Jewish bioethics

This dissertation investigates the ways scientific and biotechnological advancement impact and change Jewish law and ethics. It analyzes the contemporary Jewish bioethical debate concerning the identification of maternity and paternity in four cases of assisted reproductive technologies (ART): in vitro fertilization, gestational surrogacy, cloning, and mitochondrial replacement therapy. Unprecedented modes of procreation engender new definitions of parenthood, challenging a longstanding Jewish framework of theology, law, and ethics. Part I develops a conceptual scaffolding for the discrete analyses of Part II, and considers the philosophical bases of parenthood, the gendered nature of Jewish legal bioethics, the relationship of law and ethics, and ways of relating religion and science. For each case of ART, Part II examines the biological science and technology in historical context, locates Jewish bioethical concerns within the larger bioethical discussion, and critically reviews the epistemological and axiological dimensions of the legally oriented analyses of a select group of leading Jewish bioethicists, chosen for their copious writings on ART and contextualizing oeuvres: Rabbi J. David Bleich, Rabbi Michael J. Broyde, Rabbi Elliot N. Dorff, and the collaborative writings of Dr. John D. Loike and Rabbi Moshe D. Tendler. Insights from Jewish feminist bioethical criticism and other notable Jewish bioethical works enhance the analyses. Through a focused study of the redefinition of parenthood in Jewish law and bioethics, I demonstrate four ways in which advances in science impact Jewish law and ethics. One, scientific awareness leads to greater sophistication and nuance of analysis. Two, Jewish bioethicists grapple with religion and science relations, and speak directly to these overarching considerations. Three, the epistemological and axiological influence of religion and science relations correlate with greater openness to new technologies, theoretical conceptualizations, and their practical applications. Four, advances in science change Jewish legal and bioethical analyses and outcomes through (at least) four possible methodological mechanisms – namely, theoretic holism, innovative interpretation, indeterminate gaps, and realist realignment. Jewish bioethics are thus shown to illumine the intricate interrelationship between religion and science and its impact on Jewish law and ethics.

Newman argues that "the meaning of a text lies less in the words themselves than in the interpretive framework which the exegete brings to them." 9 Jewish ethicists, therefore, should beware of speaking in the name of "Judaism," as in "Judaism teaches that…". Rather, they should adopt a more nuanced style that reflects the nature of the interpretive process: the Jewish view on a particular ethical issue is "what we, given our particular interpretive assumptions and our particular way of construing the coherence of the tradition as a whole, find within the traditional sources." 10 Newman uses these theoretical insights to analyze and critique the writings of a number of Jewish ethicists concerning the treatment of the terminally ill. As is the case with the discussion of most ethical issues, this one is textual and interpretive in nature:

Welcome to the 24th World Congress of the World Association for Medical Law (WAML). The WAML encompasses academics and practicing professionals in the Medico-Legal specialties. Since 1967, it has convened international gatherings allowing the professional and academic community to meet and exchange ideas. These led me, almost 4 years ago, to gratefully accept the role of Program Chair of the 24th World Congress on Medical Law and Bioethics, which has been a positive challenge. On this Occasion, I would like to acknowledge the generous support of the following for the successful planning and organization of this Congress:

As technological advances increase, the frameworks of our existence become further called into question. Contemporary bioethics still tirelessly grapple with issues regarding the end and beginning of life. However there is great need to extend beyond the horizons of Western secular ethics and be able to create inter-religious dialogue surrounding these issues. The debates on abortion often become forcibly polarized in public discourse which severely hinders the development of an analytical and dialogical space which speaks not only to the content of opinions, but to the contexts of historical, theological, and philosophical traditions which have informed and shaped the way abortion is perceived and handled by both individuals and institutions.

This paper seeks to deconstruct the abortion debate within both Orthodox Jewish and Catholic tradition in order to locate the fragile points of friction and tend to the hermeneutics of each tradition in order to understand the way in which ethics is formed and deformed within them. In doing so a new dimension to inter-religious dialogue and ethical relations between traditions is formed that extends deeply into questions of embodiment, human nature, ensoulment, and the horizons of life and death as necessary variables to interact with in ethical reasoning across religious traditions in a pluralistic society.

