ב"ה
Learning from Rabbi Even-Israel (Steinsaltz)
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Rabbi Steinsaltz discusses the relationship between the Oral and Written Laws. The Oral Law developed as a "manual" for understanding the Written Law. From the time of Moses until the end of the 2nd century CE, these explanations remained oral and adapted to changing times, languages, and surrounding cultures. Rabbi Steinsaltz then discusses the consequences of the writing down of the Oral Law.
Rabbi Steinsaltz introduces the "Oral Law" (the Talmud and associated works) and contrasts it with the "Written Law" (the Bible). He discusses some of the features that make the Talmud a unique work and suggests that it can only be understood properly if engaged interactively. The Written Law, which spans several centuries, serves as a reference and springboard for the Talmud and the rest of Jewish literature.
Rabbi Steinsaltz discusses the "four-dimensional" nature of the Talmud, which spans time and space. The Talmud is a composition that brings together the voices of many generations of Rabbis, a discussion in the present tense that is never given an official date of completion. Rabbi Steinsaltz then explains the layout of a page of Talmud, noting how super-commentaries such as Rashi and Tosafot continue this discussion.
Rabbi Steinsaltz discusses the general nature of Talmudic teachings as a basis for applying the Jewish approach to contemporary matters. Comparing Talmudic Law to English Law, he describes how the Talmud focuses legal discussions around specific precedent cases. He explains that the Talmud consists of disagreeing statements on many topics spread throughout its pages and that in approaching current issues and questions one must piece together all of these statements in order to arrive at solutions.
Rabbi Steinsaltz cites the biblical source from which the Talmud derives the permissibility of a doctor to treat patients. He then discusses the related topic of whether a doctor is indeed obligated to treat patients. He questions whether such an obligation would influence a doctor's permission to receive payment for administering medical treatment and a doctor's permission to refuse to treat patients in need of medicine.
Rabbi Steinsaltz continues the topic of how to prioritize lives that can be saved. He questions whether the concept of another's life taking precedence over one's own life is necessarily ethical. How would one decide between giving a heart transplant to an elderly, incompetent criminal and a young, intelligent, and kind person?
Rabbi Steinsaltz discusses the permissibility of a doctor to strike. May doctors who are underpaid and overworked refuse to treat those in need of medicine? He concludes by comparing an approach to medical ethics in which conclusive decisions are made to an approach in which decisions are left "up in the air" and to the discretion of the patient and family.
Rabbi Steinsaltz discusses how the concept of man being created in the image of G-d places limits on the rights one has over one's body. He compares this concept to modern socio-political theories in which society owns the lives of its constituent population. He also discusses the ramifications this question has on one's right to harm oneself, analogizing the situation to a soldier who is prohibited from causing self-harm due to this being considered "damage to army property."
Rabbi Steinsaltz illustrates certain common examples in society in which we witness groups of people making decisions that directly influence the lives of others. Does society, for instance, have any rights to sterilize physically and psychologically ill people if it expects the descendants of these people to suffer and place great demands on society?
Rabbi Steinsaltz asks whether we should just allow nature to take its place and select out the strongest from society or we should treat medical illnesses through human intervention. Though the Bible and Talmud seem to indicate that medical treatment is permissible, the Rabbi cites several Biblical and Midrashic sources that suggest that medical treatment may lead the ill to neglect to seek G-d's healing. The Rabbi cites Maimonides' reconciliation of some of these sources.
Rabbi Steinsaltz cites R' Nachman from Breslav's complex opinion regarding the advisability of seeking medical treatment. The Rabbi suggests that ill people should indeed seek medical treatment and quotes a source from the Talmud supporting this idea which states that people should not live in a town that does not have a doctor. He concludes by arguing that rather than being viewed as a destroyer of nature, man should be viewed as having an obligation to perfect nature.
Rabbi Steinsaltz raises the question of whether a doctor may be sued for mistakes caused by him during treatment. He suggests that if the doctor has religious and human permission to do the work, he cannot be blamed or sued for any damage or death that might result from medical interventions he administers.
