jewish biblical and rabbinic themes that should inform the ... · the v’ahavta & pirke avot...

Jewish Biblical and Rabbinic Jewish Biblical and Rabbinic Themes that Should Inform Themes that Should Inform Themes that Should Inform Themes that Should Inform

the National Healthcare the National Healthcare DiscussionDiscussion

Jeff Levin, Ph.D., M.P.H.Jeff Levin, Ph.D., M.P.H.University Professor of Epidemiology & Population HealthUniversity Professor of Epidemiology & Population Health

Di P R li i & P l i H l hDi P R li i & P l i H l hDirector, Program on Religion & Population HealthDirector, Program on Religion & Population HealthInstitute for Studies of ReligionInstitute for Studies of Religion

Baylor UniversityBaylor University

Human Dignity and the Future of Health Care, 2010 Baylor Symposium on Faith and Human Dignity and the Future of Health Care, 2010 Baylor Symposium on Faith and Culture, Baylor University Institute for Faith and Learning, Waco, TX, October 30, 2010Culture, Baylor University Institute for Faith and Learning, Waco, TX, October 30, 2010

OUTLINEOUTLINEOUTLINEOUTLINE1)1) Jewish health policy statementsJewish health policy statements1)1) Jewish health policy statementsJewish health policy statements

2)2) A Jewish moralA Jewish moral--theological lens:theological lens:2)2) A Jewish moralA Jewish moral theological lens:theological lens:the the V’ahavtaV’ahavta & & Pirke AvotPirke Avot

3)3) Salient Torah & rabbinic themesSalient Torah & rabbinic themes

h ’ hh ’ h d “ f h”d “ f h”4)4) Lech L’chaLech L’cha: How do we “go forth”?: How do we “go forth”?

I JEWISH HEALTH I JEWISH HEALTH I. JEWISH HEALTH I. JEWISH HEALTH POLICY STATEMENTSPOLICY STATEMENTSPOLICY STATEMENTSPOLICY STATEMENTS

Jewish law endorses “the unqualified Jewish law endorses “the unqualified statement that the physician’s right to heal statement that the physician’s right to heal p y gp y g

is a religious duty and that he who shirks this is a religious duty and that he who shirks this responsibility is regarded as shedding blood.”responsibility is regarded as shedding blood.”

-- Lord Rabbi Immanuel Jakobovits, Lord Rabbi Immanuel Jakobovits, Jewish Medical EthicsJewish Medical Ethics(1959), p. 7.(1959), p. 7.

“Prophylactic hygiene [is] raised to the level of “Prophylactic hygiene [is] raised to the level of a legal, national and collective institution . . . . a legal, national and collective institution . . . . Considered in this perspecti e the pre ention Considered in this perspecti e the pre ention Considered in this perspective, the prevention Considered in this perspective, the prevention of disease becomes the major preoccupation of of disease becomes the major preoccupation of

Hebrew medicine.”Hebrew medicine.”

-- Lord Rabbi Immanuel Jakobovits, Lord Rabbi Immanuel Jakobovits, Jewish Medical EthicsJewish Medical Ethics(1959), pp. xxi(1959), pp. xxi--xxii.xxii.

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS D i i lSTATEMENTS D i i lSTATEMENTS: DenominationalSTATEMENTS: Denominational

From “left” to “right”

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS I i i lSTATEMENTS I i i lSTATEMENTS: InstitutionalSTATEMENTS: Institutional

Major Jewish agencies & organizations

JFNA Health & LongJFNA Health & Long--Term Care WorkgroupTerm Care WorkgroupHealth Care Reform Talking Points Health Care Reform Talking Points

Equal Opportunity & Social Justice: Health CareEqual Opportunity & Social Justice: Health Careyy

Healthcare Repair: A B'nai B'rith Agenda for ReformHealthcare Repair: A B'nai B'rith Agenda for ReformStatement on Restrictions on Reproductive Statement on Restrictions on Reproductive Health Care in Health Care Reform LegislationHealth Care in Health Care Reform Legislation

