Toward an Israeli medical ethics

This chapter seeks to give an account of clinical ethics in Israel in its social and historical context, and to highlight the challenges that the society and its medical profession face in formulating a locally relevant ethics. The interplay of European, Levantine, American, and religious influences is the environment in which the politics of Israeli medicine is conducted, and which provides the context for the moral reactions of its practitioners. As a basis for proposing possible future directions for Israeli medical ethics, we look back over the seventy-odd years since the foundation of the state. THE SOCIAL AND HISTORICAL CONTEXT OF CLINICAL ETHICS IN ISRAELWhen faced with ethical dilemmas, Israeli doctors, like everyone else, have moral reactions, and in this chapter, we seek to discover the underpinnings or underlying assumptions of these reactions. Although the overwhelming majority of Israel’s physicians are Jewish, this does not mean that they are religious and committed to or knowledgeable of religious law (halakhah). So their moral reactions cannot be directly related to the dictates of religious doctrines (Liebman 1999). Their current cultural environment, alongside their Jewish culture, must therefore be considered in understanding these reactions. Israeli medicine, historically, developed out of Eastern and Central European medicine. Its earliest practitioners were typically Jews who fled from European antisemitism, but whose affinity with the rituals and laws of the Jewish religion was vestigial or nonexistent. They brought with them the liberal enlightenment of Kant embedded in a Bismarckian social bureaucracy. In the mold of Kant, human reasoning gave authority to their opinions, with the dignity of the individual at the moral epicenter. Bismarck contributed policies of social solidarity, including a commitment to the maintenance of the health of the productive worker and for the temporarily or permanently disadvantaged, sick, or disabled. This being in the overall economic interest of the employers, it was they and not the government who were deemed responsible for the health care system. This was organized through public “sick fund” insurance, funded jointly by employee and employer premiums.