J. et al. (2003). "Anatomy's Full Monty." to witness the inner workings of the body. Finally, some Sc icnce 301 : ll12-11'75. ,, .t 1.. ( 1958). "Thc Dissection of the Dead supporters cite the possibility of the exhibits to change | 1 ckobowitz, irr .lewish Law." Tradition. l'.11-103. attitudes about the body that Westerners have harbored for I ll lrnrdcn, l. (1737). Responsa. Partl,no. 41. ( I Mourning in Halacha, Mesorah so long. They explain that people are often confused, l.l I i ioldberg, C. 999). l'ublications, Brooklyn, NY. ashamed own bodies, and and self-conscious about their | \ | Wenig, C. (2004). Under the Skin: Is "Body Worlds" Anti Values? Jewish Joumal. that by seeing the exhibits, they will come to appreciate just Jewish http://www jewishjoumal.com/home/preview.php?id- I how miraculous the human body is.6 266ti (retrieved December 4, 2006). Anonymous (2002). Bodies Beautiful. Economist. When considering the ethics of Plasination and the l{r I 362:.54. Bodies exhibitions it seems that there is the fundamental l7l http://www.bodyworlds.com/cn/media.html (rctrieved December 4, 2006). questions about what visitors of the exhibits are provided l{ (2000). Plastic Body I | Roach, M. A New Studcnt Aid: with. Supporters of the exhibits argue that visitors are Parts, Made From thc Real Things. New York Times. 149:F7. provided with a potentially inspiring educational
14 l5 Science & Ethics: A Joint Perspective Stience & Ethics: A Joint Perspective
[9] Dooley, Tara. (2004). Exhibit displays real flesh and Animal Experimentation bones to educate about the body in motion. Houston Chronicle. February 24: l. Ariella Cohen l0] Associated Press. (1998). Corpse Exhibit Prompts I 'I hc topic of animal experimentation is indeed a Controversy in Germany. Chicago Tribune. January 8:12. l('r ltous one. Although the animals used for prrirrrcntation comprise only a tiny percentage of the I nLrmber of animals used for human purposes each r, nlany pcople feel passionate about this particular c. lloth those for and against the use of animals in rrlch laboratories seem to be motivated in their c quests bv mo re than oglc al argumentation al one rrrolions and the propaganda these emotions engender lrry l significant role in this controversy. Thcse strong rrlirlcnts can at times lead to violent acts which in many lrs('s ure detrimcntal to the goals of the perpetrators, rrsng them to losc credibility in thc eyes of the public. lrLry. many regard animal rights activists as lanatical and rolcnt individuals and thereforc dismiss thc issue of lnirnul cxperimentation without giving it much thought is, however, is a mistake. Animal experimentation is a or contemporary ethical issue and understanding the vlcwpoints both for and against its use is therefore very lntportant.
t6 1'7 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective
The utilization of animals for research purposes is a lus. irrc sometimes entitled to inflict pain upon animals practice that has been in existence since the time of the ortlcr to obtain benefits from them. However. animal Roman Empire. Historically, experimenting on animals lli'ring can only be engendered when a legitimate need was not spoken out against until the 1800's, when scnts itself. An in-depth analysis of each of these thee discussions and debates surrounding this issue became very ir,.ws will be extremely useful in understanding the volatile heated. The ethical dilemma posed by animal l[(l controversial topic of animal experimentation. experimentation in the 1800's was and continues to be Those who speak out against animal whether or not humans have supremacy over animals, and ct;tcrirnentation believe that there is an ethical problem the implications thereof. Currently, the parties embroiled with causing pain to a sentient being. Atthough in the debate over animal research are extremely polarized. Itillorically, Renee Descartes and a few others have denied On one extreme, the animal liberationists contend that ltrinrals' ability to feel pain, today most people accept that humans evolved from animals, and therefore animals are llrnals do experience pain. If the animal nervous system morally equivalent to humans. They strongly decry the use lr sulliciently similar to the human nervous system to of animals for human means such as scientific research and Justily animal expcriments for leaming purposes, then there are sometimes willing to resort to violence to prevent this lr slrong reason to believe that animals too have pain practice. At the opposite extreme are those who equally tcecptors and can feel pain. Following this line of vehemently defend animal experimentation, believing that rcusoning, Renaissance philosophcr Jcrcmy Bentham animals have no moral rights, and using them to serve hclicvcd that animals, by virtue of their ability to feel pain, human purposes is therefore entirely legitimate, and even {Ic (lcscrving of moral deliberation.l praiseworthy. Interestingly, the Bibte and most world Those who seek to attack the practice of animal religions take a more moderate approach. Their position on cxpcrinrentation point to the cruel tests that millions of thc matter is that humans, by virtuc of thcir clcvatcd moral lninrals arc subjcctcd to each year. Animals are frequently
Iu l9 Science & Ethics: A Joint Perspective Stience & Ethics: A Joint Perspective used to determine what dosage of an active ingredient in rr';x'llcdly applying electric shooks to dogs imprisoned drug will be fatal. The LD5O test, which was used from I wrrc cage In another, baby monkeys were rcmoved 1950's to the 1980's, aimed to find the dose of a drug tha r thcir biological mothers and given 'surogate would kill 50 percent of the animal subjects being used llrcrs' made of wire to test the effccts of "maternal incrementally increasing the doses. Subsequent politic livir(ion" on problem-solving skills.l activism against the use of this test drastically reduced its ln tight of these practices, it is not at all difficult to use. Another test, the Draize eye test, is utilized to krslirrrd the vicw of Samuel Johnson cxpressed in the asceftain the likelihood that a particular cosmetic product l(rrr ccntury. Johnson explained that although will cause damage to human eyes. It is canied out by ;x'rrrncnting on animals could produce benefits fbr placing the product on the eye of a conscious, rety. it came at a very steep price. Any gain was in unanesthetized rabbit and obser,,ing whether or not the eye lrty detrimental to society, as individuals who were becomes blistered. The use of this test also decreased after prrgctl in these kinds of cruel cxperiments would become campaigns against it were initiated.' rr['ncd to human suffering as well. This could ultimately Similarly, animals are often subject to cruel tests in rlrll in the degeneration of society.l the military. ln one such test canied out in 1984, monkeys There are also those who argue against the practice were forced to run on a treadmill for hours at a time. If the I lxpcrimenting on animals from a utilitarian perspective monkeys stopped running they were given electric shocks. lltrlrtarianism, a philosophical approach attributed to Afterward, the monkeys were exposed to radiation in order Jclerny Bentham, posits that the pain and pleasure of all to determine how long the sick animals could runl hcirrgs, human or otherwise, must be taken into account Animal models are also used in psychological wlrcrr.judging an action to be ethical or not. According to experiments to study behavioral phenomena. In one llrrs cost-benefit approach, animal cxperimentation is experiment, thc statc of "learned helplessness" was studied rrrrclhical if the harm inflicted on animals outweighs the
20 2t Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective
benefit to humankind. However, those experiments which It(,tli)fllrcd to treat, thus eliminating the need to test out only mildly maltreat animals and result in a high level of nrlgclics on animal subjects.l benefit to humans would be morally correct according to Animal rights activists also contend that animal Bentham. Thus, those opposed to the practice of animal Itrrxlcls can at times be extremely misleading. For research argue that the benefit resulting from animal rrur)rple, the development of the polio vaccine was experiments is rarely significant. Moreover, the likelihood llrwilrtcd for many years because of the misleading results that an individual experiment will be beneficial is very ol rrnimal research.l small. Those who hold this view encourage researchers to On the other side of the spectrum, those who defend
seek altematives, which they believe can be just as Irrirnal research argue that experimenting on animals is effective as experimenting on animals.2 rthrcally correct from a deontological perspective They
Those opposing animal research also claim that the rgrrulc Immanuel Kant, the father of deontology, who scientific advanccs such as the extension of the human cxplained that animals do not have rights and therefore the
lifespan which have been attributed to animal rcsearch have rlilization of animals for human purposes is not an ethical not actually been derived through animal models. Rather. pr',,blem.2 Animals are and have always been regarded as a they posit that humans have begun to live longer because of rcrrcwable resource for food, clothing, sport and other ,] their improved hygiene, nutrition and living conditions. II rposes. They also claim that the money spent on animal research Following this view, Renee Descartes, one of the could be furureled instead to public health programs thal cllliest and most passionate defenders of animal research, would run campaigns to educate the public about proper pcrfbrmed many experiments on live, unanaesthetized dietary habits and living conditions. The dissemination of irnimals in order to better understand their anatomy and health-related knowledge could help prevent the physiology. Descartes (1596-1650) explained that animals development of diseases that surgcrics are routinely wcre "insensitive automata," machines that did not feel any
