Between 1988 and 1998 the Dr. Falk Schlesinger Institute for Medico-Halakhaic Research, which is associated with Jerusalem’s Shaare Zedek Medical center, published the six volume Entziklpedia Hilkhatit Refuit (Encyclopedia of Medical Halakha”).
This extraordinary work, which has been much praised in both rabbinic and medical circles, is a compilation of Jewish medical laws from the most ancient sources to current Halakhic discourses and decisions. The historic background of these laws is described, and the Jewish approach to medical issues is compared with the approach of general ethical theories and principles.
The encyclopedia was assembled and written by one person: Professor Avraham Steinberg, an outstanding physician and a well known rabbinic scholar.
A graduate of the Hebrew University Hadassah Medical School, trained in general pediatrics at the Share Zedek Medical Center and in pediatric neurology and New York’s Montefiore Medical Center and Albert Einstein College of Medicine, Professor Steinberg currently serves as Senior Pediatric Neurologist in the Department of Pediatrics at Shaare Zedek Medical Center and is the the Pediatric Neurology consultant for various Health funds in Jerusalem and for institutions for neurologically impaired children in Jerusalem.
He is also Clinical Associate Professor in Medical Ethics at the Hebrew University Hadassah Medical School and has served as Head and Director of that medical school’s Center for Medical Ethics since 1984.
He served as medical officer with the rank of major in the Israel Air Force and subsequently was appointed neurological consultant to the Air Force. He studied at Yeshivat Merkaz HaRav in Jerusalem. He is the founder and first editor of Assia, a quarterly devoted to Halakhic studies relating to medicine and was the first director of the Dr. Falk Schlesinger Institute for Medico Halakhic Research. He has served as advisor to the Chief Rabbinate of Israel and to the Rabbinical Board of the Shaare Zedek Medical Center on medical Halakhic issues. He was very close to the late renowned Posek Rabbi Shlomo Zalman Auerbach and published many of the latter’s Halakhic rulings on medical questions. For his writings on Jewish medical ethics, including the six volume encyclopedia, Professor Steinberg was awarded the Israel Prize for Torah and Talmudic Literature in 1999.
A while ago Feldheim Publishers of Jerusalem put out an English version of Professor Steinberg’s encyclopedia in three volumes under the title of Encyclopedia of Jewish Medical Ethics. The translation was done by Professor Fred Rosner and the updated and edited English version appeared in 2003.
Dr. Rosner, who serves as professor at the Mount Sinai School of Medicine is a prolific writer. He has written and lectured widely on Jewish medical ethics. His books on this subject include Modern Medicine and Jewish Ethics, Medicine and Jewish Law, and Pioneers in Jewish Medical Ethics. He has also translated from German, Julius Preuss’s classic Biblisch Talmudische Medizin, has written about Maimonides as the physician , and has translated a number of the latter’s medical treatises into English.
In his introduction to the English Version of his encyclopedia, Professor Steinberg expresses his “boundless appreciation and thanks to Fred Rosner, MD for his tremendous effort in the accomplishment of the excellent translation.”
At the beginning of the English version of the encyclopedia, there is a note about the author, Professor Steinberg, listing the positions he has held and the organizations and committees on which he has served. May we note here that although this is not mentioned anywhere in the English edition, Professor Steinberg is the scion of a famous family of Galician rabbis.
(To be continued)
The Jewish Press, Friday January 14, 2005
Continued from last week
Professor Avraham Steinberg is a descendant of Rabbi Avraham Menahem Mendel Steinberg (died 1928) who was rabbi of Sniatyn and Brody and the author of responsa Mahazeh Avraham.
His great grandfather, Rabbi Shemaya Steinberg (d. 1941) served for 50 years as rabbi of Premeyshliyany. His grandfather, Rabbi Yitzhak Steinberg was rabbi of Jaroslaw, served in Brussels after World War II and was later head of a rabbinical court in Tel Aviv-Jaffa. He died in 1966.
