The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics

THE SEMINAL CONTRIBUTION OF RABBIMOSHE FEINSTEIN TO THE DEVELOPMENT

OF MODERN JEWISH MEDICAL ETHICSAlan Jotkowitz

ABSTRACT

The purpose of this essay is to show how, on a wide variety of issues, RabbiMoshe Feinstein broke new ground with the established Orthodox rabbinicconsensus and blazed a new trail in Jewish medical ethics. Rabbi Feinsteintook power away from the rabbis and let patients decide their treatment, heopened the door for a Jewish approach to palliative care, he supported theuse of new technologies to aid in reproduction, he endorsed altruistic livingorgan donation and recognized brain death (thus laying the groundworkfor Orthodox Jewish acceptance of heart transplantation), he downplayedthe value of social worth in triage decisions, and was a fierce defender ofthe rights of the fetus. I develop broader theological principles from RabbiFeinstein’s ethical positions and compare them to those of his Jewish andChristian contemporaries.

KEY WORDS: Jewish medical ethics, euthanasia, artificial reproduction, organdonation, abortion, triage

1. Introduction

The academic discipline of Jewish Medical Ethics (JME) is thought tohave begun with the publication of Lord Immanuel Jakobovits’s magnumopus Jewish Medical Ethics (Jakobovits 1975). Jakobovits, former ChiefRabbi of the United Kingdom, collected and summarized all previousJewish legal decision-making related to medical ethics and made itunderstandable to the modern reader. Jewish Medical Ethics, an adap-tation of his doctoral thesis, was first published in 1959, followed by arevised edition in 1975. Jakobovits’s expressed purpose in writing thebook was not to break new ground in the field, but to present the rabbinicconsensus on the major ethical issues facing the medical community.Following in Jakobovits’s footsteps, other scholars have entered the fieldof JME. Physicians such as Avraham Steinberg (2003), Fred Rosner

Dr. Alan Jotkowitz is Associate Professor of Medicine, Director of the Jakobovits Center forJewish Medical Ethics, Associate Director for Academic Affairs, Medical School for Interna-tional Health, Faculty of Health Sciences, Ben-Gurion University of the Negev and a SeniorPhysician, Soroka University Medical Center both in Beersheva, Israel. Alan Jotkowitz MD,Prywess Center for Medical Education, Faculty of Medicine, BGU, POB 151, Beer-Sheva,Israel 84105, [email protected].

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(2001), and Shimon Glick (2012) have combined their medical expertisewith an interest in JME to make important contributions to the field. Inaddition, figures from the Orthodox rabbinical world such as MosheTendler (Feinstein 1996) and J. David Bleich (1977), who combine Jewishlegal expertise with wide secular knowledge, have published widely onmodern ethical dilemmas and Jewish law. Rabbinical figures from outsidethe Orthodox world such as Elliot Dorff (1998) and David Feldman(1974) in the Conservative rabbinate, David Teutsch (2011) in theReconstructionist rabbinate, and Mark Washofsky (2012) and RichardAddress (Address and Person 2003) in the Reform rabbinate have alsobrought their unique perspectives and values to clinical ethical decision-making. Professional ethicists who also happen to be Jewish such asBaruch Brody (1974), Dena Davis (1992), the late Benjamin Freedman(1999), and Laurie Zoloth (Davis and Zoloth 1999) have sought to syn-thesize the wisdom of the Western liberal approach and the Jewishrabbinic tradition in their scholarship and practice. This is by no meansan exhaustive list of modern contributors to JME, but these are thefigures most frequently quoted by secular authorities. However, the mostimportant Orthodox Jewish decisor of ethical dilemmas in medicine, RabbiMoshe Feinstein, is usually not mentioned by name for a variety ofreasons. He has no formal secular education or academic degrees, and allof his writings are in Hebrew. In addition, his work is very technical innature, and for the most part is not meant for a lay audience. Histreatments of ethical quandaries common in JME—in his mode of think-ing, ethical analysis, and his presentation of conclusions—are very diffi-cult to follow without a strong background in Talmudic casuistry.(However, some of the Jewish ethicists mentioned above have madevaluable contributions as interpreters of R. Feinstein’s work to thegeneral public.) Finally, until relatively recently there has been a dearthof academic scholarship on rabbinic figures in the ultra-Orthodox com-munity in general (Brown 2011). The purpose of this essay is to show how,on a wide variety of issues, R. Feinstein broke new ground with theestablished Orthodox rabbinic consensus (as reflected in Jakobovits’sJewish Medical Ethics) and blazed a new trail in JME. I will then attemptto develop broader theological principles from Rabbi Feinstein’s ethicalpositions and compare them to those of his Jewish and Christian contem-poraries.

2. Biography

R. Feinstein was born on March 3, 1895 in Tsarist Russia to a distin-guished rabbinical family (Feinstein 1996, 1). His primary teacher was hisfather and he then studied in a small yeshiva in Russia. He had no formalsecular education but devoted all his time to the study of the Talmud and

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later lawcodes. Already at a young age he was recognized as a master ofJewish law and became rabbi of the town of Luban, in Lithuania. Therehe began answering queries regarding the intricacies of Jewish law, andmany of these earlier responsa were published decades later in his classicwork Iggerot Moshe. He remained rabbi of the town after the CommunistRevolution and was persecuted mercilessly by the Soviet authorities forhis religious convictions. Under continued threat as one of the last rabbisin Soviet Russia he decided to immigrate to the United States in 1936.In America he eventually became head of Mesivta Tiferet Jerusalem inNew York and became recognized as the premier American halakhic[Jewish legal] decisor. R. Feinstein himself, with characteristic humility,addressed the question of how one becomes recognized as an authorita-tive decisor in traditional Jewish circles. “You can’t just wake up in themorning and decide you’re an expert on answers,” [R. Feinstein] said. “Ifpeople see that one answer is good, and another answer is good, graduallyyou will be accepted” (Shenker 1975).