22 23 Science & Ethics: A ktint Perspective Sr:ience & Ethics: A Joint Perspeclive pain. Descartes did not, therefore, think experimenting ln an attempt to discredit the other side, those who animal subjects and inflicting pain upon them was in ort irrrimal research contend that the hype surrounding way cruel. Other scientists who concurred with Descartes rl rcscarch is entirely blown out of proporlion. They perception of animals posited that the practice ltrr lllat the percentage of animals used for research is a experimenting on animals was in fact a noble and mo l)crccntage of the total number of animals used for activity, as it revealed the intricacies and beauty of God' rors hurran purposes each year. In fact, according to a world. Intcrcstingly, animal research is still being valida I sLrrvey published by the National Academy of for the same two reasons today. It is a "practical good" k'nrcs' Instituto of Medicine, the number of anirnals that it benefits humanity and an "intellectual good" in lirr research in the United States is less than one it increases understanding ofthe Creator and His world.r t'rl ol' the number of animals used ior food related Those who defend animal research also point to ,,rc*.' They iuilher claim that the statistics, which many scientific advances which havc rcsultcd from this rtllc that incredibly large numbers of animals are used practice, such as progress in coronary arlery bypass graft Irrlxrratorics each year, are misleading because many surgery. Animal models have also allowed researchers to nruls used in laboratories do not suffer in any way.l better understand diabetes and hypertension, and develop llowever, even those who suppoft animal modes of combating these conditions. Supporters of lirncntation acknowledge that there are many animal research view experimenting on animals as the best t'irncnts that do inflict a great deal of pain upon way to find cures for devastating disease such as AIDS and Ituirls, and they are therefore trying to reduce the number cancer. They believe that any suffering inflicted upon urrirnals used in experiments each year and diminish the laboratory animals during these studies is balanced out by llr,'ring those animals are forced to endure. Following the the resulting positivc consequences for humans.l c l{'s set out by Russell and Burch in 1959, scientists rllcrnpting to Rcfinc thcir cxpcrimcntal mcthods to
24 25 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective eliminate excess pain, Reduce the number of animals used lhh' ol the contract are not afforded this protection. in experiments, and Replace animal models with Anrrrrlls arc thus excluded from the social contract. altematives whenever possible.a lhrwcvcr, this approach is difficult to maintain because its
However, using animals as a means towards human lltrc ol rcasoning, that those who cannot reciprocate are not ends can be somewhat difficult philosophically. Some Ittoleelcd by the social contract, would exclude babies and scientists point out that animal experiments are not utilized lltosc sLrll'ering lrom mental disorders who cannot control for exclusively human purposes. The research that is lhr,rr hchavior. Such people are unable to adhere to their performed through the use of animals also ser"ves to help llrh'ol lhe contract.I cure many animal diseases. In this light, animal research Others argue that it is not the social contract that can be seen as a means towards both animal and human llhrrvs pcople to disregard the rights ol animals, but the en entitled to the same rights as humans and can be utilized for lhtr sl toment is problernatic as well, as it does not take human purposes.l lltur'lr irnagination to extend this method of reasoning to Another justification for using animals to serue ;ttclt'n ing cver-smaller groups of one's own kind. If human needs is the fact that animals were not included in nlr'l('r'r'ing one's species to another species were justified, the social contract, a communal oath which mandates that p,tlrrrlls prefening one race or sex to another would I each citizen respect the rights and propefty of other citizens llkervisc bc validated. in retum lor their reciprocity. Those unablc to honor their 26 2l Science & Ethics: A Joint Perspective ,\i< itnce & Ethics: A Joint Perspective Scientists who believe in animal research re " Srrrrilarly, the official positions of the Baptist and animal rights activists as a radical and vocal group Irt' elrrrrches are to condone animal research. believes that animals are 'moral agents on par with peop lrsls cncourage scientists to reduce the number of meaning that have equal legal and moral rights. They ln rrscd in experiments and minimize their suffering. feel strong resentment towards animal rights activi nlstr condemn cosmetic lesting as an unnecessary because of the violent measures thcy sometimes resort to, Iton ol'pain upon animals. The position of the Islamic The third view, held by most world religions, orr is a bit more extreme; it holds that animal research to strike a balance between man's right to utilize ani rrttc(l as long as its intent is to benefit humanity and for his own uses and the desire to prevent needl ls irlc not hurt in the process. Research which causes suffering. Although most religions consider animals to ls lo suf'fer is not permitted according to the Islamic an important part of the world, they are deemed significant than human beings, and as such, their deaths ('onversely, some religious groups such as the births are not commemorated. Humans are viewed els do not have an official position on animal superior to animals because of their ability to bring a tt h. Instead, it is up to individual members ol the salvation and relate to God. Despite the fact that h rrrrrrrity to cvaluate the morality of this practice. In were granted "dominion" over animals, kindness to ani tl. the Quaker religion is usually very supportive of remains a strong religious value.6 who ohoose to experiment on animals.6 The Protestant Christian Church of England ho llinduism also does not have an official position on that animal experimentation is justified only if all actions lll cxperimentation. However, the concept of minimize pain are undertaken. lt supports this view with rrrrration is very imporlant to the Hindu belief systern. verse from Mathew 10 w.29-31, "A man is worth rrrirls are therefbre treated with rcvercncc and sparows, but not one sparrow can die unnoticed in God lirlianism is looked upon as a praisewor{ry practice 28 29 Science & Ethics: A Joint Perspeclive Science & Ethics: A Joint Perspectiye Despite this, many Hindus do experiment on animal Moreover, there are also many biblical injunctions because of the human benefits that result from it.6 lrrch cxplicitly prohibit causing animals suffering, such as Similarly, Judaism holds the belief that humans vcrse in Deuteronomy 22:10, "You shall not plow with superior to animals, and animals can thus be utilized ox and a donkey together." This practice is disallowed human ends such as biomedical research. As evidenced irrrsc of the pain the weaker animal would feel in his the Bible, God did grant man dominion over the animals in trrllglc to keep up with the stronger animal. This Genesis I :28, 34: I 3 and 9:2-4, as well as in Psalms 8:6-8. rrrrnrandment is also designed to prevent the suffering of However, the concepts presented in these verses must be llx' slronger animal, whose natural tendencies would be balanced with the idea from the verses in Psalms (1:5-9): lltrstlltcd by being forced to work with a weaker animal. "The Lord is good to all, and his tender mercies are over all litrrrilarly, Jews are also commanded to provide aid to His works." Similarly, Psalms 104 states, "He opens His flrrrruals in distress: "If you shall see a donkey of an hand anrl satisfies the desire of every living being." Central ttrt'rny lying under its burden you shall surely not pass him; to Jewish belief is the idea of emulating God; Jews are thus yorr shall surely unload it with him" (Exodus 23:5).8 strongly encouraged to protect the animal kingdom.T Compassion for the emotional well-being of In a similar vain, many verses in the Torah rttrirnirls is also stressed in the Torah. in the commandments encourage Jews to display compassion towards animals and lhll arc designed to prevent the emotional suffering of an provide for their needs. For example, animals must be Ittrirnal parent for its child. Among them are "Oto V'et given rest on the Sabbath. As the verse in Exodus 20:8-10 lh'tnf' (Leviticus 22:28), and "Shiluah Haken" states, "Remember the Sabbath day, to keep it holy. Six (l )cutcronomy 22:6). There are two main views, days shall you labor, and do all your work; but the seventh rltclrheaded by the Maimonides and Nachamanides, which day is a Sabbath unto the Lord, your God, in it you shall erplain the reasoning underlying these commandmcnts. not do any manner of work...or your cattle."8 Mirirnonides in Moreh Nevuc:him (3:48) explains that these 30 3l Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective mitzvot are designed to prevent animal suffering. Ani The primary source in Jewish law for the are sentient beings, and as such have sensations rlrilrition against cruelty to animals is tzaar baalei emotions. Although animals are decidedly different This prohibition is derived from a verse in human beings, they also have feelings. A mother bird rrrrrhcrs 22:32. In this verse, an angel chastises Balaam, not require intelligence to feel sorrow over the loss of h hy have you smitten your donkey?" Since this hatching chicks. Since animals do have emotions on s rlribition is leamed out from a direct verse in the Torah, level, we are forbidden to cause them to suffer. In contra lrirs the status of a deoraita, a divinely ordained Nachmanides in his commentary on Deuteronomy 22: rlrilrition (Bava Metziah 32b). In addition to this most (Shiluah Hakenl) holds that this commandment is not for plicit reference to the need for the humane treatment of sake of the animals, but rather to teach people compassi irnals, there are also many halakhot that are evidence of and kindness.e lhc value that Judaism confers upon animal life. For The biblical importance of treating animals rrrrnrple, the Orach Chayim (22:6) states that one cannot humanely is additionally shown by the fact that many of the rny the blessing of shehacheyon, the blessing over a new greatest Jewish leaders such as Moses, David and Jacob llcrn, on a new fur or leather garment because of the animal were selected for their positions of power because of the rullcring involved in the process of manufacturing these kindness they showed towards animals. Similarly, Rebecca ftcrrrs.r(' Similarly, the Choshen Mishpat (272:1) explains was chosen to be Isaac's wife by virtue of the fact that she lhtl a person must feed his animals before himself and I showed compassion towards Eliezer's camels by providing e rrrrnot overwork them.l them with water to drink after their long joumey. ln stark The Talmudic story of Rabbi discussed in Bava contrast, biblical personalities who were hunters such as Ith'l:iah 85a also emphasizes the concem and kindness one Nimrod and Eisav are described as heinous individuals.8 rrrust display towards animals. The Talmud explains that l{lbbi was punished with a serious illness for the 32 33 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective callousness he exhibited when he delivered a calf see lirr general understanding purposes or to enhance refuge from the slaughters back to the slaughtcrho lists' knowledge of the universe is more questionable. Rabbi was ultimately healed from his illness because y lrguc that this type of research does fall under the refused to allow his maid to sweep some kittens out of ytorv ol'"other purposes", but some disagree The Imrei home. This story clearly illustrates the value the T 1 sirys wc can judge the rclative significance the I places on showing kindness