Sample Essay #1 From "The Ethical Imperative"
   
(
VIEW TABLE OF CONTENTS)
   
(
VIEW SAMPLE ESSAY #2)
The "Halachic Health Care Proxy":
An Insurance Policy With Unique Benefits
Chaim Dovid Zwiebel
Shortly before the summer, the highest policy making body within
Agudath Israel of America, the Moetzes Gedolei HaTorah (Council of Torah
Sages), arrived at a historic decision: Agudath Israel should develop and then
initiate a major national campaign to encourage people to sign a halachic
health care proxy -- a standardized form designed to help ensure that all
medical and post-death decisions made by others on an observant Jews
behalf would be made pursuant to halachah.
In this article, we will address three basic questions:
I. Why the need for a halachic health care proxy?
II. What are the legal considerations that underlie such a
document?
III. What are the specific components of the standardized form
developed by Agudath Israel, and how can individual Jews avail themselves of
its protections?
I. The Need for a
Halachic
Health Care Proxy
- Nancy Cruzan and the
Legacy of Modern Medical
Technology
The Orwellian-sounding phrase right to die became
firmly entrenched in the American lexicon in 1990 when the U.S. Supreme Court
issued its ruling in the celebrated case of Nancy Beth Cruzan.
The facts of the case were undeniably tragic. Ms. Cruzan was in an
automobile accident some seven-and-a half years ago. Since that time, she has
been lying in a Missouri hospital in a persistent vegetative state,
having lost her upper brain function, legally alive but permanently
unconscious. However, Ms. Cruzan is not terminally ill; she could continue to
live for many years in her vegetative state so long as she receives adequate
nutrition and hydration. Ms. Cruzans parents asserted that their daughter
would never wish to be maintained in such a state, and they asked the court to
compel the hospital to pull the plug on Ms. Cruzans feeding
tubes. By a vote of 5-4, however, the Supreme Court denied the parents
request, and upheld the State of Missouris right to continue providing
life-sustaining nutrition and hydration to Ms. Cruzan.[1]
Cruzan may have been the first case of its kind to reach
the U.S. Supreme Court, but it is illustrative of the types of agonizing issues
that arise so frequently in this era of rapid advances in medical technology.
Those advances have enabled doctors to preserve and prolong many lives. At the
same time, they have created a painful question that confronts countless
individuals and their families: Are there any limits to the resources and
efforts that should be devoted to the maintenance of a person whose quality of
life is severely diminished, whose chances of recovery are slim or virtually
nil, whose continued maintenance is exacting a severe economic and emotional
cost? Where, if anywhere, is the line to be drawn?
The question is one that is faced not only by growing numbers of
individuals and families, but also by society as a whole as it struggles to
develop public policy in an area of extreme moral complexity.
Some in the pro-life community advocate an
uncompromising public commitment to the preservation of human life under
virtually all circumstances, no matter what the costs, no matter what the
medical prognosis, no matter what the wishes of the family or even the
individual patient. A growing number of others, in contrast, advocate the
right to die with dignity -- a policy that would allow patients and
their families to decide, at least at some point, that the patients
quality of life was so severely diminished as to justify the withholding or
termination of medical life-support.
Although most proponents of the right to die position
would hasten to disavow any support of suicide or of euthanasia
(mercy killing), those concepts are inevitable outgrowths of the right to
die philosophy and are already beginning to emerge from the shadows of
the death with dignity movement. Laws have been proposed in a
number of jurisdictions that would authorize physicians to assist patients who
wish to commit suicide. One senses that stories like the one recently reported
about Dr. Jack Kevorkian, a pro-euthanasia physician who had supplied a woman
suffering from Alzheimers Disease with a do-it-yourself
suicide kit, which she promptly used to take her life, will soon fail even to
raise eyebrows among most people.
For yet others, dying is more than merely a matter of right; it
rises to the level of an obligation. In 1984, for example, Colorado Governor
Richard Lamm told a group of attorneys that terminally ill seniors have a
duty to die and get out of the way with all of our machines and
artificial hearts and everything else like that and let the other society, our
kids, build a reasonable life. This attitude is reflected in health care
rationing plans like the one recently developed in Oregon, which would deny
Medicaid patients the right to receive certain types of medical services that
are not deemed cost-effective. Thus, in determining whether any
given life-sustaining measure makes medical sense, the key consideration is
rapidly turning into one of dollars and cents.
With these developments taking place all around us, what is to be
the attitude of the Torah community?
Halachah, the law of Torah, encompasses every facet of
human life. It also encompasses every facet of human death. There are
halachos that teach us how a persons remains are to be buried;
under what circumstances, if any, a decedents body may be autopsied or
dissected; whether it is permissible, or perhaps even a mitzvah, to
donate body organs for purposes of transplantation into needy others.
