UPDATED ISSUE on Health Care in America

obligations of tzedakah. Health care shares the characteristics that justify the priority accorded to pidyon shvuyim: both concern individuals who are suffering and may be in immediate danger. Further, both categories entail special needs that vary greatly among individuals. Jewish law and ethics understand the community to have a fundamental obligation to save lives whenever possible, diverting funds from other projects as required.

To what extent are individual patients and their family members responsible for providing health care? Individuals have the primary responsibility to care first for their own health and then for family members, either directly or through insurance. When they cannot do so, they may and should avail themselves of publicly funded programs to acquire the care they need. In any case, one should seek to prevent illness rather than wait to cure an illness that has already occurred.

To what extent are physicians and other health care providers responsible for providing health care? Based on halakhic precedent, physicians and other health care professionals must treat patients in case of emergency. They also have some responsibility more generally to make health care available to those who cannot afford their normal fees. At the same time, health care professionals legitimately may expect compensation for their efforts and should be able to earn a living.

To what extent is the community responsible to provide health care for those who cannot afford it? Halakhic sources indicate that such an obligation is a matter of justice as well as a specific halakhic obligation. In contemporary countries such as the United States and Canada, though, which “community” is responsible for health care — the Jewish community or the general society? We argue that, given the expenses and complex-

Renew ith Sh’ma

ity of health care provision in our day, the responsible “community” must be the national society, through its government, health care institutions, insurance companies, and private enterprise. Jewish citizens should support (by lobbying and other means) societal institutions that will fulfill the responsibility to ensure access to health care. The Jewish community, through federations, synagogues, and other institutions, should support these efforts. It must also assess whether and to what extent it should support hospitals and other forms of health care. It should balance that purpose against its commitment to other important Jewish needs, such as Jewish education and social services.

Jewish law and ethics understand the community to have a fundamental obligation to save lives whenever possible, diverting funds from other projects as required.

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The guarantee to provide needed health care does not extend to all desired treatment, or even all that might provide some benefit. Even needed treatment might be limited when it is so extraordinarily expensive that its provision would deprive other patients of needed care. Still, possible limits to interventions must be weighed against the value of human life and healing, and the injunction that a physician who fails to provide needed health care is considered as one who sheds blood.

Thus, in sum, patients and family members, health care professionals, and national societies and their citizens all have areas and degrees of responsibility in providing the health care required by Jewish law and ethics. Only through effective and accessible health care, both preventive and curative, can we fulfill our fiduciary responsibility to God to safeguard our bodies.

Access to Health Care Is a Human Right

RUTH B. BALSER

Elliot Dorff and Aaron Mackler conclude that Jewish law and ethics require a col- lective response to the health care crisis in the United States. I share their perception of a crisis. The large numbers of uninsured and underinsured — along with a provider community that is struggling with failing enterprises and administrative obstacles to providing quality care — are evidence of the current crisis in health care. As a legislator, my focus is on the failure of government to respond effectively to this problem. As Dorff and Mackler point out, this failure has

meaning from a Jewish ethical point of view, which suggests that the Jewish community might support political efforts to respond to this crisis.

In 1948, the United Nations declared in its Universal Declaration of Human Rights that:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care....”