to animals.r cr prrrposes" must havc to be deemed important enough However, up until now only pointless an vf(flirlc thc laws of tzaar baalei chayim by the one sulfering has been discusscd. Animal suffering for osc which is explicit medicine. The other purposes beneficial purpose is not as clear-cut, as J I bc as bencficial to society as medicine is in order to acknowledges that animals were created to serve ily inflicting pain on animals.r0 purposes. Animals may, in fact, be used for pulposes ln his book, Judaism ond Healing, Rabbi J. David cause them pain, such as plucking a feather from a bird relr concludes that animal experimentation for a a quill. However, there must be a legitimate need to jus rllnatc need is halakhically pelmitted. However, one the infliction of pain. Hunting for sport was prohibited rrltl make a strong effort to ensure that unnecessary pain the rabbis for this reason (Yoreh Deah l17:44).tl rx)l inflicted upon the animal subjects. Similarly, he Animal experimentation can be analyzed in tls that practicing surgical skills on animals is permitted same manner. The Rema on the Shulchan Aruch says wcll, as this practice also leads to great benefit for one is permitted to transgress tzaar boalei chayim lilns. However, Rabbi Bleich explains that an medical or other purposes. Most halachik authorities a pelirnent donc in order to gain general biological that an experiment which can be shown to rrvlcdge that is not directly related to legitimate human l contribute to healing illnesses, and does not ca tl is morc problematic.l avoidable pain to animals is permitted. However, rese 34 35 Science & Elhics: A Joint Perspective Science & Ethics: A Joinl Perspeclive Intriguingly, it is the religious groups, rather tlrrlahase:( Irt I p://www.questia.com/PM.qst? a:o &d-5000207 642>. thc philosophers and secular ethicists, who have reach tf Animal (Research) Rights. (2001, Wnfi). The Wilson more moderate conclusions about animal experimentati ()nurterly, 25, 112. 1l Jan. 2007. from Questia rLrlrbase: The majority of world religions seem to take into accoun ' http://www.questia.com/PM.qst?a:o&d:5000085444 both viewpoints and reach an effective compromise "lrllR- Education about Animal Research." 10 Jan. between the two. Perhaps it is the dual emphasis on the l(rl t(x)6. competing values of human superiority and the importance ' lrttp://www.fbresearch.org/education/religions.htm>. 7 "Kindness to Animals". Ed. of compassion that enables the more religious groups to I I Cantor, Aviva. Kalechofsky, Roberla. avoid the floods of emotional sentiments that cloud and .ludaism and Animal Rrgluts. Massachusetts: Micah l'ublishing Inc, 1992 polarize the views of so many others who attempt to think It( | "Treatment of Animals/ Torah 101/ Mechon Mamre." through this emotionally charged issue without a shong 2ll Dec. 2006. ':http : //canfeinesharim.org/ani mals.htm> I 0I Raisin, Jacob S. "Humanitarianism of the Laws of Works Cited I lsrael." Ed. Kalechofsky, Roberta. Judaism and Animal McMillian, John C. "Animal Research." Encyclopedia [1] Rrglu ts. Massachusetts: Micah Publishing lnc, 1992 oJ Bioethics. 3'd edition. Ed. Stephen G. Post. Vol. 1. Bleich, J. David. Judoism and Healing. Klav New York: Macmillan Reference USA, 2004 lllf Publishing House Inc, I 981 [2] Russow, L. (1990). Ethical Theory and the Moral Status of Animals. The Hastings Center Report, 20(3), 4+. 1l Jan. 2007. from Questia database: [3] Neuroscience Exploring the Brain third edition p. l6- I 8 [4] Engeman, R. M., & Shumake, S. A. (1993). Animal Welfare and the Statistical Consultant. The American Statistician, 47(3),229+. 11. Iat 2007. from Questia 36 31 Science & Ethics: A Joint Persper:tive Science & Ethics: A Joint Perspective Surrogate Motherhood othcr appealed and the case went to the Supreme Court of Reena Gottesman cw .lcrsey, which ruled that the surrogacy contract was Itrrcn lirrceable; thus, retuming to the surrogate her legal As of 2002, 7 .4%' of American married wo mother. The issue of custody was sent were infertile.l When a woman is infertile or rlrllrs as the baby's court, be determined as any custody maintain a pregnancy, one of the assisted fertilizati kr l different to techniques now available to childless couples is to use tltsllttlc. Since the now famous "Baby M" ruling, the legality surrogate mother. Surrogacy is a contracted anangement cthical standing of using a surrogate mother has bcen which a third party is involved in the birth of a child. The Irrtl subject much debate. This arlicle will attcmpt to third party is impregnated with thc husband's sperm using llrc of various positions on the subject from both aftificial insemination and camies the pregnancy to term. llurily the r,r'trrlilr and religious points of view. According to the contract, she is required to give up the The ethical issues raised in the American Medical child to the intended parents; the intended mother does a Assooiation Code regarding surrogacy includc the possible step-adoption to secure her rights to the baby.2 e of children. Most suffogate mothers are The political and cthical debatc surrounding ornmercialization ranging between $ 10,000 and surrogate motherhood was first brought to public attention pirirl a sum of money, $15,000, for their seruices. The sunogacy contract thus with the 1988 "Baby M" case. The case involved a tlctcrmines th.^ legal rnother of the child. The child itsclf is surrogate mother who aftcr bringing the baby to tcrm and rrol being bought. Rather, the intcnded parents are buying after tuming it over to the father and his wife, then "preconception termination of the mother's parental kidnappcd the child, saying that she could not live without lhc The intended parents may therefore dictatc the the baby. The father and his wife filed for enforcement of rights."3 letions ofthe sumogate during the course of the pregnancy. the surrogacy contract and won custody of the child; the has pointed that even within this definition of sunogate's visitation rights were terminated. The suffogate Ir been out 38 39 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective the surrogacy conffact, there is an inherent assumption I thore are certain safeguards in place. For example, the the biological mother does not have the intrinsic rlh rnother should have the right to void the contract responsibility that a mother typically has to her chil wrthin a "reasonable period of time after the birth of the Rather, "it makes the obligations that aco rhrltl"a and custody should then be decided according to the parenthood, alienable and negotiable."3 r,hrltl's best interests. However, in gestational suffogacy, The Baby M case highlights another poten when the surrogate mother is not biologically related to the ethical problem with the use of surrogate mothers that chrld but simply carries the zygote to term, the contract the bond between the surrogate and the fetus, w rlrorrltl be strictly enforced.a inevitably forms during pregnancy. The legal mother, in all The official standing of the Christian Church is that cases, is the childless woman, and sumogate agencies heuruse surrogacy involves a relationship between two extend this definition to say that the intended parents are peoplc who are not married, it is a violation of the unity of the real parents of the child. The term "conoeption of the Irurrriagc and ofthe dignity ofhuman creation. In addition, mind" is used to justify this position that because the rt "ropresents an objective failure to meet the obligations of surrogate did not have the intention of accepting rrrirlcrnal love, of conjugal fidelity and of responsible parenthood when the child was conceived, she is not the rrrotherhood."5 'real' mother.l However, parenthood is not based entirely Islam has also declared that surrogacy is forbidden on choice; one can lose parental rights, but cannot become hccausc it involves the introduotion ofa man's sperm into a an 'ex-parent.' Viewing parenthood in such a way is based wonran who is not his wile. which may constitute adultery.6 on the view that children are objects to be owned, a view lrr addition, a parallel can be drawn from Islam's position which would re-create the problem of baby-selling.3 tlmt artificial insemination is forbidden because using the In light ofthe ethical issues involved, the American spcm of a man other than the mariage partner confuses Medical Association Code permits surrogacy, providing 40 41 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective 1ineage.7 In surrogacy, the egg of a woman other than 'l lrt'rc is no attempt on the part of biblical commentators to marriage partner is used and the same problem exists. ltir liarah's psychological state to explain her actions.e In the Jewish tradition, surrogacy is one of 'l hrs highlights the very significant problcm that the oldest ways "of overcoming infertility."s Sunogacy 'trrlcrrded' mother may not be able to overcome the sometimes compared to concubinage,s of which there lrrrrkrgical fact that she is not the natural mother of her three recorded cases from the biblical period. The first i llrild. As a rcsult, she may treat the surogatc the incident of Hagar, whom Sarah gives to Abraham trrrrppropriately. order to bear him children, since Sarah is unable to do so. Dcspite the possible negative psychologioal cffects, Thc second incident of sunogacy is that of Bilhah, whom ,lrrrlaism recognizes surrogacy and addresses a number of Rachel tells Jacob to take as a concubine, when she cannot hirlakhic issues which are involved. One major question is bear him children. Finatly, Leah also gives her rrhcther the arlificial inscmination of the surrogate with the handmaiden, Zllpah, to Jacob as a concubine, when she lrrrsband's spem constitutes adultcry. Rabbi J. David stops conceiving. lllcich cites numcrous opinions which understand adultcry The case of Hagar introduces an important issue irs scxual contact between unmarried individuals, thereby with using concubines, or surrogates. In discussing the cxcluding arlificial insemination from the prohibition. He case, Nachmanides makes two observations. First, that citcs the position of Rabbi Perctz of Corbeil in Hagohot while Hagar was going to bear the children, Sarah would be ,\cmak, in which he expresses the concem that a woman the one to raise them. Second, that when the Bible records should not lie on the shects that were used previously by a that Sarah oppressed Hagar, Sarah was at fault because she rnan who is not her husband, for fear that she might become should have been generous even when Hagar mocked her. pregnant (from the man's sperm) and the resulting children Nachmanides further denounces people who are overcome rright marry the other children of this man, which would be by sudden feelings of generosity but do not follow through. incestuous. The fact that the concem is incest and not 43 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective adultery shows that adultery is not a concem when there lhlr thc natural mother) refuses to surrender