I must begin with a confession. Once upon a time in a previous reincarnation when I was a young family physician in Manchester, England I had the audacity to lecture in the field of medical ethics. My only justification was that there was nobody else doing so, and there was but one basic source book, authored by the late British Chief Rabbi, Lord Immanuel Jakobovitz.
Soon after moving to the Holy Land, though, I gave my final lecture. In a city of giants such as Prof. Avraham Steinberg and others, I simply was not needed. My interest in the field, however, didn't end. In fact, over the years, I began to amass a large number of books, many of which were written or edited by Steinberg and translator, Dr. Fred Rosner.
Indeed, Steinberg's latest offering in translation at 8.1 pounds and 1,191 pages won the Israel Prize, the Jewish state's most prestigious civilian award. The three-volume, slip-cased set is not only informative but also very easy to read and absorb. The subjects are often exciting, always interesting, and worthy of browsing during a spare moment.
While the Encyclopedia is certainly about Jewish medical law, it also incorporates a comparative analysis with other religions and with secular ethical concepts. But unlike similar books, the medical contribution has considerable detailed descriptions of the relevant anatomy and physiology, which would not disgrace a medical textbook. Some readers will probably pass over this section. While Jewish medical law, is not the same as ethics, both themes are discussed where applicable.
Each chapter opens with the relevant biblical and Talmudic sources. If the subject is more in the legal area, many responsa from the earliest to modern times are included along with their references. Unlike other encyclopedias, the author does not hesitate to inject his own personal opinion from time to time.
He is certainly qualified to do so. Professor Steinberg is not only a Pediatric Neurologist, a Clinical Assistant Professor in Medical Ethics and a Government adviser on many ethical issues, but is also the author of many papers and works based on the responsa of one of the most prominent Jewish legal scholars of modern times, Rabbi Shlomo Zalman Auerbach.
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It's not easy to choose a single chapter that is fairly typical in its format and of interest to most readers. (Abortion, autopsy, contraception, and the moment of death are included. There are also "modern" topics such as AIDS, allocation of scarce resources, artificial insemination, cloning and disclosure of illness to patients) But there is one topic that should concern all: the elderly.
As with every chapter, the opening section is called Definition of the Term. "Throughout the generations and cultures, people have wrestled with the definition of old age. Is it related to objective criteria such as chronological age and/or physiological changes? Or is old age defined by subjective criteria such as the personal feeling of the elderly person and/or socially accepted criteria?", Dr. Steinberg writes.
In Jewish law, old age is sometimes defined according to chronological age that varies in regard to different legal situations. The Mishnah states that at sixty years of age a man attains old age, and at seventy, he has a hoary head. I was even more upset to read that the Kabbalistic literature refers to ages 10 years earlier.
Treatment of the Elderly among the Nations and Israel notes that the ancient Indians, Chinese and Japanese, treated their elderly with the respect and dignity bestowed on greatly experienced people. But most of the ancient Greeks and Romans had a negative opinion except for the Greeks Plato and Sophoceles, and the stoics, headed by the Romans Cicero and Seneca.
Most modern societies act with ambivalence because of the practical difficulties of giving the elderly the honor they deserve. The problems of the elderly are economic, health and social. But the syndrome of "elder abuse" is now recognized in Western society and laws have been enacted to protect the elderly.
The Jewish approach in general is to try and accommodate the elderly in the family environment. Thus, the first Jewish old age home was only established in the first half of the eighteenth century in Krakow, Poland.
The section on Scientific Background is typically extensive with statistics on the changes in life span from about 30 years, in ancient Roman times until the Renaissance, but is now about 75 years for women and 72 years for men in the West. The proportion of Israelis 65 years of age and older increased from 3.9% in 1950 to 9% in 1988. But Steinberg notes that the elderly occupy about 35% of the hospital beds and consume about 50% of all medical services provided to patients.
I was not happy to read that compared to the full functioning of various body systems at age 25, I can expect that when, hopefully, I reach age 65, I can expect a reduction of heart activity of 87%, renal function to 78%, and lung function to 62%.
"People do not die of old age per se; rather, old age greatly increases the chances of occurrence of a variety of illnesses from which old people die," Steinberg observes. Science has tried to increase the average human life span, and to improve the quality of life of adults without changing the maximum life span which is about 100 years. Another approach is to change the basic mechanism of old age and death and thereby increase the maximum life span. "This approach is far from reality, may be impossible to achieve, and may not even be desirable....At the moment we view aging as a primary process and old age as a fact of life," he writes.
