Where Does Jewish Teaching Come From? Torah (5 Books of Moses) - - PDF document

12/11/2018 1

Understanding Jewish Religious Values & Their Role In Health Care

A View From Jewish Tradition Rabbi James A. Gibson, Temple Sinai, Pittsburgh, PA

Where Does Jewish Teaching Come From?

 Torah (5 Books of Moses)  Genesis, Exodus, Leviticus, Numbers, Deuteronomy  (compiled from 1850-650 BCE)  Seen as source of God’s authority in the world  Understood by Jews as God’s will for the Jewish people  Contains 613 Commandments knows as mitzvot  Judaism, despite its many streams, sees its mission and integrity in

interpreting and applying these laws to our lives

 These laws cover our relationship to God through ritual and every

conceivable human interchange, from criminal jurisprudence to labor law, from marriage & divorce to how we treat animals

The 3 Parts of our Bible: Torah, Prophets, Writings

 Total of 39 books:  Torah – Genesis, Exodus, Leviticus, Numbers, Deuteronomy  Prophets - Joshua, Judges, I/II Samuel, I/II Kings, Isaiah,

Jeremiah, Ezekiel, Hosea, Joel, Amos, Obadiah, Jonah, Micah, Nahum, Habakkuk, Zephaniah, Haggai, Zechariah, Malachi

 Writings - Psalms, Proverbs, Job, Song of Songs, Ruth,

Lamentations, Ecclesiastes, Esther, Daniel, Ezra, Nehemiah, I/II Chronicles

12/11/2018 2

The Five Books of the Torah Are More Authoritative than All Other Bible Books

 Example of Abortion – The Book of Jeremiah  Jeremiah 1.5 The word of God came to me: Before I created you in the

womb I selected you; Before you were born I consecrated you; I appointed you a prophet concerning the nations.

 This verse is regularly used to infer that the Bible recognizes

personhood of a fetus before birth

 Because the statement is from the Bible it is presumed to have the

highest spiritual authority

 BUT…

Torah’s View Trumps Jeremiah

 Example of Abortion - From the Torah  Exodus 21.22: When men fight, and one of them pushes a pregnant

woman and a miscarriage results, but no other damage ensues, the one responsible shall be fined according as the woman’s husband may exact from him…but if other damage ensues, the penalty shall be life for life…

 Torah law says that a fetus is protected with the threat of a monetary

• fine. A born person is protected with the threat of capital
• punishment. Therefore, fetal life is not equivalent to born life
• utside the womb

How Can The Rest of the Bible Carry Less Weight?

 Only Torah is given in its entirety by God to the Jewish people in a

mass revelation described in Exodus 19

 More than 600,000 individuals at Mt. Sinai were there  God wrote the Mitzvot (Commandments) endowing them with

ultimate authority and perfection

 All other revelations of God’s will are to individuals or small

• groups. Miracles are not revelations

12/11/2018 3

613 Laws of The Torah

 Fulfilling the Mitzvot correctly is the goal of observant Jews – by doing so they

fulfill the will of the Creator of the Universe who gave us Torah as a gift and an

• bligation

 There are (acc. to Rabbinic tradition) 613 commandments/mitzvot in the Torah  248 + commandments (bones in body)  365 – commandments (days of year)  >300 have been null and void since the destruction of the 2nd Temple by the

Romans in 70 CE

 Study of Torah and Talmud for their own sake is a primary religious act in Judaism  Scholars take up the challenge of applying the laws to everyday modern life  Torah’s laws are considered more authoritative for Jews than any other book or

section of the Hebrew Bible – nothing trumps Torah!

