CCAR RESPONSA
New American Reform Responsa
152. A Medical Experiment
QUESTION:A patient is afflicted with a fatal disease which leads to an unpleasant death. An effort to control it for a short period of time (less than one year) can be made through using drugs which in the final stages have the following side effects: The body skin peels constantly and this is accompanied by pain which no drug will alleviate. Some researchers feel that the full effects of the medicine can only be studied through such human utilization. Should a physician permit his patient to undergo this treatment? (Rabbi Mark Staitman, Pittsburgh PA)
ANSWER: The general principles governing our question are fully discussed by the modern Israeli authority, A. Abraham (Lev Avraham Vol II pp 75-76; Meiri to San 84b; I.Y. Unterman Noam Vol 12 pp 5 ff). He stated 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/herself to danger (sofeq sakana) when she/he attends an infectious patient, as that is her/his duty as a physician, but he cannot ask a patient to submit to danger. 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; Moses Sofer Hatam Sofer Yoreh Deah #76) disagreed with this view of safe experiments and denied any religious obligation even when there was no danger. At the most, one may permit such participation, but it is in no sense a religious duty (mitzvah).
It is a general rule that every person should avoid danger to life. So, the Talmud (Ber 3a; Shab 32a) warned people against walking among ruined buildings as a weak 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.
This general rule of avoiding danger is, however, confronted with the duty of rescuing a fellow human. Discussion of these issues have continued through the centuries (Lev.19.16; San 73a; Yad Hil Rotzeah Ushemirat Nefesh 1:2, 14, 15; Shulhan ArukhHoshen Mishpat 426). The question then is to what extent we may endanger ourselves in order to help others. There is no doubt that we must assist our fellow human beings, but where are the limits? This question has been discussed in a rather picturesque responsa of the 16th century scholar David ibn Zimri of Egypt (Vol 111 #627): 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 through the amputation in order to save the life of a fellow Jew? David ibn Zimri 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 I #13, Ill #85; Binyan Zion #111; Hatam SoferYoreh Deah #76).
In this instance the patient appears to be doomed by the disease, and both patient and doctor have a choice whether to use this experimental treatment which leads to a horrifying death or whether a natural death somewhat sooner and also unpleasant shall be permitted. No one should persuade the patient to undertake this therapy which leads to a terrible death even if the patient may wish to help others and to use the last portion of his/her life in some useful fashion. In this instance the weeks of agony before death are so terrible that we can not justify the “treatment”. It is unlikely that the patient or the family will be able to imagine the horrifying nature of this death. We should therefore do everything possible to persuade the attending physician not to suggest this treatment if he/she feels that it must be mentioned then to put it into the bleakest possible context so that the patient is unlikely to choose it.
We cannot justify an experiment which will cause long terrible suffering through the vague hope that it will eventually produce a cure for others. The researchers who are working on this project must devise another means of testing their therapy.
February 1991
If needed, please consult Abbreviations used in CCAR Responsa.