For most Jews, the suggestion of medical experiments conducted on vulnerable populations smacks of Nazism, Mengele and concentration camp prisoners.
But is experimentation always evil? Is it ever permissible? What if the results of those tests can save lives?
And what does halachah, Jewish law, say on the subject? Can a Jew volunteer to be a test subject?
Those were some of the issues explored by Dr. Michael Friedman, an assistant surgeon general of the United States, and Rabbi Moshe Kletenik of Seattle’s Bikur Cholim-Machzikay Hadath Congregation at a forum Feb. 14 on human experimentation on vulnerable populations. Their talk was part of the International Conference on Jewish Medical Ethics, co-sponsored by the Hebrew Academy of San Francisco and held at the Park Plaza Hotel in Burlingame.
According to Friedman, those in the military are the most likely population today to be subject to medical experimentation. Recruits, after all, have limited autonomy and must follow orders.
That population is also most likely to be exposed to biologic agents that can cause serious illness or death.
“The situation today is that soldiers will be exposed to biologic weapons. The only question is when and where,” said Friedman, pointing to the use of nerve gas and microbiologic warfare in recent encounters in Southeast Asia, Iraq and possibly Iran. “It is irresponsible, I suggest, not to prepare for these weapons.”
In theory, the best ways to prepare are to either immunize soldiers against a particular agent before they are exposed, or to provide treatment afterwards to limit the toxic effect.
But discovering what those treatments may be is a complicated matter. One approach is animal testing, but the results don’t always work on humans.
Though the best method would be to use humans for testing, Friedman said, “You cannot knowingly expose people to nerve gas.”
In Kuwait and Iraq, when the military feared that troops would be exposed to nerve gas, soldiers were given pyridostigmine bromide (PB) to take prophylactically, he said. Although PB is an approved drug whose side effects are generally known, it had never been used as a counter-agent for nerve gas. Had the soldiers been given this information and the opportunity to consent to taking the drug, this kind of testing would have been OK, Friedman suggested.
But there was no informed consent. The soldiers were just given the drug and told to take it. Some did and some didn’t.
That, combined with the fact that the military didn’t do any post-combat studies, explains why it is still unknown whether the use of PB was effective, Friedman said.
Some Gulf War veterans blame PB for the maladies they suffer today, he added.
Kletenik looked to the Torah and halachah for answers to questions such as whether one should voluntarily submit to medical testing. “We don’t have proprietary ownership over our own bodies,” said Kletenik. “God gives us life. It is not our decision to take it.”
Yet Leviticus commands us not to stand idly by when a neighbor’s life is in danger, he noted.
So the question becomes when to act, and what degree of risk to take to save one’s life or that of another.
Kletenik said risks fall into three categories: those that must be taken, those that are permitted and those that shouldn’t be taken.
Giving blood is the type of action that must be taken — it’s a mitzvah, he said.
On the other hand, being a live organ donor may or may not fall into the acceptable category, depending on the circumstances — such as whether the procedure would endanger the donor’s life.
Using several examples interposed with halachah, Kletenik made two things clear in the discussion: No matter how old the principles, Jewish law can be applied to any modern-day situation, and halachah is flexible.
Kletenik also talked about “temporary life” or “life of the moment,” when one would be allowed to take greater risks. For instance, if death is certain due to disease or another condition, then a person would be allowed to undergo an experimental though life-threatening procedure, if there is the chance of some benefit.
And in some circumstances, he said, commandments can be set aside in order to preserve or save a life.
“If two people are eating together and one dies” then an autopsy would be acceptable because it may give useful information to treat the survivor, Kletenik said. But doing an autopsy because the findings may be of some general medical benefit is too remote to be acceptable under halachah.
As for the use of the drug PB in the situation posed by Friedman, Kletenik said that even though the drug had never been tested in that situation, if the risks and possible benefits are disclosed and there is informed consent, then it would be consistent with halachah to take the drug.
Friedman also touched on a newly developing area of medicine — xenotransplantation, transplanting animal tissue or organs into humans.
“The problem is that we do not know what evils lurk in those animals,” said Friedman, referring to genetic baggage an animal may carry that is harmless to the animal but deadly to humans. One example — the HIV virus — is carried by some primates.
“Patients can judge the risk and agree,” Friedman said. “But what about the risk to everyone else? Health-care providers? Family? Everyone else in the world? The benefits [of these procedures] are exciting, but the risks are unknown.”