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS R bbi iSTATEMENTS R bbi iSTATEMENTS: RabbinicSTATEMENTS: Rabbinic

Rabbinic t’shuvot (responsa) by leading by leading poskimposkim

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS A d iSTATEMENTS A d iSTATEMENTS: AcademicSTATEMENTS: Academic

Scholarly works by leading Jewish academics

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS S iSTATEMENTS S iSTATEMENTS: SymposiaSTATEMENTS: Symposia

Conferences and special issues of journals

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS CSTATEMENTS CSTATEMENTS: ConsensusSTATEMENTS: ConsensusSummary of major points across health policy statements

1)1) Obligations to vulnerable populationsObligations to vulnerable populations

2)2) Social justice (distributive, egalitarian, Social justice (distributive, egalitarian,

utilitarian, or communitarian)utilitarian, or communitarian)

3)3) Affordability & access for allAffordability & access for all

4)4) P i h lif id lP i h lif id l4)4) Preserving human life as an idealPreserving human life as an ideal

But . . . .But . . . .

JEWISH HEALTH POLICY JEWISH HEALTH POLICY STATEMENTS Wh ’ Mi iSTATEMENTS Wh ’ Mi iSTATEMENTS: What’s MissingSTATEMENTS: What’s Missing

Most rabbinic writing on Most rabbinic writing on bioethics focuses on bioethics focuses on clinical clinical decisiondecision--makingmaking and and discrete discrete medical issuesmedical issues::

abortionabortionabortionabortionstem cell researchstem cell researcheuthanasiaeuthanasiatesttest--tube babiestube babies

ttautopsyautopsytransplantationtransplantationetc.etc.

Less so on Less so on public health public health “. . . we do have the clear duty to try “. . . we do have the clear duty to try to heal, and this duty devolves upon to heal, and this duty devolves upon pp

issuesissues, such as the nuts & , such as the nuts & bolts of a putative communal bolts of a putative communal responsibility to provide responsibility to provide (preventive) healthcare for (preventive) healthcare for

both the physician and society. . . . both the physician and society. . . . [H]owever, Jewish sources on [H]owever, Jewish sources on

distributing and paying for health distributing and paying for health care are understandably sparse.”care are understandably sparse.”(preventive) healthcare for (preventive) healthcare for

the populationthe population -- Rabbi Elliot Dorff, Rabbi Elliot Dorff, Matters of Life and Matters of Life and Death: A Jewish Approach to Modern Death: A Jewish Approach to Modern

Medical EthicsMedical Ethics (1998), p. 281.(1998), p. 281.

II. A JEWISH MORALII. A JEWISH MORAL--THEOLOGICAL LENS THEOLOGICAL LENS THEOLOGICAL LENS: THEOLOGICAL LENS:

THE THE V’AHAVTAV’AHAVTA & & THE THE V AHAVTAV AHAVTA & & PIRKE AVOTPIRKE AVOTPIRKE AVOTPIRKE AVOT

A A D’rashD’rash on Two Textson Two TextsA A D rashD rash on Two Textson Two Texts

D’varimD’varim (Deut ) 6:4ff(Deut ) 6:4ff Pirke AvotPirke Avot 1:2 & 1:181:2 & 1:18D varimD varim (Deut.) 6:4ff.(Deut.) 6:4ff.TextText:: The The ShemaShema prayer’s prayer’s V’ahavtaV’ahavta paragraphparagraph

Pirke AvotPirke Avot 1:2 & 1:181:2 & 1:18TextsTexts:: “Upon three things “Upon three things the world stands”; the world stands”; 2 2 versionsversions

ContentContent:: How to “love the How to “love the LL--rd thy Grd thy G--d,” d,” 33--part part formula:formula:

לללל (“ i h ll h ”)(“ i h ll h ”)

ContentContent: : Expounds on the Expounds on the V’ahavtaV’ahavta: how to love G: how to love G--d d and the consequencesand the consequences