Old Age in Scriptures and Talmud follows on with many interesting quotations. The Talmudic sages recognize 100 years as the usual limit of human life span, although the usual average is between 70 and 80 years which corresponds to modern day statistics. Apparently, the blessing "until one hundred and twenty years" is based on an erroneous interpretation of a Biblical verse and should be until "one hundred".
Long life is promised to those who fulfill all the commandments and some are specified, such as honoring one's parents and the use of honest weights and measures in commerce, and to those who prolong prayer, and meals. Additionally, repentance, giving charity, participating in the burial of the dead, are amongst activities that prolong life. Accepting suffering, coming early to the synagogue and leaving late, and prolonging the saying of Amen are yet more examples quoted.
The attitude to the elderly is mostly favorable. Old age is considered a blessing, and increases wisdom, and he who greets an elderly person is as if he greets the Divine Presence but shaming an old person is a sign of corruption. However, it is said that old age is a crown of thorns, and the days of old age are called bad days. Steinberg writes that there "are old people and there are old people. If a person acquires knowledge in his youth and uses his old age for positive things, his old age is a blessing and an attribute. By contrast, if a person does not acquire knowledge and does not prepare himself during youth, he becomes a burden on himself and on others during his old age."
Physical and functional changes of old age are well described in our religious writings. One may age prematurely due to fear, anger at children, an evil wife, wars, worry, and the wickedness of one's sons, as well as other reasons quoted. In old age, the skin becomes wrinkled, teeth fall out, vision and hearing deteriorate and the list continues. But Maimonides wrote that an elderly person is neither totally healthy nor ill.
Specific Laws occupies a large section beginning with "general laws also applicable to the elderly." These include visiting the sick, even a young person, and even if it is not fitting for his dignity, as well as participating in the burial of the dead. If he married in his youth, he should marry again in his old age, because it is forbidden for a man to live without a wife. In one interesting law not known by many cited, some sages rule that a meal on one's sixtieth birthday is akin to a seudas mitzvah, or religious feast, but others say it applies to the seventieth birthday. There is also a difference of opinion as to whether or not to say the special shehecheyanu blessing with or without mentioning the Divine's name on one's seventieth birthday.
Turning to" legal exemptions or modifications for the elderly",we are reminded about the relevant laws of fasting on Yom Kippur, and eating matza on Passover. The first choice for a cantor should be an elderly man, especially on fast days, unless his voice is weak.
The obligations of others toward the elderly is very interesting. If a son or daughter objects to their elderly parents living with them, their objection is valid and is accepted, and they can even change their mind after accepting them. However it is "meritorious and gracious" for the children to feed and provide for the needs of their parents who should pay rent if they have the financial resources.
When riding in a bus, one should offer one's seat to an old person. Rising for the elderly applies after the age of seventy, but some say sixty. If you are appointed to a position of leadership for an unspecified period of time, you cannot be fired just because you are old. This refers amongst others to physicians and rabbis. There is no difference between a young or old person when it comes to healing or saving life.
The Chapter concludes with an over review of the Ethical Background. Is old age a stage, a process, illness or what? How much economic resources should be allocated to the elderly who often have many illnesses and do not work? What are the rights of the elderly but also what are their obligations?
As in other chapters, we are directed to other relevant sections such as "Terminally Ill", "Human Experimentation' and "Mental Illness" but I decided that I had read enough of what the future held for me ( hopefully also) and declined!
Rarely does a reviewer comment on the indexes unless it is to note their absence. But over 60 pages of 11 different categories of indices must surely be a record. For example, there are listings of science, medical specialties, religions and cultures (including Buddhism and China and India),and secular scholars (including Kant, Aristotle and Leonardo de Vinci).
Translators are usually unknown but Dr. Fred Rosner is a definite exception. A Professor of Medicine and Haematologist, he is also a prolific writer on Jewish Medical Ethics and has translated many books of Maimonides on medical topics. So he is well qualified to translate the original Hebrew version of this encyclopedia that was published in six volumes between 1988 and 1998. The English edition has been significantly updated, and condensed.
Encyclopedia of Jewish Medical Ethics is a serious and unique work of scholarship, which, also, extends the boundaries of the subject to places where others have never trodden. It is remarkably enjoyable to read because of the content, style of writing, and excellent graphics.