So too does halachah govern the many issues that may arise
in near-death situations: the types of medical circumstances, if any, that may
justify the withholding or termination of various forms of medical care; the
permissibility, or non-permissibility, of undergoing experimental treatment
that could shorten life if it does not cure the disease; the extent, if any, to
which an individuals personal preferences with respect to medical care
are relevant halachic considerations in determining the course of his
treatment; the special laws that apply when a person reaches the stage of
gesisah (in the throes of death), as well as the means by which
gesisah is determined; the criteria by which to determine a
persons death.
Obviously, to state the self-evident axiom
that halachah provides answers to all of these questions is by no means
to state that there is always definitive halachic consensus as to what those
answers are. Indeed, with respect to certain especially complex matters, the
rabbinic responsa and other halachic literature reveal a considerable disparity
among a number of contemporary poskim (halachic decisors).
Moreover, the enormous technological and physiological complexity involved in
many of these sheeilos (questions of Jewish law), as well as the
high stakes, may result in a reluctance on the part of certain rabbanim
to render halachic rulings in specific cases.
For the believing Jew, though, the bottom line is that the
resolution of such issues must come through the halachic system, not through
personal predilection as molded by contemporary culture. There are inevitably
bound to be disparities between halachah and the mores of the time; the
underlying philosophies are in fundamental conflict. As Rabbi J. David Bleich
has written:
Man does not possess absolute title to his life or his body. He
is charged with preserving, dignifying and hallowing that life. He is obliged
to seek food and sustenance in order to safeguard the life he has been granted;
when falling victim to illness or disease he is obliged to seek a cure in order
to sustain life. The category of pikuach nefesh (preservation of life)
extends to human life of every description and classification including the
feeble-minded, the mentally deranged and yes, even a person in a so-called
vegetative state. Shabbos laws and the like are suspended on behalf of such
persons even though there maybe no chance for them ever to serve either
Gd or fellow man. The mitzvah of saving a life is neither enhanced nor
diminished by virtue of the quality of the life
preserved.[2]
Thus, death with dignity, the
rallying cry of the modern day euthanasia movement, clearly does not find its
roots in the law or values of Torah. Elderly persons who speak of their desire
to die rather than become a financial or emotional burden on the
children may have the most noble of intentions, but nobility of intention
is not the yardstick by which Jews measure conformity with Hashems will.
Those who champion only the quality of human life as the
overriding value in health care decisions disregard the longstanding Jewish
emphasis on the sanctity of human life, even in its most diminished
qualitative form.
In sum, the complexity of the halachic issues, the diversity of
views among rabbinic authorities with respect to certain sheeilos,
the relative difficulty of finding rabbanim prepared to offer halachic
guidance -- none of these considerations detracts from the fundamental fact
that for the Jew, the framework of analysis and decision on these issues must
be the halachah.
-
Who Will Ask the Questions?
Who Will Make the
Decisions?
In ordinary circumstances, when a person has a
sheeilah, he will pose it to the halachic authority whose guidance
he personally accepts as binding -- the Rav of his shul, his
rebbe, his rosh yeshivah, someone recognized as a halachic
decisor for all of Klal Yisrael -- whomever. Yet that is obviously
impossible with respect to the many medical and post-mortem issues that may
arise when the person about whom the sheeilah is being asked is
incapable of posing the question himself.
One would hope that the sheeilah under those
circumstances would be posed by those who will be making decisions on the
individuals behalf -- in most cases, the members of his family -- and
that it would be posed to the very same halachic authority to whom the
individual himself would have turned were he capable of doing so.
But not always can it be so. Some people do not have family
members with whom they retain contact or upon whom they can rely to contact
their morei horaah (halachic decisors) in times of
emergency. And, even for those who do, not always will the
sheeilos arise under circumstances where those family members will
be available to contact the individuals halachic authority. When, for
example, a person is involved in an accident far from home, emergency decisions
will be made for him by doctors and nurses who may not even know that he is
Jewish, let alone who his relatives are or who his rabbi is. The likelihood is
all too great in such situations that medical procedures will be performed, or
withheld, in ways that constitute a violation of halachah.
The problem arises even more frequently in the context of
post-mortem procedures. Many horror stories have come to light involving
autopsies, post-mortem procedures and non-halachic burials of Jewish decedents
who have passed away under circumstances where nobody was available to ensure
that halachah would be followed after the persons death.
Hence the need for some form of protection -- a mechanism whereby
one can obtain at least a measure of assurance that when he becomes incapable
of making his own health care decisions, when he dies and is unable to direct
the course of his own burial, when he becomes incapable of asking the
sheeilos himself, that others will take the steps necessary to
ensure that halachah will be followed. As detailed below, the
halachic health care proxy is designed to respond to that need.
II. Legal Underpinnings
- The Doctrine of Personal Autonomy
The renowned American jurist Benjamin N. Cardozo established in
1914 the principle that continues to guide medical jurisprudence to this day:
Every human being of adult years and sound mind has a right to determine
what shall be done with his own body; and a surgeon who performs an operation
without his patients consent commits an assault, for which he is liable
in damages.
