Who decides--the patient, the physician or the rabbi?

I am deeply honored to have been invited to give this second annual Jakobovits Memorial Lecture. I first met the Rav as a young physician who attended his biweekly shiurim at the Fifth Avenue Synagogue. He was my teacher, guide and personal friend for over four decades. As you all know, it was he who coined the term “Jewish Medical Ethics” which has taken firm hold throughout the world. The Rav directed this term, as well as the field, towards at least two audiences; one to the observant Jewish physicians and patients who wanted guidance on how to conduct themselves in the face of serious ethical and halachic medical dilemmas. But no less important to the Rav was the message to the world at large, which was, of course, under no particular obligation to follow Jewish norms. But the Rav felt that we, as Jews individually, and as a collective, had an important message to the world – םייוגל רוא, a unique, divinely inspired message which the Rav so ably articulated at every opportunity and for which he was so respected and admired. Tonight I will try to discuss a subject of fundamental importance to medical ethics, no matter in what area, and to examine with you the basic principles and the subtle differences and similarities between the Jewish approach and that of the secular western world. When we encounter life and death medical decisions involving a competent patient facing an ethical dilemma, who decides – the patient, the physician or the rabbi? I have deliberately posed the question in its most simplistic and attention-getting format. Obviously in no system is the decision really an either/or matter.