ללללל לל לבבך לבבך --בכלבכלל (“with all your heart”)(“with all your heart”)נפשך נפשך - - ובכלובכל (“with all your soul”)(“with all your soul”)מאדך מאדך - - ובכלובכל (“and with all your (“and with all your

might”)might”)

ועל גמילו החסדיםועל גמילו החסדים,,ועל העבודהועל העבודה,,על התורהעל התורה(“upon learning & upon worship (“upon learning & upon worship & upon acts of lovingkindness”)& upon acts of lovingkindness”)

ועל השלוםועל השלום, , ועל האמתועל האמת, , על הדיןעל הדין (“upon (“upon g )g )justice & upon truth & upon justice & upon truth & upon peace”)peace”)

Summary of Our Summary of Our D’rashD’rashSummary of Our Summary of Our D rashD rash

1)1) We are to love GWe are to love G dd1)1) We are to love GWe are to love G--d.d.

2)2) We do this through our actions.We do this through our actions.

3)3) Our actions matter: Our actions matter: I.e., this is how we I.e., this is how we

attain truth, peace, and justice.attain truth, peace, and justice.

So . . . So . . . what ideas & concepts should what ideas & concepts should inform our actions?inform our actions?

III SALIENT TORAH III SALIENT TORAH III. SALIENT TORAH III. SALIENT TORAH & RABBINIC THEMES& RABBINIC THEMES& RABBINIC THEMES& RABBINIC THEMES

SALIENT TORAH & SALIENT TORAH & RABBINIC THEMESRABBINIC THEMES

B’ritB’ritB ritB ritK’dushahK’dushahTzedekTzedekTzedekTzedekChesedChesedMip’nei darkhei shalomMip’nei darkhei shalomMip nei darkhei shalomMip nei darkhei shalomPikuach nefeshPikuach nefeshK’lalK’lalK’lalK’lalTikkun olamTikkun olamT’ h hT’ h hT’shuvahT’shuvahJovelJovel


B’ritB’rit (“covenant”)(“covenant”)B ritB rit ( covenant )( covenant )“Covenantal morality” (Rabbi Jonathan Sacks).“Covenantal morality” (Rabbi Jonathan Sacks).Governs both our Governs both our verticalvertical & & horizontalhorizontalGoverns both our Governs both our verticalvertical & & horizontalhorizontalrelationships, and both are bidirectional/mutual.relationships, and both are bidirectional/mutual.Through the yoke of Through the yoke of torahtorah; the body of positive ; the body of positive and negative and negative mitzvotmitzvot (commandments); and the (commandments); and the collective commentaries of our collective commentaries of our chazalchazal and the and the halakhic halakhic codes & codes & responsaresponsa, through the present , through the present day, we have a sense of what we’re supposed to do. day, we have a sense of what we’re supposed to do. Our obligations to GOur obligations to G--d translate into obligations d translate into obligations to our fellow humans to our fellow humans to our fellow humans. to our fellow humans.


K’dushahK’dushah (“holiness”)(“holiness”)K dushahK dushah ( holiness )( holiness )Our mission statement, as Jews, is to “redeem Our mission statement, as Jews, is to “redeem the sparks,” to unlock the innate holiness in all the sparks,” to unlock the innate holiness in all

iicreation.creation.We do this by striving to follow the path of We do this by striving to follow the path of mitzvotmitzvot and act in accordance with moral & and act in accordance with moral & mitzvotmitzvot and act in accordance with moral & and act in accordance with moral & ethical principles in our dealings with people.ethical principles in our dealings with people.Every person is a reflection of GEvery person is a reflection of G--d’s d’s k’dushahk’dushah. . Th ’ h l h lik l Th ’ h l h lik l That’s why we are to love them like we love That’s why we are to love them like we love ourselves: we are one, in Gourselves: we are one, in G--d.d.Respecting the needs of others honors their Respecting the needs of others honors their Respecting the needs of others honors their Respecting the needs of others honors their innate holiness and reverences the Linnate holiness and reverences the L--rd.rd.


