Respecting bodies and saving lives: Jewish perspectives on organ donation and transplantation

Cambridge Quarterly of Healthcare Ethics

Volumn 10, Issue 4, 2001, Pages 420-429

  Mackler, Aaron L ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HUMAN; ORGAN TRANSPLANTATION; RELIGION; SOCIOECONOMICS; UNITED STATES;

HUMAN; JUDAISM; ORGAN PROCUREMENT; ORGAN TRANSPLANTATION; RELIGION AND MEDICINE; UNITED STATES; VALUE OF LIFE;

EID: 0035538818     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180101004066     Document Type: Article

References (50)

1. 1. Each movement is complex and includes a broad range of stances. For Orthodoxy, Jewish teaching and Jewish law are essentially unchanging. Although new situations may call for thoughtful application of past precedents, Orthodox leaders tend to emphasize the need for caution and a desire to minimize change. Reform Judaism originated with a sense that, as Judaism changed radically in the past, radical changes are called for by modern developments. Throughout the history of Reform Judaism, autonomy has been central to the articulation of Jewish ethics (see Borowitz EB. Exploring Jewish Ethics. Detroit: Wayne State University Press, 1990:22-5, 176-92). The Conservative movement seeks to balance tradition and change. It would agree with Orthodoxy that Jewish law (halakhah) plays a definitive role in Jewish life and Jewish ethics but would see halakhah as developing over time. Moreover, although halakhah is central, significant weight is given to general ethical values and to each individual's autonomous conscientious judgment. For further discussion, see the Introduction to Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, Finkelstein Institute, 2000:1-14.
2. 1. Each movement is complex and includes a broad range of stances. For Orthodoxy, Jewish teaching and Jewish law are essentially unchanging. Although new situations may call for thoughtful application of past precedents, Orthodox leaders tend to emphasize the need for caution and a desire to minimize change. Reform Judaism originated with a sense that, as Judaism changed radically in the past, radical changes are called for by modern developments. Throughout the history of Reform Judaism, autonomy has been central to the articulation of Jewish ethics (see Borowitz EB. Exploring Jewish Ethics. Detroit: Wayne State University Press, 1990:22-5, 176-92). The Conservative movement seeks to balance tradition and change. It would agree with Orthodoxy that Jewish law (halakhah) plays a definitive role in Jewish life and Jewish ethics but would see halakhah as developing over time. Moreover, although halakhah is central, significant weight is given to general ethical values and to each individual's autonomous conscientious judgment. For further discussion, see the Introduction to Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, Finkelstein Institute, 2000:1-14.
3. 2. Maimonides M. Mishneh Torah. Deot ch. 3-4; Rosner F. Modern Medicine and Jewish Ethics, 2d ed. Hoboken, N.J.: Ktav, 1991:5-19; Mackler AL. Judaism, justice, and access to health care. Kennedy Institute of Ethics Journal 1991;1:143-61.
4. 2. Maimonides M. Mishneh Torah. Deot ch. 3-4; Rosner F. Modern Medicine and Jewish Ethics, 2d ed. Hoboken, N.J.: Ktav, 1991:5-19; Mackler AL. Judaism, justice, and access to health care. Kennedy Institute of Ethics Journal 1991;1:143-61.
5. 2. Maimonides M. Mishneh Torah. Deot ch. 3-4; Rosner F. Modern Medicine and Jewish Ethics, 2d ed. Hoboken, N.J.: Ktav, 1991:5-19; Mackler AL. Judaism, justice, and access to health care. Kennedy Institute of Ethics Journal 1991;1:143-61.
6. 3. Feldman DM. Health and Medicine in the Jewish Tradition. New York: Crossroad, 1986:15-21.
7. 4. One classical narrative depicts two rabbis as offering medical advice, only to have the patient accuse them of interfering with God's will of making the patient ill. The rabbis asked the man, a farmer, why he interfered with the God-given state of his vineyard by fertilizing and weeding. When he responded that crops would not grow well without human care, the rabbis replied: "Just as plants, if not weeded, fertilized, and plowed, will not grow and bring forth fruits, so with the human body. The fertilizer is the medicine and the means of healing, and the tiller of the earth is the physician" (Midrash Temurah, translation based on note 3, Feldman 1986:16). See similarly: Bleich JD. The obligation to heal in the Judaic tradition: a comparative analysis. In: Rosner F, Bleich JD, eds. Jewish Bioethics. New York: Sanhedrin, 1979:20-8.