Dr. Viktor Frankl’s abiding belief was that distress about the meaning of life is the proper domain of the physician's practice. He identified three syndromes of neurosis in the Age of Anxiety: fatalism, tranquilization, and fanaticism.  In The Doctor and the Soul, a manuscript begun even before his incarceration in German concentration camps, he argues that physicians must be able to identify the phenomenology of these conditions and intervene through activation of Conscience, or Will-to-Meaning.  With generous textual support and secondary analysis from Frankl's own writings. this paper offers three contemporary medical case studies in which patients have diminished quality of health due to beliefs and behaviors that are associated with fatalistic, tranquilized, or fanatical attitudes.  In addition to accurate diagnosis, Frankl provides clinicians with practical interventions that emphasize "the task character of life" for their patients, inviting his medical colleagues to see themselves as both the activator and safety rope to the patient's own climbing journey. He demands physician neutrality about patient value judgments, saying repeatedly that a physician’s responsibility is to activate conscience, not dictate to it.  The paper closes with thoughts on Frankl's curiosity not only to individual meaning-making, but to questions about Ultimate Meaning.

המאמר דן באופיה של פסיקת ההלכה כמושפעת ממערך של שיקולים ערכיים ותפיסות עולם סובייקטיביות של פוסקי ההלכה, בניגוד לתפיסה הפורמליסטית שלה. הטענה מודגמת באמצעות ניתוח משווה בין פסיקתם של הרב ולדנברג והרב גורן באשר לסוגיה שהסעירה את גדולי פוסקי ההלכה בעידן המודרני, על אודות קביעת רגע המוות והשתלות איברים חיוניים. ניתוח הפסיקות מדגים כיצד קביעת רגע המוות ההלכתית מושפעת ממערך של שיקולים ערכיים ותפיסות עולם סובייקטיביות ביחס לממסד הרפואי, להתפתחות המדע והטכנולוגיה הרפואית, לערך החיים ולתפיסות נטורליסטיות.

קישור לספר:
https://www.magnespress.co.il/book/%D7%94%D7%9E%D7%95%D7%95%D7%AA_%D7%95%D7%94%D7%A4%D7%99%D7%9C%D7%95%D7%A1%D7%95%D7%A4%D7%99%D7%94_%D7%A9%D7%9C_%D7%94%D7%94%D7%9C%D7%9B%D7%94-8286

Bogactwo prokreacyjnych odniesień w Piśmie Świętym skłania do postawienia pytań o znaczenie tekstu biblijnego jako materiału wyjściowego w rozważaniach nad statusem istoty ludzkiej w łonie matki. W czasach biblijnych nie dysponowano jednak szczegółową wiedzą biologiczną na ten temat. Pomimo tego, teksty biblijne, jako objawione przez samego Boga, stanowią podstawę żydowskiej refleksji medycznej, filozoficznej i teologicznej na temat statusu conceptusa i nasciturusa. Rozważania na temat prenatalnego rozwoju człowieka są obecne także w Talmudzie. Biblia i Talmud zaś stanowią podstawę religijnego żydowskiego prawa stosowanego - Halachy, które określa status człowieka przed urodzeniem. Niniejszy tekst stanowi próbę rozpoznania tego tematu w refleksji rabinicznej, która wspiera się właśnie na tych trzech filarach - Piśmie Świętym (Torze), Talmudzie i Halasze.

Some Reform Jews urge that, as a "non-halachic movement," Reform Judaism develop an approach to bioethical theory based in aggadah, the non-legal sections of traditional Rabbinic literature. The present article offers a counter-argument. 1) Reform Judaism is decidedly not a "non-halachic movement"; 2) the Reform halachic tradition has produced a substantial literature on bioethical concerns; 3) the so-called "non-halachic" approaches to Jewish bioethics are in fact deeply grounded in halachah; 4) a sharp dichotomy between halachah and aggadah cannot be maintained, because halachic decision (Reform and otherwise) is a product of non-legal as well as formally legal elements.