TzedekTzedek (“justice”)(“justice”)TzedekTzedek ( justice )( justice )Related to Related to tz’dakahtz’dakah: in the vernacular, : in the vernacular, “charity,” but really “justice.”“charity,” but really “justice.”Other terms for justice: Other terms for justice: dindin & & mishpatmishpat..R’difat tzedek v’shalomR’difat tzedek v’shalom: pursuit of justice & : pursuit of justice & peacepeace..“Justice, justice (“Justice, justice (tzedek, tzedektzedek, tzedek) shall you ) shall you pursue, that you may live . . .” (Deut. pursue, that you may live . . .” (Deut. 1616::2020).).pursue, that you may live . . . (Deut. pursue, that you may live . . . (Deut. 1616::2020).).We are obliged to ensure that people who are not We are obliged to ensure that people who are not as advantaged as us do not suffer as a result of as advantaged as us do not suffer as a result of

l k f thi ti l t th i ll l k f thi ti l t th i ll b ib ia lack of something essential to their wella lack of something essential to their well--being.being.


ChesedChesed (“mercy”)(“mercy”)ChesedChesed ( mercy )( mercy )Also can mean “love” or “lovingkindness” (as in Also can mean “love” or “lovingkindness” (as in g’milut chasadimg’milut chasadim).).The great rabbinic sages & mystics explained that The great rabbinic sages & mystics explained that justice must be tempered/balanced by mercy.justice must be tempered/balanced by mercy.“Y t l th t i id t “Y t l th t i id t “You are to love the stranger in your midst, “You are to love the stranger in your midst, because you were strangers once” (Deut. 10:19).because you were strangers once” (Deut. 10:19).We must be merciful to the less fortunate, as we We must be merciful to the less fortunate, as we We must be merciful to the less fortunate, as we We must be merciful to the less fortunate, as we have been in their shoes; we are to act out of have been in their shoes; we are to act out of compassion.compassion.


Mip’nei darkhei shalomMip’nei darkhei shalom (“for the sake of (“for the sake of Mip nei darkhei shalomMip nei darkhei shalom ( for the sake of ( for the sake of peace”)peace”)

This phrase appears throughout the This phrase appears throughout the talmudtalmud & the & the midrashmidrash..“All that is written in the Torah was written for the “All that is written in the Torah was written for the sake of peace” (sake of peace” (TanhTanhuma Shoftim uma Shoftim 1818))sake of peace (sake of peace (TanhTanhuma Shoftim uma Shoftim 1818).).Our actions “for the sake of peace” take Our actions “for the sake of peace” take precedence over allegiance to any secular ideology.precedence over allegiance to any secular ideology.For the sake of peace, we are to forego focusing For the sake of peace, we are to forego focusing solely on ourselves, on our immediate welfare, on solely on ourselves, on our immediate welfare, on “being right ” and instead attend to “doing right ”“being right ” and instead attend to “doing right ”being right, and instead attend to doing right.being right, and instead attend to doing right.


Pikuach nefeshPikuach nefesh (“to save a life”)(“to save a life”)Pikuach nefeshPikuach nefesh ( to save a life )( to save a life )“To save a life” supercedes all other negative “To save a life” supercedes all other negative mitzvotmitzvot (except three: those forbidding idolatry, (except three: those forbidding idolatry, d l & d )d l & d )adultery, & murder).adultery, & murder).

“. . . neither shalt thou stand idly by the blood of “. . . neither shalt thou stand idly by the blood of thy neighbor” (Lev. thy neighbor” (Lev. 1919::1616).).thy neighbor (Lev. thy neighbor (Lev. 1919::1616).).A guiding principle for Jewish bioethics, both A guiding principle for Jewish bioethics, both clinical & public health ethics. It encompasses clinical & public health ethics. It encompasses h h d h ld h lthe the duty to healduty to heal..

When a life is on the line, little else mattersWhen a life is on the line, little else matters——certainly not one’s political ideology, financial certainly not one’s political ideology, financial certainly not one s political ideology, financial certainly not one s political ideology, financial wellwell--being, or ritual piety.being, or ritual piety.