8. 4. One classical narrative depicts two rabbis as offering medical advice, only to have the patient accuse them of interfering with God's will of making the patient ill. The rabbis asked the man, a farmer, why he interfered with the God-given state of his vineyard by fertilizing and weeding. When he responded that crops would not grow well without human care, the rabbis replied: "Just as plants, if not weeded, fertilized, and plowed, will not grow and bring forth fruits, so with the human body. The fertilizer is the medicine and the means of healing, and the tiller of the earth is the physician" (Midrash Temurah, translation based on note 3, Feldman 1986:16). See similarly: Bleich JD. The obligation to heal in the Judaic tradition: a comparative analysis. In: Rosner F, Bleich JD, eds. Jewish Bioethics. New York: Sanhedrin, 1979:20-8.
9. 5. The rabbis of the Talmud (Yoma 85b) found a basis in a passage from the Book of Leviticus (18:5), "You shall observe my statutes and rules, which a person should do, and should live by them." As the Talmud interpreted: one should live by the commandments, and not die by them. All references in this paper to the Talmud refer to the Babylonian Talmud.
10. 6. Talmud, Yoma 82a-3a, Sanhedrin 74a.
11. 7. Talmud, Sanhedrin 37a (Mishnah Sanhedrin 4:5). This passage may be familiar to readers from its use in the movie Schindler's List.
12. 8. Nahmanides M. Torat Ha'adam. In: Reisner AI. Care for the terminally ill: halakhic concepts and values. In: Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, Finkelstein Institute, 2000:239.
13. 8. Nahmanides M. Torat Ha'adam. In: Reisner AI. Care for the terminally ill: halakhic concepts and values. In: Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, Finkelstein Institute, 2000:239.
14. 9. Klein I. A Guide to Jewish Religious Practice. New York: Jewish Theological Seminary of America, 1979:270-82; Lamm M. The Jewish Way in Death and Mourning. New York: Jonathan David, 1969.
15. 9. Klein I. A Guide to Jewish Religious Practice. New York: Jewish Theological Seminary of America, 1979:270-82; Lamm M. The Jewish Way in Death and Mourning. New York: Jonathan David, 1969.
16. 10. See similarly the view of Protestant thinker William F. May. "While the body retains a recognizable form, even in death, it commands the respect of identity. No longer a human presence, it still reminds us of that presence which was once utterly inseparable from it" (Religious obstacles and warrants for the donation of body parts. Transplantation Proceedings 1988;20[1]Suppl.:1081).
17. 11. Mekhilta, Bahodesh, ch. 8. Cited in: Zohar NJ. Alternatives in Jewish Bioethics. Albany: State University of New York, 1997:92.
18. 12. Talmud, Sanhedrin 46b. The translation is that of note 11, Zohar 1997:124.
19. 13. Steinberg A, ed. Encyclopedia of Jewish Medical Ethics, Vol. 2. Jerusalem: Schlesinger Institute, 1991:219-22, and sources cited therein; see note 2, Rosner 1991:279-99, and sources cited therein;
20. Unterman IY. Shevet Mi'yehudah, Vol. 1. Jerusalem: Mosad Harav Kook, 1955:313-22 (all Orthodox);
21. Klein I. Responsa and Studies in Jewish Law. New York: Ktav, 1975:126-7 (Conservative);
22. Jacob W. American Reform Responsa. New York: Central Conference of American Rabbis, 1983:288-96 (Reform).
23. 14. See note 13, Klein 1975:126, Steinberg 1991:220-1.
24. 15. See note 13, Steinberg 1991:222.
25. 16. See note 13, Steinberg 1991:227-9, Unterman 1955, Klein 1975, Jacob 1983.
26. 17. Feinstein M. Iggerot Moshe. New York: Moriah, 1973:
27. Yoreh De'ah 2(174):294; see note 13, Steinberg 1991:221-2;
28. Prouser JH. Hesed or hiyuv? the obligation to preserve life and the question of post-mortem organ donation. In: Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, Finkelstein Institute, 2000:446-70.
29. 18. Prouser JH, ed. Organ and tissue donation card. In: Mackler AL, ed. Life and Death Responsibilities in Jewish Biomedical Ethics. New York: Jewish Theological Seminary of America, 2000:473.
30. 19. Feinstein M. Halakhic ruling on heart transplantation. Hapardes 1969;43:4.
