Reading Freedman
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* David Novak

**Duty and healing: foundations of a Jewish bioethic** Benjamin Freedman Edited and with an introduction by Charles Weijer New York and London: Routledge; 1999 344 pp $34.99 (paper) ISBN 0-415-92180-5

The publication of Benjamin Freedman‚s *Duty and Healing* is cause for both joy and sorrow. Freedman was a brilliant clinician and bioethicist at McGill University, and there is much to rejoice about in the fact that his voice is now to be heard in a systematic representation of great power, lucidity and persuasion. And so it is sad to note that he died in 1997 at the age of 46. This posthumous volume, edited by Freedman‚s disciple, Charles Weijer, could very well have been the introduction to more and even better work had the author lived. Yet, despite its being in some ways a literary debut, the book is well written and stands on its own merits. The use of real clinical cases, especially, makes for a fascinating interplay between theory and practice throughout.

Freedman identified himself as an Orthodox Jew, implying a full commitment to the primary moral authority of the biblical‐rabbinic tradition expressed in Jewish law (Halakah). His first task in *Duty and Healing* is to show how one engages in the theory and practice of bioethics from the perspective of this ancient (but never antiquated) tradition. His second task is to show how this tradition approaches bioethical questions very differently from what he calls ”secular” or ”Western” ethics. His third task is to show how these two approaches, despite their philosophical opposition, can often be ”complementary rather than contradictory.”

The theoretical key to all three tasks is contained in Freedman‚s reliance on ”Jewish legal sources whose appeal is to reason” and which, therefore, are ”of more than parochial interest.” He wants to show how the Jewish ethic of duty is inherently a more rational approach to some of the most important issues in contemporary bioethics than the secular ethic of rights (which also justifies itself by rational criteria), and how the ethic of duty and the ethic of rights can nonetheless inform one another. In this task — a refreshing one in view of Freedman‚s orthodoxy — the author not only presents the Jewish tradition but reinterprets it on some central points. In so doing he is not at all timid in criticizing the less sophisticated views of some of the most prominent contemporary spokespersons for that tradition in the popular area of bioethics.

The practical key to Freedman‚s project lies in the issue he grapples with more than with any other: informed consent. That patients have the right to determine the course of their own medical treatment seems to imply that the duty of medical personnel is to inform them of their reasonable options so that they, not the medical personnel, have the final say as to what is done to their bodies. This right is usually based on the principle of patient autonomy. That is, the right to informed consent seems to be justified by the idea that, in the end, the patient owns his or her own body and thus has the ultimate responsibility for it. This justification, however, is diametrically opposed to the Judaic idea that one‚s body belongs to God, and that one‚s first duty is to keep the body alive no matter what. Furthermore, since it is assumed that medical personnel (being ”scientific”) know more about the patient‚s bodily situation than the patient (being ”subjective”) does, they have the authority to command the patient, so to speak, to follow their regimen in the name of God. Following this theoretical dichotomy, how could someone committed to traditional Judaism possibly accept the notion of informed consent at all? On rational grounds, it would seem that the idea of autonomy is more humane, since it does not burden patients with more responsibility for their own bodies than they can realistically bear.

What Freedman brilliantly argues, however, is that the idea of ultimate duty to God (and then to others) does not necessarily preclude informed consent; in fact, it can actually be shown to offer a better, more rational, basis for it. Thus Freedman learns something significant from the secular approach without capitulating to its philosophical foundation. He speaks of the patient as ”a responsible steward of his or her own body” and of patients as ”prudent caretakers.” By this he means that the first responsibility for the care of the patient‚s body lies with the patient. After all, patients have the most extensive and intensive experience of their own lives and are thus the best judges of what they can endure and of how they can live and not just exist. Freedman wisely points out that too many traditionalist Jewish ethicists emphasize the duty to preserve life at the expense of other duties, especially the duty to treat pain. Moreover, he notes that, since the outcome of medical treatment is far less certain than many traditionalists (with their general lack of ”professional exposure to health care settings”) seem to think it is, medical personnel have far less authority than they did when medicine came across as a more self- confident enterprise. His model of care, then, is far less authoritarian and much more based on mutual consultation than the traditionalist approach. Freedman invokes the theological concept of a ”covenant” to denote the relational nature of care.

One advantage of Freedman‚s relational emphasis is that it makes room for the patient‚s family. The secular approach, founded in the notion of patient autonomy, deals very awkwardly with the most intimate social context of most people‚s lives: their families. The concept of autonomy is most useful in structuring relationships between the individual and the State, not the more thickly intimate human relationships between ourselves as communal (meaning historical) beings. Our families lie at the core of our communal nature. Families, with their duty to care for each member, should have more responsibility in making medical decisions involving their own kin than most secularists would allow.

My only real criticism of Freedman‚s work is strictly philosophical. I disagree with his sharp distinction between an ethic of rights and an ethic of duty. If a duty is what I owe somebody else (the Hebrew word *chovah* means, first, ”debt” and, by extension, ”duty”) then doesn‚t that other person have a right to my duty? (The modern Hebrew word for ”right,” *zekhut*, literally means ”privilege,” something one is entitled to ask for.) Otherwise, duties are arbitrary, and that goes against Freedman‚s desire to present the Jewish tradition as having a rationale. Nevertheless, that philosophical quandary does not detract from the value of so much else in this book. Freedman certainly fulfilled his objective of showing how ”Religion [in his case, Judaism] can provide a fuller understanding, by placing the questions raised within a global and even cosmic context.”

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/163/5/577/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/163/5/577/F1)

Figure. Photo by: Fred Sebastian