Professor Steinberg’s father, Rabbi Moshe Steinberg, served as junior rabbi in Peremyshlyany before World War II and in Hof, near Munich in West Germany after the war. In 1949 he settled in Israel where he officiated for 35 years until his retirement as rabbi of Kiryat Yam near Haifa. He died in 1993. He was the author of Torat HaGer on the minor tractate Gerim, a history of the Jews of Jaroslaw; Hukat Hager on Laws relating to proselytes, Shaa’rei Moshe on the laws of synagogues, Hilkhot Nashim, a Halakhic guide for women, Torat HaTur, Halakhic and Aggadic novellae based on verses of the Torah found in the four volumes of the Tur, commentaries on Tractates Beitza, Hagiga and Megilla of the Jerusalem Talmud, as well as responsa and Halakhic studies. He was a member of the board of directors of Otzar HaPoskim.
In the introduction to the encyclopedia, Professor Steinberg writes about his parents: For Jewish training and humanistic inspiration, I am immeasurably grateful to my father, Rabbi Moshe Steinberg and to my mother, Gitel Steinberg, both of blessed memory.”
Professor Steinberg’s Encyclopedia of Jewish Medical Ethics is as stated earlier, an extraordinary work. All the entries, which generally open with a “Definition of the term” are pack with relevant information, written in a lucid language and presented in a concise orderly and systematic manner. Source references and explanations, offered in footnotes, substantiate all statements.
For example, the entry Autopsy fills more than twelve pages plus five pages of references and notes and is divided into four major sections: Historical Background, Scientific Background, Specific Laws and Ethical Background.
In the section Historical Background we read that the Jews of Poland were faced for the first time with the problem of autopsy in 1922, when the universities of Warsaw, Vilna and Lvov demanded that Jewish students provide them with bodies for the study of anatomy, otherwise Jewish students would not be admitted in their medical schools. This demand caused much conflict among Jews and also increased anti-Semitism. In 1924 a number of Jews from Cracow asked several prominent rabbis to clarify the Jewish laws regarding autopsies. All the rabbis consulted declared that it was prohibited. In 1927 the rabbis of Poland met and issued a statement that autopsies for the sake of studying anatomy and for research were prohibited. Despite this decision, Jewish bodies were dissected in several medical schools. In 1930 the Rabbinical Council of Warsaw issued a declarations that “despite the great need to provide bodies for the sake of studying medicine in order to save human lives, we cannot find a source in the Torah to permit impeding the burial of the dead and their desecration.”
The universities continued to demand that Jews provide them with bodies for medical research. In 1936 several faculty members of the University of Poznan declared that they would not permit Jewish medical students to take their final examinations because the Jewish community had not provided them with Jewish bodes for medical research. The Jews protested against this blackmail but gave into the demand in a limited way by providing a few Jewish bodes for anatomical dissection.
In the same section Professor Steinberg acquaints the reader with the discussions about autopsies in Israel and the decisions of the Government of Israel in that matter.
(To be Continued)
The Jewish Press, Friday, January 21, 2005
(Continued from last week)
Professor Avraham Steinberg writes that the autopsy question was sharply debated in the Land of Israel at the time of the founding of the Hebrew University in 1925, and that the opening of the University’s medical school was delayed for twenty-two years because of the autopsy issue and the lack of bodies for anatomical dissection.
In 1947, when the Hebrew University– Hadassah Medical School was founded, Hadassah Director General Prof. Yassky came to an agreement with Chief Rabbi I. Herzog, and Rabbi P. Frank, the chief rabbi of Jerusalem, regarding the circumstances under which autopsies could be performed.
Autopsies would be permitted for forensic medicine (dealing with legal matters such as suspicion of murder) if the cause of death could not be established without an autopsy (provided three physicians attested to this fact); if the results of a autopsy might contribute immediately to saving the life of another patient (provided three physicians attested to this fact). or in case of genetic or inherited diseases where an autopsy would help to preserve the health of a relative with the same disease. In addition, the autopsy would have to be performed with dignity and respect for the deceased and all body parts would have to be returned for burial. The Chief Rabbinate also would not oppose autopsies in cases where people freely willed their bodies to the medical school, provided all organs and body parts were eventually buried.