K’lalK’lal (“peoplehood”)(“peoplehood”)K lalK lal ( peoplehood )( peoplehood )As Jews, we see ourselves as a As Jews, we see ourselves as a communitycommunity, as , as a a peoplepeople——not as a conglomeration of separate, not as a conglomeration of separate, di d i di id l li k d l b di d i di id l li k d l b disconnected individuals linked only by a disconnected individuals linked only by a voluntary social contract.voluntary social contract.We Jews operate under a We Jews operate under a communalcommunal perspective perspective We Jews operate under a We Jews operate under a communalcommunal perspective perspective regarding:regarding:

identity (identity (whowho we are)we are)redemption/salvation (redemption/salvation (whywhy we are here)we are here)redemption/salvation (redemption/salvation (whywhy we are here)we are here)obligations to others (obligations to others (whatwhat we are to do)we are to do)

A central task for us is to work together to A central task for us is to work together to repair the world, to fix the broken, to heal the repair the world, to fix the broken, to heal the sicksick——we are Gwe are G--d’s agents in this work.d’s agents in this work.


Tikkun olamTikkun olam (“repair of the world”)(“repair of the world”)Tikkun olamTikkun olam ( repair of the world )( repair of the world )Implies healing & restoration, in a communal Implies healing & restoration, in a communal context.context.An especially popular concept among Jewish An especially popular concept among Jewish liberals & progressives and within Jewish liberals & progressives and within Jewish Renewal (but a defining concept for Renewal (but a defining concept for allall Jews).Jews).Renewal (but a defining concept for Renewal (but a defining concept for allall Jews).Jews).E.g., TikkunE.g., Tikkun, the Jewish political magazine , the Jewish political magazine edited by Rabbi Michael Lerner.edited by Rabbi Michael Lerner.The presence of the poor or needy amongst us is The presence of the poor or needy amongst us is a sign of the world’s brokenness and of our a sign of the world’s brokenness and of our failure to take seriously Gfailure to take seriously G--d’s charge to us to d’s charge to us to failure to take seriously Gfailure to take seriously G d s charge to us to d s charge to us to “[d]evote yourselves to justice” (Isaiah 1:11“[d]evote yourselves to justice” (Isaiah 1:11--17).17).


T’shuvahT’shuvah (“repentance”)(“repentance”)T shuvahT shuvah ( repentance )( repentance )Also means “return,” as in turning back from Also means “return,” as in turning back from transgression or aligning oneself with moral & transgression or aligning oneself with moral &

hi l ( hi l ( h l kh hh l kh h))ethical precepts (e.g., ethical precepts (e.g., halakhahhalakhah).).A legal decision in the Jewish A legal decision in the Jewish responsaresponsa literature literature is also known as a is also known as a t’shuvaht’shuvah (pl. (pl. t’shuvott’shuvot).).is also known as a is also known as a t shuvaht shuvah (pl. (pl. t shuvott shuvot).).The ongoing healthcare crisis could be viewed as The ongoing healthcare crisis could be viewed as a crisis in Jewish moral commitment, perhaps as a crisis in Jewish moral commitment, perhaps as k f k f a marker of our apostasy.a marker of our apostasy.

How we address this issue (healthcare) speaks to How we address this issue (healthcare) speaks to how we, communally, recognize our pressing how we, communally, recognize our pressing how we, communally, recognize our pressing how we, communally, recognize our pressing need to return to obedience to Gneed to return to obedience to G--d.d.


