The Soul of Medicine: Spiritual Perspectives and Clinical Practice

3. Judaism

CHAPTER THREE Judaism Steven C. Schachter, M.D., and Terry R. Bard, D.D. Oath-taking enjoys a long and rich history in human culture. In ancient times, oaths were among the most serious commitments people could make to each other. In ancient Hebrew culture, oaths between Abraham and his slave (Genesis 24:9) and between Joseph and his father, Jacob (Genesis 47:9), exemplify verbal oaths undertaken with physical expressions that underscored their seriousness. Oaths therefore represented a responsibility that one individual had to another . As roles in society evolved, oath-taking by an individual who assumed responsibility for many others became common. The formalization of professions in Greek times led to the creation of professional oaths of responsibility. The Hippocratic Oath for physicians in the fourth century BCE became a model for the declaration of responsibility that physicians “swear” to their fellow physicians and, by extension, to their patients. In Jewish culture, the oldest formal precedent of any oath of responsibility for physicians dates to the sixth century CE and is attributed to Asaph ben Berakhyahu and Yohanan ben Zabda (Sefer ha-R’fuot, or The Book of Medicines ). Another physician’s oath—Daily Prayer of a Physician, or the Prayer of Maimonides—is identified with Moses Maimonides (Moshe ben Maimon; 48 Major Traditions and Medicine 1135–1204), an eminent rabbi, physician, and philosopher of the Middle Ages who wrote extensively on Jewish law and ethics as well as on numerous medical topics. The Prayer of Maimonides may have actually been written by Marcus Herz (1783), a German physician and pupil of the philosopher Immanuel Kant. It first appeared in print in the late 18th century and was introduced into the medical literature in 1917 by Harry Friedenwald (see the appendix to this chapter ). Irrespective of authorship, the Prayer of Maimonides has inspired generations of physicians in their practice of medicine. In this chapter, we—as a Jewish physician (SCS) and a rabbi and medical ethicist (TRB) who have provided medical and pastoral care, respectively, for many years at a hospital founded with Jewish roots—use the Prayer of Maimonides to frame our personal perspectives on key themes in Jewish medical ethics as they apply to the clinical practice of medicine and the conduct of clinical research. Consequently, this chapter is neither a comprehensive treatment of Jewish medical ethics nor necessarily representative of the views generally held by other Jewish physicians, rabbis, and medical ethicists. These views have all been shaped, of course, by centuries of both mystical experience and rabbinical teaching. Insights about Life and Healing Thou hast chosen me to watch over the life and health of Thy creatures. The concept that Jews are a special people, with certain privileges and responsibilities , is a fundamental tenet of Jewish theology. Although the nature of this claim to uniqueness has been understood variously throughout Jewish history and among branches of Judaism, this concept of specialness is common to all and is considered to convey special responsibilities on all Jews to make the world better, l’tikun olam (literally, “restore the world”). In this context, physicians in Jewish culture assume special societal roles and responsibilities. Because the practice of medicine has a theological mandate, serving as a physician is regarded as both a calling and a privilege, perhaps second in prestige only to the rabbinate. Throughout the millennia, Jewish tradition has understood the physician as “God’s right hand” (c. second century BCE, Sefer Ben Sira [the book of Ben Sira]) because of the physician’s responsibilities for the care and preservation of human life. Just as physicians were required to do all Judaism 49 in their power to preserve human life, individuals were required to assume their responsibility to keep out of harm’s way. Jewish law therefore prohibited people from living in towns lacking a physician (Babylonian Talmud, Baba Kama 46a). In the last two centuries, Jewish communities in the United States, beginning with energetic nickel-and-dime fundraising and eventually evolving into equally robust individual and community commitment, have generated substantial financial resources to support the establishment of hospitals with Jewish identities, especially to provide care for Jewish patients along with others and to provide places for Jewish doctors to train. Beth Israel Hospital in Boston , established by the Boston Jewish community in 1916, Michael Reese Hospital in Chicago, Mt. Sinai Hospital in New York and Cleveland, and Cedars Sinai Medical Center in Los...