Abstract
As the technology of medical care has advanced in recent years, the ethical, religious, and legal problems and questions surrounding it have multiplied. This principle is nowhere more true than in decision making in the care of patients at the end of life. Increasingly, scholars in the fields of ethics, sociology, and the sciences are beginning to recognize that the definitions of life and death and the necessary responses to various medical conditions at the end of life are often culturally contingent rather than strictly objective and verifiable. Within Jewish practice, end-of-life decision making takes on a singular character. Responses by Jewish patients, rabbinic authorities, and caregivers to issues as fundamental as the definition of death are inflected by the particular history of Judaism in the modern age. Taken together, those responses constitute what I call “Jewish Medical Culture,” the concept that lies at the heart of this work. \r What is Jewish Medical Culture? It is a subset of Jewish culture that deals with health, the body, and issues of life and death. For Americans who associate with the constellation of symbols and definitions that come from a lived experience of the ethno-religious community of Judaism, behavior is often guided by principles that may be traced to that community. This is especially true in cases at the end of life, when the turn to religious principles may become most pronounced. Thus analysis of particular cases in end-of-life decision making represents a means for elucidating this highly charged manifestation of Jewish Medical Culture. My aim is not to prescribe a Jewish bioethics or to determine the halakhic (Jewish legal) response to end-of-life cases. Instead, I study Jewish Medical Culture from a sociological perspective—how it manifests itself in actual practice.\r Drawing on literature dealing with cultural differences toward American medical care, as well as the history and ethics of Jews and medicine, this study considers three significant cases related to end-of-life medical issues—two within Orthodox Judaism and one outside of it: the cases are those of Mordechai Dov Brody, the conjoined twins of 1977, and Terri Schiavo. These three cases in succession highlight complex medical issues around the end of life. Using a variety of source bases—including academic case reports, newspaper articles, websites, and halakhic writings—I propose to explicate the Jewish themes that are implicit in the American Jewish community’s responses to major issues in medical decision-making. Although there is no single, unified Jewish American voice on medical care or ethics, I will argue that many of the responses to these cases from within the Jewish community—from patients, doctors, rabbinic leaders, and lay observers—had their underpinnings in Jewish tradition and Jewish concepts—that is, in Jewish Medical Culture. These manifestations of Jewish Medical Culture, I argue, reveal a great deal about contemporary Jewish ideas and practices, the extent to which Jewish identity is rooted in or distinct from the surrounding contemporary society, and the thumbprint of Jewish history in the present moment.