the child, the no sexual contact between the unmarried individuals.l0 tnre would have to be adjudicated as a custody dispute.ll surrogacy, no sexual contact occurs between the husb A third issue which must be addressed is the and the surrogate. While there is a minority opinion w rtrp;trcssion of the mother's identity after the child has been states otherwise, concem about adultery is not Irlrplcd by the father and his wife. Rabbi Moshe Feinstein, impediment to surrogacy according to most rabb whcn discussing the suppression of parental identity in authorities. Resulting from the position on artific rr'rrlcd adoptions, sees such suppression as a violation of a insemination, most rabbinic opinions hold that a child hrhlical commandment that a man may not keep multiple from a surogate relationship is not considered illi llrrrilics which are unaware of each other's existence. The because there were no sexual activities between the fa trntlcrlying concem is that eventually the children of thcse and the surrogate. lrrrrrilies may end up marrying each other, not knowing that An additional issue is the enforceability of the tlrcy havc the same father.l0 This concem could be applied surogacy contract. In Jewish law, baby-selling is not lo suppressing the identity of thc child's natural mother in considered a criminal act (however unethical it may be). A sllrogacy, and the suppression would therefore violate the surrogacy contract would therelore not pose any problems hrhlical commandment. on that count. However, children are not considered The situation becomes more complicated when property. Child custody is considered an obligation, not a rlclling with a case of "gestational sumogacy," a situation right; if any rights are involved, they belong to the child. A rr which the surrogate is a host for the ferlilized egg ofthe surrogacy contract, which provides for the surrender of the e hildless woman. The fertilized egg is removed from thc baby by the natural mother, is by definition not fair to the childless woman and then implanted in the womb of the rights of the child, and cannot be considcred valid.lo srrrrogatc mother, who is not biologically related to the Therefore, if, as in the Baby M casc, the surrogate (who is ll'tus which she then carrics. Thc Chicf Rabbi of Grcat 44 45 Science & Ethics: A Joint Perspective Science & Elhics: A Joint Perspective Britain, Rabbj Immanuel Jakobovits, condemned the use ofl However, in Tractate Chullin 79a there is a gcstational surrogates when used "as a convcnience" as "al rhseLrssion of the role of the mother and father in revolting degradation of matemity and an af lront to human tlrlcrrnining the species of the offspring. While the dignity."ll However, there are tirnes whcn such a ('onscnsus holds that it is the mother who determines the procedure is the only way fbr the natural mother to have a rpr'cics, thcre is a conflicting opinion that the father does child. In such cases, the issuc of matemal identity becomes plrry some role. This can be applied to gestational crucial as Jewish law does not always usc genetics to urrrogacy to say that while the birth mother is recognized determine familial relationships. In Tractate Yevamol 97b Ir lhc 'real' mother, the rolc of the natural mother is there is a Talmudic discussion rcgarding whcther twin huportant and cannot be ignored. Rabbi Bleich suggests brothers may marry cach other's wifc in the casc of a lhtt pcrhaps a child born from a gestational surrogate I levirate marriage. The decision is that they may not engage worrld have two 'mothers.'l in levirate marriagcs with each othcr's wif'e if thcir mother Since its dramatic introduction to thc public, was not Jewish when they were conceivcd, but converted nrrrogacy has become a widely debated issue among befbre they were bom. Ra,shi, on this discussion, cxplains policy-makers, ethicists, and laymen. lt must be treated that sincc their mother convefied beforc they were bom' wrlh scnsitivity and care, for it touches and challenges the thcy are considercd half brothers because they wcre bom to lrlca of 'family' and therefore affects our lives at all levels. the samc Jewish mothcr. While convcrsion usually scvers all genetic rclationships, in this case, the mother is Works Cited I Chandra A, Marlinez CM, Mosher WD, Abma JC, recognized as such bccause she gavc birth to them after her I I .lones J. "Fertility, family planning, and reproductive conversion. It would seem, therefore, that Judaism health of U.S. women: Data from the 2002 National Survey of Family Growth." National Center for Health recognizes the birth mother as thc 'real' mother.r2 Statistics. Vital Health Stat 23(25). 2005. NCHS Publications and Informotittn Pruducts. 2 January 2007. 46 47 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective January Itlcich, J. David. Judaism and Healing Halakhic "' .;Jil,';.Jlr.f[T"t"'.. ' 't I' t't.\l,c(:tives, Augmented Editlor. Jersey City, NJ. Ktav .,I:;,"11,h,. t';'.',.0:1,1""J'",,)''lit;,,"*'! I'rrblishing House, Inc. 2002 ''' I lllryde, Michael J. "The Establishment of Matemity surrogate motherhood." Journal ol Medical Ethldl nntl l'atcrnity in Jewish and American Law." Jewish 2OO0: 26:404-4O9. JME Online Journal o/ Medt{ I rtv' Articles.26 July 2006. 48 49 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Per.spective Belief and Medicine |r'ccdom of religion, in other words, is a basic right of the Dalia Barenboim Arrrcrican people under constitutional law. What does the do when people have religious reasons for Conflict, as any citizen of the contemporary wor Iovcrnment healthcare from themselves or their children? knows all too well, is the basis of bioethics. We live in withholding Traditionally, Christianity did not have a problem strange era, in which civil courts mitigate betwecn a child' giving taking medication. According to the medical needs and his parent's religious convictions wilh or ( History Medicine, Christianity started off Members of some religious groups have no qualms itmbridge of an overall positive attitude towards medical care, quandaries about tuming to physicians, medications, and with rrtlvocating the presence of both a priest and doctor at the treatments, while others groups place severe restrictions on Christians were taught to see medicine and physical healing. As an era boasting the ready availability srckbed. surgery as "prime examples of the bounty of God towards of advanced procedures and complex medications, the Irumanity."l Rabbi Dr. Immanuel Jakobovits traccs the intersection between medicine, religion, and civil law has rrrnbiguous attitudes of both Christianity and Islam towards never been so pronounced. rncdicine, explaining they both began with open arms to The First Amendment to the United States rncdicine later began to oppose physical means of Constitution states: but seems that both religions developed and Congress shall make no law hcaling. It respecting an establishment of continue to retain elements of both streams of thought religion, or prohibiting the free exercise thereof; or abridging the loday.2 freedom of speech, or ofthe press; or However, when dealing with the Christian sects of the right of the people peaceably to assemble, and to petition the Jchovah's Witness and Christian Science, the situation Covemment for a redress of becomes more complicated. According to its official grievances. 50 5l Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective website, Jehovah Witness official doctrine contains tho Christian Scientists are known for placing a general notion: han on all means of physical healing. Their text Science "[Abstaining from blood] means that unl Health explains this position: we must not take into our bodies in "Obedience physical any way at all other people's blood to the so-called checked or even our own blood that has been laws of health has not sickness. Diseases have multiplied, stored. . . so true Christians will not material theories accept a blood transfusion. They since man-made the place of spiritual truth. You will accept other kinds of medical took treatment, such as transfusion of say that indigestion, fatigue, distressed nonblood products. Jehovah's sleeplessness, causes aching heads. Then Witnesses value life, but they will stomachs and you your brain in order to not try to save lives by breaking consult you, when God's laws."r remember what has hurt your remedy lies in forgetting the matter has no This law is based on their reading of the verse in Genesis whole thing; for sensation of its own, and the human 9:3 which states: "but flesh; with its soul its blood you shall mind is all that can produce pain....when Mind at last asserts its not eat." However, the commentary of Rashi, the chief mastery over sin, disease, and death , Biblical commentator in the Jewish scholarly tradition, is then is man found to be harmonious and immortal. . .Drugs and hygiene that this verse prohibits the eating of a limb torn off of a cannot successfully usurp the place live animal or the consumption blood taken from a live and power of the divine source of all perfection. . .The flesh and animal. The only halakhik (Jewish legal) ramihcations of health and Spirit can no more unite in action. this verse are in the area of dietary laws. When Jehovah's than good can coincide with evil. It is not wise to take a halting and half- Witnesses use this verse to prohibit blood transfusions, it is way position or to expect to work important to note that they are quite at odds with Jewish equaliy with Spirit and matter..."a scholarship and legal opinion. ln short, they advocate a purely spiritual means of achieving health in order to fix the spiritual root of the 52 53 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective ltlAtttu h nefesh (saving of life). .." Additionally, Rabbi Dr. Alrrirham S. Abraham quotes the Shevet Yehudah which ilil:i':;; oxplains that patients nowadays are obligated to go to Hfr:::;.,:_ I lLrttors and seek the best healthcare they can.' It is clear Judaism has a lot to say abour rhis approach. fn" foral llrrrt .ludaism not only has no problem with, but actually #,;:;:",J :;;;l te(luires, sick people to physically take care of themselves. yerapei"- "he shall cause him to bc thoroughly healed". In Naohmanides, picks up on Rav Acha's side of the context, this injunction is directed at someone who hiti nlirrqmentioned talmudic discussion. In the context of his someone elsc and caused him to be injured. Rashi t'rlrnrrrentary to Leviticus 26:1 1, he explains the state of the commcnts that this phrase commands the pelpetrator to pay ,lewish people in a bygone age. As perfect people, the the physician's fees lor the injured party. Already, it is world did not function for them according to physical laws; obvious that doctors are permissible. The Talmud in lhcy cxisted above them. They did not experience illness. Brakhot 60a brings down a divergence ol opinions about l( ighteous as they were, it was still possible to commit medical treatment. Rav Acha states that it was not right for