3. Autonomy and Informed Consent

Autonomy is now almost universally recognized as the dominanttheme in Western medical ethics. The acceptance by Western medicine ofautonomy as the focal point of modern bioethics was partly a response tothe inhumane experiments performed by Nazi physicians on concentra-tion camp inmates. The Western medical community was shocked by theinvolvement of doctors in these crimes and an international effort ledto the adoption of the Nuremberg Code and the first World MedicalAssociation (WMA) Declaration of Helsinki (1964), which provided ethicalguidelines to physicians on research involving human subjects. In theUnited States this work has been continued by the National HumanResources Protections Advisory Commission (under the aegis of theDepartment of Health and Human Services) to define the parameters ofinformed consent in difficult cases such as children, soldiers, and prison-ers. Jay Katz and others have brought the concepts of informed consentand patient autonomy to the medical wards and to the physician-patientrelationship. Katz argued in The Silent World of Doctor and Patient thatpatients have very little say in medical decision-making relating to theirhealthcare and quality of life. He attacked this way of practicing medicineas an assault on human dignity and an affront to autonomy (Katz 1984).According to Katz, not only do patients have to give consent regardingtheir treatment, but they should also play the role of primary decision-makers regarding their care. This emphasis on patient decision-makingwas incorporated into the law in many western countries and was slowlyadopted by doctors. Recently, a large number of worldwide medical organi-zations ratified the Charter on Medical Professionalism, which states as

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one of its cardinal principles that “physicians must be honest with theirpatients and empower them to make informed decisions about theirtreatment” (American Board of Internal Medicine 2002).

This paradigm of bioethics based on autonomy and human rights has,from its outset, been challenged by Jakobovits and other theologians,particularly Roman Catholics. He eloquently writes:

Now in Judaism we know of no intrinsic rights. Indeed there is no word forrights in the very language of the Hebrew Bible and of the classic sources ofJewish law. In the moral vocabulary of the Jewish discipline of life we speakof human duties, not of human rights, of obligations not entitlement. TheDecalogue is a list of Ten Commandments not a bill of Human Rights. Inthe charity legislation of the Bible, for instance, it is the rich man who iscommanded to support the poor, not the poor man who has the right todemand support from the rich. In Jewish law a doctor is obligated to cometo the rescue of his stricken fellow-man and to perform any operation heconsiders essential for the life of the patient, even if the patient refuses hisconsent or prefers to die. Once again, the emphasis is on the physician’sresponsibility to heal, to offer service, more than on the patient’s right to betreated. (Jakobovits 1977, 128)

Following in Jakobovits’s footsteps, Benjamin Freedman has pointed outthat what distinguishes a Jewish approach to moral dilemmas is itsemphasis on a duty-based ethic as opposed to a secular ethic based onrights (Freedman 1999).1

Jakobovits’s formulation has the effect of taking medical decision-making away from the patient and placing it in the hands of the rabbis.This is most readily seen in Jakobovits’s discussion of the principle ofinformed consent in medical ethics. As we have discussed, this stipulationbased on autonomy and human freedom is the cornerstone of modernmedical ethics, but it receives only scant mention in Jewish MedicalEthics. Consent is not mentioned at all in the first edition published in1959 and only mentioned in the revised edition published in 1975 in the

1 The eminent legal scholar Robert Cover makes a similar point: “Every legal culture hasits fundamental words. . . . The word ‘rights’ is a highly evocative one for those of us whohave grown up in the post-enlightenment secular society of the West. . . . Judaism is, itself,a legal culture of great antiquity. . . . When I am asked to reflect upon Judaism and humanrights, therefore, the first thought that comes to mind is that the categories are wrong. I donot mean, of course, that basic ideas of human dignity and worth are not powerfullyexpressed in the Jewish legal and literary traditions. Rather, I mean that because it is alegal tradition, Judaism has its own categories for expressing through law the worth anddignity of each human being. . . . The principal word in Jewish law, which occupies a placeequivalent in evocative force to the American legal system’s ‘rights’, is the word ‘mitzvah’which literally means commandment but has a general meaning closer to ‘incumbentobligation’. . . . All law was given at Sinai, and therefore all law is related back to theultimate heteronomous event” (Cover 1987).


context of obtaining it from the family before an autopsy or organdonation. In an article published in 1966 he expands on the issue inrelation to obtaining patient consent before a surgical procedure. “InJewish law the consent of a patient is not required for any operationmedically deemed necessary for his health. Indeed, even if he wished toavoid the operation and submit to danger as a means to penitence throughsuffering, he should be forced to undergo the treatment ‘against his willif necessary’” (Jakobovits 1966, 158).

This approach, rooted in Jakobovits’s concept of human duties andresponsibility, also explains his teaching that “The rabbis insisted onmaintaining the patient’s hopefulness not merely by withholding infor-mation of his imminent death, but by positive means to encourage hisconfidence in recovery” (Jakobovits 1975, 120). For in Judaism, “we givepreference to the good of the patient over everything else.” In his conceptof JME, beneficence takes precedence over autonomy. Rabbi EliezerWaldenberg, one of the foremost modern decisors on questions relating tomedical ethics, takes a similar position. In response to the question of aterminal patient who does not want his or her life extended, does thephysician listen to the patient? R. Waldenberg cites Rav Yaakov Emden(1995/96, #328) who discusses a case of a patient who prefers to die ratherthan live in suffering and requires the doctor to amputate a limb evenagainst his own will because it is not the doctor’s decision to make.R. Waldenberg explains Rav Emden’s opinion based on the principle thata person’s soul does not belong to him but to God. He says in similarsituations that it is not the patient’s or the family’s decision to makewhether to extend life, but the physician is required to do everything inhis or her power to compel the patient to extend their life (Waldenberg1945–1994, 18:62).2

R. Feinstein challenged this paradigm (Jotkowitz 2010). In responseto the question of whether one is required to treat a second illness in aterminal patient, for example a suffering patient with end stage cancerwho develops a secondary infection. He says this depends on the wishesof the patient, if she wants to continue to live in pain. “It is plausible thatone is not required to cure this patient who does not want treatment thatwill only extend his life of pain” (Feinstein 1959–1996, H· oshen Mishpat2:74:2).3 Rabbi Dr. Moshe Tendler, in explaining R. Feinstein’s opinion,comments: “It is a decision which the patient must make” (Feinstein 1996,

2 References to the Responsa Tzitz Eliezer are to a volume number, followed by a colonand the responsum number. If necessary, the responsum number is followed by anothercolon, and then the appropriate section number of the responsum.

3 References to the Iggerot Moshe are to the division of the lawcode Shulh· an Arukh onwhich the responsum comments, and then the volume number treating that division,followed by a colon and the responsum number. If necessary, the responsum number isfollowed by another colon, and then the appropriate section number of the responsum.