This principle, which has come to be known as the doctrine
of personal autonomy, has been applied in numerous contexts to allow a
patient the right to dictate the course of his own medical care, including the
right to choose among various treatment alternatives and even the right to
decline life-sustaining measures. In the famous Karen Anne Quinlan case, the
New Jersey Supreme Court held that an individuals right to choose whether
or not to receive treatment was of constitutional dimension, encompassed within
the constitutional right of privacy. The U.S. Supreme Court came
close to endorsing this view in Cruzan, stating that a competent
person has a constitutionally protected liberty interest in refusing unwanted
medical treatment.
That is not to say that the doctrine of personal autonomy is
absolute. Some legal limitations do exist. Prohibitions against suicide or
assisting others in committing suicide, for example, run contrary to the notion
of unlimited personal autonomy; yet such prohibitions are recognized as legally
valid. Indeed, the Supreme Court in Cruzan intimated that under certain
circumstances, at least, a state may have the authority to override a
patients constitutionally protected liberty interest and
insist that the patient receive life-support even against his own
wishes.[3]
Limitations notwithstanding, it is fair to
say that the clear trend in American law is to accord virtually unfettered
deference to the wishes of the individual patient in matters of medical care.
But what if the patient is not physically able or competent to express those
wishes?
-
Ascertaining the Patients Wishes
A patients inability to express his wishes with respect to
health care decisions does not necessarily negate the doctrine of personal
autonomy. The law typically imposes an obligation on those who will be
dictating the course of an incompetent patients health care to do so in a
manner that complies with what the patient would have wanted, were he able to
express his own wishes. Stated simply, it ordinarily will be incumbent for
third party medical decisionmakers to ask the question: What would the
patient have wanted us to do?[4]
Very often, though, it may not be possible
to ascertain with any degree of certainty what the patient would have wanted.
It is under those circumstances that there is a broad disparity of legal
guidelines throughout the United States. Some states insist that all forms of
life support must be provided to incompetent patients unless there is
clear and convincing evidence that the patient would not have
wanted such support. Others accept less definitive evidence as sufficient
indication of the patients wishes. Yet others allow the withholding or
withdrawal of life-sustaining measures from an incompetent patient even if
there is absolutely no evidence of the patients wishes, so long as it is
determined that the patients best interests would be served
by allowing him to die.
These legal considerations have given rise to organized efforts to
encourage competent persons to provide clear evidence of what their wishes
would be with respect to medical decisions when they become incompetent. Two
basic means of achieving this purpose have been developed: the living
will and the health care proxy.
A living will is a document prepared by a competent
adult that provides specific instructions with respect to a number of medical
procedures that may arise if that person becomes incompetent. For example, the
Society for the Right to Die, an organization in the forefront of
the death with dignity movement, encourages people to sign a form
(which was reproduced in The New York Times two days after the Supreme
Court issued its Cruzan decision) that includes the following:
I direct my attending physician to withhold or withdraw
treatment that serves only to prolong the process of my dying, if I should be
in an incurable or irreversible mental or physical condition with no reasonable
expectation of recovery.
While I understand that I am not legally required to be
specific about future treatments, if I am in the condition(s) described above,
I feel especially strongly about the following forms of treatment:
I do not want cardiac resuscitation.
I do not want mechanical respiration.
I do not want tube feeding.
I do not want antibiotics.
I do not want maximum pain relief.
By the same token, obviously, a living will could
specify the individuals desire that those various medical procedures
should be maintained in the event of the individuals incompetence.
The point of the document is simply to enable an individual to make his
specific wishes known.
The health care proxy takes a different approach to
the issue. Rather than specify the types of medical procedures to be
undertaken, or to be withheld, the proxy simply appoints someone to serve as
the health care agent of the person signing the proxy form, empowered to make
health care decisions on the persons behalf if the person ever becomes
incapable of making such decisions on his own. The health care proxy thus
operates essentially as a power of attorney (and is indeed known in many
jurisdictions as a durable power of attorney).
A number of states have enacted health care proxy laws, providing
specific guidelines as to the formal requirements of the proxy, as well as the
scope of the agents authority and other pertinent substantive issues. New
York, in the final days of its 1990 legislative session, shortly after the
Supreme Courts Cruzan ruling, passed the Health Care Agents
and Proxies Act, scheduled to go into effect in early
1991.[5]
The two approaches outlined above -- the living will
and the health care proxy -- are by no means mutually exclusive.
One may, in the same document, accomplish both purposes: appoint an agent to
make health care decisions when the individual cannot make such decisions on
his own; and provide the agent with specific guidance as to the types of
procedures that should or should not be undertaken.
As will now be seen, that dual approach is embodied in the
halachic health care proxy.
