BOOK REVIEW: JEWISH GUIDE TO PRACTICAL MEDICAL DECISION-MAKING

Reviewed by Devorah Talia Gordon • 

Medical Decisions web 1

When asked to review Rabbi Jason Weiner’s book, Jewish Guide to Practical Decision-Making, I hesitated. Surely my editor had asked the wrong writer. Having almost no medical or halachic knowledge, I imagined the read would be akin to the obligatory earth science class I took as an undergrad, where I struggled to retain even the most basic information to get a “C” in the class. Gratefully, reading this book was nothing like that experience.

As the Senior Rabbi and Director of the Spiritual Care Department at Cedars-Sinai Medical Hospital, Rabbi Weiner has helped numerous patients and their families with the highly sensitive issues raised in this book. Rabbi Weiner brings this vast experience in chaplaincy, along with his compassion, knowledge, and humility, to present a work that is not only a wellspring of vital information on contemporary healthcare, but a source for learning medical issues and the intricacy of halachah when interacting with those issues. The book, filled with real-life scenarios Weiner faced at Cedars, is intended for many types of individuals – from laymen, to patients and clinicians, to rabbinic scholars.

Weiner’s goal is “to provide an introduction to the general principles relevant to each issue and the essential questions that must be asked by laypeople in order to productively move towards a resolution to each situation.” Further, he hopes that the information in the book will help medical professionals understand the needs of the observant Jew.

Although Weiner defines this book as an introduction, I found each chapter rich in its content and detail. The more I explored each topic presented, the more intrigued I became. Such issues as “Truth-Telling: When Painful Medical Information Should and Should Not Be Revealed”; “Palliative Care and Hospice in Jewish Law and Thought”; and “Is Prayer Ever Futile? On the Efficacy of Prayer for the Terminally Ill,” are explored in an accessible yet intelligent style. Each chapter is complete with copious endnotes, giving sources and explanations for those who wish to delve deeper into the topics (which I even found myself doing).

In this work, of course, Weiner addresses the highly controversial issues surrounding the end of life. After reading his discussion of the topic, I could grasp words and concepts I’d previously heard but barely understood, such as DNR, Advance Directives, and “Terminal” (what does that mean according to Jewish Law?). For example, Rabbi Weiner does a fine job explaining the difference between withholding vs. withdrawing treatment for patients, including the various halachic opinions with intubating and extubating from a ventilator. I was also quite impressed with the sensitive chapter on mental illness, and Rabbi Weiner’s elucidation on the Jewish approach: “Just like one should not be ashamed when they are stricken with a physical malady, mental illness is an illness like any other, which can be treated and for which there need not be a stigma.” Weiner goes on to discuss pertinent issues in therapy like lashon ha-rayichud, and obsessive-compulsive disorder.

A fascinating case study Rabbi Weiner explores is an increasing popular innovation called TAH (Total Artificial Heart). This electronic device which serves as a mechanical substitute for the entire heart, carries both “wonderful potential as well as perplexing ethical dilemmas.” Rabbi Weiner elucidates on some of the halachic issues involved, such as what happens when the “heart” continues to beat but the body is failing? Although this is a brief study of the topic, Weiner includes a whopping 55 endnotes just on this topic!

The final third of the work focuses on such current topics as physician-assisted suicide, after death, the loss of a baby or fetus, organ donation, autopsies, genetic testing, and reproductive technology. Again, each topic is handled with care and extreme sensitivity, and it is obvious that a vast amount of research went into producing this substantive work.

What this reviewer most appreciated was the fact that the author’s personality came through while he delved into intricate medical and halachic issues. This made the work highly engaging. Rabbi Weiner’s compassion for those with whom he works, and really all people, is palpable as he explains his role as chaplain: “Attempting to balance my role as serving as an advocate for patients and their values at the same time that I remain a full member of the interdisciplinary healthcare team is complex, but it is also a privilege – and quite an opportunity, when done right, for positive influence and kiddush Hashem (sanctification of God’s name).”

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