57). R. Feinstein leaves the decision of whether a life of pain is prefer-able to death in the hands of the patient. It is illuminating to comparehis position with that of another leading decisor, Rabbi ShlomoZalman Auerbach. In a similar situation, Rabbi Auerbach agrees with R.Feinstein’s position that the decision is the patient’s to make, but addsthat “if the patient is a God fearing person and is competent one shouldexplain to the patient that one hour of repentance in this world is morevaluable than life in the world to come” (Auerbach 1986–2003, 1:91).4 Thisappeal to influence the patient is missing from R. Feinstein’s responsum.He also tries to develop a legal rationale of why the choice should bethe patient’s to make. According to R. Feinstein, the question of whoshould decide is dependent on who has the primary obligation to care forthe patient; when a patient is cognitively intact it falls on the patient,when he or she is unable to fulfill that task it falls on the relatives(Feinstein 1959–1996, H· oshen Mishpat 2:74:2). Freedman develops asimilar approach in arguing for the doctrine of informed consent from aJewish perspective. He posits that even though Judaism recognizes thatthe body belongs to God, a person is legally considered a watchman overtheir body. He explains:

Persons have duties with respect to the body, duties to act as prudentcaretakers. Because of the nature of the relationship between a person andhis or her body, nobody else can understand precisely what medical treat-ment will mean better than that same person. Hence, only the patient cantruly fulfill the demands of bodily preservation and caretaking. (Freedman1999, 176)

R. Feinstein’s positioning of the patient as the primary decision-makerfrom a Jewish legal perspective enabled Jewish physicians to practicewithin the consensus of modern medical practice and freed patients toappropriately make their own treatment decisions.

4. End of Life Care

Remarkably, in the 439-page book Jewish Medical Ethics, only fivepages are dedicated to a discussion on the Jewish attitude toward end oflife care. Jakobovits writes:

Anyone who kills a dying person is liable to the death penalty as a commonmurderer. At the same time, Jewish law sanctions, and perhaps evendemands, the withdrawal of any factor—whether extraneous to the patienthimself or not—which may artificially delay his demise in the final phase. Itmight be argued that this modification implies the legality of expediting the

4 References to Minchat Shlomo are to a volume number, followed by a colon and theresponsum number.


death of an incurable patient in acute agony by with holding from him suchmedicaments as sustain his continued life by unnatural means—an issuealso considered in Catholic moral philosophy. Our sources advert onlyto cases in which death is expected to be imminent; it is, therefore, notaltogether clear whether they would tolerate this moderate form of eutha-nasia, though that cannot be ruled out. (Jakobovits 1975, 123–24)

R. Feinstein ruled that this moderate form of euthanasia is acceptableaccording to Jewish law. He writes in response to a query:

Are there patients who should not receive medications to lengthen theirlives? In regard to the question of whether there are patients who should notreceive medications to lengthen their lives a little. It is explicit in B. Ketubot104a in the story of the death of Rebbe [Rabbi Judah the Prince, born in 135CE and compiler of the Mishnah], the Rabbis’ prayers worked so that Rebbedid not die but he also did not recover and when Rebbe’s handmaid sawthat he was suffering, she said “May it be your will that the heavens willovercome the earth”; however, the Rabbis were not silent and continued tobeg for mercy, she took an urn and threw it to the ground, the (Rabbis) weresilenced from begging for mercy [because of the sound of the urn breaking]and Rebbe’s soul rested. And the Talmud related the story [to teach] thatthere are times when one has to pray for a patient to die if he is sufferingand there is no therapy available and our prayers are not working.(Feinstein 1959–1996, H· oshen Mishpat 2:73:1)

Surprisingly, the main source R. Feinstein brings for his original positionthat one does not have to treat a terminal patient according to Jewishlaw is a Talmudic narrative (Jotkowitz 2013). One would expect that forsuch a significant and innovative opinion R. Feinstein would bring a legalsource. This apparently perplexed the next petitioner in Iggerot Moshewho is obviously surprised by R. Feinstein’s position and perhaps also hisreasoning. R. Feinstein responds:

I do not see a reason for further explanation and I do not see where one couldmake a mistake because the law I wrote is simple. If the physicians do nothave the ability to cure the patient or alleviate his suffering but only havethe ability to lengthen his life for a short time they should not treat thepatient. And we learn this from the story of Rebbe. (Feinstein 1959–1996,H· oshen Mishpat 2:74:1)

Again, R. Feinstein’s source for this landmark position is the folktale ofthe death of Rebbe. The use of Talmudic narratives in the development ofa Jewish position is not at all self-evident, as law is usually based on thelegal sections of the Talmud. However, the use of the story does demon-strate the importance of these narratives, particularly in areas where thelaw is not fully developed, and attests to the importance of stories in thelegal tradition as demonstrated by the legal theorist Robert Cover:


We inhabit a nomos—a normative universe. We constantly create andmaintain a world of right and wrong, of lawful and unlawful, of valid andvoid. The student of the law may come to identify the normative world withthe professional paraphernalia of social control. The rules and principlesof justice, the formal institutions of the law, and the conventions of a socialorder are, indeed, important to that world; they are, however, but a smallpart of the normative universe that ought to claim our attention. No set oflegal institutions or prescriptions exist apart from the narratives that locateit and give it meaning. (1983, 1)

Harel Gordin has pointed out that R. Feinstein uses Talmudic narrativesin other contexts as well but notes that there are other times that R.Feinstein explicitly rejects the use of stories in helping resolve legaldisputes (Gordin 2008). Notwithstanding this tension, R. Feinstein’ssupport of passive euthanasia is revolutionary and his use of Talmudicnarratives to support his position is of particular importance in the fieldof JME, where frequently there is a paucity of legal precedent on whichto base decisions.

