Professor Abraham S. Abraham

Director, Internal Medicine B

Shaare Zedek Medical Center

Medical and Halachic Aspects


AIDS, the scourge of our generation is still, fortunately, not as rampant in Israel as in other countries. The latest figures published by the Israeli Ministry of Health (fig. 1 & 2 ) show that most of those affected are homosexuals or drug addicts. However, the increase in the carrier rate, particularly amongst heterosexuals is indeed alarming and certainly matches the trends seen in other parts of the world.

Fig 1: HIV Infection in Israel - April 93

 

AIDS

Seropositive

Total

234

1045

Homosexuals

105

155

IV Drugs

47

125

Blood Products

35(H27)

105(H93)

Heterosexuals

33

332

Unknown

8

296

Children

6

32

(Courtesy of: The Dept. of Epidemiology, The Ministry of Health)

H= hemophiliacs


History is replete with epidemics, many of which resulted in high death rates. However, a pandemic of this nature, usually venereal in origin and so far without exception fatal, has never been encountered. There are, of course, those unfortunate patients (children, hemophiliacs, recipients of infected blood products, etc.) who have also been infected. More than 1500 years ago our Sages described just such a situation.

Rabbi Simlai said: "Wherever you find promiscuity (sexual relations outside that permitted by the Torah), a scourge strikes the world that kills the innocent with the guilty."[i]

Fig 2: HIV Infection in Israel - April 93

 

AIDS

Seropositive

Total

234

1045

Male

217

739

Female

17

217

Unknown

-

89

Died

163

17

(Courtesy of: The Dept. of Epidemiology, The Ministry of Health)


Like any other new challenge in medicine, be it a newly recognized disease, a new instrument, test or medication with its medical & legal problems, we are faced with new halachic questions and problems. AIDS, in particular, abounds with such questions which cover the whole span of life, from before birth to after death. I shall present three halachic problems which Rabbi Y.Y. Neuwirth will then discuss.

Question 1. If a known carrier of the AIDS virus refuses to divulge the fact of his infection to his spouse, is the physician permitted or obligated to inform the spouse?

Background: The prohibition of passing damaging information (lashon hara) about one person to another is pertinent here, since only under special circumstances is this halachically permissible.[ii] The carrier of AIDS has the halachic status of a potential murderer (and this is true even if the person is an innocent victim of the disease) with the spouse as a potential victim.

The Chelkat Yaakov[iii] held that a physician of a patient suffering from cancer whose prognosis is but one year of life, is obligated to inform a fianceé. The Tzitz Eliezer[iv] obligated a physician to tell a potential bridegroom that his bride had no uterus. The Yechave Da'at[v] obligates a physician to inform the appropriate authorities of the epilepsy of a patient who insists on driving. On the other hand, the Iggrot Moshe[vi] held that the father of a girl who has not yet commenced her periods need not divulge this information to her suitor.

It is clear that a patient is obligated to warn all those who may contract the disease from him. However, if the patient refuses to do so is it the duty of the physician to inform the spouse of the patients diagnosis? Furthermore, is it also the physicians responsibility to alert all those who may come into contact with the patients bodily fluids - other physicians, nurses, laboratory, technicians, cleaners - of the diagnosis.

Question 2: In the situation described above has the wife the right to a divorce from her AIDS infected husband? Or may she, on the other hand, opt to accept the risk and continue to live with him? If so, may he use a condom?

The answer of western civilization to the epidemic of AIDS is the condom. Quite apart from the fact that it is only relatively but not absolutely "safe," such a campaign actually gives legitimization to what is halachically totally unacceptable - extramarital sex and homosexuality. Up to 80% of women of a tribe in New Guinea died of Kuru (a fatal neurological disease akin to Creutzfeldt-Jacob's disease), because of their custom of eating the infected brains of family members who died. Children who were involved in the preparation, manually squeezing the brain tissue into bamboo cylinders for cooking, also contracted the disease. The Australian authorities in the mid-50's eradicated the disease by simply banning cannibalism. By today's standards this would of course be unacceptable, because a cannibal lobby might claim this to be an infringement of individual rights. Today perhaps we would give them pressure cookers and free rubber gloves, and lecture them on how to modify the techniques of their "lifestyle" without actually forsaking it![vii]

Question 3: Under which circumstances may one, according to halachah compel an individual to be tested for HIV? When do the responsibility and the rights of the community supercede those of the individual?

 



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7. J Royal Soc Med at: 200, 1987.