spiritual transgressions, which would be manifest in the people (past tense) to go to doctors, and Rashi adds that lxrtly as diseasc of some sort. Upon noticing the ailment, a they should havc just prayed for God's mercy. Abayei |crson would not go to a doctor, but rather to a prophet to brings thc phrase "V'rapo yerapei" to say that people tlilgnosc the spiritual source of the problem. There was no should go to doctors, but should also pray for healing and place fbr a doctor in the lifc of the truly righteous. thank God when they become healed. This has been Nachmanides quotes the aforementioned Talmud to codified into Jewish law, within the Shtlkhan Aruch in cxplain that it was not the way of people to seek medical Yorah Deah:336, stating: "The Torah has given permission ltl(cntion but then they grew accustomed to it. From here to the doctor to heal; it is a mitzvah to do so and part of hc states a stunning idea: IIad the Jsws not tumed to 54 55 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective medicine, they would continue to experience illncst , evcr heard of a hungry person denying himself bread healing in direct correspondence to their sins and llrc name of righteousness? Just as we eat but make wlll. Because people began to seek medical attention, uiirrgs over our food, we should use medications as placed them under natural law. In other words, that 'e ssflry and thank God for them. generation that tumed to medicine was culpable. Iichoing the aforementioned Talmud, Rav Dessler chose to eschew a direct relationship with God by pu xolvcs the two disparate opinions of Nachmanides and themselves under the system of natural laws. They lurr)onides, and shines a needed shaft of light on the the physical world, so God treated them- and then tlrotc issue. The two commentaries are talking about two descendents- through physical means. As such, tllll('rcnt situations. For a person on an extraordinarily altered the state of the Jewish people, who must lolty spiritual level, turning to a doctor instead of a prophet function within the confines of nature. As explains Itr irkin to tuming away from God's wi1l. It is evidence of Eliyahu Eliezer Dessler in Michtav M'El Irr lpathetic attitude towards the inner spiritual reason for Nachmanides understands "V'rapo yerapei" to llre illness. This corresponds to Nachmanides opinion. permission to the doctor to heal, not permission to llowcver, according to Maimonides, lor peoplc in later patient to seek treatment. However, since patients h pcnorations not living on this level, life functions within become accustomed to seeking treatment doctors shou rlrlurc, and it is proper to address both the physical and heal these patients.6 sgriritual. One should pray to God for healing, seek medical Rav Dessler also brings down the commentary lltcntion and thank God for the healing medications! In Maimonides, who addresses this issue in Peirush olher words, use the physical when required, but recognize Mi,shnayol. Unlike Nachmanides, Maimonides holds tha its spiritual source. Maimonides calls it plain loolishness even one who does God's will should see doctors. He asks lirr a person in who is not on such a high level to act as how this is any different from the physical aot of cating. tlrought he is and thus not seek physical, medical attention. 56 57 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective "Man's seruice [of Cod] needs lo be according to hirl lhcn quotes the following statement from the eighteenth level." writes Rav Dessler. "someone who acts in a wafl r'cntury Rabbi Chaim Azulay: befitting a higher level. which is not ingrained in hi{ "Nowadays one must not rely on heart... his service is not genuine..." In other words, fo{ miracles, and the sick man is duty bound to conduct himself in service of God to be genuine, it has to be in tune with th{ accordance with the natural order by person's particular level. ln our generation. it is simply nol calling on a physician to heal him. In fact, to depart from the general possible to be on the same level as those who lived with th{ practice by claiming greater merit prophets. " than the many saints [in previous] I generations, who were cured by Rabbi Jakobovirs and Rabbi Abraham come to dtl physicians, is almost sinful on same conclusion in dealing with Maimonides. nuUbl account of both the implied arrogance and the reliance on Jacobovitz highlights the problematic nature al miracles when there is danger to Nachmanides' seeming injuncrion against medicine widl life...Hence, one should adopt the ways of all men and be healed by three points: the lack ol codification olrhis anti-medicird ..4 pnysrclans. . . himsell was opinion. the lact that Nachmanides I Rabbi Abraham explains also, in conjunction with physician. and lquoting the Aromathou does it.ate sen{ c e ommentary of Rav Waldenberg, that Nachmanides' lor a verse in the Torah to allow doctors to treat patienl ttttetion against medicine was "only referring to the who are not allowed be healed? Writes RaUl lo rleous and only to thc era of the prophets when the Jacobovitz. the divergent opinion of Nachmanides "can I rplc of Israel were free of sin and their affairs were understood only in the context their cosmologi{ ol rhrclcd above and beyond the laws of nature." He outlook in which the perfect man. not being subject to I Irgs tbe ll,[idrash Shochar Tov Shmuel 4: I in which natural law, is not in need of doctors or medicines."a I hhi Akiva and Rabbi Yishmael engage in debate with a I trlrn who is astonished that the rabbis recommend 58 59 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective medication for his ailment. The rabbis point out that lt rs a gift from God. It is a lot harder to stay away from the man is a farmer, who engages the physical world to no rkrelor, than to still go to h'im and remember that on a deep himself. Says the midrash, "the body of man is like a ['vcl, the true healing is in God's hands alone. its fertilizer is mcdication. and its farmer is the doctor The United States Govemment has been forced to Just like the farmer is required to work the land in order r'orrfiont these issues in many trials brought to court. How acquire food, similarly he must use medications in order rrrtrch can the govemment interfere with a parent's wishes? care for his body.s ln 1988, the Common Pleas Court of Philadelphia Jewish sources, unlike Christian Science, ovcrruled the Jehovah's Witness parents' desire to withhold bursting with references to the importance of unifying blood transfusions from their daughter Tara Cabrera spiritual and physical worlds. We are urged to work within Irrgram, six-year-old who had sickle-cell anemia and had our own levels, rather than pretending to be on a level irlrcady sufiered two strokes. A doctor testified that the which we are not. In doing so, we can transform whatever hlood transfusion would give Tara a 90% chance of physicality we are connected to at our respective levels into tvoiding future strokes which would put Tara at risk for vessels for spirituality. Rabbi Moshe Chaim Luzzato in physical crippling as well as mental retardation. Tara was Mesillat Yesharim explains that a sanctified person given a guardian ad-litem to consent to blood transfusion transforms his physical acts into holy deeds.T Rabbi Chaim lherapy for one year. The case discussion points out that Friedlander writes in Siftei Chaim that it is "easier to fast Iieedom of religion does not give parents absolute on Yom Kippur than to eat on Erev Yom Kipprr lishmah- autonomy of their children's lives. Rather, the state can for the right pr.pose."t In 60 6l Stiance & Ethics: A.Ioint perspetlive Science & Ethics: A Joint Perspective situations in which a child is deprived of a treatmcnt cviu could become psychologically scarred in the could prevent the likelihood of dcveloping debilitating lclirn.l0 fatal conditions. The govemment,s position is that. In 1991, the Superior Court of Sonoma County and best way to futfill the rights of children is to protect lhr ('ourt of Appeal of Califomia ruled that the Christian promote their healthy development into adults who Nuerrcc parents of eight-month-old, Natalie Middleton- decide for themselves the aims for their lives_ _ .,,e l(rppbcrger, who died of bacterial meningitis, were guilty In another case, in 1970, the Family Court of N ul child endangcnnent.ll Although the parents' Christian Ulster County ovemtled parental wishes with a verd Sr'rcnce health manual instructed them to repofi meningitis upheld by the New York Court of Appeals. Fifteen_ trr thc health deparlment, they did not recognize this to be old Kevin Sampson had the disfiguring diseaso tlrc child's illness, and thus did not veer from their normal neurofibromatosis (von Recklinghausen,s disease). It was prlctice of abstaining from medical attention. Natalie was so extreme that he was exempted from school attendance. sick and untreated for fiftcen days bcfore dying. The The court ruled that he was a neglccterl child, since his l)urcnts were put on a five-year probation in which they Jehovah's Witness mother would not allow him to undergo rvcrc rcquired to attend a family health class, allow their a surgery in which blood transfusions would be nccessary. children to be givcn emergency medical treatment for a The ruling to force the mother to allow the surgcry was on lit'c{hreatening illness or injury, and notily the health the basis that although Kevin was not medically imperiled, dcpartment of a child's illncss lasting more than twenty- he was at social, behavioral, and psychological risk by Ibur hours. being exiled from normal school and suffering from such From all this, it is apparent that U. S. law does not deformity. Waiting until Kevin was old enough to decide seek to force adult individuals to obtain medical treatment for himself, it was decided, would be waiting too long, as (unlike Jewish law which mandates it), but it does intervene to cnsure that children do get treatment for childrcn so they 62 63 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective can grow up to make their own decisions about theso Ultimately, it is clear that doing one's utmost to matters. In his 2005 lecture at the Illinois College of Law, l)rotect life is a value that the United States Govemment Kent Greenawalt mentioned the 1944 Supreme Court ruling shares with traditional Judaism. In our day and age, there in Prince t). Massachusetts that parents may make martyrs nocd be no conflict between spiritual healing and medical of themselves, but they are not free "to make maftyrs of irttention. Indeed, if one strolls into any state-of-the-art their children." Greenawalt says: hospital and opens his eyes, he will see God's hand in "Someone might argue that cvery worker, treatment, and medication. the state should defer to parents, because no one knows what acts will endanger souls. . .Were that line of Acknowledgments: argument accepted, it would open the I would like to thank Dr. Janet L. Dolgin for her door to the state's accepting every outpouring