JovelJovel (“jubilee”)(“jubilee”)JovelJovel ( jubilee )( jubilee )Obligation to Obligation to restorerestore things to Gthings to G--d’s created order.d’s created order.All things belong to GAll things belong to G--d; they’re only on loan for a d; they’re only on loan for a g gg g ; y y; y yseason. After a time, they must be restored to Him.season. After a time, they must be restored to Him.Evocative of several of our themes:Evocative of several of our themes:

the presence of a moral gold standardthe presence of a moral gold standardour covenantal obligations to “the poor among us”our covenantal obligations to “the poor among us”pursuit of “justice, justice” supercedes most elsepursuit of “justice, justice” supercedes most elsethe communal dimension of personhoodthe communal dimension of personhood

If some people’s needs aren’t being met, through If some people’s needs aren’t being met, through no fault of their own, Gno fault of their own, G--d requires of us a d requires of us a no fault of their own, Gno fault of their own, G d requires of us a d requires of us a redistributive justice more thorough than any redistributive justice more thorough than any secular government could dare to legislate.secular government could dare to legislate.

IV. IV. LECH L’CHALECH L’CHA: : HOW DO WE “GO HOW DO WE “GO

FORTH”?FORTH”?

“The L“The L--rd said to Abram, ‘Go forth from your native land and from your rd said to Abram, ‘Go forth from your native land and from your father’s house to the land that I will show you I will make of you a great father’s house to the land that I will show you I will make of you a great father s house to the land that I will show you. I will make of you a great father s house to the land that I will show you. I will make of you a great

nation, and I will bless you; I will make your name great, and you shall be a nation, and I will bless you; I will make your name great, and you shall be a blessing. I will bless those who bless you and curse him that curses you; blessing. I will bless those who bless you and curse him that curses you;

and all the families of the earth shall bless themselves by you. Abram went and all the families of the earth shall bless themselves by you. Abram went forth (“forth (“Vayelech AvramVayelech Avram”) as the L”) as the L--rd had commanded him ”rd had commanded him ”forth (forth ( Vayelech AvramVayelech Avram ) as the L) as the L rd had commanded him . . . .rd had commanded him . . . .

-- B’reshitB’reshit (Genesis) (Genesis) 1212::11--44

LECH L’CHALECH L’CHA::h llh llFour ChallengesFour Challenges

1)1) P liP li1)1) PolicyPolicy

2)2) EconomicEconomic2)2) EconomicEconomic

3)3) PoliticalPolitical))

4)4) MoralMoral

LECH L’CHALECH L’CHA::P li Ch llP li Ch llPolicy ChallengesPolicy Challenges

Couched in conventional bioethical terms, how to Couched in conventional bioethical terms, how to ,,meet obligations of meet obligations of justicejustice & & beneficencebeneficence without without violating principles of violating principles of nonmaleficencenonmaleficence & & autonomyautonomyN l l i li i l/i di id l b i N l l i li i l/i di id l b i Not solely in a clinical/individual context, but in Not solely in a clinical/individual context, but in the communal context of population health:the communal context of population health:

How to elevate How to elevate accessaccess for underserved or vulnerable for underserved or vulnerable populations without threatening that of everyone else?populations without threatening that of everyone else?How to foster How to foster social justicesocial justice for some without sacrificing it for some without sacrificing it for others?for others?How to provide How to provide carecare for less advantaged people without for less advantaged people without creating entitlements that put others at financial risk?creating entitlements that put others at financial risk?

These challenges produce These challenges produce economiceconomic challenges.challenges.These challenges produce These challenges produce economiceconomic challenges.challenges.

LECH L’CHALECH L’CHA::E i Ch llE i Ch llEconomic ChallengesEconomic Challenges

Command economy vs. free marketCommand economy vs. free market (inevitabilities of (inevitabilities of yy ((central planning & Statecentral planning & State--socialism; see Mises, Hayek, Hazlitt, etc.)socialism; see Mises, Hayek, Hazlitt, etc.)::

Abrogation of the discovery processAbrogation of the discovery processI ffi iI ffi iInefficiencyInefficiencyCreation of shortagesCreation of shortagesInevitability of rationingInevitability of rationingMostMost--favored status for political allies; in this context, could favored status for political allies; in this context, could mean Statemean State--sanctioned refusal of care for outsanctioned refusal of care for out--ofof--favor groupsfavor groups

Current administration may have earnest motives, Current administration may have earnest motives, Current administration may have earnest motives, Current administration may have earnest motives, but has not translated these into viable strategies. but has not translated these into viable strategies. Will create more problems than are solved.Will create more problems than are solved.These challenges produce These challenges produce politicalpolitical challenges.challenges.

