MG 2025 min 1' Introduction: Historical Ethical Psychological background to show different aspects a

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• 1. Medical Ethics, Ethical
• Historical Background
• 2. Jewish Sources their relevance
• for Clinicians
• Maimonides on Truth-Telling and Patient-Physician
  Relationship
• Case Study Discussion

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(No Transcript)
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4 principles of Bioethics
Truth-Telling
Encyclopedia of Bioethics 1995 Information
Disclosure Assia 7, 12-50 (Hebrew) Pellegrino
ED. The metamorphosis of medical ethics. A
30-year retrospective. JAMA. 1993 Mar
3269(9)1158-62
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Introduction A Historical Overview
Old Testament Judaism
New Testament
Catholic Church
Antique Greece, Rome
Enlighten-ment
Modern Medicine 19-20th century
Egypt, Mesopotamia

• .

Paternalism
Autonomy
Oliver Holmes (1883) Your patient has no more
right to all the truth you know than he has to
all the medicine in your saddlebags He should
get only as much as is good for him.
Hippocrates (460 BC 370 BC)
Equivalence Independence Total
responsibility
Dependence
Stanley Joel Reiser Words as Scalpels
Transmitting Evidence in the Clinical Dialogue.
Annals of Internal Medicine 198092837-842. Lanto
s J. Informed consent. The whole truth for
patients? Cancer. 1993 172(9 Suppl)2811-5
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4 Models of the Physician-Patient Relationship




Emanuel EJ, Emanuel LL. Four models of the
physician-patient relationship. JAMA. 1992 Apr
22-29267(16)2221-6.
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• Hebrew Etymology ??? TRUTH

