The Jewish Tradition Religious Beliefs and Healthcare Decisions By Elliot N. Dorff he Jewish tradition traces its roots to Abraham. TThe patriarchal stories of the Bible reflect the migration of the ancient Hebrews from Mesopotamia to Canaan and from there to Egypt. Jewish history continues with the Exodus from Egypt; the Sinai event; the gradual conquest of Canaan during the period of Joshua, the Judges, and the Kings; the Contents building of the First Temple and, with it, the first The Individual and the 6 Jewish commonwealth under Solomon; the splitting Patient-Caregiver Relationship of the Jewish commonwealth into northern and southern kingdoms around the year 930 B.C.E.; the Family, Sexuality, and Procreation 8 defeat of the northern kingdom by the Assyrians in Genetics 15 722 B.C.E.; and the conquest and exile of the Jews of Organ and Tissue Transplantation 17 the southern kingdom by the Babylonians in 586 B.C.E., and, with that, the destruction of the First Mental Health 19 Temple and the first Jewish commonwealth. All of Medical Experimentation 20 these events are familiar from their biblical accounts. and Research Jews established a strong community in Babylonia Death and Dying 21 (modern-day Iraq) that continued to exist for another fifteen hundred years under the Persians and then the Special Concerns 26 Muslims. A number of Jews returned to rebuild the temple in 516 B.C.E., and with their return the second Jewish commonwealth was born. It continued to exist in Israel through Greek and Roman conquest until 70 C.E., when the Romans destroyed the Second Temple. Jews continued to exist in what is now Israel in fairly large numbers for the next three hundred years, but their situation became increasingly dire, and the Part of the “Religious Traditions and Healthcare Decisions” handbook series published by the Park Ridge Center Rabbi Elliot N. Dorff, Ph.D., is Rector and Distinguished Professor for the Study of Health, Faith, and Ethics of Philosophy at the University of Judaism, Los Angeles, Calif. THE PARK RIDGE CENTER focus of Jewish history shifted to the community GENERAL TENETS OF JEWISH BELIEF in Persia. The Persian Jewish community was at AND PRACTICE the forefront of world Jewry through the Muslim period, extending to approximately 1050 C.E., Jewish belief centers on the revelation of God at but there were sizable Jewish communities in Sinai contained in the Torah (the five books of Israel, North Africa, and southern Europe dur- Moses) and on the historical relationship of God ing that time. to the Jewish people from the time of Abraham From around 1000 C.E. to the fifteenth cen- through the Exodus and into the present day. tury, the Jewish communities of North Africa Traditional Jews consider themselves bound by and western Europe became the major centers the commandments of God as articulated in of Jewish culture. Jews, expelled from the west- Jewish law. Because Jewish law gives Judaism a ern Mediterranean region and western Europe distinctly activist cast, even those Jews who do in the fourteenth and fifteenth centuries, moved not observe the law often are actively involved in to eastern Europe and the eastern Mediterranean many projects for the improvement of life on basin, where they were concentrated until the earth. Jewish values concentrate on the life of late nineteenth and early twentieth centuries. At the family and the community, education that time, because of persecution in Russia and throughout life, historical rootedness, and hope the development of Zionism—a movement to for a Messianic future when all peoples will come reconstitute Jewish national life in the ancient to know God and follow Jewish law. In that way, homeland—many Jews moved to America and Jews understand themselves as having a mis- Israel, although the majority of them remained sion—that of demonstrating morality to the world in eastern Europe until they were slaughtered in and being, in Isaiah’s terminology, “a light unto the Nazi Holocaust. the nations” (Isaiah 49:6).2 For Jews, the land of The largest Jewish community as of 1997, the Israel is the Jewish homeland not only because last year for which figures are currently avail- many of the critical events in the birth and able, lives in the United States (approximately development of Judaism took place there, but 5.7 million Jews), and the second largest lives in also because, according to Scripture, God gave Israel (approximately 4.7 million Jews). There the land to the Jews. Although Jews understand are also Jewish communities (in order of size) themselves as having a divine mission, that mis- numbering in the hundreds of thousands in sion is to be carried out by example rather than France, Canada, Russia, the United Kingdom, by actively pursuing converts; in fact, Judaism Argentina, Ukraine, and Brazil, and there are has historically been reluctant to accept converts. sizable but somewhat