LINK Kollel Hosts Shiur On Medical Ethics and “The Right Not to Know

In a Legal Holiday shiur on Labor Day, Monday, September 1^st, the LINK Kollel  hosted a fascinating shiur by Rabbi Dr. Jason Weiner, the Director of Chaplaincy at Cedars- Sinai Hospital, on the subject of “The Right Not to Know.”   The topic pertains to the vexing question of how much a patient, especially one who is seriously ill, should be told about the nature of his condition, especially if the outlook is dire.  A packed house of men and women hung on his every word as he discussed a number of real cases that he has had to deal with in his work.

The issue is discussed in Shulchan Aurech, Yoreh Deah, Siman 337.  Under most circumstances, a patient should not be informed of anything resembling “bad news” even if it doesn’t relate to his condition whatsoever but pertains to other people that he is close to.  For example, he should not be informed of the death of a loved one, because we assume that in most cases it will cause him “tiruf hadaas” (great distress).  In fact, Rabbi Weiner quoted a number of opinions that one would be permitted to even be Mechallel Shabbos in order to bring a seriously ill  patient Yishuv HaDaas (inner tranquility).  Given the fragile nature of a choleh’s mental outlook, anything that can be done to alleviate his distress- even his mental angst - must be done for the patient.  Conversely, one should endeavor to shield him from any news  that could bring him to anguish.

In his masterful presentation, Rabbi Weiner brought a number of Midrashic sources as well as halachic ones, to elucidate the matter.  The clear consensus of today’s poskim is that under most circumstances, one does not inform a seriously ill patient about the gravity of his illness, since this might lead him to despair of recovery.

Rabbi Weiner discussed the common practice of a sick patient saying viduy (confession), especially if he’s going to be undergoing a surgery.  The halacha mandates that the one who says viduy with him must tell him that “many people  who have said Viduy that have gone on to live long lives, while conversely,  others  who have not said it have  it  have  met an untimely demise”. So we see that while a person has to be realistic about the future, he must be shielded from any sudden information that can greatly disturb his mental equilibrium.  (He quoted the Ramban on Parshas Vayigash that when Yaakov Avinu heard that Yosef was still alive, after 22 years of being informed of his death,  his heart sank – meaning,  the shock of even good news can principate  a heart attack. 

On the other hand, Rabbi Weiner quoted contemporary poskim who say that with the advancement of medical treatments and the  availability and options in today’s world, it is often beneficial for the patient to be an informed partner in that decision-making process.  For example, he must have some idea of what the  situation is in order determine what type of treatment he would like to take and how aggressive those treatments should be and for how long they should be utilized.  In this case, the knowledge that he is being informed of is actually helping to prolong his life, not chas v’shalom to shorten it. 

He ended the shiur with a discussion of the effect that new technologies such as  artificial intelligence (AI), and advanced genetic testing are having on medical prognostication.  For example, even before a baby is born, he can undergo advanced genetic screening in utero.  He can even have his own genome mapped out.  This can help predict what the future health challenges of that child might face.  This obviously raises thorny hashkafic and halachic questions.   Similarly, AI is being used to make thorough evaluations of a person’s medical condition that often involves extrapolation into the future with strong accuracy.  This means that a patient who is seemingly is not critically ill may be on the verge of a major downturn, even a fatal one.  While it may be beneficial for the doctors to have advanced notice of this dynamic and perhaps they can take measures to alleviate the patient’s distress, informing the patient of this sudden impending  downturn can have very serious adverse consequences. 

It is important in all of these issues to have knowledgeable and competent halachic guidance from Rabbonim that are well-versed in the medical field as well as in the halachic sources. 

Rabbi Weiner’s presentation was well- received, especially for its thoroughness and in-depth analysis.  The many real-life examples that he offered helped clarify a number of difficult issues.  The large crowd felt that they had utilized their day off from  work  a most instructive and beneficial manner.