РЕЗЮМЕ: Специфика иудейского подхода к решению биоэтических проблем вытекает из общей приверженности этой религии строгому следованию закону, изложенному в Торе и Талмуде. В любых спорных и неоднозначных вопросах, требующих выбора, иудаизм обращается к мудрости многотысячелетней традиции толкования закона, стараясь понять волю Бога и следовать ей. Соответственно и в решении этических проблем, касающихся медицины, по мнению рабби, следует больше доверять древним текстам, раскрывающим волю Бога, чем собственной моральной интуиции. Методом, который доминирует в поле иудейской биомедицинской этики, является «правовой анализ» - изучение религиозного законодательства с целью отыскания и истолкования случаев, релевантных современным проблемам. Вопросы, связанные с возможностью применения тех или иных технологий в медицине, решаются на основании религиозного законодательства (Галахи) и, отчасти, с привлечением собственно этического (внегалахического) дискурса.  Согласно этой методологии биоэтическая проблема сначала рассматривается как «галахический запрос», как вопрос, решение которого может быть найдено через анализ респонсов галахической литературы. Когда оказывается невозможным отыскать случаи релевантные проблемам, порожденным современностью, решения выносятся на основании интуитивных этических суждений, соответствующих общим гуманистическим ценностям иудейской традиции. В рамках данной статьи иудейский подход к выработке решений, касающихся  этических проблем, связанных с медициной, демонстрируется на примере проблемы абортов и использования вспомогательных репродуктивных технологий. И в том и в другом случае биоэтический дискурс начинается с обсуждения «галахических прецедентов», но в ситуации отсутствия таковых в силу вступает чисто этическая аргументация. Большинство иудейских авторитетов склонно к достаточно «гибкому» толкованию закона и все более широкому признанию достижений современной медицины. При сохранении общего подхода к рассмотрению  биоэтических дилемм, предполагающего первичность обращения к закону, все более возрастает значение собственно этического дискурса.
ABSTRACT: The specificity of the Jewish approach to solving bioethical problems stems from the general adherence of this religion to strict observance  of the law set forth in the Torah and Talmud. In any controversial issue that requires a choice, Judaism turns to the wisdom of the millennial tradition of interpreting the law, trying to understand the will of God and follow it. Respectively, in solving ethical problems related to medicine, according to the rabbi, people should more trust the ancient texts that reveal the will of God than their own moral intuition. The method that dominates the field of Jewish biomedical ethics is "legal analysis" - the study of religious legislation in order to find and interpret cases that are relevant to contemporary problems. Issues related to the possibility of using certain technologies in medicine are resolved on the basis of religious legislation (Halakha) and, in part, with the involvement of the actual ethical (extra-halachic) discourse. According to this methodology, the bioethical problem is first viewed as a “halachic inquiry”, as a question whose solution can be found through an analysis of the responses of the halachic literature. When it turns out to be impossible to find cases relevant to the problems generated by modernity, decisions are made on the basis of intuitive ethical judgments, consistent with the general humanistic values of the Jewish tradition. In this article, the Jewish approach to making solutions to ethical problems in medicine is demonstrated by the example of the problem of abortion and the use of assisted reproductive technologies. In both cases, bioethical discourse begins with a discussion of "halachic precedents", but in the absence of such, purely ethical argumentation enters into force. Most of the Jewish authorities are inclined towards a rather "flexible" interpretation of the law and an increasing recognition of the achievements of modern medicine. While maintaining the general approach to the consideration of bioethical dilemmas, which presupposes the primacy of reference to the law, the significance of the ethical discourse itself is increasing.

