CCAR RESPONSA
Contemporary American Reform Responsa
17. A Dangerous Medical
Experiment
QUESTION: A man with a severe heart disease and no more
than six months to live wants to know whether he may participate in a controlled experiment with a new drug; he is anxious to do so. Since the purpose of the experiment is to save lives in the future, may he participate even though there is some danger of shortening his lifespan? His own chance for a cure at this late stage of the disease is slight. (H. T., Los Angeles, CA)
ANSWER: It is a general rule that every person should avoid danger to life. So,
the Talmud (Ber. 3a; Shab. 32a) said that a person should not walk among ruined buildings because of the danger that a shaky wall may collapse. The Talmud (Hul. 10a) stated that danger to life and health was of greater concern than religious prohibitions (sakanta tamira meissura). In other words, one must exercise greater care to avoid danger than a religious prohibition.
The general rule of guarding against danger is,
however, confronted by the duty of rescuing a fellow human from danger. This has been discussed from early times by our tradition (Lev. 19.16; San. 73a; Shulhan Arukh Hoshen Mishpat 426). The question then is whether we may endanger ourselves in order to help others. There is no doubt that we must assist our fellow man through our means or influence, but are we permitted or required to go further? This question has been discussed in a rather picturesque way by David Ibn Zimri of Egypt (16th century). In his responsa (Vol. III, #627), the following incident was cited: The Pasha told a certain Jew to allow his leg to be amputated or else he (the Pasha) would kill another Jew. May this man endanger his life (since the amputation was dangerous) in order to save the life of a fellow Jew? David Ibn Zimmi considered this beyond the call of duty.
The medieval Sefer Hassidim (#467, ed., Margolis) described a
medicine which cured or killed the patient in nine days. The book prohibited the drug on the basis that it might kill the patient before his time (qodem simno). A number of later authorities have agreed with this assessment (Shevut Yaaqov, Vol. I, #13, Vol. 3, #75; Binyan Zion, #111, Hatam SoferYoreh Deah #76).
The general principles
governing our question are fully discussed by the modern Israeli authority, A. Abraham (Lev Avraham, Vol. II, pp. 75-76). He states that no doctor has the right to subject another person to a medical experiment even though such an experiment may eventually help others. The doctor may expose himself to danger (sofeq sakana) when he attends an infectious patient, as that is his duty as a physician, but he cannot ask a patient to submit to a dangerous experiment. The author adds that if the experiment is not dangerous, then the patient may participate in it and that would be reckoned as a mitzvah. Eliezer Waldenberg (Tzitz Eliezer, Vol. XIII, #103) disagrees with this view of safe experiments and denies any religious obligation even when there is no danger. At the most, one may permit such participation, but it is in no sense a religious duty (mitzvah).
We would generally agree with the
tradition and the decision reached by Dr. Abraham, yet our patient’s desire to participate must also be considered. The need and mitzvah to help others through his part in such experiments is important. Tradition would reject any participation, but we may argue that as we have benefited from medical progress, we must help to continue it.
We must ask
many questions before we reach a decision. Is the patient fully informed? Does he have the capacity to understand the implications of his choice? Has this been discussed by him with his family? What actually is the risk/benefit ratio?
We would permit participation in an
experiment of limited risk and doubtful benefit by this patient if these questions have been answered and if he is certain that this would give meaning and purpose to the last phase of his life. Many individuals search for some useful act during this period, and the experiment may provide it for this individual and his family. If successful, it may, of course, also prolong his life somewhat.
August 1985
If needed, please consult Abbreviations used in CCAR Responsa.