III. The Halachic Health Care Proxy: Its
Components and Mechanics
With the assistance of its Commission on Legislation and Civic
Action, as well as a number of knowledgeable rabbanim, doctors and
lawyers, Agudath Israel has developed a halachic health care proxy
that is now available for broad distribution and use.[6]
Actually, the halachic health care proxy consists of
two separate standardized forms: (1) a legally binding, formal document,
entitled Proxy and Directive With Respect to Health Care Decisions and
Post-Mortem Decisions, which has been designed to conform to all the
technical requirements of the recently enacted New York State health care proxy
law; and (2) a short, credit card-sized form, entitled Emergency
Instructions, which summarizes the key provisions of the first form and
is designed to be carried in a persons wallet or handbag. Both forms
should be used in conjunction, as each serves a distinct purpose.
-
The Proxy and Directive
As its title implies, the Proxy and Directive form
accomplishes two essential functions.
First, it is a proxy: the appointment by a competent adult
(the principal) of another person to serve as an agent to make
health care decisions on the principals behalf if the principal becomes
incapable of making such decisions on his own. Subject to certain statutory
exceptions, the agent can be virtually any competent adult -- a family member,
a friend, anybody the principal trusts to carry out his wishes. The principal
can also appoint a second person to serve as an alternate agent if the original
agent is not available or willing to make decisions. The agents authority
commences only upon a medical determination of the principals lack of
capacity to make health care decisions for himself.
Second, the form is a directive: an instruction by the
principal to the agent to make all health care decisions, as well as
post-mortem decisions, in accordance with halachah. In order to ensure
that the agent will direct sheeilos to the rabbinic authority the
principal himself would consult were he able to do so, the form includes a
section allowing the principal to designate a specific rabbi to be consulted by
the agent whenever a sheeilah arises. Or, if such rabbi is
unavailable or unwilling to rule on a particular halachic issue, the form
further allows the principal to designate an Orthodox Jewish organization or
institution to be contacted for purposes of referring a competent rabbinical
authority.
The Proxy and Directive form should be completed and
signed by the principal. However, if the principal is physically incapable of
signing the form, he may ask another adult to sign his (the principals)
name on his behalf. In either event, the signing should be done in the presence
of two witnesses, who in turn should sign their names to the document as
well.
-
The Wallet-Size
Emergency Instructions
Form
Copies of the Proxy and Directive should be kept
among the principals important documents, and with a number of key
people: the agent and alternate agent, members of the principals family,
his doctor, his lawyer, his rabbi and whomever else may be called upon in cases
of emergency. At the same time, however, an unforeseen emergency may arise far
away from family and home, where the Proxy and Directive will be of
no avail unless the principal happens to be carrying a copy with him -- hardly
a likely happenstance in view of the sheer bulk of the document.
Hence the second halachic health care proxy form
developed by Agudath Israel: a small, credit card-size form designed to fit in
a persons wallet or handbag. The text of the card makes reference to the
fact that its bearer has executed a formal Proxy and Directive. It
then proceeds to outline, in abridged form, the key provisions of the larger
formal document; and provides the names, addresses and telephone numbers of the
agent and rabbinical consultant designated by the principal.
It is questionable whether the wallet-size form, on its own, would
be regarded as a legally binding document. Nonetheless, carrying it (on days
when carrying is permitted!) is an effective means of ensuring that ones
wishes with respect to medical and post-mortem decisions will be known under
virtually any eventuality that may arise. And, when used in conjunction with
the more formal Proxy and Directive outlined above, it will provide
considerable legal protection against the possibility of such decisions being
made in violation of halachah.
There are some things the halachic health care proxy
does not do. For one, it does not attempt to spell out precisely what
types of procedures, under what types of circumstances, should or should not be
undertaken as a matter of Jewish law. This omission reflects a conscious policy
decision by the Moetzes Gedolei HaTorah. They concluded that the range
of halachic issues was too great, the changes in medical technology too rapid,
the sheeilos too dependent upon individual circumstances, to
presume to identify in advance the precise course of action to be taken under
all future hypothetical situations. Rather than engage in such a speculative
and possibly misleading exercise, the Moetzes Gedolei HaTorah felt that
the form should simply provide a mechanism that would ensure that
sheeilos would be posed in whatever circumstances may eventually
arise.
Yet another thing the forms do not purport to do is tell
individuals which rabbis or organizations they should choose to serve as
halachic consultants/decisors with respect to medical and post-mortem
procedures. This, too, was a conscious decision of the Moetzes Gedolei
HaTorah. As noted above, there is a diversity of viewpoints among
contemporary poskim with respect to a number of the issues an agent may
have to decide. The Moetzes decided that it was not the role of an
umbrella organization like Agudath Israel to identify specific rabbanim,
to the implicit exclusion of others, as competent authorities in
the area of medical halachah -- especially in developing a form designed
to be used by all communities and segments of Klal Yisrael.Rather, each
individual should designate as a halachic consultant the particular moreh
horaah whose guidance he himself would seek -- recognizing, of
course, the specialized and highly complex nature of some of the
sheeilos that may arise.
