Eye on religion: the reflective physician and the Jewish patient.

These notes are most sharply constructed for the non-Jewish physician who tends to a Jewish patient and who operates with the assumption that religion is of therapeutic value, having the potential to guide, comfort and motivate.

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The physician should know that in Judaism, formally speaking, life is carried and guided by beliefs, commandments, rituals and ceremonies, both uttered and enacted, that address all aspects of life, including dietary regulations, moral and ethical behavior, prayer, Sabbath and holiday rules. Yet, Jewish people cover the broadest spectrum of adherence to and knowledge of these particulars. Four major movements of American Jewish life--Orthodox, Reform, Reconstructionist, and Conservative--offer profiles of observance that present only the broadest characterizations of beliefs and practices. In order, therefore, to say something most broadly about the Jewish patient I must excavate beneath Judaism's formal structure of beliefs and practices; otherwise, there can be no end of discussion or description of a Jewish patient whose profile likely does not even fit cleanly into one of the four major streams of American Judaism. In presenting one stereotypical profile, I will succeed in describing no one. Indeed, I will have offered little useful information to the physician.

Therefore, I offer four broad characterizations and some thoughts on their practical implications that I hope will serve the non-Jewish physician and will also be useful to the Jewish physician: (1) The importance of belonging. At base, as the American theologian Mordecai Kaplan taught, Judaism is more a matter of belonging than believing. I would add that belonging also trumps behaving as the primary marker of Jewish identity. It would be an overreaching assumption for a physician to assume that a patient's strong identity as a Jew tallies with religious faith and observance or with a potentially therapeutic "spiritual" disposition. In a hospital context, a visit from the chaplain--a fellow spiritual traveler--is not sure to be productive. Even if the patient has no religious habits, either in prayer or in lifestyle, markers of "otherness," or "not belonging," such as a crucifix on the wall or pork--the ultimate icon of "other" eating habits--might well be troubling. (2) A culture of discourse. Jewish life is basically the product of interpretive give and take with its scriptural base. How else could the text at the center remain the vital, supple source for responses to ever-changing circumstances? This culture of discourse infuses all varieties of Jewish life. Well-reasoned positions are honored. The ear tolerates multiple authoritative voices and dissent is valuable. A physician might expect that a Jewish patient is likely not to be unsettled by a medical situation that does not yield one. and only one, solution. Judaism's deeply embedded culture of discourse makes it a reasonable expectation that the patient will be hospitable and open to reflection on varied and nuanced positions on the ethics of certain procedures, life support, or end-of-life issues. (3) Autonomy rather than predestination. Even the most theologically traditional Jewish views celebrate autonomy. Resignation in the face of that which was "meant to be"--if such resignation exists--is not based upon any religious principle. Medical interventions are not rendered meaningless in the face of inscrutable fate. A sense of predestination does not neutralize inventiveness, ingenuity, or hopefulness. It is never "too late," nor is pain understood to be one's lot. (4) Respect for medicine. "The Jewish Doctor" stereotype certainly has its roots in historical realities. Beginning with a biblical tradition that valued hygiene, nutrition, public health standards and diagnosis, signs of respect for medicine and its practitioners are abundant throughout the millennia of Jewish history. Distrust or antipathy toward medicine would not be manifestations of any Jewish stance. It is reasonable for the physician to expect respect, trust, and a willingness to conspire with the physician toward health.

When mortality is in the air--"mortality" meaning any profound sense of fragility--people tend to relax more easily into the strong arms of religious tradition that is a mysterious and powerful, if unpracticed, legacy. For example, it would not be unreasonable that, while nonkosher food is a patient's regular fare, pork would become offensive in a fragile moment. Sabbath and holiday traditions, traditional prayers, and carrying the calming tastes, sounds and smells of the family home might be summoned for strength and stability. The reflective physician, through sensitive, careful attention to such matters as these, serves the cause of health and well-being.

Acknowledgments

Thanks to James Tulsky, MD, for his advice.

The language of citizenship suggests that self-interests are always
embedded in communities of action and that in serving neighbors one also
serves oneself.
--Benjamin R. Barber

Rabbi Steven G. Sager, PhD

From Duke Divinity School, Duke University, Durham, North Carolina 

Reprint requests to Rabbi Steven G. Sager, PhD, Duke Divinity School, Durham, NC 27707. Email: [e-mail]