Monday, February 8, 2010

New book by Rabbi Dr. Tatz

Highly recommended - a new book by Rabbi Dr. Akiva Tatz, to be published by Targum:

Dangerous Disease and Dangerous Therapy in Jewish Medical Ethics

Introduction 19
Principles 23
Differences between Jewish and Modern Secular Approaches 23
Definition of Principles 23
Quality of Life 24
Cost 24
Best Possible Treatment 27
Halachic Methodology 27
Dispute and Opinion 30
Risk 30
The Primary Value of Life 32
Statistics 37
Unknown Benefit, Unknown Harm 37
Standard of Care 39
Clinical Logic 40
Preparation and Education 40
Clinical Case 1: Benefit or Harm? 42
Approach to Risk in Halacha 45
Minimal Risk 45
Moderate Risk 48
High Risk 51
Risk to Caregivers 54
Doubtful Danger 58
Risk in Military Situations 59
Clinical Case 2: Risk to Caregivers 60
Danger to Life and Lifesaving Interventions 61
Lifesaving Interventions with Low Risk 61
Lifesaving Interventions, Low Risk but Painful or Mutilating 62
Lifesaving Interventions that Add Immediate Risk 63
Danger to Life in Halacha: Specific Causes 63
Obligation to Incur Cost to Save Life 65
Incurring Costs or Damages to Others to Save Life 67
Obligation to Incur Discomfort or Minor Illness to Save Life 68
Endangering Others in the Course of Saving Life 68
Clinical Case 3: Incurring Cost to a Third Party to Save Life 69
Pain Relief and Functional Improvement 71
Pain Relief and Palliation in Life Threatening Conditions 71
Pain Relief and Palliation in non-Life Threatening Conditions 71
Functional Improvement 72
Danger to a Limb, Organ or Faculty 73
Incurring Cost to Save a Limb 74
Risking or Sacrificing an Organ or Limb 75
Endangering or Sacrificing a Limb to Save Life 75
Endangering a Limb to Save Function of that Limb 76
Sacrificing a Limb or Organ to Save another Limb or Organ 76
Saving Life - Risking and Donating Organs/Limbs 77
Risking an Organ or Limb to Save Another’s Life 77
Donating or Sacrificing an Organ or Limb to Save Another’s Life 77
Organ Donation with No (or Minimal) Danger to Life 77
Regenerating Organ 77
Non-regenerating Organ 78
Saving Life – Risking Life for Others 81
Organ Donation with Danger to Life 81
Regenerating Organ 81
Non-regenerating Organ 82
Non-sentient and Minor Donors 85
Risking Life for Another’s Benefit (not to save life) 87
Interventions in Pregnancy 89
Undertaking Risk to Become Pregnant 89
Prevention of Pregnancy to Avoid Risk 90
Screening and Diagnostic Investigations in Pregnancy 91
Invasive Testing 91
Non-invasive Testing 91
Obligation to Save a Fetus and Appropriate Interventions 92
Cesarian Section Against Mother’s Wishes 92
Fetal Reduction 93
Operating on a Fetus in Utero 94
Clinical Case 4: Obstetrical Risk 95
Clinical Case 5: Delaying Chemotherapy to Preserve Pregnancy 98
Approach to Dangerous and Terminal Illness 101
Dangerous Illness 101
Terminal Illness 101
Terminal Illness – chayei sha’a (“temporary life”) 102
Withholding and Withdrawing Therapy 103
Withholding Treatment in chayei sha’a Situations 105
Unconscious Patients 109
Minors and Mentally Incompetent Patients 110
Neonates and Infants with Short Life Expectancy 110
Analgesia in Dangerously or Terminally Ill Patients 112
Withholding Fluids, Nutrition and other Basic Needs 114
Withholding Ventilation, Dialysis, Cardiac Pacing 117
Risky Treatment in chayei sha’a Situations 118
Limits of Risk 122
Terminal Life, Therapy Safe but Efficacy Doubtful 123
Risking Terminal Life to Prolong Terminal Life 124
Intercurrent and Secondary Problems in Terminal Illness 125
Acute Intermittent Threats to Life 125
Chronic Disease with Acute Life-threatening Exacerbations 125
Extreme Old Age 126
Risking Long Term Life for Longer Term Life 126
Prolonging Long Term Life with Severe Suffering 127
Terminal Illness – goses (end-stage terminal illness) 127
Clinical Case 6: Withdrawing and Withholding Therapy 130
Clinical Case 7: Dangerous (but not Certainly Terminal) Illness 131
Clinical Case 8: Risky Procedure in chayei sha’a 131
Clinical Case 9: Risky Procedure in chayei olam 132