It should also be recognized that the halachic health care
proxy is by no means the answer to every problem that may arise. Among
its most obvious limitations is the fact that by law, only competent adults can
sign such forms. Children, and adults who are not mentally competent, will not
be able to avail themselves of its protections. Agudath Israel is currently
pursuing with the New York State Department of Health the possibility of
developing a variation of the basic form that would enable adults to protect
their children and guardians to protect their incompetent wards against medical
or post-mortem violations of halachah.
Another question that requires careful consideration, and
consultation with competent halachic authority in individual cases, is whether
encouraging gravely ill patients to sign such forms could itself constitute a
violation of halachah by creating the possibility of tiruf
hadaas -- emotional shock that could further jeopardize the
individuals fragile health. (See generally Shulchan Aruch, Yoreh
Deah 337.) Obviously, the optimum time to encourage people to fill out and
sign a halachic health care proxy is when they are in sound health
and in full possession of their faculties, not after they have already entered
a hospital or nursing home.
One final caveat: As noted above, the forms developed by Agudath
Israel have been designed to conform with the specific formal requirements and
other provisions of the New York State health care proxy law. Although the
concept underlying the halachic health care proxy would likely be
recognized as binding throughout the United States (and presumably in most
other countries as well), other states may have certain particular requirements
that might require minor modifications in the basic form. For example, whereas
New York law provides that a proxy will remain in effect indefinitely unless
specifically revoked by the principal, California law limits the effectiveness
of its proxy (known in California as a durable power of attorney)
to a seven-year period.
Agudath Israel is in the process of developing alternate
halachic health care proxy forms for use in jurisdictions where the
New York model may be inappropriate. Individuals who reside outside of New York
may wish to consult with a local attorney to determine whether the New York
model would be recognized in their jurisdiction; or they may wish to contact
Agudath Israel for additional assistance.
Life is a precious gift from Hashem. Generally speaking,
man is not permitted to squander the gift no matter how difficult or even
unbearable the circumstances of human existence may become. As believing Jews,
we must cling firmly to these basic values even when the secular world all
around us is abandoning them. A society that subscribes to the principle that
each person is entitled to choose death -- the right to die with
dignity -- is a society that fails to appreciate fully the sanctity of
human life. Stated simply, the doctrine of unlimited personal autonomy in
medical decision making is totally repugnant to the foundations of our
faith.
Yet, in one of the ironic twists that is so common to our
millennia-long experience in galus (exile), the very same doctrine of
personal autonomy provides each individual Jew an opportunity to obtain
protection that will allow him to serve Hashem even when he is totally devoid
of consciousness, even when he is at the brink of death, even after he has
returned his soul to his Maker. The halachic health care proxy is
an insurance policy that costs no money to obtain, is available to all, and
provides the types of benefits that no insurance company can ever
offer.
[BACK]1. In so ruling, the Supreme
Court reached the result urged by Agudath Israel of America in its amicus
curiae (friend of the court) brief -- the only such brief submitted
by a Jewish organization to the high court. The Courts reasoning was
essentially this: Even assuming that an individual would have a personal
constitutional right to refuse lifesaving measures, states are free to insist
that there be clear and convincing evidence that a comatose patient
would in fact have refused life support before any outside party could make
that decision on the patients behalf. Since there was no such clear
and convincing evidence of Ms. Cruzans own wishes, her parents
could not compel the State of Missouri to pull the plug and end her
life.
[BACK]2. Bleich The Quinlan
Case: A Jewish Perspective, reprinted in Rosner & Bleich,
Jewish Bioethics, p. 270 (Heb. Publ. Co. 1979).
Sadly, certain others who allegedly represent the
Jewish viewpoint propound a different philosophy. The October 17, 1989 edition
of the Congressional Record contains the statement of Rabbi Dayle A.
Friedman (Reform) in support of the Patient Self-Determination Act of
1989, a bill pending at that time that would encourage patients to
prepare living wills or health care proxies. In the context of his remarks,
which were presented by the bills sponsors as part of a series of
statements from authorities on the ethical teachings of the three
main-line religions traditions. Rabbi Friedman explains the Reform
movements endorsement of a persons ultimate right to choose to
die:
In contrast to our
heteronomous tradition, Reform Jews have held that individuals have a direct,
personal relationship with G-d in addition to their relationship via the Jewish
peoples covenant with G-d....We Reform Jews champion the right of
individuals to make choices regarding their own conduct, including the
right of conscientious dissent from the dictates of tradition when
mandated by individual conscience, or by individual understanding of
contemporary circumstances (Borowitz, Choices in Modern Jewish
Thought, p. 269). We reject imposition of specific choices from
external authorities, either contemporary or historical.... What is being
proposed here is that the value of autonomy must be a guiding principle in a
Reform Jewish discussion of choices in medical ethics. In the instant case,
based on the principle of autonomy, we would have to hold that the patient, a
competent, mature adult, has made a decision which must be respected. We would
hope that the decision which such a person had made would emerge from a
confrontation with the values expressed in Jewish tradition, both
halachah and aggadah. Ultimately, however, the principle of
autonomy requires us...to respect even choices which might seem to conflict
with our understandings of the values of the
tradition.