5. Artificial Reproduction

Jakobovits was also wary of new forms of artificial reproduction. Hisdiscussion of artificial insemination (AI) in Jewish Medical Ethics beginswith a survey of the historical and legal sources relating to the subject andthe opinions of the major religions regarding AI. He demonstrates througha deft analysis of the halakhic sources that “The considerations involved,though complex, may appear to warrant rather liberal conclusions onthe legitimacy of the practice . . . if Jewish law nevertheless opposes AIwithout reservation as utterly evil, it is mainly for moral reasons, notbecause of the intrinsic illegality of the act itself” (1975, 248). The moralrevulsion is due to the reduction of human procreation to stud-farming,breaking the link between childbearing and marriage, empowering womento have children without husbands, potentially increasing promiscuityby enabling an adulterous woman to claim her pregnancy is due to AI,destroying the mystical partnership between God and man in the creationof life, and threatening the integrity and sanctity of the traditional family.A leading colleague of R. Feinstein wrote summarizing much of contem-porary rabbinic opinion:

This whole question of using AI is an abomination to the tents of Jacob andthere is no greater desecration of the family in the tents of Israel. This [AI]destroys all the principles of purity and sanctity in the life of a Jewishfamily which has distinguished us from the time we became a nation. It alsobreaks the chain between sons and fathers . . . and who are those who donatetheir sperm for this purpose in order to receive money. They are the lowestof the low and what kind of children can come from this seed. (Waldenberg1945–1994, 9:51; 4:5)


In a similar vein, Leon Kass has written that the use of artificialreproduction is dehumanizing:

Because human procreation is not simply an activity of our rationalwills . . . is there possibly some wisdom in the mystery of nature that joinsthe pleasure of sex, the inarticulate longing for union, the communicationof love, and the deep and partly articulate desire for children in the veryactivity by which we continue the chain of human existence? Is biologicalparenthood a built in device selected to promote the adequate caring forposterity? Before we embark on new modes of reproduction, we shouldconsider the meaning of the union of sex, love, and procreation, and themeaning and the consequences of its cleavage. (1985, 72)

The Catholic Church also had concerns about permitting AI. Pope Pius XIIfelt it was unethical because it was not natural, and maintained thatconception needed to occur as the result of a sexual act between a manand a woman (1951, 850). Likewise, Paul Ramsey was disturbed by theseparation of the sexual act from conception and maintained that AI froma non-husband donor “puts completely asunder what God joined together”(1987, 336).

R. Feinstein felt otherwise and had no moral revulsion at the use of AI,and for certain technical legal reasons preferred the use of a non-Jewishsperm donor. His lenient and singular opinion caused him much disdainin the rabbinic world. R. Feinstein responded to his critics:

It appears from your letter that I would be insulted by your rebuke but onthe contrary I am satisfied that there are spiritual people that are not afraidor embarrassed to give rebuke. But in truth there is nothing in what I wroteand instructed that will cause any desecration of the sanctity of Israel butit is the eternal truth from our Rabbis. And your objection comes fromphilosophies based on external knowledge that influence even very wisepeople to understand the mitzvoth of the Torah based on this alien know-ledge . . . but I am not like that and all my philosophies come only fromknowledge of the Torah without any outside influences. . . . And any reasonsthat come from external knowledge or explanations that come from the heartare worthless even if they are more stringent and are thought to increase thepurity and sanctity of Israel. (Feinstein 1959–1996, ’Even Ha‘ezer 2:11)

From a legal perspective, R. Feinstein is certainly right: there are noinsurmountable halakhic objections to allowing AI. His critics’ objectionsare based on theological principles that R. Feinstein felt were alien toJudaism. It is not clear from his responsum which “philosophy” he feltwas alien to Judaism. Is it the Christian idea that the sexual act andconception need to be, in the words of Ramsey, “joined together” or themodern scientific understanding that the genetic makeup of a person ismade up of contributions from both mother and father? Nevertheless,


R. Feinstein’s brave and lonely support of AI at the expense of muchpersonal criticism set the stage for the Orthodox world’s positive embraceof new reproductive technologies and the alleviation of the suffering ofthousands of childless couples.

6. Plastic Surgery

Jakobovits’s discussion of the permissibility of cosmetic surgery isdifferent than his usual writings. As he himself points out in his presen-tation, he could not find any direct reference to the topic in the rabbinicliterature; he therefore had to develop his own analysis of the issue. Henotes three possible objections to the procedures. The prohibition againstputting oneself at risk, as every operation has an inherent risk; theprohibition against injuring one self; and a problem of a more theologicalnature.

We believe of course that our world is governed by divine Providence. Godis not only our creator, but the ultimate authority for all lawful humanactivities, especially when these may involve changing the order of things asHe created them. The question therefore is: By trying to improve on God’swork and create a human being other than He had created or intended, dowe not attack the scheme of Providence? . . . This permission [to practicemedicine] may well be restricted to healing, so that the physicians’ thera-peutic work, since it enjoys divine sanction, would thus not be regarded asan unauthorized interference with providence. But whether such sanctiongoes beyond healing to include also acts of surgery dictated by purelycosmetic considerations, is a question which would still require a great dealof careful thought. (1966, 196–97)

He concludes that these objections can be set aside in only two instances:(1) if the deformity is serious enough to interfere with a woman’s abilityto marry, or (2) if they prevent a person from playing a constructive rolein society.

Jakobovits anticipates the opinions of R. Waldenberg who prohibitsplastic surgery because he feels that it does not fall under the generaldispensation that is learned from the verse “he shall surely be healed,”which gives a physician permission to heal. He continues “One shouldknow and believe that there is no creator like God and he created eachperson in a unique way and one should not add or detract from thiscreation.” He further maintains that an operation done for aestheticpurposes would not be considered an act of “loving your neighbor” andwould be “prohibited on the basis of assault” (Waldenberg 1945–1994,11:41). This concern of the doctor playing the role of creator does not enterat all into the thinking of R. Feinstein, who maintains that cosmeticsurgery is allowed (Feinstein 1959–1996, H· oshen Mishpat 2:66). For him,the legal question is simply whether one is permitted to injure oneself for


a favorable purpose. In other words, is one allowed to undergo the traumaof surgery for the potential benefits of plastic surgery? R. Feinstein quotesMaimonides, who defines assault as an action done with the intent ofdemeaning the victim. This obviously would not apply in the case of anoperation; therefore cosmetic surgery should be permitted. He furtherargues that even those who disagree with Maimonides’s definition ofassault would not prohibit plastic surgery because of the commandmentto “love your neighbor like yourself,” which would override the principle ofassault in this case because of the benefit of the surgery to the patient.

7. Definition of Death

Even in the revised edition of Jewish Medical Ethics there is scantattention paid to the definition of death. In the 1960s, however, thisbecame a pressing issue as the possibility of organ transplantation movedquickly from the laboratory to the clinic. There was worldwide acclaimand enthusiasm for the work of Christiaan Barnard and others as theyperformed the first heart transplants. At first R. Feinstein was reluctantto endorse the new science. He writes in 1968:

Heart transplantation that the physicians have started to do recently ismurder of the donor and the recipient. Because they actively kill the donorbecause he is still living (when they take the heart) not only according tothe laws of the Torah but even physicians who tell the truth admit that heis still living . . . and they are also killing the recipient who can potentiallylive years or even decades. And all the patients who have received hearttransplants died within days or hours. (Feinstein 1959–1996, Yoreh De‘ah2:174)

He is hesitant about allowing heart transplantation for two reasons. First,he is not sure if the donor is dead when they harvest the heart; second ishis concern for the welfare of the recipient.

