"The Heart Knows its Own Bitterness": Authority, Self, and the Origins of Patient Autonomy in Early Jewish Law

One of the central problems of modern bioethics concerns the relative merits of medical expertise, legal authority and patient autonomy. This article examines the pre-modern conflict between these principles, revealing how the early tradition of Jewish law sustained different models of expertise, authority and personal autonomy. Rabbinic sources preserve opposed and contradictory voices regarding who is authorized to define a patient's needs as dire enough to supersede important legal prohibitions. Early rabbinic law enshrined the authority of experts, while later rabbis emphasized that life is the preserve of the individual and maintained that only the patient can make critical decisions about prolonging life, based on his or her physical and psychological needs and desires. This transition is related to notions of consciousness and the self emergent among Christian contemporaries of the rabbis. The rise of a more sophisticated inner world and the significance accorded to individual choice influenced the interpretation and construal of law. By the late rabbinic period individuals were regarded as capable of recognizing their own needs and making informed choices regarding their bodies and selves. This ancient conversation offers a window into the history of the ethical questions that arise specifically in the field of medicine and more broadly in the legal realm.