Frank: In the fifth century B.C. one of the oldest documents in history was written by Hippocrates and involved a code of ethics for the practitioner of medicine. While this code of ethics has been modified over the years to fit in with a more modern time, it remains today one of the only such codes for a profession.
The code of medical ethics highlights four basic principles: beneficence, non-maleficence, autonomy, and justice. Beneficence relates to doing good for patients while non-maleficence relates to refraining from doing harm. In today’s language, that is viewed in the context of the risk benefit ratio of medical care. Autonomy is the principle that relates to a patient having a sacred right to make decisions about medical care that is offered, while justice is the equal dispensation of the benefits (health care) and burdens (costs) of health care.
In America today, we seriously violate this last ethical principle of justice every day by not having a system of universal health care as all other comparable countries throughout the world have. This lack of health care insurance exists today for 8% Americans which represents 27 million Americans with another 25% being under insured, and statistics reveal that when these patients present for medical care, their disease and condition is often more advanced, and they experience a worse outcome including higher mortality rates.
In addition, it has been established that of the hundreds of thousands of bankruptcies in this country, each year, two thirds are due to medical expenses, a situation that does not exist in any other country. We have a problem with the ethical issue of justice when it comes to health care in America, and I believe this to be a moral issue that is heavily involved in religious doctrine.
Mark, what do you believe are these religious doctrines that we violate in America by the absence of universal health care, and do you believe health care is a right or a privilege?
Mark: Every faith tradition values the preservation of human life as its highest moral value. In Hebrew we refer to this as “Pikuach Nefesh”: It is a commandment for which every other commandment can be set aside.
Judaism shares this point of view, that every life is sacred and that, therefore, access to adequate healthcare is a fundamental human right. It is not a privilege left only to a certain few. Rather, it is incumbent on society to extend an equal amount of sufficient medical care to all who require it.
The earliest recorded prayer we know of in Western civilization come from the biblical text, found within the Book of Exodus. Moses implores God to intervene in the treatment of his sister Miriam’s suffering: “O God, please heal her now” (Numbers 12:13).
But prayers alone, while powerful, are not in and of themselves enough, neither to heal nor to cure those who are ill. For that, medical intervention is required.
It is why the Talmud, the ancient Jewish legal code offers the instruction that, “One who saves even a single soul, He or She is to be viewed as if they’ve saved an entire world.” Because to that person’s family, they are, in so many ways, the worth of the entire world.
Therefore, from this we affirm the fundamental right of every human being to enjoy full and unfettered access to adequate and affordable medical care and health insurance, regardless of economic circumstance.
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Frank, why do you think it has been such a struggle, here, in the most affluent country in the history of the world, for so many to be denied equal access to comprehensive medical care? As a physician, do you feel that every citizen of this country should have equal access to competent healthcare? Is that a right or a privilege?
Frank: It appears that when it comes to healthcare, science and religious views agree that healthcare is a right and not a privilege and I am in total agreement. Statistical outcome evidence and theological principles all point to a right for individuals to be able to obtain medical care prevention and treatment when it is needed as well as to have it affordable. And herein lies a huge problem. Healthcare in America is extremely expensive.
With an ever-increasing life expectancy and cost for healthcare, we are in dire need of finding ways to reduce healthcare costs. Drug costs alone are out of control. America is one of only two countries in the world that allows for television ads for prescription drugs (New Zealand is the other), and the saturation of daily ads to the public creates an increase in demand and usage of expensive drugs. The costs for an increasing need for operative procedures and diagnostic modalities are also extremely expensive.
One argument used by those who disagree with a universal health care system is that it puts into practice socialized medicine. What these individuals fail to realize is that we already have in place a universal health care insurance plan for close to half of all Americans with Medicare, Medicaid, Military and Veteran plans.
In 1900, life expectancy was forty-seven years and when I was born in 1940 it had risen to sixty. Today that figure is close to eighty years, and it is anticipated that with the advances in medicine, genetic testing, and treatment, life expectancy will reach one hundred in the not-too-distant future. With this increase will come the need for even more medical care at an ever-increasing cost. We need to do something, and we need to do it now. We need to bring the ethical principle of justice into the practice of medicine.
Mark: Frank, you have made a strong and scientific argument for a more equitable and fair system of healthcare, as a right that would improve the health of all Americans.
In my years as a congregational rabbi, there were many congregants who came to meet with me in my office to ask for relief for their medical bills, whether for themselves or for their family members. The costs were often well beyond their reach. For some, they were left trying to determine which of their prescriptions they could fill with the limited resources they possessed. This remains true for many, despite the passage of the Affordable Care Act and the wonderful insurance of Medicare.
There were others without even basic coverage. For them, any medical care was either inaccessible or unavailable. At those times, I would reach out to the medical professionals within my congregation, asking them, imploring them, sometimes even begging them to see their fellow congregants. Those were difficult calls for me to make. No one should have to go begging for care in the United States of America.
That is the message I delivered from the pulpit on the High Holy Days, in the year when the Affordable Care Act was being vigorously debated in Congress. I described healthcare coverage as a fundamental human right for all, not solely for a privileged few. I based my message on a two-thousand-year-old Jewish tradition that explicitly and consistently places the preservation of human life above all else.
At the conclusion of the service, a gentleman jumped on the pulpit to tell me how strongly he disagreed with my remarks. Given the solemnity of the occasion and the dignity of the sacred space, I offered no rebuttal. That response would come, in its own way, months later, with the passage of Obamacare.
We still have a long way to go to extend an equal system of medical access and care that is more just and fair. Let this be our incentive to do better, to do more for the sick among us: God has no other hands, than ours, to heal those who are ill, to care for and bandage the wounded and to bring comfort to the infirm. Let us go and do just that.
Rabbi Mark Schiftan can be reached at mschiftan@aol.com Dr. Frank Boehm can be reached at frank.boehm@vumc.org
