Jewish Perspectives on the Sacred in the Physician-Patient Encounter
Alan Astrow, M.D., Director, Hematology/Medical Oncology, Maimonides Cancer Center
Healing, wholeness, and holiness share the same Old English root, yet the holy or sacred dimension to healing has been insufficiently explored. The patient is 55 with metastatic cancer to her liver that has progressed despite treatment with many different chemotherapy regimens. Her liver is massively enlarged, and her disease is incurable, yet she looks and feels well, and runs her own small business. She is at the cancer center for treatment and tries to avoid seeing her doctor, out of fear of what he might tell her, but the doctor greets her nevertheless and informs her that she won’t be receiving treatment that day, that unfortunately her current treatment is not working. She asks if there are any other possible treatments. The truth is that at the moment, the doctor cannot think of any, but he responds, yes, there are still options available. The patient responds, “I’m so relieved to hear that because otherwise I would find myself in a dark space . . . I still can’t believe that this is happening to me.” Was the physician right to defer full truthfulness with his patient? Ethical analysis of situations such as this, commonplace in oncology practices, have focused on principles of medical ethics: autonomy, justice, beneficence, non-malfeasance. These principles, however, may not fully capture the moral dimension to what is at stake in the physician-patient encounter when life itself is on the line. Respect for the patient in a manner that acknowledges the uniqueness of human life, and the mystery of consciousness might require awareness, and analysis of the sacred or holy dimension to medical practice. “Holiness,” according to Alan Mittleman, Professor of Philosophy at the Jewish Theological Seminary “is that designation by which the underlying goodness of being is asserted, stabilized, and protected in Jewish life and thought . . . Holiness helps to develop the world, helps a new world to emerge in which human action and contemplation are intensified.” While holiness does not justify paternalism, it may lead a physician to think twice before speaking to a patient in a way that promotes despair. I will discuss Jewish concepts of holiness as represented in biblical accounts of priestly rituals and in the ethical imperatives of the “Holiness Code” (Leviticus 19-26). I will review Jewish approaches to truth-telling and suggest how these derive from biblical notions of the sacred. I will reference the work of Schnook and Churchill who argue that conceptualizing the physician-patient encounter as “sacred space” promotes healing. I will conclude by explaining why a broad view of the ethics of medical practice that supplements principles of medical ethics which a sense of the sacred dimension to care supports the physician’s approach in this case. I will argue that the physician’s actions did not represent mere evasion or seek to promote false optimism, but were an attempt to support a desperately sick person at a moment of existential crisis. I suggest that this broader view led to a better outcome for the patient.
Healing, wholeness, and holiness share the same Old English root, yet the holy or sacred dimension to healing has been insufficiently explored. The patient is 55 with metastatic cancer to her liver that has progressed despite treatment with many different chemotherapy regimens. Her liver is massively enlarged, and her disease is incurable, yet she looks and feels well, and runs her own small business. She is at the cancer center for treatment and tries to avoid seeing her doctor, out of fear of what he might tell her, but the doctor greets her nevertheless and informs her that she won’t be receiving treatment that day, that unfortunately her current treatment is not working. She asks if there are any other possible treatments. The truth is that at the moment, the doctor cannot think of any, but he responds, yes, there are still options available. The patient responds, “I’m so relieved to hear that because otherwise I would find myself in a dark space . . . I still can’t believe that this is happening to me.” Was the physician right to defer full truthfulness with his patient? Ethical analysis of situations such as this, commonplace in oncology practices, have focused on principles of medical ethics: autonomy, justice, beneficence, non-malfeasance. These principles, however, may not fully capture the moral dimension to what is at stake in the physician-patient encounter when life itself is on the line. Respect for the patient in a manner that acknowledges the uniqueness of human life, and the mystery of consciousness might require awareness, and analysis of the sacred or holy dimension to medical practice. “Holiness,” according to Alan Mittleman, Professor of Philosophy at the Jewish Theological Seminary “is that designation by which the underlying goodness of being is asserted, stabilized, and protected in Jewish life and thought . . . Holiness helps to develop the world, helps a new world to emerge in which human action and contemplation are intensified.” While holiness does not justify paternalism, it may lead a physician to think twice before speaking to a patient in a way that promotes despair. I will discuss Jewish concepts of holiness as represented in biblical accounts of priestly rituals and in the ethical imperatives of the “Holiness Code” (Leviticus 19-26). I will review Jewish approaches to truth-telling and suggest how these derive from biblical notions of the sacred. I will reference the work of Schnook and Churchill who argue that conceptualizing the physician-patient encounter as “sacred space” promotes healing. I will conclude by explaining why a broad view of the ethics of medical practice that supplements principles of medical ethics which a sense of the sacred dimension to care supports the physician’s approach in this case. I will argue that the physician’s actions did not represent mere evasion or seek to promote false optimism, but were an attempt to support a desperately sick person at a moment of existential crisis. I suggest that this broader view led to a better outcome for the patient.