Journal ofmedical ethics, 1983, 9, 109-112 J Med Ethics: first published as 10.1136/jme.9.2.109 on 1 June 1983. Downloaded from Jewish medical ethics - a brief overview Sir Immanuel Jakobovits ChiefRabbi ofthe Brintish Commonwealth Editor's note Emphasis on ethics This paper outlines the traditionalJewish approach to Paramount throughout this long and highly creative medical ethics, as perceived by the ChiefRabbi ofthe association between Judaism and medicine has been British Commonwealth, himselfan academic specialist in the emphasis on ethics as their common denominator. thisfield. It is based on a 'St Paul's Lecture' given to the Building materials for the imposing edifice of Jewish London Diocesan Councilfor ChristianJewish medical ethics came from all strata of our religious understanding. literature, while the architects were legal experts, who, In medical ethics converge two of the Jewish people's as already noted, often combined rabbinical and most notable contributions to the progress of hum- medical experience. The Bible provided the foun- anity: medicine and ethics. From the beginning, our dations: the sanctity and dignity of human life, the people have shown a special concern with the healing religious duty to preserve health, an uncompromising art. Already the Bible includes in its religious legi- opposition to superstition and irrational cures, in- slation some revolutionary concepts of preventive cluding faith-healing, a rigid code of sexual morality, medicine and public health. In the Talmud we find, and many basic definitions of moral imperatives in among the numerous medical references almost 2,000 medical practice, including the rights of the dead. years ago, the earliest mention of such innovations as By the way, these rights, as defined in Deuter- artificial limbs, some form of artificial insemination, onomy, expressly extend even to executed criminals, oral contraceptives and Caesarian operations on living and I need hardly stress how significantly this provision http://jme.bmj.com/ mothers. Many authors of the Talmud themselves alone contrasts with the callousness of other legis- practised medicine. They were succeeded by what lations, ancient and modern, which treats the bodies of became, in the Middle Ages, the common pheno- such criminals and of so-called 'unclaimed persons' as menon of the rabbi-physician. Indeed, it is estimated res nullius and denies them the claim to dignified burial. that over one-half of the best-known rabbinical The impact ofthe biblical tradition on the development scholars and authors - philosophers, poets, exegetes, of medical ethics in Western society may be un- grammarians as well as rabbis - in medieval times were derstood when it is contrasted with the Code of on September 25, 2021 by guest. Protected copyright. physicians by occupation; men like Maimonides, Hamurabi and other ancient legislations which pro- Nachmanides, the Ibn Ezras, Ibn Tibbons and vided, for instance, for the amputation of a doctor's countless others. arm if he proved unsuccessful in an operation on his These historical antecedents no doubt contributed patient! significantly to the extraordinary predilection among On these biblical foundations, the Talmud (the Jews for a medical career in modern times. Only an depository of the 'Oral Law' finally edited about attitude conditioned by centuries ofnurture could have 500 C E) established the legal framework in virtually produced such a disproportionate preoccupation with all fields ofmedical ethics, setting forth the main prin- medicine as to have enabled Jews to receive some 20 per ciples on such problems as abortion, euthanasia, con- cent of all Nobel prizes for medicine - a proportion traception, sterilisation, malpractice claims, etc. The more than 40 times the ratio of Jews in the world! Talmud, followed by the great codes of Jewish law, Likewise most leading medical historians were Jews; even enacted certain eugenic laws against marriages one recalls names like Max Neuberger, Arturo Cas- suspected to result in physically or morally diseased tiglioni, Charles Singer of this country, and Joshua children. Anyone who has read the famous Oath of Leibowitz and Sussman Muntner ofIsrael. Asaph Judaeus (7th century) or the medical writings of other early Jewish notables in the history of medicine Key words will recognise at once how profoundly the spirit of the Jewish medical ethics; history of Jewish medicine; abortion; Bible and the Talmud suffused their ethical outlook. contraception; euthanasia; experiments on humans; genetic Little wonder that there never existed a Jewish form of engineering; medical ethics trining. the Hippocratic Oath, though there were Christian and 110 Sir ImmanuelJ7akobovits J Med Ethics: first published as 