The Practitioner’s View
Professor Jonathan Halevy
Director – Shaare Zedek Medical Center
The Practitioner’s View
Justice Menachem Elon, Mr. Chaim Kahn, honored members of the Council;
I serve this hospital in two capacities: as Director General, and as head of a department of internal medicine. There is no need to elaborate on the importance of this symposium, which is devoted to the analysis of ethical questions, but I would like to share with you some of the ethical problems which have arisen here in the hospital over the last three days alone.
As Director of the hospital, I was called upon to decide whether to approve the administration of a medication costing about $20,000. The medication was destined for a single patient. According to medical literature there is a 20% chance that this medication will improve that patient's health. Here we confront the ethical issue of priorities in allocation of limited resources. Hospital administrators stand at the forefront in dealing with issues of this nature.
People joke and say that every physician today requires a lawyer as a constant escort. I have the feeling that every physician, or at least every hospital administrator, should have an in-house ethicist. So let me be the first to congratulate you on convening this professional symposium dealing in depth with ethical issues on the basis of both Jewish halacha and modern medicine.
As head of internal medicine, over the last couple of days I have had to deal with a patient diagnosed as carrying the AIDS virus. The patient stubbornly refused to allow his wife to be informed. Am I to tell her or not?
Another question arose: Should a 68 year old patient be informed that his liver disease had developed to the point where he requires a transplant? Although according to dry medical literature his age makes him an unlikely candidate for the procedure. But there have been numerous cases of successful transplantation at his age. Do we have the right to deny the patient a transplant? Should we tell him all the facts? Should he be counseled to undergo the transplant? What is our obligation in terms of the allocation of resources?
An additional problem I encountered in my department involved a patient suffering from abdominal pain, who has been hospitalized for a long time for observation. By a process of elimination we concluded that his problem is psychiatric. The patient refused to accept this diagnosis and consequently refused to see a psychiatrist. Instead he placed the blame on us. Here, too, there is an ethical question: can we force him to see a psychiatrist when it is our professional opinion that he could benefit from psychiatric care?
These a just a few of the ethical problems which I have encountered during the last seventy-two hours; problems created by modern medicine. Without involvement and input by ethicists, halachists and physicians, the daily functioning of the hospital would be impossible.
In view of this I am proud to serve as Shaare Zedek's Director General. I am sure that the guests who have gathered here from all over the world, who deal with these problems in their own countries and in their own capacities, will agree that the Falk Schlesinger Institute is one of the world's leading centers for halachic-medical research. I believe that most of the leaders in the field of medical ethics, and especially Jewish medical halacha, are present here today. Therefore I am proud to represent an institution which, together with the Albert Einstein School of Medicine in New York and the Schlesinger Institute, is sponsoring this symposium in order to deal with many of the specific problems which I have recently encountered.
I would like to congratulate all those who have worked so hard to make this symposium possible: first and foremost Professor Dov Hyman, who joined us twenty years ago as a new immigrant after having retired in New York. Since then he has faithfully served Shaare Zedek as a leading dermatologist and as a founder of the field of dermatopathology, as a rabbinical scholar, and as a researcher in the field of medical ethics. Professor Hyman is the chairman of the scientific committee for this symposium.
I would also like to congratulate Rabbi Dr. Mordechai Halperin who, in addition to contributing continually to the research of the Schlesinger Institute, has played a central role in planning this conference. The list of all those who have helped in preparing this event is too long to enumerate here, so I have named only those who headed the steering committee.
I would also like to pay tribute to Mr. Chaim Kahn, a public figure who serves on the Board of Directors of Shaare Zedek as well as on our Executive Committee. Mr. Kahn initiated this symposium and its preparations, and is largely to thank for its success. Last but not least, the funding body behind many of those activities of this Medical Center not directly involving the treatment of patients. One of our proudest achievements is, thank G-d, our relative self-sufficiency in financing the medical treatment of our patients. But all matters touching on development or construction work – whether in new medical departments or in auditoriums such as this one – are made possible by generous friends throughout the world. Mr. Moshe Talansky, who is sitting with us on the podium, is the Chairman of the American Friends of Shaare Zedek, our source of funding for this symposium.
May you all be richly rewarded for your efforts, and may we all enjoy a successful and fruitful conference.