With the passage of time, autopsies began to be performed without rabbinical permission and without consent of the deceased’s family. Controversy and social strife resulted. In 1952, the Ministry of Health established a committee of rabbis, which after testimony from many experts recommended that autopsies be restricted in the following cases: 1) to immediately save another life. 2) for organ transplants. 3) if a significant medical error is expected. 4) if the cause of death needs to be established in order to avoid a danger to the public or to the family. The committee also recommended that the next of kin be consulted. These recommendations were never fully implemented. Physicians objected to the requirement that the next of kin must give their consent, fearing this demand would reduce the number of autopsies by 90%.
In 1966 Orthodox Israeli physicians and scientists petitioned the Knesset to pass a law requiring the consent of next of kin for the performance of an autopsy, and permitting autopsies only where it was absolutely necessary — and then only with the preservation of dignity and respect for the dead. During the next two years, Israeli rabbis, including both Chief Rabbis of Israel, issued sharp declarations against autopsies, stressing that these could be performed only with the approval of an expert rabbis authorized to do so.
The issues were strongly debated throughout the country. There were demonstrations and protests, Knesset debates and government crises. Rabbis and physicians accused each other of various wrongdoings.
In 1980 the government revised the Anatomy and Pathology Act, mandating that family consent had to be obtained for autopsies, requiring a five hour waiting period before an autopsy could start, and giving certain relatives who may not be the closest next of kin veto power over an autopsy.
The entry Blessings and Prayers fills close to seven pages, plus four pages of references and notes. It is divided into seven sections. “Prayers of Patients and Prayers on their behalf in the Bible and Talmud”; “The Prayer Heals Us” (the reference is to Refo’enu, the eighth blessing of the Amidah): “Prayers on behalf of a Sick Person”; Prayers for Healing by the Patient”; “Blessing for the Consumption of Remedies”; The Blessing of Thanksgiving (“Birkat HaGomel”) and “Physicians’ Prayer for Healing”.
In the last section we read: “Although healing the sick is a commandment, the physician does not recite a blessing for it. This ruling is based on several reasons.” The text goes on to list seven reasons and then continues: “In Talmudic and Rabbinic writings there is no mention of an obligation for a physician to recite a physician’s prayer,’ nor do these writings have any texts of such prayers. However, many physicians wrote such prayers.”
(To be continued)
The Jewish Press, Friday, January 28, 2005
(Continued from last week)
In the entry Disclosure of Illness to the Patient the following questions are discussed. Is one obligated or should one reveal to the patient the whole truth about his medical condition, if he has a serious or life threatening illness? Should one disclose only part of the truth? Should one withhold the truth from the patient or even lie to him? The entry states that these questions pertain primarily to dying patients or patients with serious chronic illness associated with severe suffering.
The decision as to whether or not to disclose the truth to the patient depends on factual, with ethical and Jewish legal considerations. It must also be determined who is best qualified to decide whether or not the patient is to be told the truth and what is the appropriate method and approach to implement that decision.
The first section of the entry discusses the factual and ethical reasons in favor of disclosing the truth to the patient as well as the factual and ethical reasons against doing so, and acquaints us with the results of surveys carried out in different countries among physicians and patients as to whether the patient should be told the truth about his illness.
The next section, “The Method and System of Telling the Truth,” is devoted to the questions: Who is the most appropriate person to tell the patient the truth, and when and how should it be done? The following section, “Halakhic Considerations” state that though truth is an exceptionally valuable principle there are circumstances in which Judaism permits you to deviate from it. The same section also refers to a number of Biblical and Talmudic sources which deal with the question whether one should tell the patient the truth about his condition.
Professor A. Steinberg states that there are several opinions on that question among rabbinic decisors and thinkers, and he cites their different views in great detail.
His own conclusions are that one cannot establish absolute rules in that matter. “Rather, one must make the disclosure appropriate for the individual patient according to one’s best judgement and experience. The individual patient’s best interest should be our guide. Therefore the Halakhic approach to this question must be appropriate for the time and place. If, in a specific case, there is hope for a cure, knowledge of the truth helps the patient. In contrast if there might be great trembling and fear of the truth the patient should not be told. Each case must be individualized. Sometimes it might even be required to tell the patient about his grave situation, but one should never cause a patient to despair or leave him without any hope; depression and despair reduce the ability of the patient to cope with his illness by reducing his immunological capabilities.