Rabbi Steinsaltz argues that only G-d owns the bodies of human beings. If man only has a temporary "lease over his body," does he have the right to injure himself or allow someone else to cause injury to him? The Rabbi suggests that medical treatments that involve some form of injurious side-effect would be permitted if they serve higher values such as preserving the health of the body and saving one's life.
Rabbi Steinsaltz suggests that though doctors and family members typically have no special right over the body of their patients and family members, in certain situations they, as the closest legal guardians, would be given permission to make decisions regarding them. The Rabbi cites several examples in which people are obligated to make medical decisions for those in need of medical treatment because those in need do not have the capacity to consent to measures that would preserve their health.
Rabbi Steinsaltz states that suicide is not any more permissible than is murder. Tangentially, he argues that even if one were to disregard the question of whether a fetus possesses independent life, the fetus is considered a biological part of its mother and therefore aborting it would be considered self-inflicted damage to the mother's body. Killing the fetus would thus be at least equivalent to cutting off the mother's finger, which would only be permissible if the well-being of the woman is in danger.
Rabbi Steinsaltz raises the question of whether cosmetic surgery is permissible, considering that it involves a certain amount of self-harm and self-endangerment. He explains that the permissibility of such a surgery is decided based on a comparison of the current physical and psychological "damage" to the potential damages that such a surgery might cause.
Rabbi Steinsaltz discusses the status of the human body after death as a source of defilement rather than holiness. He suggests that any abuse of a dead body is contrary to the Jewish principle of "Honoring Creatures" (Kavod HaBriyot) because it is equivalent to abusing a defenseless person. He touches on the question of whether an autopsy may be performed in order to save another patient's life and whether the opinions of the family of the deceased may influence such a decision.
Rabbi Steinsaltz discusses the permissibility of organ donation. He compares live-organ donation to deceased organ donation and considers the impact of the family's opinions on the decision to harvest organs. Rabbi Steinsaltz addresses the concern of some that organ donation will negatively impact resurrection of the deceased person in the future.
Rabbi Steinsaltz relates to the topic of imminent death. He defines "Treifah" as a creature, either animal or human, that is almost certain to die within 12 months and says that those in this category are no longer considered completely alive. He touches on the impact this has on the laws of slaughtering and Kashrut as well as medical ethics issues.
Rabbi Steinsaltz states that murder of a “Treifah” (someone who is expected to die within 12 months) is technically viewed as manslaughter and not true murder, for the treifah isn't considered fully alive when killed. The Rabbi then defines the category of "Goses", which refers to the period of time in which the condition of the dying patient is rapidly deteriorating and he is on the brink of death. Even such a person is treated as alive with respect to such legal considerations as inheritance.
Rabbi Steinsaltz discusses the question of whether we may terminate the life of a suffering, dying patient in order to relieve him of his pain. He states that we must attempt to save life even when there is great uncertainty that there is a life to be saved and when we would likely only succeed in prolonging life by one minute. The Rabbi concludes by introducing the Talmudic concept of "Death with a Kiss."
Rabbi Steinsaltz contrasts the traditional definition of death (cessation of heartbeat) with the relatively novel definition of death known as brain-death. He discusses the significant practical ramifications these definitions have on organ donation; many more organs can be harvested from a corpse if brain-death is accepted as the halachic definition of death.
Rabbi Steinsaltz opens by discussing the definition of the biblical word "Nefesh." He then elaborates on the symbiotic coexistence between the soul and body, drawing on sources from the Torah and Midrash. He closes by presenting a Talmudic parable that attempts to analogize the teamwork of a blind and lame man to the powerful combination of the soul and body.
Rabbi Steinsaltz delves into the relationship between the mind and the body. He compares it to the relationship between a fiddler and a fiddle. Arguing that the brain is the mechanical "vehicle" that does the thinking associated with the mind, suggesting that the brain and mind are interdependent, with neither functioning fully without the other.
Rabbi Steinsaltz elaborates on the various proscribed medicines in the Talmud. He notes that most medicinal treatments recommended are verbal, with little from animal and mineral products. The medicine in the Talmud seemed to remain rather independent from medicine of its surrounding culture (e.g. four-humor theory of humorism). He suggests that this may have been one reason why Jewish doctors moved away from Talmudic medicinal recommendations. He also highlights certain medical achievements of Talmudic medicine.
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