LECH L’CHALECH L’CHA::P li i l Ch llP li i l Ch llPolitical ChallengesPolitical Challenges

Threats to effectively addressing these issues in the Threats to effectively addressing these issues in the y gy gcurrent political environment:current political environment:

Woeful polarization of discourseWoeful polarization of discourseI t i t C hi h f t d it I t i t C hi h f t d it Instransigent Congress which refuses to read its own Instransigent Congress which refuses to read its own legislation (H.R. legislation (H.R. 39623962/H.R. /H.R. 35903590))Ideological White House unwilling to negotiateIdeological White House unwilling to negotiateN bl k t i it t l (H R N bl k t i it t l (H R 25162516 H R H R News blackout on minority party proposals (H.R. News blackout on minority party proposals (H.R. 25162516, H.R. , H.R. 39703970, S. , S. 10991099, H.R. , H.R. 25202520, H.R. , H.R. 32183218, H.R. , H.R. 34003400, H.R. , H.R. 37003700))DecisionDecision--making based on nonce political calculus rather making based on nonce political calculus rather than on careful policy deliberation economic realities or than on careful policy deliberation economic realities or than on careful policy deliberation, economic realities, or than on careful policy deliberation, economic realities, or moral principlesmoral principles

Not yet convinced this situation will change much Not yet convinced this situation will change much t k th l i l lt k th l i l lnext week; the players may simply reverse roles.next week; the players may simply reverse roles.

These challenges produce These challenges produce moralmoral challenges.challenges.

LECH L’CHALECH L’CHA::M l Ch llM l Ch llMoral ChallengesMoral Challenges

Jewish consensus on certain basic points:Jewish consensus on certain basic points:ppDo moral values & principles influence health policy? Do moral values & principles influence health policy? YESYESShould they? Should they? YESYESA blig d t k f t ti i l h g ? A blig d t k f t ti i l h g ? YESYESAre we obliged to work for constructive social change? Are we obliged to work for constructive social change? YESYESAccording to only certain ideological perspectives? According to only certain ideological perspectives? NONOAre we in breach of our covenantal obligations if we eschew Are we in breach of our covenantal obligations if we eschew thi ibilit ? thi ibilit ? YESYESthis responsibility? this responsibility? YESYESShould concern for justice, mercy, saving life, & preserving Should concern for justice, mercy, saving life, & preserving peace take precedence over political calculation? peace take precedence over political calculation? YESYES

“[Rabbi Tarfon] would also say: It is not incumbent “[Rabbi Tarfon] would also say: It is not incumbent upon you to finish the task, but neither are you upon you to finish the task, but neither are you f b l lf f i ”f b l lf f i ” i ki kfree to absolve yourself from it” free to absolve yourself from it” (Pirke Avot (Pirke Avot 22::1616))..

TAKETAKE--HOME POINTHOME POINTTAKETAKE HOME POINTHOME POINTRegardless of political & economic preferences, or level of Regardless of political & economic preferences, or level of h l khih l khi b h bbi ld b i i b h bbi ld b i i halakhichalakhic observance, the rabbis would be near unanimous in observance, the rabbis would be near unanimous in support of an obligation to provide for the healthcare of support of an obligation to provide for the healthcare of those unable to afford it or provide it on their own.those unable to afford it or provide it on their own.

TAKETAKE--HOME POINTHOME POINTTAKETAKE HOME POINTHOME POINTRegardless of political & economic preferences, or level of Regardless of political & economic preferences, or level of h l khih l khi b h bbi ld b i i b h bbi ld b i i halakhichalakhic observance, the rabbis would be near unanimous in observance, the rabbis would be near unanimous in support of an obligation to provide for the healthcare of support of an obligation to provide for the healthcare of those unable to afford it or provide it on their own.those unable to afford it or provide it on their own.This is a redThis is a red--letter moral issue for rabbinic Judaismletter moral issue for rabbinic Judaism..