Later Rabbis Interpret & Apply the Commandments

 Core Rabbinic literature was composed between 200 BCE-550 CE  It is composed of two main works/disciplines:  Midrash – Interpretation of all Torah verses and the laws contained

within

 Mishnah – Application of Torah laws through reasoning and experience  Talmud – Composed of of Mishnah (200 BCE-200 CE) and the

Gemara (200-550CE)

 There are two Talmuds, one composed in Babylon (Iraq) the other in

the land of Israel (known as the Jerusalem Talmud)

 The Babylonian Talmud is considered the more authoritative of the two

Talmud Discussions Redacted Into Codes

 Core Legal Codes in Judaism  Mishneh Torah by Moses Maimonides (1135-1204)  Shulchan Aruch by Yosef Karo (1488-1575)  Karo’s code refined because of differences between Jewish

practice in Mediterranean countries (Sephardic) and German/Eastern European countries (Ashkenazic)

 Moses Isserles (1522-1572) wrote interlinear notes to show

how Ashkenazi Jews were to follow the laws set out in the Shulchan Aruch

12/11/2018 4

When The Law Isn’t Clear, Ask!

 Rabbis have served as judges on Jewish legal matters for

more than 2,000 years

 Individual rabbinic decisions are known as responsa (sing.

responsum)

 If a traditional Jew is not certain whether an act is

permitted or prohibited or is not sure what course of action accords with the Torah, s/he asks a rabbi who either consults other rabbis or issues his own legal ruling

Who Owns You?

 Clear in Jewish sources from the Torah through the

Talmud that God owns us

 Only God has the authority to gives & take life  Human decisions to end life are illegitimate:

 Murder  Suicide (exceptions?)  Abortion – a very complicated matter! (not for today)

God Creates Humanity By Infusing Breath

 Then the LORD God formed man of the dust of the ground,

and breathed into his nostrils the breath of life; and man became a living soul (Genesis 2.6)

 Breathing is a condition of life  The very word for soul in Hebrew is based on the verb “to

breathe”

 Question: Does breath have to be initiated by the

individual or can it be prompted by machine and still be called human life?

12/11/2018 5

God Ends Moses’ Life By Drawing Out His Breath

 So Moses the servant of the God died there in the land of

Moab, by God’s word (literally: mouth). And he was buried in the valley in the land of Moab over against Beth- Peor; and no man knows of his burial place unto this day. And Moses was a hundred and twenty years old when he died: his eye was not dim, nor his natural force abated. (Deuteronomy 34.1-7)

V’chai Bahem – You Shall LIVE by Them (mitzvot)

 Leviticus 18.5 implies that we should follow the

commandments in order to “live by them”

 This is taken to mean that living is itself a

commandment and we are to use the means of science, medicine and faith to heal and further life

 For example – Normative Orthodox law now prohibits

smoking as it causes premature death. Similarly it would ban illegal drug use or other human habits that might shorten life

 Why? Again, life is from God!

End Of Life

T’reifa – A person “…known for certain that he had a fatal

• rganic disease and physicians say that his disease is incurable

by human agency and that he would have died of it even if he had not been killed in another way.” Goses/Goseset – One who is dying, usually within 3 days of death Physician determines status of patient Rabbi yields to physician on the physical condition of the patient Niftar/Nif-t’ra – One who has died (literally, departed)

12/11/2018 6

Are We Allowed To Hasten Death?

 And so it is forbidden to cause the dead person to die quickly.

Such as one who was dying for a long time and he could not separate, it is forbidden to remove the pillow or the mattress from underneath hum, because they say that there are feathers

• f some birds that cause this, and similarly they should not

move him from his place.

 And similarly it is forbidden to place the keys of the synagogue

under his head, in order that he take leave. But if there is something there that is causing delay in the departure of the soul, such as if there is a banging noise next to that house, such as a wood chopper, or there is salt on his tongue, and these are preventing the departure of the soul, it is permitted to remove it from there, that in this there is no activity at all, rather he removes the barrier. (Shulchan Aruch/Yoreh Deah 339.1)