smaller Jewish communi- While Jewish law specifies many particulars ties in Australia, South Africa, Germany, about the actions of Jews, Jewish belief is much Hungary, Mexico, and Belgium. It can be said less determined. Consequently, Judaism has a truthfully that Jews live in almost every country long history of lively intellectual debate on philo- of the world, including some that are currently sophical issues, and rabbis have taken theological hostile to Judaism and Israel. This wide distri- positions ranging from supernaturalism to natu- bution is the result of the remarkable fact that ralism, from rationalism to mysticism, and from a Jews lived without a homeland for close to nine- community-based revelational understanding of teen hundred years, the only people to survive Jewish law to an individualistic, existential under- under those conditions. Although it is difficult standing of it. to determine exactly how many Jews there are in Traditional and liberal manifestations of the world today, demographers estimate that Judaism exist in most countries. In the United there are about thirteen million.1 States there are four movements: the Reform Movement, the Reconstructionist Movement, the 2 THE JEWISH TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Conservative Movement, and the Orthodox philosophies and practices do not coincide with Movement. Orthodox Jews, constituting approxi- those of the institutions that they join.3 mately 20 percent of affiliated American Jews, believe that the Torah is the literal word of God and that Jewish law is to be determined by ref- FUNDAMENTAL JEWISH BELIEFS CON- erence to the codes and responsa (literally, CERNING HEALTH CARE “queries and replies”; the rabbinic term denotes the exchange of letters in which one party con- Judaism’s positions on issues in health care stem sults with another on a matter of Jewish law) of from three of its underlying principles:4 that the the past. Conservative Jews, who include some body belongs to God; that the body is integrated 41 percent of affiliated American Jews, believe into the entire human person and, as such, is that all Jewish sources must be understood in morally neutral, its moral valence being deter- their historical context and that Jewish law mined by how we use our physical abilities; and developed historically as well. Therefore, while that human beings have both the permission Conservative Jews consider Jewish law binding, and the obligation to heal. they are more willing than Orthodox Jews to make changes in its content in response to mod- ern needs. Reconstructionist and Reform Jews GOD’SOWNERSHIP OF OUR BODIES do not consider Jewish law to be binding, although many voluntarily choose to observe According to Judaism, God owns everything, sections of it. The Reconstructionist Movement, including our bodies.5 God loans them to us for approximately 2 percent of American Jewry, has the duration of our lives, and they are returned historically possessed a greater sense of commu- to God when we die. The immediate implication nity than the Reform Movement has manifested of this principle is that neither men nor women and hence offers more encouragement to adopt have the right to govern their bodies as they the folkways of the People of Israel. Autonomy will; God can and does assert the right to restrict is a central value for the Reform Movement, the use of our bodies according to the rules which represents about 35 percent of American articulated in Jewish law. Jewry. (The remaining percentage consider One set of rules requires us to take reason- themselves “just Jews.”) Thus for Reform Jews able care of our bodies. That is why a Jew may the law is at most a resource that the individual not live in a city where there is no physician.6 It may choose to consult in making a decision; it is is also the reason rules of good hygiene, sleep, certainly not the authoritative command of God. exercise, and diet are not just recommendations Still, the 1999 Pittsburgh Platform Statement of but commanded acts that we owe God. So, for the Reform rabbinate encourages Reform Jews example, bathing is a commandment (mitzvah) to learn and practice not only the moral, but according to Hillel, and Maimonides includes also the ritual elements of Jewish tradition, his directives for good health in his code of law, although the individual still has the right to making them just as obligatory as other positive determine how much to observe. The rabbis of duties like caring for the poor.7 the various movements adhere to the positions Just as we are commanded to take positive described above, but for lay people family histo- steps to maintain good health, so are we obligat- ry, convenience, and friendships are at least as ed to avoid danger and injury.8 Indeed, Jewish important in choosing an affiliation as ideology law views endangering one’s health as worse and practice.