Healthy Legacies? Moses Maimonides and Thomas Aquinas on Caring for Ourselves and Others
John Fitzgerald, JD, PhD, St. John's University
Moses Maimonides wrote extensively (in his magnum opus – the Mishneh Torah – and elsewhere) on ethical issues in medicine, such as proper health regimens, the virtues and vices of drinking alcohol, the value of human life, the moral status of the unborn, and the praiseworthiness of visiting the sick. While Thomas Aquinas wrote comparatively less on health care topics, he does address each of the matters enumerated above in his treatments of the virtues of temperance, justice, and charity in his own masterpiece, the Summa Theologica. But how relevant are these giant medieval thinkers to contemporary medical ethics? In comparing the authors’ pertinent considerations (a task surprisingly neglected to date), this paper will argue that while some of them are biologically outdated or otherwise open to challenge, others can be reflected upon profitably by medical ethicists today.
For example, as some have noted, the position that Maimonides takes on abortion is arguably inconsistent, since he permits therapeutic abortion for Jews but not for Gentiles. As for Aquinas, his belief that sinners “fall away from [their] dignity” and may be put to death is troubling, especially to those who prioritize need and expected benefit over moral responsibility in allocating organs and providing health care services. And the “principle of double effect” that his reasoning gave rise to may lead to incorrect conclusions; in particular, the principle appears to dictate that extraordinary care generally should not be withdrawn, since causing the death of the patient would be the means to relieve his or her pain from the underlying condition.
On the other hand, there are strains in Aquinas’s thought which rightly caution us against placing an absolute value on the preservation of bodily life, and his basic reflections on the cardinal and theological virtues should more strongly inform the practice of medicine today. Similarly, some of Maimonides’s considerations ought to receive greater attention in modern texts in Jewish and Christian health care ethics. Of special note here is his emphasis on caring for our own bodies as a moral task (more specifically, his view that preventive medicine enables us to serve God well), as well as his suggestion that there is an ecological dimension to medical ethics (in that environmental pollution is detrimental to physical and spiritual health). Finally, both thinkers helpfully reinforce a “morality of happiness,” particularly through their insight that moderation in food and drink conduces to further growth in virtue and to our overall flourishing.
Partial Bibliography: Thomas Aquinas, Summa Theologica; Moses Maimonides, The Guide of the Perplexed; Maimonides, Mishneh Torah; Tom Beauchamp and James Childress, Principles of Biomedical Ethics; Carl Cohen and Martin Benjamin, “Alcoholics and Liver Transplantation”; William Mattison, Introducing Moral Theology: True Happiness and the Virtues; Edmund Pellegrino and David Thomasma, The Virtues in Medical Practice; Pellegrino and Thomasma, The Christian Virtues in Medical Practice; Fred Rosner, The Medical Legacy of Moses Maimonides; Daniel Schiff, Abortion in Judaism; and Daniel Sulmasy, “Double Effect Reasoning and Care at the End of Life: Some Clarifications and Distinctions.”
Moses Maimonides wrote extensively (in his magnum opus – the Mishneh Torah – and elsewhere) on ethical issues in medicine, such as proper health regimens, the virtues and vices of drinking alcohol, the value of human life, the moral status of the unborn, and the praiseworthiness of visiting the sick. While Thomas Aquinas wrote comparatively less on health care topics, he does address each of the matters enumerated above in his treatments of the virtues of temperance, justice, and charity in his own masterpiece, the Summa Theologica. But how relevant are these giant medieval thinkers to contemporary medical ethics? In comparing the authors’ pertinent considerations (a task surprisingly neglected to date), this paper will argue that while some of them are biologically outdated or otherwise open to challenge, others can be reflected upon profitably by medical ethicists today.
For example, as some have noted, the position that Maimonides takes on abortion is arguably inconsistent, since he permits therapeutic abortion for Jews but not for Gentiles. As for Aquinas, his belief that sinners “fall away from [their] dignity” and may be put to death is troubling, especially to those who prioritize need and expected benefit over moral responsibility in allocating organs and providing health care services. And the “principle of double effect” that his reasoning gave rise to may lead to incorrect conclusions; in particular, the principle appears to dictate that extraordinary care generally should not be withdrawn, since causing the death of the patient would be the means to relieve his or her pain from the underlying condition.
On the other hand, there are strains in Aquinas’s thought which rightly caution us against placing an absolute value on the preservation of bodily life, and his basic reflections on the cardinal and theological virtues should more strongly inform the practice of medicine today. Similarly, some of Maimonides’s considerations ought to receive greater attention in modern texts in Jewish and Christian health care ethics. Of special note here is his emphasis on caring for our own bodies as a moral task (more specifically, his view that preventive medicine enables us to serve God well), as well as his suggestion that there is an ecological dimension to medical ethics (in that environmental pollution is detrimental to physical and spiritual health). Finally, both thinkers helpfully reinforce a “morality of happiness,” particularly through their insight that moderation in food and drink conduces to further growth in virtue and to our overall flourishing.
Partial Bibliography: Thomas Aquinas, Summa Theologica; Moses Maimonides, The Guide of the Perplexed; Maimonides, Mishneh Torah; Tom Beauchamp and James Childress, Principles of Biomedical Ethics; Carl Cohen and Martin Benjamin, “Alcoholics and Liver Transplantation”; William Mattison, Introducing Moral Theology: True Happiness and the Virtues; Edmund Pellegrino and David Thomasma, The Virtues in Medical Practice; Pellegrino and Thomasma, The Christian Virtues in Medical Practice; Fred Rosner, The Medical Legacy of Moses Maimonides; Daniel Schiff, Abortion in Judaism; and Daniel Sulmasy, “Double Effect Reasoning and Care at the End of Life: Some Clarifications and Distinctions.”