What would Maimonides say about health-care reform?
President Obama yesterday spoke to two conference calls of religious leaders—one organized by the Religious Action Center of Reform Judaism and featuring rabbis from all three major movements; the other an interfaith call including clergy and lay leaders—seeking their help in selling the need for health-care reform. With no end in sight to the nationwide debate over the need for and nature of health care reform, we decided to call in an expert witness: Maimonides. The medieval philosopher and rabbi was also a physician and commentator on medical ethics whose outlook was shaped by both the Greek tradition of Hippocrates and Galen and Jewish teachings on medicine found in the Talmud. Maimonides himself wasn’t available for an interview—he has been dead since 1204—so instead we spoke to Sherwin Nuland, a doctor, Yale professor, and the author of multiple books on health and medicine including Maimonides, a biography from Nextbook/Schocken Press.
What kind of role would Maimonides have played if he were here today—would he be a practicing physician? A policymaker? A bioethicist?
I like to think that every physician is in his soul a bioethicist. But there’s no doubt in my mind that Maimonides would want to be thought of as a bedside physician who used the ethical principles both from Hippocrates and from Judaic beliefs taken from the Torah and Talmud. In addition, as the leading physician of his time, he would have been called upon by government to make his thoughts about health care known to the government.
And what were those thoughts?
Anyone who is ill has not only the right but the obligation to seek medical care. It’s very applicable to the current debate about health care. Maimonides is saying that universal health care is an absolute necessity. Healing is not only urged, it’s obligatory, not only on the part of the patient but on the part of the physician. Each doctor is obliged to treat any patient who comes to him for treatment, he’s not allowed to shuffle him off to another doctor. The doctor, as he saw it, was an agent of God, and providing people with health care was a way of finding God and a way of leading people to the moral life. Had Maimonides been living in our time, we would have had universal health care decades ago, probably during the Truman administration, when it was first proposed. The medical associations, at that point, stood in the way of universal health care, and he not only would not have stood in the way, he would truly have been one of its strongest supporters.
There’s been debate over Judaism’s take on universal coverage: some see the Torah and Talmud as insisting that society take care of the sick, while others put more emphasis on people’s individual responsibility to take care of themselves. Where did Maimonides fall on issues of collective versus individual responsibility?
He would fall on both sides. You are sinning if you don’t take care of your body. We keep hearing about preventive care, and he agreed that living a life that is physically healthy is an obligation, but also that the doctor is obliged to provide care to anyone who needs it. Maimonides conducted his practice irrespective of social status. He treated the courtiers in Saladin’s court; I’m assuming he was on a retainer for that. And then he went home, I think his home was about two hours away, and he treated anyone who came to see him.
Is there anything that indicates whether, within the spectrum of universal health care, he would have been inclined toward a public option?
We can’t say that. He would have been in favor of anything that assured a totality of care for the populace. When he was treating Saladin’s people, he was a physician on salary working for the state who also had his own private practice. He would be in favor of anything that absolutely assured that everybody got care and got the same level of care. He was the leading physician of the Arabic world, and he was treating anyone who came to him the same way he treated the vizier’s family.
The notion that the administration’s health care plan would establish government-run “death panels,” though discredited, has, nonetheless, reframed the debate for some voters as a question of who should be able to determine when a person dies. What was Maimonides’s opinion about how much say individuals, or their families or doctors—humans in general—should have in how they want to die?
It would have been forbidden for a doctor to end a person’s life in Maimonides’s way of thinking, in terms of both Hippocratic ethics and Jewish ethics. He believed that nature was determined in a general way by God, and nature must be allowed to take its course. He would not have believed in some of the unnecessary courses of action we take to keep a person alive on a respirator for no good reason; he would have considered those unnecessary invasions of god’s will. This derives both from the Hippocrates—do no harm—and from the Ten Commandments—you can’t kill anybody. It’s as Jewish as can be.