31. 20. Talmud, Yoma 85a. One reason for this primacy was practical, for breathing was the surest way to ascertain death in ancient times. Also, biblical support was found in the Book of Genesis (7:22), which describes Noah's flood as causing the death of "all in whose nostrils was the breath of life." The Book of Genesis (2:7) also portrays God as bringing Adam to life by breathing life into him. See note 3, Feldman 1986:103; note 2, Rosner 1991:266-8;
32. Bleich JD. Contemporary Halakhic Problems, Vol. 4. Hoboken, N.J.: Yeshiva University Press, Ktav, 1995:336-42.
33. 21. See note 2, Rosner 1991:263-77; Jakobovits Y, trans. [Brain death and] heart transplants: the [Israeli] chief rabbinate's directives [brackets original]. Tradition 1989;24:1-14; Dorff EN. Choosing life: aspects of Judaism affecting organ transplantation. In: Youngner SJ, Fox RC, O'Connell LJ, eds. Organ Transplantation: Meanings and Realities. Madison: University of Wisconsin Press, 1996:173.
34. 21. See note 2, Rosner 1991:263-77; Jakobovits Y, trans. [Brain death and] heart transplants: the [Israeli] chief rabbinate's directives [brackets original]. Tradition 1989;24:1-14; Dorff EN. Choosing life: aspects of Judaism affecting organ transplantation. In: Youngner SJ, Fox RC, O'Connell LJ, eds. Organ Transplantation: Meanings and Realities. Madison: University of Wisconsin Press, 1996:173.
35. 21. See note 2, Rosner 1991:263-77; Jakobovits Y, trans. [Brain death and] heart transplants: the [Israeli] chief rabbinate's directives [brackets original]. Tradition 1989;24:1-14; Dorff EN. Choosing life: aspects of Judaism affecting organ transplantation. In: Youngner SJ, Fox RC, O'Connell LJ, eds. Organ Transplantation: Meanings and Realities. Madison: University of Wisconsin Press, 1996:173.
36. 22. See note 2, Rosner 1991:268-9; note 20, Bleich 1995:316-50.
37. 23. Truog RD. Is it time to abandon brain death? Hastings Center Report 1997;27(1):29-37.
38. 24. Waldenberg EY. Tzitz Eliezer. Jerusalem: n.p., 1990;17:144.
39. 25. Bleich JD. Halakhah, brain death, and organ donation: an interview with Rabbi J. David Bleich. Jewish Review 1989;3(2):12. This argument was rebutted by Rabbi Moshe David Tendler in Halakhic death means brain death. Jewish Review 1990;3(3):20.
40. 25. Bleich JD. Halakhah, brain death, and organ donation: an interview with Rabbi J. David Bleich. Jewish Review 1989;3(2):12. This argument was rebutted by Rabbi Moshe David Tendler in Halakhic death means brain death. Jewish Review 1990;3(3):20.
41. 26. In discussing the permissibility of autopsies, Yehudah Leib Graubart argued that to refuse to allow autopsies of Jews in appropriate cases would result in hillul Hashem. "In order that it not be said that Jews are not interested in saving lives, and do not care about the improvement of endangered patients, there is great reason to permit it" (Responsa Havalim Ban'imim. Jerusalem: Feldheim, 1975, reprint;3:125, no. 64).
42. 27. Gillman N. The Death of Death: Resurrection and Immortality in Jewish Thought. Woodstock, Vt.: Jewish Lights, 1997:227, 262, 215-74.
43. 28. Saadia Gaon. The Book of Beliefs and Opinions, 7.1. Rosenblatt S, trans. New Haven, Conn.: Yale University Press, 1948:264. This passage is discussed by Dorff; see note 21, Dorff 1996:179-80.
44. 29. Popular tales in earlier centuries could imagine spirits of the newly dead being concerned with the clothing worn by the corpse in the grave. See note 21, Dorff 1996:176.
45. 30. Peters T, Kittur DS, McGaw LJ, First MR, Nelson EW. Organ donors and nondonors: an American dilemma. Archives of Internal Medicine 1996;156:2422. Religious considerations generally were not responsible for these attitudes.
46. 31. See note 2, Mackler 1991.
47. 32. See note 30, Peters et al. 1996:2421, 2419.
48. 33. Caplan AL. If I Were a Rich Man Could I Buy a Pancreas? And Other Essays on the Ethics of Health Care. Bloomington: Indiana University Press, 1992:158-77.
49. 34. Evans RW. Organ procurement expenditures and the role of financial incentives. JAMA 1993;269:3113-8; Sloan FA. Organ procurement: expenditures and financial incentives. JAMA 1993;269:3155-6.
50. 34. Evans RW. Organ procurement expenditures and the role of financial incentives. JAMA 1993;269:3113-8; Sloan FA. Organ procurement: expenditures and financial incentives. JAMA 1993;269:3155-6.