Book review – Care and Covenant- A Jewish Bioethic of Responsibility
Rabbi Jeffrey Cohen reviews Rabbi Jason Weiner’s book.
This is the third book I have reviewed by Rabbi Weiner. My overall critique of this book is the same of his two predecessors- in claiming to present a Jewish perspective, he only presents an Orthodox viewpoint. Truth be told that most writings on the area of Jewish Bioethics come from the Orthodox community, but it has never been limited to just Orthodoxy [even though much of their writings are based on, but not limited to Orthodox sources].
Having established that caveat, I turn to the book itself. The book’s publisher is based in a Catholic Jesuit University. The book is heavily based on Jewish sources, most of which would be unfamiliar to non-Jewish scholars. I had to ask for whom the publisher thought would be the book’s users. Would it be the repeat of another Catholic publisher, Dartman Longmore and Todd, which half a century ago published Louis Jacob’s A Jewish Theology on the assumption that it would appeal to a Jewish market only to have it become popular in the Christian market?
This book itself has received mixed reviews in the Jewish press and scholarly publications. The usual critique of anthologies is that they are of mixed quality. Unfortunately, the same can be said about this book by just one author.
In a time when so much of the world speaks of Rights, I was glad Weiner used the word Responsibility in the title. As Rabbi Louis Jacobs used to say that Judaism never speaks of a person’s rights but only about their Responsibility.
Let me begin with the two chapters with which I had the most trouble- Introduction and Chapter 4 about the history of Jewish hospitals in the United States. The Introduction is effectively a homage to the late Orthodox Rabbi, Lord Jonathan Sacks- it was almost raising him to Sainthood. Yes, Jonathan (he was my Instructor in Talmud in my first year of Rabbinical School) had an incredible ability to synthesise and popularise Jewish Thought. Ultimately I found the introduction sycophantic!
Chapter 4 was more problematic for me. I have some knowledge about the story of Jewish Hospitals in the USA [and reality be told, there is much parallelism to the story of Jewish hospitals in (western) Europe but like much material from North America there seems to be neither much interest nor any understanding about Jewish history in Europe post-1900 except for the Holocaust but that is a story for another day!
I read this chapter with much interest. I had lived in St. Louis when the Jewish Hospital merged with two other systems to form Barnes-Jewish-Christian [now known as BJC] in the early 1990s. The seminal work on the disappearance of Jewish hospitals was written in 1993 by the then-CEO of St. Louis’ Jewish Hospital, David Gee [who interestingly was not Jewish and who served as Jewish Hospital’s CEO for 27 years- something which rarely happens in Christian faith-based hospitals even today]. Imagine my surprise to not even seeing any reference to Gee’s article.
The last two chapters on Conscientious Objection and Self Care in Challenging Times are extremely good as they raise some important thoughts on these concepts. I found myself applying his discussion and even adapting those things which the text implied were strictly Jewish to the world in which I operate- namely, a faith-based (non-Jewish) hospital.
Conscientious Objection is an interesting challenge. There are both physicians and hospitals who conscientiously hold objections to certain procedures. One only has to think about some religious hospitals having strong moral objections to procedures such as Voluntary Assisted Dying [a fancy way of saying Euthanasia] or Abortion. Some would argue that the ACT Government’s take over of Calvary Hospital as a response to the government’s frustration with a hospital not willing to provide certain services which the government feels it should even when the hospital’s values put it in conflict with the government. In the case of VAD the legislation requires those with conscientious objections to still refer the patient to a provider who will perform the procedure. Some would argue that this requirement does not allow the person holding the conscientious objection to feel so strongly that even making an onward referral is a violation of their conscious. Weiner seems comfortable in permitting onward referrals.
The question of self-care is one which will become more and more prescient in the months and years ahead. We have already seen that people entering nursing homes are older than they used to be and are reported as more and more sick. In a recent seminar at the hospital at which I work there was a discussion about the emergence of “Hospital in the Home” where more and more services, including, say, dialysis, will be at home rather than as a day programme in the hospital. Within this subject Weiner raises an important issue about self-care of the staff. It is an important issue about which we became more aware following COVID.
The middle chapter discusses the Unrepresented Patient. In general, this seems less of a problem that many commentators make it out to be. Where it does become an issue is how often do I discover that a patient with whom I am chatting reveals that they do not have an Advanced Care Directive. Having worked in the State of Missouri when this became a national court case over the wishes of a comatose patient and whether to withdraw life-support- some family members expressed that the young woman would wish withdrawal of support while other family members argued that she would not want withdrawal. And the reality is that it is quite easy to execute such a document.
At the end of reading this book, it was a case of Sweet and Sour. For me, and in reality, a relatively small group of Jewish practitioners in health care, this is a book that should not only be on one’s bookshelf but will be one which together with the works of Bleich, Rosner, Shteinberg and Dorff, will be an invaluable reference. The Sour part is that many others in health care seeking an understanding of Jewish Bioethics will find it quite challenging, especially in following many of the footnotes.
Rabbi Jeffrey Cohen is associated with Notre Dame Australia’s School of Medicine and St. Vincent’s Private Hospital. Previously he was associated with UNSWMedicine; University of Ballarat (now Federation University); and St. Louis University. He served as CEO of the Sydney Jewish Museum for 5 years. He has been a member of the NSW Health Ethics Committee; NSW Health Research Ethics Committee and the Australian Gene Technology Ethics Committee.