Clinical Case 10: Serious Disease, Risky Procedure 133
Clinical Case 11: Neonate with Abnormalities & Poor Prognosis 133
Clinical Case 12: Futile and non-Futile Treatment 134
Definition and Timing of Death 135
The Circulatory Death Debate 139
Time of Death 142
Resuscitation 143
Time of Death in Failed Resuscitation Attempt 145
When is Resuscitation Obligatory? 145
Adequate Duration of Resuscitation Attempt 145
Advance Directives and “Do Not Resuscitate” (DNR) Orders 146
“Do Not Hospitalize” and “Allow Natural Death” Orders 148
Clinical Case 13: “DNR” and “Do Not Treat” Confusion 150
Euthanasia, Suicide and Assisted Suicide 153
Euthanasia 153
Suicide and Assisted Suicide 154
Coercion and Consent 155
Principles of Coercion and Consent in Halacha 156
Treatment Obligatory 156
Treatment Forbidden 158
Treatment Discretionary 158
Treatment Against Patient’s Wishes – Summary of Principles 159
Obligation to Disclose Risk 160
Danger to Life 160
Serious Illness Without Danger to Life 161
Where Therapy May Result in Significant Harm 162
Clinical Case 14: Treatment without Consent 163
Clinical Case 15: Treating a Child Against Parents’ Wishes 164
Clinical Case 16: No Consent and Against Parents’ Wishes 165
Clinical Case 17: Obliging One Person to Save Another 168
Clinical Case 18: Unreasonable Refusal of Therapy 169
Triage 171
Triage in the Acute Setting 173
Proximity 173
Relatives 174
Definite vs Doubtful Danger 175
Many vs Few 175
Saving Many with Possible Harm to Few 175
Many Doubtful vs Few Certain 175
Where Treatment has Already Begun 177
Healthy vs Ill 178
Salvageable vs non-Salvageable Patients 178
One Salvageable vs Two non-Salvageable Patients 180
First Come, First Served 181
Men or Women First 181
Age 182
Marital Status 182
Military Triage 183
Conflict with Secular Protocols 184
Clinical Case 19: Triage: Many vs Few and Definite vs Doubtful 185
Clinical Case 20: Disaster Scene Triage 185
Destroying Life to Save Life 189
Sacrificing One to Save Many 189
Fetal Reduction 190
Abortion 190
Conjoined Twins 190
Killing a goses, treifa or chayei sha’a to save a chayei olam 190
Clinical Case 21: Triage; Killing One to Save Another 191
Cosmetic Surgery 197
Manipulating the Natural 197
Injury 198
Male Cross-dressing 198
Tattooing 199
Risk 200
Valid Indications for Cosmetic Procedures 201
Experimental Therapy and Research 203
Experimental and non-Established Therapies 203
Research and Clinical Trials 204
Screening and Prevention 207
Screening 207
Prevention 209
Risks 209
Clinical Case 22: Prophylactic Surgery 211
Comparison of Torah and Secular Principles 218
The Four Principles 218
Autonomy 219
Competence 222
Non-maleficence 224
Withholding vs Withdrawing Treatment 227
Ordinary vs Extraordinary Treatment 227
Feeding & Artificial Feeding vs Life-sustaining Technologies 227
Intended Effects vs Foreseen but Unintended Effects 228
Futility 229
Beneficence 231
Justice 232
Veracity 232
Privacy 233
Confidentiality 233
Moral Dilemmas 234
Torah and Secular Law 235
Euthanasia, Assisted Suicide and Withholding
Therapy in Current Thought and Practice
Euthanasia and Assisted Suicide – Changing
Attitudes and Practices in Recent Times
It’s Over, Debbie 241
Diane 247
Mind Reading 253
The Medicalization of Death 263
Kevorkian and the Suicide Machine 263
Anatomy of a Disaster: Hurricane Katrina –
A Medical Ethical Nightmare
Murder or Mercy? Hurricane Katrina and Euthanasia 271
Materialism and Medical Ethics 279
Not a Doctor’s Decision 279
Afterword 289
Hope and Therapy; Medical Treason; A New Ideal;
Moments of Eternity
I. How a Rabbi Decides an Issue in Medical Halacha 299
II. Modern Historical Overview of Euthanasia and Assisted
Suicide in Western Countries
III. Monetary Cost of Saving Life 315
IV. Risky Professions 317
V. Transport Modes – Comparative Risks 321
VI. Selection Criteria for Renal Dialysis and Transplantation 323
Clinical Cases
Clinical Cases 329
Bibliography and Sources
Sources and Responsa 341
English Bibliography 349
Glossary 351