Medical ethics and halachic expert takes SA’s temperature

JORDAN MOSHE

“While we do need to respect a patient’s autonomy as doctors, if something needs to be done in the interest of a patient’s well-being, we need to override their demands, and do what we must to save their lives,” Steinberg says.

In South Africa at the invitation of Chief Rabbi Dr Warren Goldstein, Steinberg will spend his time delivering lectures, and consulting with the rabbis of Johannesburg and the Beth Din on halachic medical ethics. He will also work closely with local mohalim under the auspices of the Brit Milah Regulatory Board.

His wisdom is sought after, not least because of his extensive learning and expertise. When Steinberg chose to pursue a career in medicine, it was not the desire to become a qualified doctor that drove him, rather, it was a determination to study a subject which could complement his Torah knowledge, inspire him to keep learning, and enable him to make balanced decisions on questions of medical ethics.

Steinberg is a Senior Paediatric Neurologist at Shaare Zedek Medical Center in Jerusalem, and Director of the Medical Ethics Unit. He is the author of The Encyclopedia of Jewish Medical Ethics, for which he was awarded the Israel Prize in 1999. He is also an associate clinical professor of medical ethics at the Hebrew University’s Hadassah Medical School in Jerusalem. He is head of the editorial board of the Talmudic Encyclopaedia, and a member of national and international societies of child neurology, medical ethics, and Jewish medical ethics.

In terms of medical ethics, Steinberg says doctors used to adopt a paternalistic approach to their patients, telling them what to do without inviting their opinions, but today, the pendulum has swung to the other extreme.

“Patients today dictate to their doctors what they want, and because of modern thinking which places the respect of an individual’s autonomy above all else, it has become almost unquestionable. This over-emphasis on a patient’s autonomy and rights needs to be weighed against the true value of human life, which is something doctors should always strive to honour.”

Born in a displaced persons camp in Germany to Holocaust survivors, Steinberg and his family arrived in Israel in 1949. His unique upbringing established the person he would become.

“My upbringing was not the standard one religious people tend to have,” he says. “My father had been a rabbi in Galicia (Eastern Europe), and the culture of learning there was completely different to that of the typical yeshivot.” So, instead of getting involved in detailed analyses of texts and intense focus on certain areas, his father taught him a method to derive applicable, practical knowledge from any text studied.

Steinberg explains. “When we learned the laws of kosher slaughter, my father would take me to the abattoir, so I could see it being practised. The text was made real and tangible.” This approach to study informed Steinberg’s career, the desire to learn things practically, not just through abstract theories.

He began his studies at Hadassah Medical School in Jerusalem, the only medical school in Israel at the time. To be accepted, candidates had to have studied at least one scientific subject, as well as either a humanities subject or an additional science subject. “As I hadn’t completed any proper schooling,” says Steinberg, “my knowledge of science was rather weak. However, biology was acceptable. I paired this with my knowledge of 50 memorised pages of Gemorah as my humanities subject, and was the first, and probably only candidate to be accepted into the school based on my knowledge of biology and Gemorah.”

Steinberg then specialised in paediatric medicine, and did his internship at Shaare Zedek Medical Center in Jerusalem. He went on to specialise further in paediatric neurology in the United States, publish his encyclopaedia, and subsequently returned to Israel.

He says ethical considerations in medical matters are not always straightforward. When his own father lay dying in hospital, comatose, and suffering from multiple-organ failure, he was faced with a difficult decision. “A drip was attached to my father that maintained his blood pressure,” says Steinberg. “It was effectively keeping him alive. When the drug ran out, his blood pressure would drop, and the hospital staff hurried to replace the drip, and he would stabilise again.”

Steinberg was unsure how to handle the situation, so he consulted with the renowned orthodox Rabbi Shlomo Zalman Auerbach, who ruled that while he could not remove the drip, he was permitted to refrain from replacing it when it ran out. “My family and I prepared ourselves, said our final goodbyes to my father, and gathered at his bedside to recite viduy (deathbed confession). The drug ran out, and my father passed away.”

This experience would enable Steinberg to develop a procedure for dealing with practical end-of-life matters for other families. Together with Auerbach, he published it, and it remains a basis for discussion.

Under his guidance, the Israeli government has taken halachic perspectives into account in drafting legislation, including the dying patient act, the brain death act, and the surrogacy act. He has also submitted more than 4 000 expert witness opinions in court cases in paediatric neurology and medical ethics.

From malpractice suits to car-accident cases, Steinberg says that every case is unique and requires a nuanced approach. Moreover, as head of the preimplantation genetic diagnosis (PGD) board at Shaare Zedek, he is involved in judging the merits of every case brought to the hospital concerning intervention in the genetic development of unborn children.

Today, at 71, this prize-winning senior paediatric neurologist, author, and expert in Jewish medical ethics shows no signs of slowing down, in fact, he continues to gain momentum.

“I wear more hats than I can count,” laughs Steinberg. “Whatever issues are of interest to me, I become involved in. That’s all there is to it.”

He maintains that there is no reason why the fields of halacha and medicine cannot operate hand in hand, supporting one another where necessary. “We need to show people that there is an ethical foundation to halacha. There are nuances in Jewish law. It is sensitive to our needs, and needs to be taken into account. Halacha can be a part of legislative processes, medical matters, and others, and is certainly capable of meeting all the criteria we could possibly have.”