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?)    ??? "???? ???? ?????" (????? ?"?, ??) ????
??? ?? ???? ?????? ????? ????? ?????? ??
(??????? ?"? ?"?)
Sanhedrin 97a The truth will be absent
neederet (Isaiah 59,15), in the academy they
said it teaches that the truth will be split
into groups adarim and go away.
Comprehensive Details, Multi Disciplinary
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??? (??????? ?"? ?"?)
???
Sanhedrin 64a The signet of G-d is Truth.
Truth-Telling Imitating G-d
?? ???? ??? ??? ??? ?????? ????? ??? ??? - ????
???? ????? ????? ???? ???? ?????? ???? ??? ?????
?????? (??? ?' ?"?)  
Shabbat 10a Any judge who renders a true
judgment to its truth even for one hour, is
considered by Scripture as if he became a partner
with G-d in the act of creation.
NO GENERAL POLICY CONTEXT OF TRUTH gt case-by-case
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THE JEWISH SOURCES
Commentators Responsa
Modern Medicine Medical Ethics
Talmud
Bible
Mishna
450 CE
450- 28/5/2002
1500 BCE
200 CE
19-20th century
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????????? ?' ??? ????????? ?????? ???? ???????
?????? ?????? ????? ??????? ????? ???????
?????????? So Sarah laughed to herself, saying,
"After I have withered, shall I again have
delicate skin and my husband is old ! The Lord
said to Abraham, "Why did Sarah laugh, and say,
"Shall I indeed bear a child, now that I am
old?'
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????? ?? ?"? ?"? ??"? ????? ???? ??? ????? ??'
????? ???? ?? ???? ????? ???? ?????, ?????
(?????? ?') ???? ??? ???' ?? ????? ????? ??? ??
?? ???'. ?' ??? ???? ???? ????? (????? ?' ?"?)
????? ????? ??? ??? ???? ???? ?????? ???'. ???
??? ?????? ??? ???? ?????, ??? ????? ???? ???
???? ??, ??????? ???? (?????? ?"?( ?????? ???,
?????? ???? ???? ?????.
Yevamot 65b Rabbi Illa said in the name of Rabbi
Elazar the son of Rabbi Shimon It is permitted
for a person to deviate from the truth in a
matter that threatens the peace for it says
(Bereshit 50, 15-17) Rabbi Nathan said It is
even a Mitzvah for it says (Sam I 16,2) The
academy of Rabbi Ishmael taught How great is the
peace, for even G-d altered the truth for the
sake of peace, for initially it is written
(Bereshit 18,12) My husband is old yet later
it is written (ibid 14) Though I am old.
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???? ?"?, ? ?????? ???????? ??? ???? ????????
???? ???? ???????? ??? ?????? ????????? Prov
22,6  Educate a child in his own way even when
he gets old he will not depart from it.
Education long term effect!!!
FOLLOW THE CHILD - ALWAYS FOLLOW THE CHILD the
truth they can tolerate will be made obvious to
you
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??????????? ?????????? ?????? ?"?, ?
????????????? ???????????? ?????? ????????????
?????????????????? (?) ?????????? ???? ?????
?????????? ???????????????? ??????? ???????
?????? ??????? ????????????????
Psychology of Survival Long term follow-up
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??"? (?????? ?"?, ??) ????? ???? ????, ????
????? ???? ????? ??? ??? ?? ??? ?????, ???? ????
???? ????? ????? ??? ??????? ?????, ????? ???
??? ?????? ?"? ???? ???
Facing Truth gt Integration in Life
Denial Truth gt Poor Outcome
B. Jacob 1864-1945
Benno Jacob Genesis 45,7
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???"?  ?? ???? ?? ??? ???? - ?"? ???? ????? ???
??' ?? ??? ???? ?? ??? ??? ????? ?? ????? ?? ???
?? ??? ???? ??? ??? ???? ??????? ?? ??? ?????
???? ????? ??????.
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 ????? ?"? ?"?  ????? ??????? ????? ???? ????
??? ????? ???? ???? ???? ?? ???, ???? ????????
????? ?? ???. ??"? ??? ????? ????? ?? ???? ??
???.
 ???"? ??? ????? ???? "???? ???? ?? ??? ??? ????
???? ??? ??? ????? ??? ?????? ???? ????? ..."
????? ??? ??,? ???? ?? ??? ???? ???????? ?? ???
??? ???? ??"? ?-????? ??? ????? ??? ?????, ???
???? ?????????? ????? ?? ??? - ?? ??? ????
???? ?? ??? ??? ?? ??? ???? ?? ?? ??? ???? ????
Rav Kook
Midrash Bamidbar 21,5 (Berachot 58b) If one sees
a large crowd of people, he says Blessed are
youthe Sage of the secrets, for their minds
are not similar to each other and their faces are
not similar to each other.
INDIVIDUALITY case-by-case
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 ???? ??? ?"? ?"? ??? ???? ???? ??? ?? ?? - ???
??????? ???? ???, ??? ???? ???? ????. ???? ??????
?????, ??????? ?? ????? ?????.   ????? ????
???? ??? ???, ? (?"? ???? ????? ???? ???? ??)
???? ??? ?? ??, ??? ??????? ????, ??? ???? ????
????. ???? ?????? ?????, ???? ????? ????
??????? ?????, ??? ???? ???
Moed Katan 26b An ill person whose relative
died, we do not inform him that the relative
died, lest his mind become muddled, and we do not
rend our garments in his presence and we
silence the women from lamenting in his
presence. Shulchan Aruch in order not to
depress him
(lit not to break his heart).
????? ????? ?????
CAVE TOO MUCH TRUTH PROTECTION FROM THE TRUTH
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 ????? ?? ?' ?"? ?? ?? ???? ???? ???? ??? ?????.
?? ???? ???? ??? ??? ????? ????? ??? ??? ????
?????? ??? ??? ???? ?????? ??? ??? ????? ?????
??? ??? ?????? ???? ?? ?????, ?????? ??? ????
???? ?????.
Pesachim 4a Rav was the son of Rabbi Hiyas
paternal brother and the son of his maternal
sister. When he Rav went up to Eretz Yisrael,
he Rabbi Hiya asked him Is Aibu alive? He
replied Is then Eyma alive!?! He asked Is
my mother alive? He replied Is your father
alive!?! Rabbi Hiya Halachot of Mourning
maternal sister
Father
Rav Hiya
Mother
Paternal brother
Rav
Listen Follow the Patient Language of
Truth-Tellling The truth he can tolerate will be
made obvious to you
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?????? ?"? ?"?-?"? ?"????? ?????? ???? ????? ???
???? ?????? ??? ???? ???? ???? ??? ?????? ???
??? ??????. ???? ??? ?"? ??"? ??? ????? ????? ??
????, ?????' ??, ??? ??? ?????? ?????? ???? (????
?"?) "???? ??? ????"! ???? ??? ?"? ??"? ???????,
?? ???? ??? ?? ?? ????, ?????? ?????? ?? ?????
??????? ??? ???? ?????? ??????, ???? ???? ?????
????? ??? ???? ?? ??? ?????? ?? ??????.
Subjective Truth, No Absolute Truth
Ketuvot 16b-17a How do we dance before the
bride? Bet Shamai say we praise the bride as
she is. Bet Hillel say in all cases we say A
beautiful and charming bride. BS said to BH
If she was lame or blind, do we say about her
beautiful and charming bride the Torah says
Distance yourself from falsehood (Shmot 23,7)?
BH said to BS According to your view, if
somebody made a bad purchase in the market,
should one praise it in the purchasers eyes or
denigrate it in the purchasers eyes? Of course
you would say that one should praise it in his
eyes. From here the Sages said A persons mind
should always be mingled with people.
 
Shamai
Hillel
Avot 112-15
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"Summary"

• Truth the signet of G-d
• Details Comprehensive
• Rule NO ABSOLUTE RULE,
• NO GENERAL POLICY
• The context of Truth, Case-by-case
• Subjective Truth, No Absolute Truth
• Determine the ideal amount of
• Truth for each individual
• Follow the CHILD
• The language of Truth-Telling
• Avoid Isolation No Killing by Truth

Soroka!
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• Continuous Medical Education
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REFERENCES Encyclopedia of Bioethics 1995
Information Disclosure A. Steinberg Encyclopedia
Hilchatit Refuit 1988 Vol 1988, 136-6144. Assia
Vol 7, 12-50 (Hebrew). J.David Bleich A
Physicians Obligation with Regard to Disclosure
of Information in Fred Rosner Medicine and Jewish
Law 1990 31-63.
Discussion
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