Many thanks to Adam J Sher for drawing my (and others') attention to
this particular aspect of the IPRA's genesis. Notwithstanding that it
renders my own contribution to such debates even more modest than I had at
first suspected, to discover that my thoughts echoed (however belatedly!)
those of such a respected individual as Rabbi Feinstein is somewhat
edifying, and I would hope that most people would rather find their views
redundant than novel in matters of such importance. Nevertheless, I feel
it may be worthwhile to make a few brief clarifications as to both my
intentions and conclusions.
I had not wished to imply that non-maleficence was a new idea per se.
Beauchamp and Childress' use of the term in the 1st edition of Principles
of Biomedical Ethics predates my own birth by several months; moreover, it
was notable even then for being articulated, not in terms of any Western
philosophical tradition, but as an expansion of the ancient (if somewhat
obscure) injunction to 'first, do no harm' (Beauchamp and Childress, 1979,
p.97). Not only that, since there is a plausible argument that as soon as
one claims any kind of special ability to heal one's fellows one has
accepted a moral obligation to at least not make things any worse, it may
even be seen as (if nothing else, chronologically) the very first element
of medical ethics.
In truth, as I had hoped to make clear with regards to Gross' article
at least, I had not even wished to imply that non-maleficence was not
already being considered in cases of coercive treatment; rather that,
given its evident importance to the decision-making process, it is rather
underused in discussion of them (although perhaps less so than I had
realised in the case of Israel). That said, given the judges'
deliberations in Shefer v State of Israel, I am rather surprised that
neither Gross nor Glick made more use of it. As noted in the original
article, I think it important that in discussing such cases we adopt where
possible the language that best enables us to give these elements their
due weight. It is a rather subtle point and of relatively slight
importance, but I fear the evident wisdom of Jewish law in such matters is
somewhat undersold by describing decisions in binary terms as a conflict
between, or balancing out of, two opposing poles named autonomy and either
'dignity' or 'beneficence'.
Furthermore, it seems clear to me that despite Glick's claims of
"virtual unanimity [as to the pre-eminence of patient autonomy] in the
West" such concerns are not, and should not be, the sole preserve of what
Gross terms "a society... where respect for life supersedes respect for
dignity". As I argued in the original article, the apparent pre-eminence
of autonomy in Western medical ethics seems to me the result of failing to
realise that concerns of non-maleficence are often implicitly present in
such decisions. I would contend that this is not a case where Jewish law
and "Western" values assign different relative weights to similar
principles; rather it is a case where Jewish law has prompted reflection
that can help to better articulate what I suspect many in the West already
consider important (Glick's examples from Britain and the US appear to
suggest as much).
I am not concerned to claim any particular moral insight for myself.
However, given that the 6th Edition of Principles of Biomedical Ethics
(2009) still does not include non-maleficence in its discussion of
paternalism and coercive treatment, and that neither Gross nor Glick
explicitly mention it in their discussions of the IPRA, it seems that
there is room to argue further for its inclusion. If in doing so I am
merely adding my own voice to an existing chorus of others', then so much
the better!
Conflict of Interest:
None declared
Many thanks to Adam J Sher for drawing my (and others') attention to this particular aspect of the IPRA's genesis. Notwithstanding that it renders my own contribution to such debates even more modest than I had at first suspected, to discover that my thoughts echoed (however belatedly!) those of such a respected individual as Rabbi Feinstein is somewhat edifying, and I would hope that most people would rather find their views redundant than novel in matters of such importance. Nevertheless, I feel it may be worthwhile to make a few brief clarifications as to both my intentions and conclusions.
I had not wished to imply that non-maleficence was a new idea per se. Beauchamp and Childress' use of the term in the 1st edition of Principles of Biomedical Ethics predates my own birth by several months; moreover, it was notable even then for being articulated, not in terms of any Western philosophical tradition, but as an expansion of the ancient (if somewhat obscure) injunction to 'first, do no harm' (Beauchamp and Childress, 1979, p.97). Not only that, since there is a plausible argument that as soon as one claims any kind of special ability to heal one's fellows one has accepted a moral obligation to at least not make things any worse, it may even be seen as (if nothing else, chronologically) the very first element of medical ethics.
In truth, as I had hoped to make clear with regards to Gross' article at least, I had not even wished to imply that non-maleficence was not already being considered in cases of coercive treatment; rather that, given its evident importance to the decision-making process, it is rather underused in discussion of them (although perhaps less so than I had realised in the case of Israel). That said, given the judges' deliberations in Shefer v State of Israel, I am rather surprised that neither Gross nor Glick made more use of it. As noted in the original article, I think it important that in discussing such cases we adopt where possible the language that best enables us to give these elements their due weight. It is a rather subtle point and of relatively slight importance, but I fear the evident wisdom of Jewish law in such matters is somewhat undersold by describing decisions in binary terms as a conflict between, or balancing out of, two opposing poles named autonomy and either 'dignity' or 'beneficence'.
Furthermore, it seems clear to me that despite Glick's claims of "virtual unanimity [as to the pre-eminence of patient autonomy] in the West" such concerns are not, and should not be, the sole preserve of what Gross terms "a society... where respect for life supersedes respect for dignity". As I argued in the original article, the apparent pre-eminence of autonomy in Western medical ethics seems to me the result of failing to realise that concerns of non-maleficence are often implicitly present in such decisions. I would contend that this is not a case where Jewish law and "Western" values assign different relative weights to similar principles; rather it is a case where Jewish law has prompted reflection that can help to better articulate what I suspect many in the West already consider important (Glick's examples from Britain and the US appear to suggest as much).
I am not concerned to claim any particular moral insight for myself. However, given that the 6th Edition of Principles of Biomedical Ethics (2009) still does not include non-maleficence in its discussion of paternalism and coercive treatment, and that neither Gross nor Glick explicitly mention it in their discussions of the IPRA, it seems that there is room to argue further for its inclusion. If in doing so I am merely adding my own voice to an existing chorus of others', then so much the better!
Conflict of Interest:
None declared