Religious commitment in medical practice: a Jewish perspective.

The physician-patient relationship, which is the cornerstone of medical practice, is based upon a transaction between a sufferer and a healer. The healer is not only confronted with the patient's immediate medical needs but also with psycho-social problems which the illness causes, or is caused by. The physician therefore fulfills many functions: those of a technologist, philosopher, priest, social worker, and economic advisor. In discussing the influence of religious commitment on medical practice it is helpful to dissect the practice of medicine into the physician's different functions. Although these functions may overlap, for the purpose of discussion they may be classified into two groups: (A) therapeutic functions and (B) etthical functions. Therapeutic functions deal with the scientific aspect of medicine, how to treat disease. Ethical functions deal with philosophical questions, e.g., should one treat disease? When called upon to fulfill a therapeutic function, such as diagnosing and treating pneumonia, diabetes mellitus, or myocardial infarction, the physician functions as a technologist, operating on scientific grounds. The rules of competent medical practice are relatively clear and will be followed by all physicians regardless of their religious commitment. It is when called upon to fulfill an ethical function such as deciding whether to treat a secondary illness in a primarily hopeless situation that religious commitment may influence medical practice. An example of such a situation is the patient with an incurable cancer suffering great pain, who develops pneumonia. By withholding antibiotic therapy the physician allows the pneumonia to carry the patient away, thus relieving him of his pain. The physician must now decide whether or not to treat the pneumonia. What guidelines can the physician follow when confronted with this ethical question? The guidelines I follow are dictated by my religious commitment. I subscribe to the views of Orthodox Judaism. In this religious system, all human acts are legislated by law considered to be of divine origin. These laws treat the same questions raised by the secular medical ethicist and very often give the same answers. For the Orthodox Jew, however, medical ethics are based on divine law rather than on philosophy. These laws therefore are not subject to the whims of society nor to the interpretation and influence of a human dictator. By the religious anchoring of medical ethics one is assured of a standard to be followed in every generation in every social milieu. The advantage of firmly anchoring medical ethics in an inviolate law rather than a personal ethic which can be changed by manipulating public opinion was demonstrated in recent history. Leo Alexander in his paper "Medical Science under Dictatorship" (1) writes,