TAKETAKE--HOME POINTHOME POINTTAKETAKE HOME POINTHOME POINTRegardless of political & economic preferences, or level of Regardless of political & economic preferences, or level of h l khih l khi b h bbi ld b i i b h bbi ld b i i halakhichalakhic observance, the rabbis would be near unanimous in observance, the rabbis would be near unanimous in support of an obligation to provide for the healthcare of support of an obligation to provide for the healthcare of those unable to afford it or provide it on their own.those unable to afford it or provide it on their own.This is a redThis is a red--letter moral issue for rabbinic Judaismletter moral issue for rabbinic Judaism..It’s hard to imagine any organized Jewish entityIt’s hard to imagine any organized Jewish entity——religious, religious, communal, or rabbiniccommunal, or rabbinic——that would sanction a purely that would sanction a purely communal, or rabbiniccommunal, or rabbinic that would sanction a purely that would sanction a purely laissezlaissez--faire or social Darwinist or Randian approach or faire or social Darwinist or Randian approach or something similar. something similar.

TAKETAKE--HOME POINTHOME POINTTAKETAKE HOME POINTHOME POINTRegardless of political & economic preferences, or level of Regardless of political & economic preferences, or level of h l khih l khi b bbi ld b i i b bbi ld b i i halakhichalakhic observance, rabbis would be near unanimous in observance, rabbis would be near unanimous in support of an obligation to provide for the healthcare of support of an obligation to provide for the healthcare of those unable to afford it or provide it on their own.those unable to afford it or provide it on their own.This is a redThis is a red--letter moral issue for rabbinic Judaismletter moral issue for rabbinic Judaism..It’s hard to imagine any organized Jewish entityIt’s hard to imagine any organized Jewish entity——religious, religious, communal, or rabbiniccommunal, or rabbinic——that would sanction a purely that would sanction a purely communal, or rabbiniccommunal, or rabbinic that would sanction a purely that would sanction a purely laissezlaissez--faire or social Darwinist or Randian approach or faire or social Darwinist or Randian approach or something similar. something similar. Such a view might even be considered a Such a view might even be considered a chillul Hashemchillul Hashem in in Such a view might even be considered a Such a view might even be considered a chillul Hashemchillul Hashem in in some quarters. The anarchosome quarters. The anarcho--libertarian or minimallibertarian or minimal--state state end of the spectrum, at least when it comes to healthcare, end of the spectrum, at least when it comes to healthcare, would probably have close to zero traction among observant would probably have close to zero traction among observant would probably have close to zero traction among observant would probably have close to zero traction among observant Jews, regardless of affiliation or political preference.Jews, regardless of affiliation or political preference.

“The Jewish demand that everyone have access to health care does not “The Jewish demand that everyone have access to health care does not The Jewish demand that everyone have access to health care does not The Jewish demand that everyone have access to health care does not necessarily mandate a particular form of delivery, such as socialized medicine: necessarily mandate a particular form of delivery, such as socialized medicine: any delivery system that does the job will meet these Jewish standards. . . .any delivery system that does the job will meet these Jewish standards. . . .

“However, the fact that more than forty million Americans have no health “However, the fact that more than forty million Americans have no health insurance whatsoever is, from a Jewish point of view, an intolerable insurance whatsoever is, from a Jewish point of view, an intolerable dereliction of society’s moral duty. . . .dereliction of society’s moral duty. . . .

“While the specific form of health care system may vary, Jewish ethics “While the specific form of health care system may vary, Jewish ethics definitely demands that American Jews work to ensure that the United States definitely demands that American Jews work to ensure that the United States definitely demands that American Jews work to ensure that the United States, definitely demands that American Jews work to ensure that the United States, as a society, provides health care to everyone in some way.”as a society, provides health care to everyone in some way.”

-- Rabbi Elliot N. Dorff, Rabbi Elliot N. Dorff, Matters of Life and DeathMatters of Life and Death ((20032003), pp. ), pp. 307307--309309..

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