[BACK]3. For the record, it should be noted that Agudath
Israel, in its amicus curiae brief to the Supreme Court and
innumerous other contexts, has expressed its strong opposition to the notion of
unlimited personal autonomy. For example, in testimony submitted to the New
York State legislature earlier this year, Professor Aaron Twerskl (chairman of
Agudath Israels Commission on Legislation and Civic Action) and I
observed that the doctrine of personal autonomy under New York law would
generally permit a person to refuse medical treatment even where the prognosis
is that such treatment would lead to full recovery. We stated as follows:
Agudath Israel is troubled by the message this notion of unlimited
personal autonomy delivers. It embodies a value judgment that societys
interest in the preservation of human life must bow before an individuals
decision that his life is no longer worth living. The implications of this
message run directly counter to prohibitions against suicide and euthanasia
that have long been accepted among civilized societies, and portend ominous
changes in these social norms.
[BACK]4. In addition to the general doctrine of personal
autonomy that requires surrogate decisionmakers to attempt to ascertain what
the patient would have wanted, a number of governmental bodies around the
country have enacted statutes or regulations designed specifically to protect
the religious rights of patients and decedents. In New York, for example, the
state with the most comprehensive series of religious accommodation provisions
(thanks to the efforts of organizations like Agudath Israel and COLPA, and of
individual public officials like Assemblyman Sheldon Silver and Health
Commissioner David Axelrod), the following protections have been explicitly
written into the law:
General: Section 2803-c of the New York
Public Health Care Law provides, in part, as follows: Every
patients civil and religious liberties...shall not be
infringed.
Do Not Resuscitate (DNR) Orders:
Section 2965 of the Public Health Law, which relates to decisions by a
surrogate with respect to the cardiopulmonary resuscitation of a patient who
has suffered cardiac or respiratory arrest, provides that such decisions shall
be made on the basis of the adult patients wishes including a
consideration of the patients religious and moral
beliefs.
Health Care
Proxies: Similarly, section 2982 of the health care proxy bill
(discussed in the text accompanying footnote 5 below) authorizes an agent to
make health care decisions on behalf of his principal in accordance with
the principals wishes, including the principals religious or
moral beliefs.
Determination of Death: Under section
400.16 of the New York State Department of Health regulations, hospitals are
required to develop a procedure for the reasonable accommodation of the
(patients) religious or moral objection to a determination of
death based upon the irreversible cessation of all brain
function (the neurological condition known as brain
death, which is nearly universally recognized by the secular law as
constituting legal death, yet is held by many poskim not to constitute
halachic death).
Autopsies and Dissections: Section 4209-a
of the Public Health Law generally prohibits the performance of an autopsy or
dissection on the body of any person who carries a card stating his personal
opposition to such procedures. Similarly, section 4210-c prohibits, in the
absence of a compelling public necessity, the performance of an autopsy or
dissection over the objection of a surviving relative orfriend of the
deceased that such procedure is contrary to the religious belief of the
decedent, or, if there is otherwise reason to believe that a dissection or
autopsy is contrary to the decedents religious
beliefs.
Anatomical Gifts: Under section 4222 of the Public
Health Law, a coroner or medical examiner may seek the removal of a
decedents corneal tissue or pituitary gland tissue only if such
removal does not conflict with [the] decedents religious or other
views. More generally, section 4301 authorizes relatives of a
decedent to donate the decedents organs for transplantation and other
medical purposes, but only in the absence of actual notice of contrary
indications by the decedent, or actual notice of opposition by [a relative],
or other reasons to believe that an anatomical gift is contrary to the
decedents religious or moral beliefs. If there is reason to
believe the decedent would have religious or moral objection to an anatomical
gift, the hospital administrator is enjoined from requesting such a donation
(section 4351), and a potential recipient is enjoined from accepting such a
donation (section 4301).
[BACK]5. Agudath Israel opposed the New York health care
proxy bill, objecting to the broad authority it accorded to agents to decide
that patients should die. Even though the bill is couched in terms of the
agent making decisions in accordance with the principals wishes or best
interests, Agudath Israel believes that the potential for abuse of that awesome
decisionmaking authority is self-evident. If the social good of permitting
people to designate trusted relatives or friends to make health care decisions
on their behalf can be achieved only by granting such third parties an
essentially unlimited right to decide that their principals should die, we
think the price to pay is too high.
[BACK]6. Copies may be obtained by contacting Agudath
Israel of America, 84 William Street, New York, N.Y. 10038, (212)
797-9000.