The lengthy entry “Holidays and Fast days” (it fills close to 17 pages plus 10 pages of “References and Notes”) deals with the laws of holidays and fast days in relation to medical issues. (Laws which apply equally to the holidays and to the Sabbath are discussed in the entry Sabbath. Similarly, many laws which relate to specific people and specific situations with regard to holidays are discussed separately in their respective entries.)
In the section “Holidays” we are present with the various views of the Poskim with regard to taking medicines on Yom Tov.
It is permissible to use the telephone on a holiday even on behalf of a patient who is not dangerously ill. (In References and Notes, Rabbi Shlomo Zalman Auerbach is named as the author of this Halakhic decision.)
In the section, “The Intermediate Festival Days, we read, inter alia, “It is permissible to repair eye glasses during the Intermediate Festival Days. Even sunglasses may be repaired if the patient’s eyes are weak and may be harmed by the sun. If the patient’s only intent, however, is to change the frame, it is prohibited.”
(To be continued)
The Jewish Press, Friday, February 4, 2005
(Conclusion)
The following are several additional quotations from the entry Holidays and Fast Days, which deals with the laws of holidays and fast days in relation to medical issues.
In the section “Passover” we read inter alia: “If the patient disregarded the physician’s instructions and ate Matzah in spite of the danger and was subsequently healed, he must eat Matzah again since he did not fulfill the precept of eating Matzah when he went against the medical advice.”
“Even if a personal cannot eat Matzah, he is obligated to read the Haggadah. He should have Matzah in front of him when he does so.”
If someone would suffer when leaning on his left side– for example, if he has a wound on his left side– he is exempt form this obligation.”
The section “Passover” also includes several passages about the use of dentures on Passover, and the methods of rendering the Kosher for Passover use.
The entry Parents discusses specific laws that relate to medical care which a son or a daughter gives to a parent.
The Torah (Exodus 21:15) prohibits striking one’s father or mother, a transgression punishable by death in the hands of the court. Our Sages interpret this injunction to refer to any striking of parents that results in a wound.
Some of the directives in the entry Parents are:
If a father has a thorn embedded in his body, a son should not remove it lest he inflict a wound.
IF the son is a physician, he should not treat his father when it involves causing a wound, even if his intent is only to heal. This rule applies if someone else is available to provide the necessary medical treatment. But if no one else is available, the son is allowed to treat his parent if the latter gives his. her consent or asks to son to do so.
When non one else is available, a son is allowed to wash his father or to rub him with oil over any area of his body, but he should avoid looking at his father’s private parts.
We have presented the reader with some of the contents of a number of entries. In order to do justice to the rich contents of the encyclopedia, we mention the name of several other entries among the encyclopedia’s nearly 100 topics, each of which is a veritable treasure house of knowledge. Abortion and miscarriage, Artificial Insemination, Circumcision, Embalming, Eyes, Fetus, Hospitals, Human Cloning, Moment of Death (with three appendices: “Tests to Determine the Time of Death,” Israel’s Chief Rabbinate on Brain Death”, “Rabbi Shlomo Zalman Auerbach’s View on Brain Death”), Paternity, Redemption of the Firstborn, Study of Medicine (With an appendix, “Science and Religion”) Suicide, Transplantation and Visiting the Sick.
As noted earlier, the source of each statement, opinion and Halakhic decision mentioned in the encyclopedia is indicated in the “References and Notes” that accompany the text. One is overwhelmed by the large number of rabbinic, medical and general books and journals which Professor Steinberg consulted in the pursuance of his work.
Several prominent rabbis who wrote approbations for the Hebrew editions of the encyclopedia are mentioned in the introduction. They include the former Chief Rabbis of Israel, Rabbi Avraham Kahana Shapira and Rabbi Ovadia Yosef and Rabbi Eliahu Bakshi-Doron; Rabbi Shemuel Wosner of Bnei Brak; the late Rabbi Shlomo Zalman Auerbach; Rabbi Yitzchak Yaakov Weiss, Chief Rabbi of the Edah Haredit in Jerusalem and Rabbi Moshe Steinberg, the father of the author.
The encyclopedia is provided with a number of very helpful indices that enable the reader to find any subject without difficulty. The work is a must not only for Jewish physicians and health workers but for any Jew deeply interested in his religious and cultural heritage.
The Jewish Press, Friday, February 11, 2005