Dr. Ram Yishai
Chairman of the Israel Society for Medical Ethics
The Welfare of the Individual and the Needs of Society
Many people look for an explanation regarding the renaissance of medical ethics in our times. Some find it in disappointment with technical progress and the hyper-specialization. Others believe that the same progress which has provided us with such efficient tools has also posed new problems in the fields of life and death, procreation and infertility and the status of the fetus.
Undoubtedly, Nazi doctors who sacrificed human dignity on the altar of so-called medical research has also been a factor. Their slogan was “truth is truth regardless of the source.”
In reaction came the declaration of Helsinki, which is the corner stone of the World Medical Association. The substance of this declaration being to prevent the use of human beings for purposes other than for their own benefit. Research under unethical conditions was not previously uncommon, but there had never been a movement to exterminate a segment of the population. It was considered moral to eliminate people thought of as not worthy of living. The medical profession cooperated with the state in Germany, and the state, not medicine, decided if you were a person.
It is hard to understand how this atrocious movement carried the large part of the medical profession, who after the war resumed their careers. It took more than forty years for German physicians to begin to discuss the role of physicians in the atrocities of the Nazis. The majority of the medical profession in Germany has shown no interest in the discussion and the German Medical Association finds no fault in the election of physicians who held high professional positions in the Nazi movement.
We hope that this behavior was the consequence of factors that will never repeat themselves. Yet we have learned that we have to be alert not to allow such phenomena to happen again; we need clear-cut guidelines.
Today's worry is of the increasing involvement of government and society in the affairs of the individual. Even in democratic countries, this involvement has developed under the slogan of the good of the public. Halacha requires us to care first and foremost for the welfare of the individual. Thus we understand the maxim in Sanhedrin 37a, “he who saves one sole creature is regarded as if he has saved an entire world.”
The power of society over the patient as an individual appears in two aspects. The first lies in the violation of the individual’s privacy. The other, more serious aspect stems from the problems inherent in the allocation of limited resources for health and the need to set priorities. We are compelled to discriminate between blood and blood. The weaker groups in society which require more medical care are in fact receiving less care than should be expected. Most vulnerable are the elderly, especially those on the border of mental illness, retarded children, the chronically ill, and all of those once referred to as “useless eaters.”
A new phenomenon is the accusation that the sick have brought their problems upon themselves due to their life style. This argument is not limited to AIDS patients and drug abusers, but is also applied to patients with lung disease due to smoking and patients with liver disease due to heavy drinking. There is a tendency not to provide care for cardiacs who have not kept to a sensible diet or the right regime.
We physicians have to consider every patient as a suffering human being who needs support and help. The physician is ordered to care, to try to cure, or at least alleviate pain. Even though the halacha orders every person to safeguard his own life, in no case does it release society or the physician from the duty to take care of him. The Jewish physician does not need ancient oaths in order to obey the divine commandment to prolong life, to heal and to alleviate pain.
I congratulate Shaare Zedek, together with the Albert Einstein College of Medicine for carrying out this International Conference. I welcome all the participants and the distinguished guests and I wish you all fruitful deliberation.