Teaching

)Jewish( Medical Ethics

Euthanasia - Historical, Ethical & Jewish Aspects
regarding the Legal Debate

B. Gesundheit MD PhD
ww w.jewishmedicalethics.org
b.gesund@gmail.com
MB, YBB

 \ Euthanasia -
Introduction

Bible

Talmud
Classical
Rabbinic
Commentators

Modern
Halakha

)?Definition, Historical Background (Holocaust

Clinical Context, (Israeli) Law

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Case Discussions -

Euthanasia - Historical Background: The Hippocratic Oath

I SWEAR by Apollo the physician and Aesculapius, and Health, and All-heal,
and all the gods and goddesses, that, according to my ability and judgment,
I will keep this Oath and this stipulation-- to reckon him who taught me this Art equally
dear to me as my parents, to share my substance with him, and relieve his necessities if
required; to look upon his offspring in the same footing as my own brothers, and to
teach them this art, if they shall wish to learn it, without fee or stipulation; and that by
precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art
to my own sons, and those of my teachers, and to disciples bound by a stipulation and
oath according to the law of medicine, but to none others.
I will follow that system of regimen which, according to my ability and judgement, I
consider for the benefit of my patients, and abstain from whatever is deleterious and
mischievous. I will give no deadly medicine to any one if asked, nor suggest any such
counsel; and in like manner I will not give to a woman a pessary to produce abortion.
With purity and with holiness I will pass my life and practice my Art.
I will not cut persons laboring under the stone, but will leave this to be done by men
who are practitioners of this work.
Into whatever houses I enter, I will go into them for the benefit of the sick, and will
abstain from every voluntary act of mischief and corruption; further, from the seduction
of females or males, of freemen and slaves. Whatever, in connection with my
professional service, or not in connection with it, I see or hear, in the life of men, which
ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be
kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and
the practice of the art, respected by all men, in all times. But should I trespass and
violate this Oath, may the reverse be my lot.

Introduction

DEFINITION &
HISTORY OF EUTHANASIA

Definition: The action of inducing gentle and easy death

Etymology: Eu (= good) + Thanatos (= death)
Term Euthanasia was introduced in 1869
by the Irish historian and freethinker:
William Edward Hartpole Lecky (1838-1903)
Many early philosophers are among the advocates to actively
terminate the life of sufferers from incurable or painful disease:
PRO
Quality of Life, No Suffering
Plato Republic (3:405ff); Sir
Thomas More Utopia (2:7)
etc.
4

CONTRA
>

<
Value of Life
Hippocratic Oath: I will give no
deadly medicine to anyone if asked
nor suggest any such counsel

4 principles of Bioethics applied for Euthanasia

of patient ?

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PRO

Autonomy
Beneficence
Non-Maleficence
Justice

of physician ?

?
CONTRA

1. Die in dignity
1. Error !!!
2. No obligation to prolong the
2. No right to actively induce
life of sufferers from incurable
death )= Killing(
or painful disease.
3. Slippery Slope

Pellegrino ED. The metamorphosis of medical ethics. A 30-year retrospective.

JAMA. 1993 Mar 3;269(9):1158-62

Introduction

DEFINITION &
HISTORY OF EUTHANASIA

Historical Changes with modern medicine, ICU, supportive care

Confusion of Definitions: Passive vs. Active Euthanasia

PAS = Physician Assisted Suicide

Narcotics and Double Effect
Do Not Resuscitate (DNR)
Different Legal Attitudes today: Euthanasia Society, Exit
Catholic vs. Protestant Attitude
Euthanasia Program Nationalsozialismus (NS) 1939-45
6

Euthanasia - Historical Background: The Holocaust

Holocaust Nurembergs Trial Helsinki
Medicine in Holocaust Platform for Medical Ethics?
Slippery Slope, Responsibility
Jewish/Israeli, professional responsibility?

Collective Memory for Holocaust?

Proportion?
Holocaust & Medicine
www.Lecture in Haifa ???

xxx. Collective memory

Euthanasia - Historical Background: The Holocaust

Slope

The Example of Successful Resistance by the Physicians

of the Netherlands
Thus it came about that not a single euthanasia or nontherapeutic sterilization was recommended or participated in by
any Dutch physician. . It is the first seemingly innocent step
away from principle that frequently decides a career of crime.
Corrosion begins in microscopic proportions.

Slippery

The Early Change in Medical Attitudes

Whatever proportions these crimes finally assumed, it became
evident to all who investigated them that they had started from
small beginnings. The beginnings at first were merely a subtle shift
in emphasis in the basic attitude of the physicians. It started with the
acceptance of the attitude, basic in the euthanasia movement, that
there is such a thing as life not worthy to be lived.

Leo Alexander, Medical Science under Dictatorship NEJM 1949;241:39-47.