Regarding the second reason, there is now a growing consensus thatthe first transplantations were done without the requisite basic scientificpreparation; there was an almost irrational push to be the first to succeedwithout adequate protection given to the recipient. As pointed out byRamsey, early in the transplantation era not enough attention was givento receiving adequate informed consent from the recipient (and perhapsalso from the donor’s family) (Ramsey 1970). Also regarding this secondconcern, it appears that R. Feinstein’s position slowly developed towardsan acceptance of brain death. R. Feinstein himself returns to the issueof defining the time of death in a responsum written in 1970. In thisresponsum he attempts to differentiate between cortical brain death andbrainstem death (which controls respiration). He writes “and in truthwhen the brain stops functioning this is not death because if he continues


to breathe he is still alive. Only when the brain stops functioning andthis will lead him to stop breathing is he considered dead” (Feinstein1959–1996, Yoreh De‘ah 2:146). However, later in the responsum, he addsa new factor to the discussion. In a patient who has stopped breathing butstill has electrical activity in the heart, R. Feinstein maintains that theperson is “definitely alive even if he has stopped breathing.”

In another responsum written in 1976 also based on the Talmud, R.Feinstein specifically states that the patient is dead when there is a lackof spontaneous breathing (Feinstein 1959–1996, Yoreh De‘ah 3:132). Hereiterates his position that one must be very careful not to miss any signof shallow breathing. However, he points out that this sign would notapply to trauma victims who might have suffered peripheral nervedamage preventing spontaneous respiration. In this situation he recom-mends performing a nuclide scan to determine if there is blood flow to thebrain “and we will be able to determine that the connection between thebrain and the body has been severed and the brain has lysed and it islike he is decapitated.” R. Feinstein could not accept lack of spontaneousrespiration as the sole criterion for death because there are situationalreasons where one is unable to breathe due to trauma or drug overdosewhere the brain is still functioning. He therefore suggests using thenuclide test to document if there is a connection between the brain andthe body in a case of trauma. It is not clear from his responsum if thedominant factor is the lack of physiological connection as manifested bylack of brainstem perfusion or the fact that this is a sign of brain lysis.

In his last responsum on the issue, written in 1985 (one year before hisdeath), he explicitly accepts the Harvard criteria defining brain death:“The definition (of death) called the Harvard criteria is considered as if thepatient is decapitated because the brain has already been destroyed. Andeven if the heart is able to beat for a few days, all the time the patienthas no ability to breathe independently he is considered dead” (Feinstein1959–1996, Yoreh De‘ah 4:54).5 It appears from this final responsum thatR. Feinstein equates death with brain destruction; lack of breathing is asign of this. If this definition is correct, then once this criterion is met itwould not be considered murder to donate the heart of this dead patient.R. Feinstein’s acceptance of brain death thus allows for Orthodox Jews tobe heart donors and he also has written supporting altruistic living

5 This responsum was published after Rabbi Feinstein had died; apparently thefamily was unaware of its existence and it was brought to their attention by the recipient.Regarding Rabbi Feinstein’s permitting heart transplantation if the donor is brain dead seeFeinstein 1996, 178: “My father-in-law Rabbi Moshe Feinstein was aware of the progress intransplantation and permitted in his latter years heart transplantation.” R. Shlomo ZalmanAuerbach has suggested that Rabbi Feinstein relied on the brain death definition only forpassive actions such as removing a ventilator, but not for an active act such as removing theheart. R. Shabtai Rappaport has challenged this interpretation (2006).


donation as a meritorious act. In addition to not accepting brain death,R. Waldenberg was opposed to all forms of organ transplantation. Hemaintained that transplantation does not fall under the biblical dispen-sation given for a doctor to heal because the Talmudic sages were notaware of this operation and thus all forms of transplantation should beprohibited (Waldenberg 1945–1994, 10:25).

8. Triage

Somewhat surprisingly, Jewish Medical Ethics does not discuss theethical problem of triage and allocation of scarce resources. However, R.Feinstein does and develops a new approach (from a Jewish perspective)to the dilemma. Govind Persad, Alan Wertheimer, and Ezekiel J. Emanuel(2009) recently summarized the existing literature relating to theprioritization of scarce medical resources and presented four allocationprinciples that can account for most prioritization schemes.

1. Treating people equally—which includes lottery and first come firstserved. The advantage of lottery is that it is hard to corrupt andlittle information about the patients is needed. First come firstserved protects the existing doctor-patient relationship. Ethicistswho take this approach believe strongly in the equality of all humanbeings and are reluctant to “play God.”

2. Favoring the worst-off—this includes sickest first and youngestfirst. This scheme is consistent with “the rule of rescue.” In adiscussion of this rule Hadorn wrote “Any plan to distribute healthcare services must take human nature into account if the plan isto be acceptable to society. In this regard there is a fact about thehuman psyche that will inevitably trump the utilitarian rationalitythat is implicit in cost-effectiveness analysis: people cannot standidly by when an identified person’s life is visibly threatened if rescuemeasures are available.” This scheme makes the most sense in asituation of temporary scarcity. Youngest first also has a utilitariancomponent as we will see below.

3. Maximizing total benefits—this includes number of lives saved orlife-years saved and is consistent with the tenets of utilitarianism.This scheme avoids the need for judgments of social worth or qualityof life.

4. Promoting and rewarding social usefulness—instrumental value inthe future and rewarding those who implemented important valuesin the past. This scheme would favor those with needed occupationssuch as healthcare workers, emergency personnel, or soldiers. It isvulnerable to abuse through the choice of professions prioritized andcan direct scarce resources away from health needs.


From a Jewish perspective the discussion starts with a passage in theearly rabbinic text known as the Mishnah, which states:

A man takes precedence over a woman when it comes to saving a life and torestoring something lost. A woman takes precedence with regard to provisionof clothes and to be redeemed from captivity. When both stand equal chancesof being degraded, then the man takes precedence over the woman.