of assistance in researching material for this form of behavior judged by piece, as well as Rabbi Dr. Richard Weiss for his valuable participants to be good etemally for suggestions and support. all concemed. Suppose members of Cited a religion practicing child sacrifice Works were certain that every child [] Nutton, Yiviarl.. Cambridge History of Medicine. Ed. sacrificed was assured of etemal Roy Porter. Cambridge University Press, NY 2006 happiness. The state cannot abandon [2] Jakobovits, Immanuel. Jewish Medical Ethics: a its determination about secular comparative and historical study of the Jewish religious welfare in the face of such beliefs, attitude to medicine and its practice. Bloch Publishing, and it should require medical NY, 1975. treatment that is essential for life, [3] www.watchtower.com even if parents claim that the [4] Science and Health, by Mary Baker Eddy, online treatment is harmful religiously. edition www.spirituality.com When this particular conflict reaches [5] Abraham, Abraham S. Nishmat Avraham: medical courts, judges have not hesitated to holachah Jbr doctors, nurses, health-care personnel order tre-atment over the parents' and patients. Mesorah Publications, Brooklyn, NY, wishes-"'' 2000. o4 65 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective [6] Eliyahu Eliezer Dessler. Michtav M'Elivahu c How Old is Too Old? gimel. l7) Luzzatto, Moshe Chaim. Mesillat Yesharim. Golda Stromer [8] Friedlander, Chaim. Siftei Chaim. In contemporary society, it is very common to see [9] Teitelbaum, Hanis. Chilren, parents and the ptrblic and private authority in the home, schools, women in the demanding workplace. With limited time to juvenile court,s. Aspen Publishing, NY,2002. lhink about family and easy accessibility to birth control [ 0] "In the Matter of Kevin Sampson, a Child Alleged be Neglected." 65 Misc. 2d 658; 317 N.y.S.2d 641 rrany women choose to put off marriage and childbearing 1970 Misc. runtil they have reached greater social status and financial ll ll23l Cal. App. 2d 1667;283 Cat. Rptr. 111; 1991 Cal, App. sccurity. Once these women decide that they do actually U2l Greenawalt, Kent. Lecture: Obiections in Conscienc want to settle down and have a family they find that they to Medical Procedures: Does Religion Make a Difference? Delivered Oct. 5 2005 at the University of have problems conceiving. Illinois College of Law. "According to the American Society for Reproductive Medicine, about one-third of women between age 35 and 39 and twothirds of women over 40 have fertility problems."r Older women have a harder time conceiving as female fertility diminishes with age. Although a woman is bom with millions of oocytes in her ovaries, by the time she reaches puberly she only has about 250,000 remaining. Of these 250,000 eggs only about 300 eggs will be ovulated during reproductive years. The older eggs have a harder time being fertilized because the eggs harden with age, which frustrate the spetm. Additionally, as men age their sperm count decreases, and a drop in 66 67 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspeclive testosterone levels adds to the difficulty in a couple't into an egg cell, which in essence enables women of all ability to conceive.2,3,4 lgcs to create egg cells. If a women fears not having Due to today's cutting edge technology there aro hcalthy eggs when she decides to have children at an older many ways to help couples conceive. In vitro fertilization ge, she may create an "egg bank" for herself in order to be removes the woman's egg and fertilizes it with her able to retrieve her own healthy eggs when the time is husband's sperm in a test tube. Once the egg is fertilized it right.a can be implanted directly into the uterus of the woman who In addition to having difficulties conceiving, can then carry the baby to full term. For a woman who has women who have children at a older age have an already encountered menopause, she may take certain increasingly higher risk of miscarriages or having children medications which will help stimulate ovulation. If a with disabilities. An older woman's oocltes have a greater woman is still unable to ovulate her own eggs, a woman incidence of chromosomal aberrations. The most common may choose to have another woman,s egg implanted into disorder among children arising from older mothers is her own womb and fertilized by her husban<1,s sperm.a Down Syndrome. Down Syndrome is a genetic disorder An additional ..cytoplasmic method is the transfer.,, caused by the nondisjunction of chromosomes during This approach micro-injects the ',egg white" of a younger meiosis and the child is bom with an extra copy of woman into the aged ..egg egg of the mother. The white,, chromosome 2l . The chance that a woman would give includes all the components of the egg except for the DNA. birth to a child with Down Syndrome increases with age. The "egg white" enhances the proteins and enzymes in the Research shows that at age 25, "a woman has about a 1-in- older woman's egg, '1,250 which will increases her chance of chance of having a baby with Down Syndrome; at fertilization, while still utilizing the mother,s DNA. age 30, a l-in-l,000 chance; at age 35, a 1-in-400 chance; Another fascinating way to help an infertile couple is to at age 40, a I -in- 100 chance; and at 45, a l -in-30 chance."2 take a cell from any part a mother,s body and convert it 6u 69 ,\ir'itttrc & Ethits: A Joint perspective Science & Ethics: A Joint Perspective There are also higher risks for a woman herself lirxn asphyxia and brain bleeds more often than newboms become pregnant at an older age. Women over the ago liorn younger mothers do. 35 have an increased risk of an ectopic pregnancy in w In addition to health related risks, giving birth at an the fertilized egg implants outside the uterus, usually in ol 10 7l Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective have the child they are carrying a baby to full term, it is being there, s trcatments. By the time the parents enjoy the and providing for a child. Is a 69 year old lo grateful to finally have a ohild that they sufficiently able to do this? ptrcnting more. process rs This issue is an ongoing debate. Many people ln addition to the fact that this that this new technology should be used while cnlotionally draining, these treatments are very costly' treatments' strongly disagree. Various studies have been done "l'cople who are willing to go through infertility many mothers who used assisted reproductive technology which can be very expensive and can stretch ovcr to becoming order to get pregnant. Research has shown that ye ars, are those who are really committed University who use ART have a tendency to be exceptional paren parents," says Susan Golombok, Ph D', of City "Then when They seem to spend more time with their children, s in London. a leading researcher in the field' long for their more affection and warmth towards their children, they do become parents, they've waited so Additionally, they have been found to be more emotionally children that they're just thrilled to have them "6 technology involved with their children as well. These parents also However, because assisted reproductive couples' seem to enjoy and appreciate the family life more than the is expensive, it is only accessible to more affluent to conceive average mother and experience less stress related to Many couples who have used this technology and health parenting. Some researchers have suggested that because the child are also able to afford good schooling unable to of the time and effort that these parents have invested into care. In contrast, many poorer couples arc simply having a child, they appreciate parenting more than a afford these treatments.6 reproductive regular couple. Many of these parents have gone to Although many people accept assisted laws and numerous doctors until they finally find one that can help technology as a method to circumvent nature's with the them. Even once they find the appropriate doctor, they have kids at an older age, some people disagree that these then still have to endure many emotionally draining ethicality of its use. Dr. Arthur Caplan believes 12 73 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective treatments are highly unethical. "Any woman over the l{rl (ioldcn, Frederic and Mulphy Paul, Annie: Psychology 'loday, "Making Over Mom & Dad - changing identites of40 constitutcs a high-risk pregnancy the medical ri of parents" Mav. 1999 rise rapidly for mothers older than 40 and for their | 7 | http://www.msnbc.msn.com/id/6862098 I Many of these babies bom to older women end up bom premature and have a tendency to have signi medical problems in the future."7 Currently, it is up to an individual couple to deci whether they would like to have a child at an older age. It is impofiant that the couple understand the risks which may be involved. both for the child as well as for the woman. Additionally, the couple must recognize that they themselves will be getting older along with their children and take this into account when deciding to have a child at an older age. Works Cited [1 ] http://www.marchofdimes.com/professionals/68 l_l I 55.asp [2]http ://www.theafa.org/faqs/afa_whatmotherdidnotsay.ht ml [3 ]http ://www.4woman. gov/pregnancy/tryingtogetpre gnant /tryingtoconceive.cfm [4]http://www. fi ndarticles. com/p/articles/mi_m0GER/i s_20 00_Summer/ai_ 63 5 007 41 [5]http ://www.babycenter. com/expert/pregnancy/pregcomp lications/3 1 27.html?ccRelLink: &trl-%o2F plus%o2F safe %2Fquest jhtml&xTopic:safesex&bus:content /4 75 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective Euthanasia: thc Greek "good death." In 1870, Samuel Williams first Caught Between Religious and Ethical suggested the use of painkillers and morphine in the Implications illtcmpt to end a person's life. During the next 35 years, Claudia Amzallag rnany debates arose about the ethics of euthanasia in Britain lnd the U.S. The positions regarding the pros and cons of Although the ethical debate sumounding the use cuthanasia are identical to the ones that exist today. euthanasia seems to be in full swing during the course Before we mention these pros and cons, it is this century, it can really be traced back to the times irnpoftant to note that we cannot categorize every kind of Ancient Greece and Rome. Indeed, patients who s as euthanasia. The issue of euthanasia has from unbearable pains were often given poison intervention greatly expanded and has brought us to categorize it within physicians in order to alleviate their pain. Many involuntary euthanasia. lt is important to philosophers such as Socrates (9470-3gg BCE), plato (427- voluntary and distinguish between these two because some vicws will 348 BCE) and Seneca (ca 55 BCE-41 CE) supported the allow one type of euthanasia but not the other. Voluntary use ofeuthanasia. However, this practice was also opposed is when the victim is fully aware of the situation by many physicians such as Hippocrates (Ca.460-3g0 BC) euthanasia and decides