The issue of the sanctity of human life, beginning with its development in the prenatal phase, is a constant topic of both Christian and Jewish theological reflection. In Judaism, it is closely related to the duty of procreation, understood as striving to disseminate the glory of God in the world. Life is the glory of God, because God is a living God and in him life has its source and justification. Above all, the glory of God is a living man, made “according to the essence and mind” of God (Gen 1,26). In this article, the author ponders on the subject of the Jewish conception of the sanctity of human life. In Jewish theology, from biblical antiquity to modern times, it remains in organic relation with the proclamation of procreation: “Be fruitful and multiply” (Gen 1,28). The aim of the article is also to point out that there is a space for pro-life cooperation between Christians and Jews, which may take the form of joint actions for the promotion and protection of conceived life. Both the Church and the Synagogue derive their anthropological and embryological views from the Holy Bible.

In June 2010, the Halakha Committee (Va’ad Halacha) of the Rabbinical Council of America released an educational paper regarding the halakhic recognition of brainstem death, bringing the long-simmering debate over this issue to a boil once again. The paper is most directly a belated response to the RCA’s acceptance in 1991 of the Health Care Proxy authored by R. Moshe Dovid Tendler, a move that was opposed by a majority of its Va’ad Halacha at the time. But the debate over the halakhic status of brainstem death stretches back more than two decades earlier, when the fi rst successful human heart transplant in Cape Town, South Africa brought the question of how to defi ne death to international attention. The issue, then, has been the subject of halakhic dispute for over forty years, yet it continues to occupy a central place in the public consciousness, as the Va’ad Halacha’s paper—weighing in at over a hundred pages of dense analysis—amply demonstrates. To the layperson, it may seem...

החוק אמנם מאפשר חיסון בכפייה, אך פעולה זו נראית כפגיעה קיצונית בזכויות האדם. עם זאת, לנוכח המגיפה נראה שראוי להשתמש באמצעים לא שגרתיים. ומה בהלכה? יש שרואים בחיסון מצווה של ממש

https://heb.hartman.org.il/without-coercion-but-with-sanctions/

I suggest that Levinas anticipated that when we teach empathy, without the virtuous and habituated practice of relation with a vulnerable, naked, pleading Other who shames us into acknowledging that we can and do “kill” them, we cannot help but lose that visceral and richest sense of empathy that sacralizes the practice of medicine.

Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited.

En este artículo, el cual es una adaptación del mismo ya publicado por el Rab. Dr. Szlajen, se develan las contribuciones del judaísmo a la problemática bioética del aborto a demanda. Dicho artículo fue el más comentado del día y uno de los más leídos, incluido además en la Versión Taquigráfica de la Comisión de Legislación Penal de la Cámara de Diputados de la Nación, llevada a cabo el 4-11-2014 en la Sala 1 (227).

This paper is an attempt to present the attitude of Jewish bioethics broadly understood with regards to in vitro fertilisation. The general attitude of the majority of Rabbis of the main denominations of Judaism towards artificial methods of procreation should be viewed as positive. Many of them consider in vitro fertilization as a means of fulfilling the most important commandment of Judaism: the obligation (mitzvah) to procreate (peru u-revu) and populate the earth (lashevet yetsara). In Judaism, procreation is one of the main tasks of marriage and the ability to bear children is seen as an integral part of the covenant of God with His people and a sign of God’s blessing for those who observe the Law (Deut. 7, 12-14). It is obvious that married couples that are not able to have children for various reasons are placed in a difficult situation. Their difficulties in this respect can be interpreter as a sign of being cursed and rejected by God. However, many Rabbis emphasize that there are situations in which infertility should not be regarded as God’s punishment for disobeying the Law, but as the result of the faultless human physical and psychophysical inability to have children. As such, infertility should be treated as an illness that should be treated. The problem of infertility therefore enters the realm of the practice of a doctor, who is the servant and co-worker of God. When taking into consideration the above mentioned arguments, the majority of contemporary Rabbis and Halakhic authorities permit the use of medically assisted procreation, particularly in vitro fertilization, when all other methods have failed. The vast majority of Rabbis, who belong mainly to progressive and conservative denominations, support the use of artificial methods of procreation. It is worth noting that there is strong opposition to using these methods among Rabbis, particularly those of orthodox movements. The objective of the article is to demonstrate the attitude of the main Jewish denominations to in vitro fertilization and the ethical problems associated with this procedure, including the attitude to surplus embryos.