A priest [kohen] takes precedence over a Levite, a Levite over an Israelite,an Israelite over a bastard [mamzer], a bastard over a netin [a descendantof the Givonites], a netin over a convert, a convert over a freed slave. When?When they are all equal. But if the bastard were the disciple of a scholar[talmid hakham] and the priest were ignorant of Torah [‘am ha’aretz], thebastard takes precedence. (M. Horayot 3:8)

R. Feinstein writes that “a physician should go to the patient who calledfirst and to the one who is closer to his house and when they areequivalent one should triage on the basis of the order of the Mishnah inHorayot and if this is not known to the physician it should be done onthe basis of a lottery” (Feinstein 1959–1996, H· oshen Mishpat 2:75:2).Uncharacteristically, the position of R. Feinstein is somewhat obtuse.What exactly does he mean by “not known to the physician”? Is thephysician unaware of the law or is he or she unaware of the social rankof the patient? In any case, if there is time for a lottery there might alsobe time to acquaint the physician with the law or determine the socialworth of the patient. One gets the distinct impression that R. Feinsteinseems hesitant about using the Mishnah’s ranking system. There is alsono legal precedent for his call to use a lottery “if this is not known to thephysician.”

In another responsum he writes regarding the care of a patient in acoma “that it should be obvious and clear to every student of Torah andfearer of heaven that one is obligated to cure and save every personwithout regard to their wisdom or knowledge and one should only triageon the basis of the order of the Mishnah in Horayot and it is difficult toact upon these without very careful consideration” (Feinstein 1959–1996,H· oshen Mishpat 2:74:1). He does not explain why it is difficult to actupon and what careful consideration is required. It appears that he wasdisturbed by the same issue as Ramsey, who writes:

When the ultimate of life is the value at stake, and when not all lives canbe saved, it can reasonably be argued that men should stand aside as far aspossible from the choice of who shall live and who shall die . . . randomselection is preferable not simply because life is a value incommensuratewith all other, and so not negotiable by bartering one man’s worth againstanother’s. It is sustained also because we have no way of knowing how reallyand truly to estimate a man’s societal worth. (1970, 256)


The Talmud makes a similar argument in explaining why one is requiredto be killed rather than murder another human being (B. Sanhedrin 74a):“What makes you think that your blood is redder than the blood of afellow human being?” In other words, you have no reason to assume thatyour life is more valuable than that of your friend. The explanation of theTalmud is based on the intrinsic equality of all human beings before God.

For these reasons, lifesaving decisions should not be made on the basisof social worth but rather on the basis of random allocation. Rabbi IsaacHalevi Herzog (1888–1959), the former Ashkenazic Chief Rabbi of Israel,once asked R. Feinstein who should receive the limited amount of peni-cillin available in Israel at the time, and R. Feinstein answered thatpriority should go to the first patient the physician saw who needed themedication (Tendler 1984). R. Feinstein’s insistence on treating the firstpatient is an innovation of the first order and the legal basis of thisposition is not at all self-evident. One would expect such a basis to lie ofthe prioritization scheme in the passage from the Mishnah cited above, orat the very least to be rooted in a text from a rabbinic authority amongthe rishonim (1100–1500 CE) or perhaps even from a later time aroundwhen the Orthodox lawcode the Shulh· an Arukh was written in thesixteenth century. R. Feinstein’s adoption of this position without priorprecedent shows how clearly he values the principle of treating peopleequally.

Rabbi Chaim Rapoport argues vehemently against this interpretationof the position of R. Feinstein. He maintains that “it is not in the natureof R. Feinstein’s decision making process to introduce or condone a majorchange in the legal procedure in a merely parenthetical statement. On thecontrary, R. Feinstein’s statement clearly reconfirms the unchallengedlegal system; the criteria of the Mishnah in Horayot remain binding incontemporary times and have not been displaced by any ‘custom’” (2001,27–38). The reluctance to use this system is based, according to RabbiRapoport, on an aversion to this politically incorrect and non-egalitarianideology. From a moral perspective, Rabbi Walter Wurzburger also main-tained that social rank should play a deciding role in triage decisions.

As in lifeboat ethics some rational system of priorities should be devisedrather than resorting to random selections of patients. As painful as it maybe to play God and determine who shall live as a result of our interventionand who shall die as the consequence of our nonintervention, we cannotabdicate this responsibility. Random choice can hardly qualify as a morehumane method to resolve our dilemmas. (Wurzburger 1994, 91)

9. Abortion

In Jewish Medical Ethics there is an extended discussion of abortion.Discussion of abortion in the Jewish sources goes back as far as Talmudic


times, when the Mishnah establishes the clear principle that the mother’slife takes precedence over that of the fetus. Jakobovits summarizes theJewish perspective as follows: “Until labor begins the fetus is consideredpart of the mother and therefore its life is not protected by any definitivelegal provisions, the artificial termination of pregnancy is strongly con-demned on moral grounds unless it can be justified for medical or possiblyother grave reasons” (1975, 190). According to this view there is nodefinitive legal prohibition against abortion, just a moral hesitancy for avariety of reasons against termination.

R. Feinstein disagreed vehemently with this formulation. Uncharacter-istically, he attacks R. Waldenberg, who permitted abortions in fetuseswith known Tay-Sachs: “I was shocked when I saw the responsa of acertain sage [R. Waldenberg] in Israel who permitted abortions in fetusesolder than three months who according to the tests of doctors hasTay-Sachs disease . . . and one should not err and rely on the responsa ofthis sage” (Feinstein 1959–1996, H· oshen Mishpat 2:69:3). R. Feinstein’sstrict opinion is based on a passage in the Talmud (B. Sanhedrin 57b),which cites the opinion of Rabbi Ishmael that a non-Jew (who, as adescendant of Noah, is described in rabbinic literature as a “Noahide”)who aborts a fetus is liable and sentenced to death. Maimonides codifiesthe law as follows: “A Noahide who kills a person, even if he kills a fetusin the mother’s womb, is put to death” (Maimonides 1949, 231 [HilkhotMelakhim 9:4]). R. Feinstein deduces from this law that abortion per-formed by a non-Jew is a form of murder punishable by death. There is noparallel formulation in the Talmud or Maimonides regarding the lawif a Jew performs an abortion. Regarding this point R. Feinstein citesthe Tosafot who, based on the principle of “there is nothing prohibitedto a non-Jew which is permitted to a Jew,” asserts that “Even though aJew is exempt (not punished for abortion) it is not allowed” (Tosafot adB. Sanhedrin 59a, s.v. lekha). From this comment of Tosafot, R. Feinsteinassumes that the prohibition is equivalent for a non-Jew and a Jew(Feinstein 1959–1996, H· oshen Mishpat 2:69:1). Abortion is a form ofmurder; the only difference is that a Jew is exempt from punishment.

