Jewish biomedical ethics and care of the AIDS patient

Jewish biomedical ethics form part of the broader Judeo-Christian ethical system that prescribes appropriate social conduct for most Americans. They are based on law(halachah) that is derived from the Hebrew Bible and its interpretations. The principle on which they center is that every person is sanctified by God and therefore of infinite value. Therefore, every effort must be made to preserve and protect human life. The management of the patient with AIDS engenders many problems of an ethical nature. An appreciation of the Judaic solutions to these problems may assist physicians caring for patients with AIDS in making their management decisions.     

Paying for medical care: a Jewish view

According to Jewish law, there is a clear obligation to try to heal, and this duty devolves upon both the physician and the society. Jewish sources make it clear that health care is not only an individual and familial responsibility, but also a communal one. This social aspect of health care manifests itself in Jewish law in two ways: first, no community is complete until it has the personnel (and, one assumes, the facilities) to provide health care; second, the community must pay for the health care of those who cannot afford it as part of its provision for the poor. The community, in turn, must use its resources wisely, which is the moral basis within the Jewish tradition for some system of managed care. The community must balance its commitment to provide health care with the provision of other services.     

Codes of medical ethics and the exportation of less-than-standard care

Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a "local" standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved.     

Comradery,community, and care in military medical ethics

Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds.     

Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

Jewish bioethics and medical genetics

Man has been aware of the science of genetics, i.e, how living things transport heritable traits to their offspring, since biblical times. However, knowledge regarding genetic disorders has increased greatly in recent years. Advances have been made with respect to both the methodology of genetic diagnosis and the treatment of genetic diseases. Both Jewish and secular ethicists, in general, approve of new genetic diagnostic techniques and genetic therapy if the risk/benefit ratio is favorable for humankind. However, all medical ethicists are still struggling with the ethical question: “To what extent should we tamper with the process of natural selection?”     

Feminist directions in medical ethics

I explore some new directions—suggested by feminism—for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed—e. g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. “Crisis issues” currently dominate medical ethics, to the neglect of what I call “housekeeping issues.” The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select—and neglect—to study as well as the “games” we play may be sending a message as loud as the words we do speak on ethics.     

Education as ethics: Emmanuel Levinas on Jewish schooling

For Levinas, the moment of real meaning is in the relation sustained with alterity. This relation is difficult or impossible to characterize philosophically, however, because to render it in comprehensive or objective terms would reduce the relation to one of comprehension and make it commensurate with the ego. Thus philosophy has an ambivalent status with respect to transcendence and ethics; but Levinas is convinced of the essentially transcendent or ethical meaning of Judaic practice: Talmudic exegesis, but also Jewish ritual and the keeping of the sabbath; and these elements are included within a conception of Jewish educational practices. Thus to what extent transcendent meaning can be discussed in philosophical terms and evinced in philosophical work (theoretical and practical)—or rather, to what extent transcendent meaning is possible at all—may be clarified by a sketch of Levinas’ broad approach to Jewish practice, particularly in terms of education. This essay shows how Jewish education is essential for transcendence and ethics for Levinas. Reference is made to several untranslated texts that Levinas published for intellectual but nonacademic French-Jewish journals, in which he explains his own pedagogical vocation. This offers an invaluable perspective on his philosophical and Judaic writings; and above all it gives an indication of his vision of the quotidian and life-long educational practices through which ethics and the transcendent relation between human beings are possible. Finally it raises the question of whether a secular or philosophical education could offer this as well.     

The Jewish patient in a non-Jewish hospital

The healing of the sick is a jewish religious precept. The present paper discusses the special needs of a hospitalized Jewish patient, describes a Jewish Patient's Bill of Rights, and suggests that the needs of Jewish patients, such as kosher food and religious services in a hospital environment, be provided wherever possible.     

The ethics of everyday practice in primary medical care: responding to social health inequities

Background  

Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.