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The doctor-patient relationship.

This essay focuses on the doctor-patient relationship as a measure of ethical behavior by the physician. The perspective is derived from commitment as a religious humanist to the Judaic heritage, and experience in hospitals. The ethical responsibility to be competent professionally is presupposed. Emphasis is placed on the need of the physician to respect the autonomy of the patient as person, thus to limit the paternalism inherent in the physician's position, and to re-enforce this with compassion. Judaic sources supporting such conduct are cited. Exception is taken to decisions by civil and rabbinic judges which disregard the intimacy of the doctor-patient relationship.

Abortion, Therapeutic↗

Preventive vs. curative medicine: perspectives of the Jewish legal tradition.

From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal health maintenance and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care.

Death↗

The use of Halakhic material in discussions of medical ethics.

In this paper questions are raised about the use of Halakhic material in discussions of medical ethics. Three ways in which one might use Halakhic material in such discussions are distinguished: (a) as a source for ideas about medical ethics which can be defended independently of their origin; (b) as a basis for mandating certain forms of behavior for members of the Jewish faith; (c) as the basis for claims about the Jewish view on disputed topics in medical ethics. The first two raise no methodological problems. The third use raises a number of theoretical and practical issues, with which the paper is concerned. The problems stem from the fact that Halakhah distinguishes between obligations, the fulfillment of which is required of the Jewish people, and obligations, the fulfillment of which is required of all people. With rare exceptions, the obligations imposed upon the Jewish people are more stringent. The pitfall lurking in the third of the three uses is that authors using Halakhic material may incorrectly conclude that obligations that are supposed to fall only upon the Jewish people fall upon all people. An analysis of this problem follows, along with a plea for a responsible use of Halakhic material in the third way, so as to avoid certain real pitfalls.

Ethical Relativism↗

Euthanasia: Buddhist principles.

Religions provide various forms of motivation for moral action. This chapter takes Buddhism as an example from within the Indian "family' of religions and seeks to identify the doctrinal and cultural principles on which ethical decisions are taken. Although beginning from very different religious premises, it is argued that the conclusions to which Buddhism tends are broadly similar to those found within mainstream Christianity.

Buddhism↗

Experience with patients with burns who refuse blood transfusion for religious reasons.

Patients with extensive full-thickness burns who refuse blood transfusion present a challenge to the burn team. We have recently treated four such patients, and we achieved a successful outcome in three. Staged excision and skin graft operations with minimal blood loss were performed. Two patients were treated with erythropoietin. Patient autonomy should be accepted by the burn team, but opportunity should exist for reassessment of treatment plans.

Adult↗

Hospitals sponsored by the Roman Catholic Church: separate, equal, and distinct?

For centuries, the Catholic Church has been a major social actor in the provision of health services, particularly health care delivered in hospitals. Through a confluence of powerful environmental forces at the beginning of the twenty-first century, the future of Catholic health care is threatened. Although Catholic hospitals are a separate case of private, nonprofit hospitals, they have experienced environmental pressures to become isomorphic with other hospital ownership types and, on some dimensions, they are equal. To keep pace with the changing demands of religion and the social role of the hospital, Catholic hospitals continue to redefine themselves. To justify a distinct and legitimate social role, more research should be conducted to develop and measure indicators of Catholic identity.

Catholicism↗