A Moral Guide to Medical Breakthroughs

Rabbi Mark Washofsky is professor of Rabbinics at HUC-JIR in Cincinnati, chair of the CCAR’s Responsa Committee, and author of Jewish Living: A Guide to Contemporary Reform Practice (URJ Books & Music, 2010). He was interviewed by the RJ editors.


RJ
: According to Jay Walker, social networks will be a continuous presence in which family members and friends will be “on the network” at all times automatically. What are the ethical implications of this technology from a Jewish perspective?

Rabbi Mark Washofsky: One question immediately comes to my mind. To the extent that these social networks will keep us “online all the time,” will they completely obliterate what’s left of our privacy? Jewish law in its classic expression (halachah) does not speak explicitly of a “right” to privacy, but this right is implied, for example, in the prohibition against r’khilut and l’shon hara (slander and gossip) and the protection this affords us against hezek r’iyah, damage caused by prying eyes. And what becomes of k’vod hab’riyot, basic human dignity, when our lives become a 24/7 open book—or should I say an open e-book ? While we don’t yet have firm and fixed answers to these questions, such traditional Jewish values help to frame the discussion we need to have in community.

RJ: Embryonic stem cell researchers, such as Dr. Doris Taylor, have been accused of “playing God.” Do you agree with Dr. Taylor that it’s immoral not to use this tool for healing?

Rabbi Washofsky: Dr. Taylor’s response is consistent with Jewish ethical teachings. Because In Vitro Fertilization—the process through which fertilized embryos are created—helps infertile women conceive a biological child, it is both a cure for infertility and promotes the mitzvah of childbearing. Admittedly, to increase the chances of successful conception, IVF involves fertilizing many “eggs” not implanted in the womb, which often results in the disposal of these embryos. From a Reform perspective, however—and there are Orthodox rulings to this effect as well—as long as IVF itself is judged to be a legitimate medical therapy, discarding the remaining embryos or using them in scientific research is morally justified as a necessary, if unintended, consequence of promoting life.

As for “playing God”—the arrogating of powers for ourselves that lie beyond the scope of legitimate human authority—that is not what we are doing when we are engaged in the practice of healing. Jewish tradition clearly defines the practice of medicine as a mitzvah —a religious obligation—and teaches that the duty of pikuach nefesh (to save a life) overrides virtually every other mitzvah. Thus, we are doing precisely what the Torah wants us to do.

RJ: Now that scientists have the ability to alter the genetic structure of humans in order to improve their biological makeup, what limits would Reform Judaism impose?

Rabbi Washofsky: While genetic engineering offers us the hope that we might correct hereditary defects or enhance mental and physical abilities, we need to ask: Is it proper for humans to assert dominance over the genetic characteristics of life forms we did not create?

On the one hand, the Torah declares: “You shall not let your cattle mate with a different kind [kilayim]; you shall not sow your field with two kinds of seed [kilayim]; you shall not put on cloth from a mixture of two kinds of material [kilayim shaatneiz]” (Lev. 19:19). From this perspective, mixing or altering species may be akin to suggesting that God’s creation is imperfect and insufficient, thus demonstrating a lack of trust in the wisdom of the Creator.

And yet, God also bids human beings to “subdue” the earth (Gen. 1:28), which has been understood (and, sometimes, abused) as granting humankind permission to exert control over all of nature.

How do we then resolve this dilemma between not tampering with the natural order and exerting control/pursuing knowledge wherever it leads, especially with the promise it holds of accomplishing much good? In this decision as well, the most influential factor is the mitzvah of medicine. Religiously and morally, we are obligated to seek remedies for disease. Pikuach nefesh is the overriding concern in Jewish moral teaching, and science is a primary means of fulfilling this mitzvah.

We must, however, proceed with the utmost caution—as we know from our own recent history, having suffered the Nazis’ horrific medical and eugenic misuses of power.

In short, I think that Reform Judaism would be ready to accept modifications in the human genetic structure for medical purposes on a case-by-case basis.

RJ: What about altering an individual’s human genetic code to enhance intelligence
or physical attractiveness?

Rabbi Washofsky: To the extent that genetic modification is directed toward the non-medical “improvement” of people, it ought to be met with deep concern. The Reform rabbinic responsum 5768.3, On Human Genetic Modification, explains that new techniques of “genetic enhancement” may cross the line that distinguishes our desire to exert influence upon our children’s lives—their talents, preferences, and choices—and our desire to determine those outcomes. To “influence” is a good thing; it partakes of our responsibility to “teach these things diligently to your children” (Deuteronomy 6:7). To “determine,” however, “would tend to restrict the freedom of choice that is the basis of our conception of ethics and human personhood” and might well constitute “a radical and thoroughly unprecedented assertion of our control over the lives of others.”

RJ: If, as Walker predicts, within 10 years we will be able to customize medications based on individual genetics and body chemistry, what bioethical issues might we need to address?

Rabbi Washofsky: Jewish tradition regards medicine as both a mitzvah and a community responsibility: It is the community’s duty to see to it that medical care is made available to all in the most equitable way possible. That’s the standard we ought to use in determining policies with respect to human genetic technology. We need to be wary that investment in expensive customized technologies which might ultimately benefit the wealthy do not preclude funding technologies which might benefit the larger public that cannot afford such customized care.

RJ: Walker asserts that an increase in the number of mentally fit older people would be a very positive development for society. From a Jewish ethical perspective, should we look favorably on scientific efforts to extend longevity, perhaps adding 25 or more years to the average human lifespan?

Rabbi Washofsky: Given our tradition’s teachings to honor the elderly (Leviticus 19:32) and to regard each human person, created in the Divine image, as equally precious in God’s sight (Genesis 1:27; 5:1; 9:6), Reform Judaism would have no objection to scientific efforts to extend longevity.

However, given the greater levels of medical expense associated with the elderly and society’s limited resources, it is reasonable to ask, “Is it morally just to divert money toward the elderly and away from younger citizens?” Ethically, we can best decide which individuals should receive life-sustaining resources in accordance with the Jewish responsibility to save life. Those whom we can save or “cure” take precedence over those we cannot, regardless of age. And as a community it is our responsibility to allocate medical resources to the largest number of people who can benefit from them.

RJ: What would you say to those who argue that the rate of technology is outpacing our moral development as a species?

Rabbi Washofsky: I’d say that’s probably true and not likely to change. But even so, that’s no reason to despair. Jewish tradition tends toward what I’d describe as realistic optimism, teaching that human scientific and technological achievement is, on balance, a positive good, notwithstanding humankind’s propensity to abuse our God-given intellect. The challenge, then, is to use our gifts and talents for good and not for evil. This can be difficult and daunting, but as Moses makes clear in his final speech to the Israelites (Deuteronomy 30:11-15), “difficult” is not the same as “impossible.”


Jewish Living: A Guide to Contemporary Reform Practice, Revised Edition, by Mark Washofsky

This definitive guide to Reform Jewish practice is a comprehensive examination of Jewish life—including the impact of scientific and technological changes over the last decade. For ordering information: URJBooksandMusic.com.



Bio-Ethics Study Guides

Thirteen self-contained program guides feature thought pieces, Jewish and secular resources, and program ideas on such issues as organ donation and transplantation, Jewish approaches to stem cell research, cloning, infertility and assisted reproduction, genetic testing, and autonomy—the right to live or die. To learn more, visit urj.org/life/health/bioethics or email Rabbi Richard F. Address at raddress@urj.org
Union for Reform Judaism.