R. Feinstein’s position on abortion is very similar to that of the CatholicChurch (with the caveat that he obligates an abortion if the mother’s lifeis in danger) and also shares common ground with conservative Christiantheologians. Writing from a Christian perspective based on a covenant oflove between human beings and a tacit acceptance of suffering, StanleyHauerwas also had great difficulty in justifying abortion based on mater-nal need. He argues that these “selfish” concerns of the mother should notoutweigh the claim to life of the fetus and is disappointed in a society thatwould allow this to happen (Hauerwas 1981).

According to Ramsey the fetus is entitled to our loyalty and covenantallove. The practical ramification of this position is that abortion is only


permitted when “we are not turning directly against the basic value of thechild’s (fetus’s) life . . . (but) the target is the child’s fatal function (activeor passive). Abortion is only allowed when only one life can be saved”(Ramsey 1973, 222).

10. Theological Principles

Jakobovits writes:

Secular medical ethics is the effort to turn ethical guidelines or rules ofconscience into law, i.e., into legislation. Attempts are made constantly tochoose ethical insights and then to gradually distill these into legislativelaws adopted by different legislatures, Jewish medical ethics does thereverse. We determine law or legislation, distill it, and then come to theconclusion that it contains certain ethical guidelines. Thus Jewish medicalethics derives from legislation. It does not lead to legislation. We look atlegislation as rulings of law that have been given, i.e., halakha, which meanslaw or legislation, and then try and extrapolate ethical rules from thelegislation. Therefore the Jewish concept of medical ethics is the very reverseof that commonly accepted in civilized countries of the world. (Jakobovits1990, 1–18)

If Jakobovits is right regarding how JME operates, what ethicaland theological insights can one learn from the legal positions of R.Feinstein and how do these compare to those of his Jewish and Christiancontemporaries?

The Christian ethicist James Gustafson maintains that one’s conceptof God has much relevance to how one approaches certain bioethicaldilemmas (Gustafson 1975). Does one conceive of God as the sole creatorof the world shunning any input from lowly humans or is God the enablerof possibilities encouraging humans to be partners in the wondrousmiracle of creation?

From an Orthodox Jewish perspective the most important advocate ofhumankind as a partner with God in the betterment of the world has beenRabbi Joseph B. Soloveitchik. According to R. Soloveitchik there is a moralimperative for humankind to conquer and master the world. Humankindis charged with being a partner with God in creation in order to fulfillthe requirement of imitatio dei. One accomplishes this through scientificgenius, technological creativity, and communal activity (Soloveitchik1997). In The Lonely Man of Faith, R. Soloveitchik develops this positionbased on an insightful reading of the early chapters of Genesis.R. Soloveitchik proves this argument by invoking the halakhic tradition’sposition on scientific medicine: “Unlike other faith communities, theHalakhic community has never been troubled by the problem of humaninterference on the part of the physician and patient with God’s will. Onthe contrary, argues the Halakhah, God wants man to fight evil bravely


and to mobilize all his intellectual and technological ingenuity to defeat it.The conquest of disease is the sacred duty of the man of majesty and hemust not shirk it” (1997, 59). Rabbi Soloveitchik advances a world viewthat “halakhic man prefers the real world to a transcendent existencebecause, here in this world, man is given the opportunity to create, act,accomplish, while there in the world to come, he is powerless to changeanything at all” (Soloveitchik 1983, 32).

R. Feinstein had none of the hesitancies of his contemporaryR. Waldenberg or other bioconservatives in allowing artificial reproductionor cosmetic surgery. His positions are a legal manifestation of this chargeto man to engage and better the world through technological and scientificinnovation. Achievements such as AI and transplantation are not a threatto God’s dominion, but rather acts of fulfilling God’s divine mandate forhumankind.

As opposed to some of his contemporaries, R. Feinstein does not glorifyhuman suffering. R. Waldenberg is of the opinion that every moment oflife is valuable, for there are people who justify their entire existencewith a thought of repentance at the end of life (Waldenberg 1945–1994,Ramat Rachel, 5:28).6 In addition, suffering has the potential to eraseone’s culpability from sin (Waldenberg 1945–1994, Ramat Rachel, 9:47).There are echoes of his thought in other traditions as well. Verheymaintains that a true Christian perspective on suffering is based onhumility and courage. Humility based on the notion that one’s life belongsto God and the call to “bear the brokenness, sadness and tragedy of ourworld in hope and faith and love.” This humility is joined with heroism inorder to enable man to “bear and share the burden and sadness of ourworld and our lives for the sake of God’s cause” (Verhey 1987, 470). Thistheological justification of maintaining even a tormented life is consistentwith R. Waldenberg’s thinking.

Among contemporary theologians none has written more eloquentlyabout the relation between suffering and medicine than Hauerwas. Heargues that the goal of medicine should not be simply to relieve sufferingand is skeptical of those who prefer death to a life of suffering. He haddifficulty understanding why a deformed baby in the neonatal intensivecare was allowed to die because it only had a life of suffering to lookforward to. For Hauerwas, suffering is inevitably experienced as part oflife. In his words, “It is our capacity to feel grief and to identify with themisfortune of others which is the basis of our ability to recognize ourfellow humanity” (Hauerwas 1986, 25). Humans are naturally repelled by

6 The book Ramat Rachel is Waldenberg’s commentary on the work Arukh ha-Shulh· an bythe halakhist Yechiel Michel Epstein (1829–1908). Citations are to volume number and thento section number of the tractate.


suffering and it is the sacred duty of medicine to prevent the sufferingfrom being excluded from the human community. All too often medicinefails in this respect and serves to guard us from the suffering. In addition,all suffering is not pointless, and for a believing Christian it is sometimesviewed as a proper punishment for sins or as a result of deeply heldconvictions.

R. Feinstein’s acceptance of passive euthanasia does not extend topatients in coma or chronic vegetative states. These patients are due thesame legal protections as those with all their faculties intact, as well asfull medical care that includes artificial hydration and nutrition if neces-sary. R. Soloveitchik has expressed a similar sentiment.