10.1136/jme.9.2.109 on 1 June 1983. Downloaded from Mohammedan as well as pagan versions of it. Jews law), is inclined to permit the abortion ofan embryo in simply fell back on their own ethical heritage. the earliest stage of gestation if the mother has And it was left to the voluminous rabbinical res- contracted German measles, the late Chief Rabbi ponsa, issued in increasing profusion over the past Unterman ofIsrael adamantly opposed the destruction 1000 years, to interpret and apply these principles in of any potential human life unless the mother's life the light of contemporary conditions and the advance were in jeopardy. of medical knowledge and techniques. There are now But virtually all responsa recognise only a strictly being published annually, notably in Israel, hundreds medical motivation for abortion, and they would not of such rabbinical responsa or verdicts - ranging over sanction the termination of a pregnancy unless there the entire gamut ofethical problems in medicine, from were some grave physical, or even psychiatric, hazard transplants to artificial insemination, and from ex- to the mother's life, however remote, provided every perimentation on humans or animals to autopsies. The such capital judgment - which literally determines responsa serve as case-law in the evolution of modern whether a human life is 'to be or not to be' - is most Jewish law. As a consensus gradually emerges from the scrupulously considered on the strength of the best many often conflicting judgments given, this consensus available medical evidence and in consultation with is recognised as a valid precedent and embodied in the competent moral experts. accepted corpus ofrabbinic law. Similar considerations govern the attitude to birth control. Where genuine fears exist, attested by reliable medical opinion, that a renewed pregnancy might pos- Abortion and contraception sibly cause some serious risk to the mother, rabbinical verdicts on the use of contraceptive precautions would Let me give just one example to illustrate this process in generally be liberal. Once again, of course, each case rough outline. The Bible does not specifically deal with would have to be judged on its own merits, and Jewish either criminal or therapeutic abortion. But in legi- law would make some distinction between different slating on the liability for assaulting a pregnant mother types of devices, oral contraceptives being regarded as and causing a miscarriage, the text in the Book of the least objectionable. But purely social or economic Exodus (21:22) implies that the destruction of an reasons, let alone considerations ofsheer convenience, unborn child is not culpable as murder, and that the would never be regarded as a valid indication for the fetus does not, therefore, enjoy the same absolute title artificial frustration ofthe act and duty ofprocreation. to life as an existing human being. The Talmud takes For legal purposes, ie to override or modify religious this an important step further by ruling in favour ofan laws, Judaism would therefore not unreservedly accept embryotomy where a difficult delivery otherwise the World Health Organisation (WHO) definition of http://jme.bmj.com/ threatens the mother's life. In any mortal conflict health 'as a state of physical, mental and social well- between mother and child, the ruling insists that her being'. While it naturally seeks to promote the social life enjoys priority, if necessary at the deliberate health of society and its members, by numerous laws expense of the child, provided its head or the greater and enactments designed to advance human welfare in part of its body has not yet emerged from the birth- every sphere, social and economic considerations by canal (which is the legal definition of birth). Judaism, themselves do not automatically suspend religious or therefore, in contrast to Catholic teaching, would moral imperatives in the same way as purely medical regard it as a grave offence against the sanctity oflife to factors do. on September 25, 2021 by guest. Protected copyright. allow a mother to perish in order to save her unborn The most popular argument commonly advanced in child. In other words Jewish law distinguishes between connection with both abortion and birth control, that potential (unborn) life and existing or independent is, the artificial prevention or termination of a preg- (born) life, only the latter being absolute in value and nancy, is the fear of 'population explosion'. Quite therefore inviolate, rendering its destruction an act of frankly, ifthe nations affected - maybe the Indians, or murder. Nevertheless, the unborn child, in different the Chinese, or some South American peoples-were to stages from the moment of conception, enjoys a very ask me as a rabbi for