that he wants to go through with the who clearly stated that he would not give a deadly drug to involuntary euthanasia is anyone regardless of their request. intervention. On the other hand, when the patient is in a coma or in a state where he is Today, doctors, nurses and lamilies of the ill are to make the decision and instead his family decides faced with very difficult decisions to make with critical unable they want to end the patient's life As we will see, most health situations of a patient. Many arrive in a situation if religions and ethicists view voluntary euthanasia as which leads them to consider the use of euthanasia. The more "ethically" acceptable. term euthanasia was first introduced in lg69 by William somewhat Edward Harlpole Lecky (1838-1903) and is derived from 76 11 Science & Ethics: A Joinl Perspective Science & Ethics: A Joint Parspc<'lit't' on Another distinction is between passive and acti In Buddhism, Hindu prohibits euthanasia basod euthanasia. The difference lies mainlv in the mechanics lhree aspects of their religion . Karma, moska and ahisma' one's the tetmination of life of the patient. If a person is active Karma \s the net effect of "good and bad deeds" in to injected with a lethal dose, then the procedure is acti cxistence which will be a determining factor in the life the However, if a patient is withheld lrom further trea come. Moska, regulated by karma, is the renewing of Ahisma' such as chemotherapy, it is considered passive cuthanasia. cycle for resurrection, the religion's ultimate goal not Most sources allow the practice of passive euthanasia but t basis for the religion, highlights the impodance of strongly oppose that ofactive euthanasia. lrarming others. Suicide is prohibited in Hinduism since it yielding bad karma' In ancient times , the ethics surrounding euthanasia prcvents the cycle of rebirth thereby was govemed by the different religious views. Different For the Hindu, the religion presents two opposing views religions and cultures have difTerent perspectives about regarding euthanasia. On one hand, someone who assists whether the use of euthanasia is religiously and ethically another in euthanasia helps reduce pain, and hence will acceptable. Early Christianity opposed the use of gain good karma. Ott the other hand, euthanasia interferes and euthanasia, arguing that God is the supreme creator and the with the cycle of rcbith, moska, and both the patient only one entitled to prolong or cut shoft a person's life. As doctor will therefore engender bad karma seen in his work "The City of God", St. Augustine is In Judaism, a clear distinction is made between crcditcd with thc first prohibition against suicide. Also active and passive euthanasia. Most sources prohibit the active characteristic of early Christianity is the idea that the practice of active euthanasia. An example of such suffering preceding death was necessary as an expiation of euthanasia is when the basic necessities for survival, our sins. The Christian religion was therefore opposed to as water, oxygen, food and tubing, are removed' As for the the use of euthanasia. passive euthanasia, there is a dichotomy between mitzvah of pikuach nefesh, saving life at all costs, and that 78 79 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective of helping another alleviate pain and suffering. A very prevalent. For instance, in the well-known Cruzan that "a obligated by Jewish law to save another person,s life case, the Supreme Court of the Unites States ruled any other commandment, pikuach nefesh. However, patient who has clearly communicated his or her wishes provision are some rabbinical authorities that do permit the regarding the use of life support machinery or the of passive euthanasia, such as Rav Feinstein, provided of hydration and nutdtion has a constitutional right to have suffering certain criteria are met. These criteria were designed those wishes respected even if the patient is not ensure that the patient is really in terminal condition, in from a terminal condition." Many legal issues about the great the past amount of pain, is fully aware of the procedure use of euthanasia have arisen in many state courts consentient to it (voluntary euthanasia). If a person is few decades. The Quinlan case (1976) was the first was a in the state where they can voluntarily accept it, euthanasia case which appeared in a state couft This ..wills,, girl' Rabbis do allow the practice with the use of and case of an involuntary passive euthanasia A young alcohol "next-to-kin." Karen Ann Quinlan fell into a comma aftcr mixing that she Today, we have to factor in that the perspective on and pills. When the doctors informed the family death has greatly changed. It is no longer focused upon would not make it, the family went to couft in an attempt New religion but rather upon ethics. Many relevant questions to remove her irom the respiratory machine' The the surround this debate. Is it ethical to pmctice euthanasia? Is Jersey Supreme Court ruled in their favor' Because it considered suicide? Is euthanasia ethical if the patient is parents did not request a removal of fceding and hydration suffering ln regards to greatly? Answering these questions are crucial tube, Quinlan did survive nine more years for successfully determining which ethical principles involuntary passive euthanasia, the courts are generally should be invoked. supportive of the practice but do insist on more evidence both In terms of American society, it seems that more before they rule in favor of it. However, as of today' ..right and more, the idea of a person's to die,, has become 80 8l Science & Ethics: A Joint perspective Science & Ethics: A Joint Perspeclive voluntary and involuntary active euthanasia do it out and do not take the time to fix things. Although there illegal. nre relevant justifications for the use of euthanasia and Some views are in favor of the..idea,,of euthanas there are different categories of euthanasia which can be For instance, the revival of this view is seen with used to draw useful distinctions, it still seems as though we Hemlock Society, a group of people that promote the should really ask ourselves: why euthanasia? Is it really to "dignify death,,. Some on the other hand insists because the patient is in pain? Or is it a selfish request to euthanasia destroys the respect for life. It is viewed as avoid seeing the person in pain? The patient should also degrading to humanity because it devalues life. ask himself if his decision to opt for the procedure is The reality is that illness and death are very difficult motivated by impatience and pride or by his desire to for patients and their families. However, we must ask alleviate his ever-increasing suffering. Although it may ourselves; why has this sudden demand for euthanasia seem as a harsh perspective, it is necessary and ethical to arisen? We have seen that euthanasia can be traced back go to the bottom of things and makc sure we are doing to the times of Aristotle, yet this subject has recently them for the right reasons. engendered a lot of discussion. .It seems that it is very relevant to today's society. Unfortunately, we have Works Cited become Hastings Center an impatient world that wants everything right [1] Woll,S. Holding the line on euthanasia. Report.p.13-15. 1989 away; as we are used to the fast-paced evolution of [2] Gesundheit, B., Steinberg, A., Glick, S., Or, R., and technology. and the Jewish The increased demand for the legalization of Jotkovitz, A. Euthanasia: An Overview Perspective. Bioethic. 24:621-629. 2006 the practice ofeuthanasia may be attributed to our society,s [3] Breitowitz, R.Y. The right to Die: A Halachic dependence people 2004 on quick fixes. today do not want to Approach. Jewish Law, Darrel W. "suicide and Early Christian work on things. Whether [4]Amundsen, it is marriage, objects, or work. it Values," in Suicide and Euthanasia, ed. Baruch A' seems London: Kluwer Academic that if something is not working properly, we throw Brody, Dordrecht, Boston, Publishers. 1989 82 83 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective to organ donation Negligent Behavior and the Right to Medicrl categorical support for or any opposition is a very specific one' which is Treatment The issue being addressed ones that have independent of the larger and more complex Rabbi Richard Weiss, M.D. of Jewish been written about extensively in the literatue One of the most fundamental privileges granted by medical ethics. Constitution of the United States the ..right is to lifc" a right The first question is: Does this person have while certain extreme situations may result an in be denied' or is to receive a transplantation that should not individual's forfeiture of such right a - terrorism and mitigate the negligent behavior that led to the condition homicide, for example, most of us would assume that this community ftom such a right and absolve the medical right is fundamentally categorical and, as the oonstitution question is: If our treating this individual? The second states, "inalienable". The purpose of this article is to to hea'lthcare' is alcoholic liver patient does retain a right examine whether the right to receive medical care another patient' that right significantly wcaker than that of necessary to survive should, in certain circumstances, be to cancer? who also suffers from liver failure due' however' denied. More specifically, is it ethical from a halakhic is The availabitity of suitable livers for transplantation (Jewish legal) pcrspective to deny someone medical care lists in a limited, and patients are placed on waiting based on the fact that the person himself/herself is Those toward the hierarchy based on a variety of factors' responsible for contracting the illness. The clinical survive to lower end of the list, unforfunately' may never scenario that I would like to utilize illustrate the to are a scarce receive the liver needed Given that livers principles which are relevant, is the case of a person who particular patient's medical resource, should the fact that a suffers from liver failure due to long standing alcohol use. factor in behavior caused his/her own illness be a The person, as a result, is in need ofa liver transplantation. be placed? determining where on the list he/she should The purpose of this article, I should state, is not to address the larger issues of organ transplantation, nor to imply 84 85 & Ethics: A Joint PersPeLlivc Science & Ethics: A Joint Perspective Science The issues raised above have been discussed quitc environmentalfactorsamongothers.2Havingadiagnosis nor does it is not an excuse for drinking' bit in the general bioethics literature. One recent article of alcoholism proper ffeatment a person's refusal to receive Daniel Brudney of the University of Chicago and justify such point is that not all liver transplanl for the condition My Maclean Center for Clinical Medical Ethics, presents exactly abuse should be viewed candidates due to alcohol number of important points.l It is a