Sample Essay #2 From "The Ethical Imperative"
   
(
VIEW TABLE OF CONTENTS)
   
(
VIEW SAMPLE ESSAY #1)
Making It
in the Workplace, and Creating a Kiddush Hashem in the
Process
Yosi
Heber
True kiddush Shem Shamayim sanctifying the Heavenly Name
is achieved when an individual is alone within the four walls of his
room; faced with the opportunity to violate a Torah command, he refrains from
doing so because he realizes that his every action is scrutinized by G-d. When
others are also aware of his respect for G-ds wishes, the kiddush Hashem
grows; the wider the awareness, the greater the kiddush Hashem. But the
starting place is in the privacy of the heart of that single Jew.
Widespread kiddush Hashem will prompt observers to comment:
How wonderful are the deeds of So-and-so. How fortunate are his parents
for having taught him Torah! (See Yoma 86a.)
The Orthodox Jew in the marketplace faces frequent challenges
to his fidelity to Torah values and mitzvah observance. At the same time, he
may be struggling to make his mark in his particular field of endeavor, which
may appear to be threatened as a result of his open adherence to Torah
guidelines. In the article that follows, Yosi Heber, an executive at Dannon/Lea
& Perrins, describes his effort to succeed in his corner of the corporate
world, while remaining faithful to Torah, and hoping to generate a kiddush
Hashem at the same time.
* * *
Ill never forget the first week of my career.
Here I was, a newly-minted Wharton MBA, ready to plunge into the corporate
world and make my mark. At the end of my first week at General Foods, I called
my mother and told her how worried I was about my future prospects. There was a
class of six of us who started at the same time in the Desserts
Division. Spence and Carol were best friends from Harvard. Matt was one of the
boys who played golf with the big boss on Saturdays. Mary really looked the
part of junior executive. And then there was me, Yosi. I overheard one of the
secretaries ask, Whats a Yosi? One of my new roles was to
create new Jello recipes. I couldnt even eat the Jello! Ill
never make it, I told my mother. I couldnt possibly be one of them
or fit in with them. How would I survive in this jungle?
After a year on the job, I came to the following conclusion: If an
employee is a non-Jew, he or she can be perceived in the eyes of an employer in
one of three ways: liked by people, disliked by people, or middle of the road
(one of the boys).
If a person is a frum Jew, however, there are only two
possibilities: Either you will be respected because you are a
frum Jew (and you create a kiddush Hashem), or youll be
disliked because you are a frum Jew (and that can lead to
chillul Hashem). You cannot and will not ever be accepted as one
of the boys. There is simply no middle ground for you in a corporate
environment.
Therefore, when faced with the prospects of working in this type
of setting, you would want to be sure to land on the right side. In fact, the
possibility of creating a chillul Hashem cannot be taken lightly. As the
Gemara says: If a person creates a chillul Hashem, even
doing teshuvah on Yom Kippur does not achieve atonement for him
(Yoma 86a). The question is -- how can one insure that he or she will
create a positive impression, be properly respected, and make a kiddush
Hashem in such a difficult environment? One must work hard at it. I have
consulted with people who are in similar situations, and we have come up with
six rules that have been found to be helpful in achieving success.
Bend over backwards to be nice to people. Did you ever
notice that when something goes wrong, people are always Johnny on the
spot to complain and blame? Be the one to speak up when things go right!
Offer compliments to people who deserve them. Send greeting cards on
appropriate occasions and verbally express thanks to the people who have been
of help to you. And if you move up the corporate ladder and become other
peoples boss, aim at being an easygoing boss. The bottom line
is, if you treat people well, theyll both respect you and like you as a
person.
Do outstanding quality work. Dont just do your job,
do it with a high degree of excellence. Know your field inside out, and be
creative with new ideas. Become recognized as the resident expert on chosen
subjects. Offer help and give guidance to anyone who needs it, at any level. By
giving the job your absolute best, youll be highly valued for your
contributions to the organization.
Be consistent in your religious conduct. Never waffle.
Theyll respect you for it. If they perceive that you are only religious
when its convenient for you (e.g., leaving early on Fridays), then
youre in trouble.
David, a successful systems analyst in a large firm, knew
that he was on the right track when a peer said to him, If only I were as
consistent with my diet as you are with your religion, I wouldve lost 30
pounds by now.
Be frum, but show them that you are a
normal person. Begin by being professionally
friendly. Demonstrate that you have a sense of humor, talk about politics, and
ask your co-workers about their families. Theyll appreciate your
worldliness and your interest in them personally. This type of professional
friendliness can be more powerful than conforming to the social
friendliness stereotype that people think one needs to succeed (e.g., having
drinks together after work).
Although it can be a bit tricky, one should actively look for ways
to demonstrate normality to them. Use common sense. While there are
a number of halachic issues that you cannot compromise on, there are
other things that can be done well within the boundaries of
halachah.
Josh, a finance director at a well-known New York bank,
remembers having been required to go to the companys annual
picnic and baseball game. He felt uncomfortable playing in the field, so he
grabbed the microphone and announced the proceedings play by play, and
enthusiastically cheered the hits and catches. To his colleagues, it
demonstrated that he was normal.