I. Kant (1724-1804):
Euthanasie des
Judentums

Charles Darwin (1809-82)

Political Darwinism,
Natural Selection )1859)

Racial Theories

Racial Examination

Racial Education

Euthanasie

Programm )T4) Endloesung (Final Solution)

Before 1933 during the Weimarer Republik =

Euthanasie, Rassenhygiene, Eugenie, Volksgesundheit

1938 Hitler asked his physician Dr Karl Brandt to kill a mentally
retarded child according to the wish of his parents
1939 August: Program for retarded children (3 - 17 years)
1939 October: Hitler empowers Dr. Brandt with T4 program
(= Tiergartenstrasse 4 Berlin) 61508 killed by August 1941
(by drugs/injections, later in gas chambers)
NO or only MINIMAL RESISTANCE BY PHYSICIANS!
Physicians of T4 got alcohol, vacations, salary

Slippery

1941 (August 3rd): Bishop Clemens Galen Muenster

against mass murder of T4, NS T4 experts sent to
Poland to prepare the Final Solution with gas chambers
(Treblinka, Sobibor, Belzec, Auschwitz)

Slope

1943/44 Aktion Brandt Killing of chronically and terminally ill

1947 Nuremberg Doctors Trial 275 000 killed in T4

11

HISTORY OF MEDICAL RESEARCH

Nuremberg War Trial Doctors Trials

Dec 9, 1946 August 20, 1947
23 physicians and administrators
Dr. Leo Alexander 6 points defining
legitimate research )April 17, 1947)

Dr. Leo Alexander at the Doctors

Trial, Nuremberg, Dec 1946.
http://www.ushmm.org/research/doctors

13

Doctors Trials, Nuremberg (Dec 9, 1946 - Aug 20, 1947)

23 defendants:
physicians and administrators

14

UNITED STATES HOLOCAUST MEMORIAL MUSEUM

http://www.ushmm.org/research/doctors

Euthanasia History: Death with Dignity Act (Oregan 1997)

http://oregon.gov/DHS/ph/pas

In 2008: 88 prescriptions for lethal medications were written

54/80 used it; 22 died of their underlying disease; 12 were alive at
the end of 2008; 6 used earlier prescriptions.
A total of 60 DWDA deaths in 2008 of total >30,000 deaths
15
= 0.194 % used DWDA

American Pathologist, Right-to-Die activist:

1952: Graduated from U of Michigan Med School
1980s: Published in German Journals Medicine and
Law on ethics of Euthanasia
1987: Death counseling
1991: State of Michigan revoked his medical license
1990-98: Assisted in the death of >130 patients:
Patients took the final action resulting in their
death by attaching patients to an euthanasia device
Dr. Murad "Jack"
(Thanatron = death machine) or Mercitron (= mercy
Kevorkian (1928-)
machine) = PAS.
1998: Videotape in 60 Minutes showing voluntary
euthanasia of 52y old terminal ALS patient, K. himself administered
lethal injection 26/3/1999: Charged with 1st + 2nd degree murder
1999-2007: 8 of 10-25-years prison sentence
1998: State of Oregon legalized doctor-assisted-suicide in their
Death with Dignity Act; 2008: law in Washington, Netherlands
14/4/2010: Premier in NY (+ CNN) of his movie You Dont Know Jack

Euthanasia & End-of-Life Care:

Clinical Dilemmas Jewish Sources

Mutual

Challenge

Medical Ethics in Israel

The State of Israel is an example of a newly emerging society that is
attempting to harmonize traditional values embedded in an ancient
religious tradition with the contemporary outlook in confronting the
concerns and dilemmas of bioethics.
S. Siegel in Encyclopedia of Bioethics, 1978 *Medical Ethics, History of
17


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Oath of Hippocrates
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http://knesset.gov.il/Laws/Data/law/2039/2039.pdf

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Definitions & Methodology of Jewish Medical Ethics

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Rabbi Dr. Lord
"Jewish Medical Ethics a Comparative Study
Immanuel Jakobovits
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The rational of the Prohibition

Shemot 20:13: You shall not murder.
Devarim 32:39: See now that I, indeed I, am
he! says the Lord, and there is no other god
besides me. I kill and give life, I smash and I
heal, and none can resist my power.
Yechezkel 18:4: Consider, all lives are Mine,
the life of the parent and the life of the child
are both Mine. The person who sins, only
he shall die.

Iyov 13:15-16:
He may well slay me; I may have no hope
(ktiv)
Though he slay me, yet will I trust in Him
(kri)
Yet I will argue my case before Him. In this
too is my salvation: that no impious man
can come into His presence.
(Sota 27b)

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Louis E. Newman: Woodchoppers and Respirators the Problem of Interpretation in Contemporary
37
Jewish Ethics. Modern Judaism 1990 10(1):17-42; doi

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http:// w ww.daat.ac.il/daat/kitveyet/assia/habasis-2.htm

Gesundheit B, Steinberg A, Glick S, Or R, Jotkowitz: Euthanasia: an Overview

and the Jewish Perspective. Cancer Invest. 2006;24(6):621-9.
Gesundheit B, Steinberg A, Blazer S, Jotkowitz A. The Groningen Protocol The
Jewish Perspective. Neonatology. 2009;96(1):6-10.
Jotkowitz A, Glick S, Gesundheit B. A Case Against Justified Non-Voluntary
active Euthanasia (the Groningen Protocol). Am J Bioeth. 2008;8(11):23-6.

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?International Day of Holocaust Remembrance Day
http://actv.haifa.ac.il/programs/Item.aspx?it=1234
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 Historical Review
Jerusalem Declaration
of Medical Ethics (1952)

Hippocrates

Philadelphia 1847
www.ama-assn.org

legislation,
legislation,hospitals
Hospitals

Declaration of the World Medical

Association

Helsinki

1964-1975-1983-1989-1996-2000

Nuremberg Doctors Trial 1947

International Guidelines for
Permissible Medical Experiments

Hierarchy

No Hospitals, experimenting,
captive groups
Medical Oaths & Prayers

Bio-medical Research
hospitals, medical progress,
new therapies, individuals right

International Ethical Codes

Albert R. Jonsen A Short History of Medical Ethics, Oxford University Press 2000
Albert R. Jonsen The Birth of Bioethics, Oxford University Press 1998

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JAMA. 1988 Jan 8;259(2):272.

http://web.missouri.edu/~bondesonw/Debbie.HTM