Dear Rabbi Fried,
As the debate rages throughout the country about President Obama’s proposed health care reform, all the discussion I’ve heard has been about finances vs. individual rights. Is there a religious or Jewish perspective on this question?
Martin Feldstein, Harvard professor and chairman of the Council of Economic Advisers under President Reagan, points out in his Wall Street Journal article of Aug. 19 that President Obama’s proposal is all about rationing. Rationing health care gives rise to numerous moral and religious issues.
On Aug. 18, the Agudath Israel, a national Orthodox organization, addressed a letter to President Obama and members of Congress, adding a new dimension to the debate over health care policy. Some of the points they made are the following: The conviction that the preservation of life and the promotion of good health and well-being are religious imperatives that emanate from the inherent sanctity of human life. This is a perspective shared by millions of Americans of all faiths. Any given policy proposal may have a tremendous impact on the religious freedoms of patients and providers.
Any medical decision making outside the doctor-patient relationship is inherently problematic. The further removed the decision maker, the more of concern their involvement becomes. It becomes even more disquieting when these decisions depend upon a government official’s understanding of the “quality of life” as a yardstick of whether or not to approve a given treatment. The “cost-benefit ratio” of a particular treatment, to be decided by anyone other than the doctor/patient, entails definitions which may greatly compromise the moral or religious beliefs of those involved.
Government policymakers will arrive at their decisions based upon broad, generalized notions of public policy. They will certainly assess the relevant medical factors. They will look at the social and economic implications. They will weigh overall costs and benefits. But what of other considerations that are normally part of a patient’s deliberations? How, for example, will a patient’s religious and moral beliefs figure in on the decision to provide medical treatment?
That this potential conflict is relevant and critically important to Jews can readily be seen. Jewish tradition places great emphasis on the preservation of human life, which retains its sanctity even under the direst of medical circumstances. As such, Jewish law may require medical interventions that others might not regard as “quality-enhancing” or “cost-effective.” This could lead to a severe abridgment of a Jew’s ability to engage in the free exercise of religion. It could affect religious health providers as well, who may be called upon to perform “cost-effective” or other procedures which they consider morally or religiously objectionable.
Respect for a patient’s religious conviction is far from foreign to the law. Most states have provisions for a range of religious accommodations that cover such medical issues as DNR orders, health care proxies, determination of death, autopsies/dissections and anatomical gifts. Will these provisions be present when they would override the “cost-effectiveness” of a given procedure?
For the full text of the letter and further comments, contact Rabbi Avi Shafran: firstname.lastname@example.org.
Perhaps in next week’s column we will discuss some of these issues in more detail. (I find it interesting that President Obama, in his recent pre-holiday conference call to rabbis on the subject of health care, failed to invite the entire Orthodox rabbinate. Like his meeting with Jewish leaders on the subject of Israeli settlements, he seems inclined to invite only those who share his views on the subject at hand.)
Rabbi Yerachmiel D. Fried, noted scholar and author of numerous works on Jewish law, philosophy and Talmud, is founder and dean of DATA, the Dallas Kollel. Questions can be sent to him at email@example.com.
Dear Rabbi Fried,