Be someone whom people enjoy being around. Have a positive
attitude and project yourself as a happy person. As the Gemara
(Succah 49) says: If a person projects happiness and chein,
it becomes clear to people that he is a yerei Shamayim.
Strengthen your ruchnius level at
home. This, in truth, is the core of all kiddush Hashem. Being
exposed to the added nisyonos (temptations) of the outside world
requires that extra attention be paid to your frumkeit level when
youre not at work. Make certain that you have a Rav to whom you
can present sheeilos and can consult for advice, and always
maintain a kvius (set time) to study Torah every day without fail.
Daf Yomi is an excellent vehicle for this because even if you travel on
business, the daily daf is exactly the same whether youre in Los
Angeles, London or Lawrence.
It may seem improbable, but I have met many prominent people in
the corporate world over the years, who say that by merely following these
types of guidelines, they have never really had a negative experience. Even in
seemingly difficult situations (e.g., late Friday meetings, business trips
abroad, etc.), many comment that they have always felt that they were respected
for their religious beliefs, and not thought of as odd because they
were so different from everyone else in their respective companies.
-
The Importance of Being an Ambassador
One might ask, why is it so important to bear in mind that one is
representing the Jewish people, so to speak, in the marketplace -- the
kiddush Hashem factor, if you will? Isnt it sufficient to just do
your job positively, deliver faithfully, and hope for the best? The answer is
simple. First of all, as one is always a Jew -- 24 hours a day -- so too, is
one always viewed as a Jew. Kiddush Hashem and the opposite are always
on the agenda.
In addition, it is worthwhile to bear in mind the bigger picture.
One can never know which person one works with today will be in a position of
major influence for Klal Yisrael in 20 years. The lawyer next door may
someday be sitting on the Supreme Court. If hes deciding a case important
to the Jewish community, and you were his Jewish friend, the
impression one leaves today could have a profound impact on vast numbers of
people.
An excellent example of this is President Harry Trumans
Jewish connection. While a young man, Trumans business partner and
closest friend happened to be Eddie Jacobson -- a Jew. Most likely, back in
Independence, Missouri, young Harry did not meet many Jews. But when it came
time for the U.N. to vote on the partitioning of Palestine when Israel had
declared its independence in 1948, Jacobsons influence as President
Trumans Jewish friend was pivotal to Trumans pro-Israel
policy (against the wishes of many of his advisors in the State Department).
Always tell yourself, If Im one of the only Jews they ever really
get to know, Id better be sure that they have a positive impression of us
all.
Until now, weve discussed the subject of what I would call
external kiddush Hashem -- a passive sort of projection of
kiddush Hashem, as it relates to people we work with outside of the
Jewish community. Of even greater importance is an additional aspect that I
would call internal kiddush Hashem, the positive impact one
should make on others within the Jewish community.
To begin with, each person has certain talents, and everyone has
an obligation to give of some of those talents back to his own community. One
can easily find ways to channel his or her strengths toward
internal growth and improvement, creating a kiddush Hashem
in the process. For example, if you are a computer programmer, volunteer a few
hours a month to the local yeshivah to computerize the yeshivahs
financial and academic records, or to teach computer skills to the students. If
youre a lawyer, offer to help the shul draft its real-estate
contract. If youre a yeshivah rebbe, counsel those considering a
career in chinuch. These opportunities, however, must be actively sought
out. Often, they do not just come to you by themselves.
At times, one can use ones strengths in surprising ways.
While working in England a few years ago, I had developed a cordial
relationship with my boss, who was chairman of the company, and in fact the
only other Jew in the firm. He was not religiously observant, but since we met
once a week to discuss business matters, I summoned up the guts to ask him if
he would be interested in beginning our weekly meetings with a 10-minute
session in Mishnayos. To my surprise, he was thrilled to do so. And so
we began doing this every week. As time progressed, he came to the shiur
every week not only to learn Mishnayos, but to ask questions on the
parshah and halachah, as well.
As I just indicated, many of the points
highlighted in this discussion apply not only to those who work in a non-Jewish
environment, but to those who work in a Jewish environment, as well. Being nice
to people and doing outstanding work can actually create a kiddush
Hashem, and at the same time have the not-insignificant result of
helping build a persons reputation in his and her place of work. This is
true whether youre a stock broker, a rebbe or learning in a
kollel. In fact, the Rambam in Hilchos Yesodei Hatorah (5:11)
delineates the prescription for successful kiddush Hashem. This includes
treating people well, dealing honestly in business, and keeping a positive
attitude. And the notion of internal kiddush Hashem via
volunteering some of ones talents and time is something everyone has an
obligation to do. Hashem gave each of us special abilities and talents. It is
certainly expected that we share a portion of these berachos with
others.
Sometimes the potential kiddush Hashem opportunity is right
before you, other times you must look hard to find it. The key is to always be
asking yourself, How can I do my best to be mekadesh Shem Shamayim
both externally and internally?