New Review – Jewish Guide to Practical Medical Decision-Making

Rabbi Ari Kahn • Explorations

Medical Decisions web 1Compassion and Healing

Jewish medical ethics is a robust field, which quickly grows as the medical and scientific inquiry advances. While many volumes have been written on Jewish medical ethics, Jason Weiner’s Jewish Guide to Practical Medical Decision-Making  is unique. Rabbi Weiner has written an excellent and important work from a perspective unlike others who have addressed  this topic. While previous studies have been published by experts in Halacha, or experts in medicine, or experts in ethics. Rabbi Weiner may, in fact, be all of the these, but first and foremost he is a chaplain; he works in a hospital, and deals with patients on a daily basis. While I have studied, taught, and even given psak(halachic rulings) in many of the areas discussed in this book, my involvement is often theoretical. Reading actual cases, and learning from Rabbi Weiner’s experience, sensitivity, and wisdom, is both instructive and invaluable.

One powerful example begins on p.93: Rabbi Weiner describes his interaction with the parents of a child suffering from what turned out to be a terminal illness. These parents  asked if they were permitted to pray for their son’s recovery, and Rabbi Weiner answered in the affirmative. When the illness took their son’s life, the devastated parents criticized the rabbi for allowing them to foster false hope.[1]

The human side of this interaction  left a powerful impression on me. The questions of faith and prayer that it raises transcend both the medical situation and halahic question at hand. Of all the responsa and learned articles on medical ethics I have read, the interaction Rabbi Weiner describes stands out in my mind precisely because it is an authentic human interaction. It illustrates Rabbi Weiner’s experience and humanity, born of his vast experience with patients and their families.

The Jewish Guide to Practical Medical Decision-Making is equally important for professionals and lay people. The latter will find it thought-provoking and insightful on the theoretical level, or as an important resource should they be forced to confront the issues raised by modern medicine. On the other hand, rabbis – even “experts” in this field – will appreciate the topics Rabbi Weiner covers, the primary and secondary literature he cites, and the careful and extensive footnotes and citations.

Beyond these important scholarly and technical elements, The Jewish Guide to Practical Medical Decision-Making is permeated with yirat shamayim.  Rabbi Weiner is not satisfied with merely cataloguing and tallying up all the rabbinic opinions on a given issue,  giving equal weight to obscure and mainstream sources. This volume helps the reader navigate through the literature, balancing true scholarship with reverence for mainstream halachic process and normative Jewish practice.

To achieve this delicate balance, Rabbi Weiner has consulted with leading poskim, experts in the field. The endorsement of Rav Asher Weiss on the back of the book, stating that Rabbi Weiner “sanctifies the name of God on a daily basis” and consults with Rabbi Weiss on complicated cases, does much to refute the adage that one should not judge a book by its (back) cover.

Rabbi Weiner’s book covers a vast number of case studies, each one worthy of lengthy discussion, but  I would like to address one small point regarding the issue of praying for a terminal patient.

The propriety of praying for the death of a patient is discussed by the  Ra”N[2] in his commentary on a passage in gemara Nedarim.[3] In his comments, the Ra”N associates this section with the passage in Ketuvot[4] regarding the death of Rav Yehudah HaNasi. Rabbi Yehuda HaNasi’s maid seeing the agony he was enduring (presumably, she understood that her master’s condition was terminal), prayed for his death. The Ra”N concluded from this passage that it is permissible to pray for the death of a patient who is terminally ill and is suffering.

The Ra”N’s opinion is uncontested; therefore, the Oruch HaShulchan[5] considered this opinion as a precedent.

Rav Moshe Feinstein was hesitant to allow such a prayer. He argued that if the person who had been praying for the patient’s recovery is known to be a “miracle worker” (in other words, someone whose prayers are usually answered), but in this instance their prayers have not been answered, he or she may then pray for the patient’s merciful demise; Rav Moshe adds that such people do not exist in this generation. “Regular” people should not pray for another person’s death, as they are not usually able to intuit God’s will. The irony of this approach is that Rav Moshe thus catapults the anonymous maid of Rebbi, to a status which outflanks all the great sages of this generation, to a status of Rebbi Chanina Ben Dosa. According to Rav Moshe, death should not be prayed for.[6] Presumably, Rav Moshe would prefer, a “pareve” prayer for God to have mercy on the person who is suffering. God alone can decide if the merciful thing is to heal the sufferer or to hasten a compassionate death.[7]

There is, however, a comment by Rashi recorded in the Shita Mekubetzet (who cites a “first edition” of Rashi) that is germane to the discussion of appropriate prayers. The Talmudic passage in Ketuvot about the death of Rav Yehudah HaNasi (Rebbi) states that on the day he died, the rabbis declared that whoever says that Rebbi has died will be stabbed with a sword. Why would this be punishable by death? Rashi explains, that if people learn that Rebbi had died they would stop praying – his death would be a final, immutable fact. But the power of prayer is such that when we do not realize that we are praying for an impossible miracle, the miracle is still possible.[8] We operate in a logical, rational world, but the power of prayer is such that even the impossible is, in fact, possible. In much the same way, the realm of medical ethics is a world of faith which often collides with the world of bitter reality. We remain both believers and rationalists and hope that God performs miracles in the background.

I strongly recommend this work for the important discussions and sources it contains, but also for its kind, informed, compassionate voice, which is an important addition to the genre.

 

Rabbi Ari Kahn is Rabbi of the Mishkan Etrog community in Givat Ze’ev, he teaches in Bar Ilan University and is a member of Vaad Rabbanai Zaka.

Readers are invited to view the original post to read the footnote details

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