USCJ Review - Spring 2001

Life and Death Responsibilities in Jewish Biomedical Ethics

When may artificial technologies be used to help create human life? Is abortion ever morally right? When should life-sustaining treatment be stopped? How extensive are my responsibilities to support the health needs of others?

Technological and social developments have placed these questions at the center of society's concerns and in the middle of people's lives. Our answers will shape the values and institutions of society and will literally make the difference between life and death for many of its members.

The United States and other nations have explored these issues through courts and commissions, through legislative debate and private deliberations of conscience. In Jewish tradition, the central means of addressing these concerns is through halakhah, or Jewish law.

In Life and Death Responsibilities in Jewish Biomedical Ethics, edited by Aaron L. Mackler and published this year by JTS Press and the Finkelstein Institute, Conservative Jewish scholars tackle these important issues from a variety of perspectives. While each paper is the product of a particular author, all have been discussed and authorized by the Rabbinical Assembly's Committee on Jewish Law and Standards, the halakhic guide for the Conservative Movement.

Because of the importance of the subject matter to our readers, we present below a brief survey of the papers contained in this volume, categorized by topic.

Artificial Insemination - Among reproductive technologies, artificial insemination is the most common method and, from a medical and technical perspective, the simplest. From an ethical and religious perspective, the matter can be more complicated. Especially weighty concerns are raised if a couple considers using sperm that is not from the husband, but from a donor. Rabbi Elliot N. Dorff explores this issue focusing on three areas of concern: General Considerations and Insemination Using the Husband's Sperm; The Use of a Donor's Sperm; and Using Donor Eggs, Donating Sperm and Eggs, and Adoption.
In Vitro Fertilization - Rabbi Aaron L. Mackler addresses halakhic questions entailed by in vitro fertilization (IVF). In this procedure, a human egg cell is fertilized outside the human body and transferred to a woman's uterus for gestation. After a brief statement of relevant Jewish values, the paper presents relevant background material on the medical procedure of IVF and the biology of the early stages of embryonic development. Attention is then given to the "simple case" of IVF, in which a wife's egg and a husband's sperm are joined.
Surrogate Motherhood - A surrogate mother gestates and gives birth to a child with the intention that the child will be raised by others. Most commonly, the surrogate is artificially inseminated by the sperm of a to whom she is not married, and the child is raised by the man and his wife. This procedure may be called simply "surrogate motherhood" or "surrogacy," "full surrogacy," or "ovum surrogacy." Alternatively, in "gestational surrogacy," the surrogate mother gestates and gives birth to a child from an embryo fertilized in vitro, resulting (most commonly) from the sperm of a husband and an ovum of a wife. Many aspects of this practice are controversial, including the very term "surrogate mother." The controversial status of this practice is reflected in the diverse views found in this volume. Contributors include Rabbis Aaron L. Mackler, Elie Spitz, and David H. Lincoln.
Abortion - Abortion is a controversial issue within Jewish ethics, as it is in Western societies generally. Most Jewish writers would agree that a fetus does not have the status of a full human person, so that abortion is not homicide. At the same time, the fetus is a developing life and potential person. Abortion is morally wrong prima facie that is, unless serious ethical considerations mandate an exception. Such an exception could be justified, however, in particular when required to protect the pregnant woman from severe harm. The severity of the harm required to justify abortion and the authority of the woman herself to make this judgment vary among diverse Jewish writers. Contributors to this section include Rabbis Ben Zion Bokser, Kassel Abelson, David M. Feldman, Isaac Klein, and Robert Gordis.
Medical Care at the End of Life - Treatment decisions at the end of life are among the most common, and the most wrenching, issues in bioethics. In countries such as the United States, most deaths are accompanied by decisions about forgoing life-sustaining treatment. These include dramatic decisions to terminally wean a patient from a respirator, controversial decisions to forgo artificial nutrition and hydration, and simple and sometimes implicit decisions not to try yet another round of chemotherapy. Choices about forgoing treatment can be informed by values and precedents of traditional halakhic discourse. They also have generated extensive discussion in general bioethics. Contributors to this section include Rabbis Avram Reisner and Elliot Dorff. The authors share much common ground on the guidance that halakhah offers for treatment decisions near the end of life. However, there are key disagreements between the authors concerning the provision of medication, such as antibiotics, and artificial nutrition and hydration.
Medical Care at the End of Life: Additional Reflections - Various authors support or take issue with the positions of Rabbis Dorff and Reisner. Contributors include Rabbis Amy Eilberg, Joel Roth, and Aaron Mackler. "Jewish Medical Directives for Health Care" presents an advance directive developed and edited by Rabbi Aaron L. Mackler.
Assisted Suicide and Euthanasia - This section addresses one of the most controversial issues in Western societies today, that of assisted suicide. In assisted suicide, one person contributes to another person's actively ending his or her own life, with the person whose life is ending taking the final action. Euthanasia (or "active euthanasia") is similar, but the final action is performed by a person other than the one whose life is ending. Both assisted suicide and euthanasia are distinct from the appropriate forgoing of life-sustaining treatment, as discussed in the above sections. Rabbi Elliot Dorff tackles both issues.
Organ Transplantation and Autopsy - Respect for the body of a person who has died, kevod hameit, is a powerful Jewish value. Respect for the dead body expresses not only respect for the memory of the individual who has died but also respect for God, in whose image all persons are created. The tradition understands this value to entail specific prohibitions against disfiguring a dead body, deriving benefit from a dead body, and delaying burial. This complex of values and normative rules raises problems for autopsy and organ transplantation. At the same time, the values of healing and, especially, the saving of life (pikuah nefesh), can be even more powerful. Accordingly, the papers in this section allow and, in fact, encourage, autopsy and organ donation and transplantation in appropriate cases. Contributors include Rabbis Isaac Klein and Joseph Prouser. The final selection reproduces the "Organ and Tissue Donation" pamphlet, with a donor card developed and approved by the Committee on Jewish Law and Standards.
New Challenges - The papers in this section address a variety of contemporary challenges in bioethics. A paper by Rabbis Elliot N.Dorff and Aaron L. Mackler explores "Responsibilities for the Provision of Health Care," while in "Curiouser and Curiouser," Rabbi Avram I. Reisner tackles the genetic engineering of nonhuman life. Finally, Rabbi Seymour Siegel addresses the issue of smoking, examining traditional precedents that mandate the preservation of health and prohibit endangering one's health or assuming excessive risk.

Life and Death Responsibilities in Jewish Biomedical Ethics, edited by Aaron L. Mackler, is available at a cost of $40 plus shipping from JTS Press, 212-678-8842 or jtspress@jtsa.edu.