Responses Of Different Streams: Orthodox

 Orthodox Judaism teaches:  “Any positive act designed to hasten the death of the patient is

equated with murder in Jewish law , even if death is hastened by

• nly a matter of minutes.” Rabbi J. David Bleich, quoted by Fred

Rosner in Modern Medicine and Jewish Ethics, Ktav Publishing, NYC, 1991

 YET…  “However, he is not obligated to employ procedures which are

themselves hazardous in nature and may potentially foreshorten the life of the patient. Nor is either the physician obligated to employ a therapy which is experimental in nature.” (ibid.) “[An act taken] with proper precautions to insure that such decisions are taken seriously...a decision to remove modes of medical intervention from such people in given cases may be taken in good conscience and in consonance with Jewish law, even though such action will lead to their deaths.” (from “A Jewish Approach to End- Stage Medical Care,” Rabbinical Assembly (Conservative Rabbis’ Association, 1991) “If the goses category is to be used to regulate care of the terminally ill, this policy permitting the withdrawal and withholding of aggressive treatments from such patients invokes the Jewish tradition's distinction between sustaining the life and prolonging the death of the

• moribund. The definition of the person to whom it applies (the goses),

however, is broader than most Orthodox rabbis make it- but.. more in keeping with the intent of the tradition.” (ibid.)

Reponses Of Different Streams: Conservative

12/11/2018 7

Responses Of Different Streams: Reform

 “When, however, a patient has entered the final stages of terminal

disease, medical treatments and procedures which serve only to maintain this state of existence are not required. A cancer patient, for example, would accept radiation and/or chemotherapy so long as according to informed medical judgment these offer a reasonable prospect of curing, reversing, or controlling the cancer. Once this prospect has disappeared and the therapies can serve only to increase suffering by prolonging the patient's inevitable death from the disease, they are no longer to be regarded as medicine and may therefore be withdrawn.” (CCAR Responsa- “On The Treatment Of The Terminally Il; 1994)

What About Nutrition & Hydration?

 Orthodox Judaism: “Any positive act designed to hasten the death* of

the patient is equated with murder.” (quoted above, Rabbi J. David Bleich)

 Conservative Judaism: “There are, then, only two arguments which I

can see to justify removal of nutrition and hydration from such patients. One is, if nutrition and hydration are to be categorized as medicine, one might argue that, since they are not curing the patient, they may be removed, as long as we offer normal food and water to the patient, even though we know he or she cannot possibly ingest them…”

 “…even though such a person is not dead by the standards of either

cessation of respiration and circulation or cessation of whole brain function, he or she should be allowed to die. Treatment of such a person, then, including artificial nutrition and hydration, should, in his

• pinion, be considered optional.” (ibid.)

 *Death defined as based on respiration and circulation

What About Nutrition & Hydration?

 Reform Judaism: “Does there not come a point in a patient's condition

when, despite their obvious life-saving powers, the sophisticated technologies of modern medicine--the mechanical respirator, for example, or the heart-lung machine--become nothing more than mere "salt on the tongue," mechanisms which maintain the patient's vital signs long after all hope of recovery has vanished?” (Ibid)

 “Answering "yes" to this question, some contemporary poskim allow

the respirator to be disconnected when a patient is clearly and irrevocably unable to sustain independent heartbeat and respiration. Even though the machine is considered part of routine medical therapy (for patients are as a matter of course connected to it during emergency-room and surgical procedures), it has at this juncture ceased to serve any therapeutic function. They can no longer aid in the preservation or prolongation of life.” (Ibid)

12/11/2018 8

Nutrition & Hydration (cont.)

 Once their therapeutic function is exhausted, the

machines "merely prolong in an artificial way the process

• f dying. We must disconnect the patient from the

machines, leaving him in his natural state until the soul departs.”

Persistent Questions

 If God is author of life, what is the role of medicine in

prolonging it?

 If we are stewards of life (cf. Gen 1) how can we evade

• ur responsibility to nurture life?

 Does nurturing life as a gift of God mean all life is good

and necessary and must be maintained despite pain, hardship and cost?

 Who do hospital workers speak to about this in the Jewish

tradition?

Conclusions

 Life is a positive good, a gift from God – except when it isn’t  We are not required to do something medically because it is possible –

it must benefit the patient

 Religious teaching anchors our difficult, modern decision-making in

time honored values and thought. We do not stand alone, rather on the shoulders of the greats who wrestled with these issues before us

 We carry the burden of free will and our intentions matter greatly in

life-threatening situations

 Certainty is an ideal not attainable in most end-of-life situations