prerequisite to in the disease of alcoholism the same. One has to consider discussion that the only type of behavior relevant is one and the precise degree of deliberateness that is voluntary and repetitive. We are addressing one determining one's health' in being negligent regarding who deliberately and knowingly engages in behavior that, intention by Brudney interesting concept suggested based on common knowledge, can lead to severe health A second immoral ' use is not intrinsically the notion that alcohol consequences. In addition, our patient is one who has is il health is not in and of that endangering one's indulged in alcohol use on a regular and frequent basis. He suggests to "punish' As such' it may not be ethical This kind of repetitive behavior is quite logically distinct itself unethical' for a pattem of behavior by denying a transplant and more serious ethically than that of one who acts someone repugnant' In neither criminal nor morally negligently in one isolated instance. Endangering oneself which in one's health and maintain that protecting by mountain climbing or drag racing once in ten years, Judaism, we are ethical and moral avoiding hazardous behavior should be viewed in a less incriminating way than one who in is responsible The verse principles to which a Jew drinks hcavily on a daily, or even weekly, basis. While I your lives 4:9 " and you shall protect certainly agree with Brudney's prerequisite, I do believe Deuteronomy appropriate and is a clear directive regarding that one impoftant point regarding alcohol abuse is greatly..." (Hilchot Rotzeach behaviors' Maimonides relevant. In a ceftain percentage of cases, the person inappropriate this concept and H'Nefesh' 1 1:4-5) codifies suffers from a disease known as "alcoholism". Alcoholism U'shemirat have the moral right to notion that one does not is a complex disease entity involving gcnctic and adds the 87 rJ6 'llltr Science & Ethics; A Joint perspective Science & Ethics: A Joint Perspective claim that, .....I will endanger myself and of what concem continues to engage is in such behavior is to be denied access it to others regarding me in this matter. . .,,. According to to health care. We will retum to this critical point later. Judaism, one is responsible for his4rer own well being, and The last point of Brudney,s article to which I wish behavior which leads to rsevere illness is' arguably' to refer is .distributive intrinsicaly immoral. based on the principle of justice,. 'Justice' is one of the four basic principles Brudney,s of bioethics. It third point is quite a cogent one. attempts to address issues related to inequality Regardless ofhow in access to one views the behavior ofalcohol abuse, health care. Distributive justice, specifically, ....refers to deny such a person to life saving medical treatment is fair, equitable, and appropriate distribution disproportional to the determined by behavior. It is an excessive justified norms that structure the terms consequence for of social the type of behavior engaged in. While cooperation".s As applied to our Brudney does case, the argument is that not view alcohol abuse as intrinsically a scarce resource, like a liver, should be distributed immoral, I believe his point based is valid from a Jewish on certain ethical norms to which all members of society perspective which does view it as intrinsically immoral. I are subject. A patient who suffers from liver failure due to doubt that Judaism has the legal authority to judge such a alcohol abuse and receives a liver transplant, will, in person and condemn the effect, person to not receive the cause another patient to not receive a transplant. Indirectly, treatment. Even if the Judicial system as prescribed by the the alcoholic liver patient is harming another Torah was person. The in full implementation, which presently it is not, negligent I behavior engaged in over time, will likely result don'r believe rhat such bel in the death ofone person who, ifnot rrom the judiciary ;"JJ:.1::#I'1H:'#:: for the alcoholic liver "r,,"n patient, may have lived. This does record reasoning could lead to the the right of the c conclusion that such a patient should or serr protectio" be placed lower on ""0 """,0;:::: ffiffi}:il:''l: the transplant [ist, but not completely left off. Normally, does not explicitly state, however, that a person who the principle in the Talmud (Baba Metziah 62a) that one,s ti8 u9 hi Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective own life takes priority over that justification of another is regarding the normative requirement, if need be, to violate for allowing, and requiring, that one obtain the highest the Sabbath to save a life. The question posed to Rabbi position on the list as possible. Clearly, one cannot Feinstein was whether the Sabbath should be violated to fraudulently obtain a higher position, nor engage in any save the life of a person who negligently brought the life deliberate act to undermine another patient,s position threatening situation upon himselflherself.a Rabbi (Mishnah, Oholot 7:7). An alcoholic did indeed perform a Feinstein bases his opinion on a Talmudic ban on deliberate act, but it was not aimed at any individual, nor embarking on a sea voyage within three days prior to the was it the intent to harm another individual. If our Sabbath. One of the rationales given is that such voyages conclusion will be that such patient a is deserving of carry potential dangers which would result in the need to treatment, then placing him,/her at a lower position based violate the Sabbath in order to offset such dangers. One solely on the consideration of negligence is, I believe, should not, a priori, orchestrate a situation that will, out of actively denying that person the proper treatment. It is necessity, result in the violation of the Sabbath. Hence, equivalent to punishing the person in a similarly extreme Rabbi Yehoshua Neuwirth records that one should avoid manner that was discussed earlier to be inappropriate. scheduling elective surgery within three days prior to the Daniel Brudney's own conclusion is that, under very Sabbath, so that the possibility of having to violate the limited circumstances, would it be ethical to assign a Sabbath will be avoided.s (Scheduling surgery or setting person a less deserving status for treatment based on sail the beginning of the week is not subject to such negligent behavior. restrictions for reasons not specifically germane to our The fundamental issue which I wish to discuss from discussion.) Yet, Rabbi Feinstein demonstrates that if a Jewish bioethical perspective whether is one who someone disregarded this restriction, embarked on a voyage endangers one's own life has in any way forfeited the right just prior to the Sabbath, and a life threatening situation to treatment. Rabbi Moshe Feinstein addresses a scenario arose on the ship, the Sabbath would have to be violated, 90 9l Science & Ethics: A Joint Perspective Science & Ethics: A Joint Perspective not withstanding the person's deliberate negligence. should be noted that both Drs. Abraham and Steinberg Similarly, Rabbi Neuwirlh points out that if a penon did, concede that a minority view does seem to exist which unnecessarily undergo elective surgery just prior to the would prohibit violation of the Sabbath for one who Sabbath, the Sabbath must be violated if any serious attempted suicide. However, the normative prevailing complication was to develop. Clearly, if the Sabbath must opinion is as presented above. It should be noted that I did be violated to save the life of someone who is negligent, not incorporate the fact that attempting suicide should then the basic principle of treating such a person is not ostensibly be viewed as indicative of serious illness, and, mitigated by his/her behavior. therefore, not a simple case of deliberate intent to harm It is true that our discussion regarding alcohol abuse oneself. In this way it is somewhat similar to the disease is not identical to the person on a voyage or undergoing alcoholism discussed above. elective surgery. The latter activities do not entail any While I mentioned earlier that a distinction between intrinsic immorality or unethical behavior. The timing and an isolated act and repetitive ones should be made (as halakhic restraints create an inappropriate activity. Alcohol Daniel Brudney does), from a Jewish Perspective such a abuse, as developed earlier, is intrinsically unethical from a distinction is not accurate. One of the key concepts Dr. Jewish perspective. Nonetheless, Dr. Abraham S. Abraham Abraham refers to is authored by Rabbi David Ben Zimra, and Dr. Avraham Steinberg quote numerous rabbinic in his commentary on Maimonides' Codes (Hilchot authorities who maintain that someone who attempts to Sanhedrin, 18:6). A person is rTot, he claims, a proprietor commit suicide on the Sabbath, and, as a result, requires over one's own life. Therefore, one cannot act or treat emergency ffeatment, must be treated fully even in one's life in a neglectful manner or in any way that would violation of the Sabbath.6J Rabbi Feinstein himself, as Dr. compromise one's welfare. Rather, one's life is the rightful Steinberg points out, applies the principles he developed propefiy of God. This means, in my opinion, that human regarding sea voyages to a case of attempted suicide. It beings don't have the right to decide when a person should 92 93 Science & Ethics: A Joint Perspective Science & Ethics: A Joint Pcrtlx'tlltt die. This applies not only with respect to other people's [5] Neuwi(h, Rabbi Yehoshuah. Shemirat Shultlttt K' H ilchat a, Chemed Printing,Israel, 1 979, Vol. I ; 32 : 3.1. lives, but even to one's own. Subsequently, for a person to [6] Abraham, Abraham S. Nishmat Avraham, Machon die on the Sabbath, which is normally violated to save life, Schlesinger and Machon Pri H'Aretz, Israel,1982; Orach Chaim. 328:6. because he/she attempted suicide would translate into a [7] Steinberg, Avraham. Encyclopedia Halachtit Re luit. decision made by man not God. If an alcoholic liver Machon Schlesinger, lsrael, 1988; 1:13-14. patient is denied a transplant, or possibly even placed lower on the list, then that person's death is due, arguably, to his/her own decisions during life not God's. While I certainly subscribe to patients making end-of life decisions regarding their care, those decisions are not completely open ended. Guidelines do exist based on Torah principles which guide such decisions, and are ultimately reflective of God's will. Suicide and alcohol abuse are not God's will; treating patients is. Works Cited [1 ] Brudney, Daniel. "Are Alcoholics Less Deseruing of Liver Transplants?" The Hastings Center Report, 37 :l;4'l -47 ,2007 . [2] Golan, David E. et al. Principles oJ Pharmacologt, 2"d Edition,LWW,USA, 2008;290-29 l. [3] Beauchamp, Tom L. and Childress, James F. Principles of Biomedical Ethics, 5th Edition, New York, 2001; 12.226. [4] Feinstein, Rabbi Moshe. Iggerot Moshe, Noble Book Press, USA,1959. Orach Chaim I, no. 12'7 . 94 95