Judaism, Money, and Health Care

March 1, 2004
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By Elliot N. Dorff

MAX, WITH SYMPTOMS OF the onset of Alzheimer’s Disease, does not want to squander his money or that of his children on his care; on the contrary, he wants to leave whatever money he has to his heirs. He contemplates suicide to save money and to prevent what he knows will be a humiliating descent into a mental fog.

This is one contemporary story among many others that raise not only medical questions but financial ones as well. In the past, Max might have died at home. But today, families are less inclined to care for their own at home and often place someone like Max in a facility with trained staff. That staff, unfamiliar with who Max was before the onset of his disease, will not face the daily pain of comparing Max’s current condition to the vibrant and engaging man he once had been. But Max is right: that will indeed cost money, and he may have no estate left to leave his heirs; worse, his children may have to dig into their own pockets to sustain him.
Increasingly, families are facing financial questions as American society ages and issues of money and health care become more urgent. Statistically, we spend more on our medical care in the last six months of our lives than we do throughout the rest of our lives. Is all of that outlay to the patient’s benefit? And, if so, to what extent should insurance companies or the government pay for expensive medical therapies at that time of life? Unlike Canada and West European countries, the United States has yet to have a serious national conversation to determine who should pay for what and which interventions are likely to be futile and thus should not even be offered.

Except in Oregon, Americans have resisted any suggestion that some cases might warrant assisted suicide. I wrote a rabbinic ruling for the Conservative Movement’s Committee on Jewish Law and Standards prohibiting it, in part because I do not want the liberty to commit suicide quickly to become the duty to do so, expected by insurance companies and families alike. I recognize fully, though, that my stand entails not only physical and psychological pain for patients and their families, but also financial cost.

From a Jewish perspective, we must balance a number of conflicting values. On the one hand, we have inherited a tradition that makes life a supreme value. Our ancestors, on the other hand, never had to face the costs of extending life as we do through current interventions. How, then, should we weigh the rabbinic principle that “the Torah takes pity on Israel’s financial resources” against the Jewish quest for life and health? For society as a whole, how do we balance these medical concerns with all the other things that, according to the Talmud, a community must provide? Do we give up programs in education, welfare, and even fixing roads and bridges to sustain people in Max’s state? What about supporting police and defense, which, after all, are also expressions of the value of life?

No traditional Jewish text will solve this problem for us, for these are new times, when health care is both more effective and more expensive than ever before. We will have to break new ground in formulating a realistic resolution of these issues, one grounded in Jewish sources and principles but one that is also responsive to the new context of medicine in our time.

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