August 17, 2018

Jewish guide to practical medical decision making


(Urim, 2017)

It takes considerable skill to write a book about modern medicine, and even greater skill to explain how halakha (Jewish law) responds to the dilemmas generated by modern medicine. Still, even those with the requisite knowledge of medicine and Jewish law may struggle to express themselves in a manner that laypeople can comprehend both the medical and Jewish legal concepts involved while also satisfying and educating medical and Jewish legal experts.

In light of this introduction Rabbi Jason Weiner, who is the senior rabbi and director of the Spiritual Care Department at Cedars-Sinai Medical Center in Los Angeles, deserves considerable praise for his outstanding ‘Jewish Guide to Practical Medical Decision-Making’ which is a book bursting with cutting edge medical and halakhic knowledge that explores and explains the complex medical and halakhic considerations relating to some of the most difficult life and death decisions that we may be forced to make.

Naturally, there may be those who may think there are already many books on Jewish medical ethics, and it is significant that Rabbi Weiner himself makes this observation. However, as he explains in his introduction, ‘as a hospital chaplain, my focus is on the real-life scenarios that I face along with patients and their families [and so] the focus of this work is thus more on concrete guidance than on philosophical or conceptual analysis… Indeed, the topics were chosen specifically based on what I have encountered in my work as a chaplain and regarding which I have practical advice to offer’ (p. 17).

In terms of content, the ‘Jewish Guide to Practical Medical Decision-Making’ explores six themes: i) Facilitated shared decision-making (ie. how decisions should be made and upon whom does the responsibility to decide fall especially when a patient lacks the capacity to do so); ii) How much treatment? (ie. What treatment decisions should be made when the risk is great or outcome uncertain; palliative care); iii) Prayer (ie. the role of prayer in bleak circumstances and when to recite confession with a patient); iv) At the end of life (ie. end of life directives; when to withhold or withdraw treatment; physician assisted suicide); v) After death (ie. definition of death, organ donation, autopsy and Jewish law; guidance on the loss of a baby or fetus); vi) Reproductive questions (ie. genetic testing, artificial insemination, IVF, surrogacy and egg donation).

In each chapter, Rabbi Weiner interlaces current medical policy and practice with insights and opinions from Jewish legal experts, and in doing so, he seeks to close the gap between perception and reality and to bridge the disconnect that many feel between the divine expectations as expressed by Jewish law, and the human and emotional needs of patients and their families.

For example, when discussing ‘Palliative Care and Hospice in Jewish Law and Thought’, Rabbi Weiner writes that:

“In the past, hospice care was treated with great suspicion in the observant Jewish community, perhaps based on the concern that it was akin to ‘giving up’, or even intentionally shortening life. However, when done appropriately, hospital should not be viewed as stopping treatment, but rather as continuing to engage in fulfilling the commandment to heal – merely changing the emphasis from cure to comfort. In fact, it can even be seen as ‘aggressive’ medical treatment, but it is specifically aggressive in terms of pain management and care for the whole person, rather than an emphasis on inappropriate interventions’ (p. 88).

Beyond this, each chapter is followed by some truly magnificent in-depth end notes ‘for those interested in the scholarly aspects of the discussions’ where Rabbi Weiner cites numerous sources and frames numerous debates with a level of nuance and clarity that cannot be found in any other book on Jewish medical ethics.

We are taught that when God had to make life and death decisions He ‘went down and saw’ their situation (see Rashi to Bereishit 11:5, 18:21) which is meant to teach us that whenever a judge renders a life or death ruling, they need to fully understand the context about which they are ruling.

Sadly, all too often we find that Rabbis, patients and their families make life and death medical decisions without fully understanding either the nuanced or broad halakhic opinions on the issue, or the current medical policies and practices. Rabbi Weiner’s ‘Jewish Guide to Practical Medical Decision-Making’ is intended to help Rabbis, patients and their families, so that if and when decisions have to be made, they are empowered with both the Jewish and medical knowledge to frame their questions and make peace with their answers.

To purchase a copy of this book, click here.

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