A man in the state of coma possesses all the rights with which the humanbeing is endowed. Whoever inflicts harm is liable for the act. The slaying ofa goses is synonymous with the murder of a healthy sane person. . . . Thereis not a single opinion in the Talmud that tends to deprive the goses of hiscivil rights and juridic qualifications. If Halakhah had identified the ideaof man with that of consciousness, logos, intellectual activity, anthropology,then neither the embryo, nor the newborn, nor the man in the comatosestate could be considered under the aspect of juridic person. Let us not forgetthat the embryo or the dying man deprived of all faculties resembles theplant far more than the animal. Instinct, sensation, active response tostimulation, locomotion, and many other neurological processes that char-acterize animal existence are completely extinct in such persons. And still,man remains man. (Soloveitchik 2005, 28–29)

The Catholic thinker Germain Grisez also takes this position. He main-tains that there is no dualism between the human being and the humanperson. We are not two things—a human person and a human being—butone integral whole, even if at times the person is lacking distinctly humantraits such as speech and the ability to interact with the environment. Lifeis always an intrinsic good. The practical implication of this argumentaccording to Grisez is that we must always provide nutrition and hydra-tion to a patient, even by artificial means (Hanink 1987). However, LisaCahill has argued that even from a Roman Catholic perspective theremight be room to consider even active euthanasia if “life fails to consti-tute a sufficient condition for the fulfillment of human value in eitherthe presence of gross suffering or the absence of consciousness” (Cahill1987, 451).

R. Feinstein also takes a position similar to that of the Catholic Churchthat life begins at conception (or at the latest forty days) and only permitsan abortion if the mother’s life is in danger. There are reputable Orthodoxdecisors who disagree with this position and permit abortions in cases offetal abnormalities such as Tay-Sachs disease or Down’s syndrome andeven in situations where there is no concern for the fetus but rather due


to concerns about the mother such as conception outside of marriage(Waldenberg 1945–1994, 13:102:1; 9:51:3).

R. Feinstein also believed strongly in the equality of all men andwomen before God. His original positions on triage where he endorsesrandom selection over a system based on social worth is at the very leastsurprising, as it appears to contradict an ancient Jewish ruling that menshould be saved before women and scholars before laymen. In the samevein he also disagrees vehemently with the position of R. Waldenberg thata non-scholar can donate an organ to a renowned scholar even at theexpense of his life. “One is allowed to donate for a scholar even an organthat life depends on and by doing so one will die and it is considered amitzvah [meritorious act] even though one is not required to do so. Andone should carefully consider if in practice one should allow this, and it iseasier to allow it if the recipient is a renowned scholar who is needed bymany” (Waldenberg 1945–1994, 10:25:7).

11. Conclusions

In this essay I have attempted to show that in response to thechallenges of modern medicine, R. Feinstein developed an approach tomedical ethics that, while certainly grounded in the ancient sources,taken as a whole is definitely a legal innovation of the first order. He tookthe power away from the rabbis and let the patients decide their treat-ment; he opened the door for a Jewish approach to palliative care; hesupported the use of new technologies to aid in reproduction; he endorsedaltruistic living organ donation and recognized brain death, thus layingthe groundwork for orthodox Jewish acceptance of heart transplantation;he downplayed the value of social worth in triage decisions; and was afierce defender of the rights of the fetus.

How did this Yiddish-speaking refugee from communist Russia developsuch a modern and original approach to these difficult ethical dilemmas?One can suggest a number of reasons. First of all, R. Feinstein hadtremendous confidence in his decision-making. He writes:

I maintain that it could lead to the end of the Torah, God forbid, if we onlydecide what is written in the books and if new questions arise that are notin the books and we do not decide them even if we have the ability to do so,in my opinion this is forbidden because the Torah should also grow in ourtime. And someone who is able to decide questions that come before himafter exploring and analyzing the Talmud and previous decisors with logicand vision even in a new matter that the books did not address is obligatedto do so. And even a law that is found in the books the decisor is alsoobligated to understand it and to agree with it before he decides and not justadjudicate on the basis that it is in the books because this is like someonewho decides when he is sleeping. (Feinstein 1959–1996, Yoreh De‘ah 1:101)


Responding to recent trends in the Orthodox community, Jakobovitswrites:

With the decline of the professional rabbinate and the ascendancy ofrabbinical deans as the principal arbiters of Jewish law and religiouspolicies, the present tendency is increasingly in favor of the latter group.This development is not without considerable consequence to current trendson Halachah. Practicing Rabbis are of necessity exposed to the problems,thinking and pressures of the often religiously alienated masses in thecommunities they serve, much more than scholars and teachers ensconced inthe rarified atmosphere of learning together with disciples, who, these days,frequently exceed the zeal of their masters. This factor naturally contributesto the distinctly conservative orientation in the rabbinic law-making processtoday. (1975, 259)

Rabbi Feinstein himself never studied formally at a large yeshiva and wasprimarily home schooled by his scholar father. He also started his rabbiniccareer not as a head of a yeshiva, but as a community rabbi in a small town.His subsequent fame in the orthodox Jewish world came more from his roleas a decisor of Jewish law than as a yeshiva dean. This fact may havecontributed to his tendency to develop original and in many cases lenientopinions.

The impact on Rabbi Feinstein’s thought of his student and son-in-law Rabbi Tendler is difficult to assess. Tendler, an esteemed Jewishscholar in his own right and a professor of biology, was Rabbi Feinstein’smain conduit to the medical and scientific community. Many of RabbiFeinstein’s responsa on medical ethics were addressed to Rabbi Tendlerand apparently there was much discussion between the two of them on theissues. Rabbi Tendler, an American with a Ph.D. from Columbia Univer-sity in microbiology, throughout his long career has been a crusader forthe role of human intervention in improving God’s creation (Loike andTendler 2007) and a longtime advocate of artificial reproduction, braindeath, and organ transplantation (Feinstein 1996).

R. Feinstein also had a decades-long love affair with America. Hepersonally witnessed the oppression of the Tsarist and Soviet govern-ments, lost many relatives in the Holocaust and was eternally grateful toAmerica for the freedom of opportunity it offered him and his family. Hewrites in his responsa “and we the people of Israel love [America] with afull heart” (Feinstein 1959–1996, Yoreh De‘ah 4:9) and “we pray for thewelfare of America more than any other nation because it has establisheda law that one is free to believe what one wants” (Feinstein 1959–1996,Orah· H· ayyim 5:13). Did the egalitarian nature of American society alsoinfluence his legal decision-making? It is impossible to know but taken asa whole R. Feinstein’s seminal work in the field of Jewish medical ethicswas a legal innovation of the first order.


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Documents

The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics