Ethics confab helps doctors tackle life-and-death issues

Dr. Linda Oberstein faced an ethical dilemma.

She was summoned to see an 88-year-old woman who over the recent holiday season fell ill with what appeared to be an infection and was worsening quickly. Years earlier the woman had extracted a promise from her family that they would not let her die in a hospital.

Oberstein, a private-practice internist in San Mateo, was called to the woman's home by a hospice facility. She found the woman lethargic and barely coherent. Her breathing was shallow and her pulse slow. But the family did not want her subjected to the trauma of hospital tests; they wanted to let her rest comfortably at home.

After talking to the family in depth, "I was basically supportive of their decision, and understood the promise to their mom not to let her die in a hospital," Oberstein recalled. "They felt this was her time. They strongly felt that."

Yet over the next five days, until the woman finally died, Oberstein found herself questioning her decision. Should she have pushed the family harder to take their ailing loved one to the hospital for tests and possible treatment? The doubts agonized her.

"It was all-encompassing," she said. "I felt I couldn't concentrate on anything."

What would Jewish law have to say about Oberstein's decision? The 32-year-old physician hopes to gain answers at this year's ninth annual International Conference on Jewish Medical Ethics in Burlingame.

The conference, sponsored by the Institute of Jewish Medical Ethics of San Francisco's Hebrew Academy, is expected to draw more than 400 health care professionals, rabbis and lay people from across the United States and Canada, and as far away as Australia and South Africa.

From Friday, Feb. 13 to Monday, Feb. 16 at the Park Plaza Hotel, they will explore the Jewish perspective, culled from the Torah and accompanying sources, on the hot-button issue of human cloning, as well as legal rights of newborns, drug pricing, reproductive medicine and care for those with Alzheimer's disease.

Many discussions will focus on questions raised by life-and-death quandaries like the one Oberstein confronted.

Among those leading discussions will be Ya'acov Ne'eman, Israel's finance minister; David Friedman, lead deputy commissioner for the Food and Drug Administration; and professors from such top medical schools as Stanford, U.C. San Francisco and Duke University.

As in years past, attendees, including rabbis, will represent all streams of Judaism. Generally, more than 50 percent of those attending have been non-Orthodox. Some participants have been non-Jews.

Oberstein was raised Reform and now attends a Conservative synagogue, Congregation Beth Sholom in San Francisco. She first attended the conference six years ago when she was a third-year medical student at Albert Einstein College of Medicine in New York.

"I felt that here I was, a Jew going to be a physician, and it would be nice to hear a religious perspective to ethical questions," she said.

Participating in several conferences, she added, has helped inform her self-identity as a doctor; it also has deepened the perspective she brings to secular discussions of medical ethics.

Oberstein's father, Dr. Barry Oberstein, an internist who shares an office with his daughter, is this year's conference chair. After years of delving into Jewish medical ethics at the conference and at weekly Torah study sessions, he finds himself increasingly sensitized to the implications of his medical decisions.

"I think more critically about things; I don't just say, `This is what I think and therefore that's what I am going to do,'" he said. "I try and base it on what the Torah teaches as best I can."

More than anything else, he finds himself embracing a tenet underlying all Jewish medical ethics: "Life is precious and every moment is precious. I've come to appreciate the sanctity of life more than what some people would call the quality of life," he said.

At times, that view has landed Barry Oberstein in difficult positions.

In one case, a patient with lupus erythematosus, a disease in which one's antibodies attack one's cells, began to bleed internally from an unrelated condition and needed emergency surgery. Weary of struggling with her health, the patient refused to have the surgery.

"I told her, `I just can't let you die,'" he recalled. "I felt this wasn't the time for her to decide what she wanted. If she had time to reflect on it, maybe she would have reached a different conclusion."

As it turns out, the patient's conclusion remained the same following the operation. "She wasn't pleased with me," Barry Oberstein said. "It's always touchy — free choice vs. life is precious. What can a doctor do and what should a doctor do?"

Of course, when it comes to looking at those questions from a Jewish perspective, one can't just open the Torah and seek easy answers under the heading "brain death" or "reproductive medicine."

From experts at past conferences, Rabbi Louis Feldman has learned where to search.

"They just constantly point me in the right direction," said Feldman, who is chaplain of the Jewish Home for the Aged in Reseda, near Los Angeles. "In a field where the information is so vast, the key thing is to know where to look. If you don't, you're lost. You're just absolutely lost."

A Reform rabbi who holds a Ph.D. in ethics, Feldman relies on Jewish medical ethics regularly.

"In secular ethics, human beings are valuable only to the extent they're valuable to society," he said. "In religious ethics, a person is valuable because they're created in the image of God. There's a great difference."

Adherents assert that Jewish medical ethics are hardly a cut-and-dried set of rules locked in ancient times. Instead, they say, generations of healers have been able to apply these laws and interpretations to their own eras.

"The Torah has something to say about everything," Barry Oberstein said. "Of course, there's leeway there. There are a lot of interpretations; you have a range of ideas."

The conference aims to reflect that range, according to Rabbi Pinchas Lipner, dean of Hebrew Academy and the Institute for Jewish Medical Ethics. At the conference, a medical doctor generally speaks on a given topic, followed by a rabbi or ethicist and a panel of four or five additional physicians and rabbis.

Participants then have a chance to question speakers. Often the discussions get lively.

"I was on many panels where people threw the book at me for some of the feelings I had," Lipner said. "Sometimes you come into very serious disagreements."

Seeds of the Jewish medical ethics conference were planted 20 years ago, when Lipner taught a class on Jewish medical ethics at San Francisco's Mount Zion Hospital. An enthusiastic response led to classes at other local hospitals and then conferences on the subject held at the Hebrew Academy.

Interest grew and in 1989, the institute held its first international conference. Some 450 people showed up. "The success was so enormous we were euphoric," Lipner said.

Since then, the conference has grown into something of an institution. Many participants are regulars. Past sessions are accessible on the World Wide Web — — and are available for purchase by calling (415) 752-7333 or e-mailing [email protected]

"We have put Jewish medical ethics on the map," Lipner said.

Leslie Katz
Leslie Katz

Leslie Katz is the former culture editor at CNET and a former J. staff writer. Follow her on Twitter @lesatnews.