Can you give experimental treatment to terminally ill patients?
By Jill Gutmann, Special to the Jewish News
Chloroquine, the anti-malarial drug, has been in the news as a possible cure for COVID-19. The efficacy of this drug is unproven. Only one promising study out of France has suggested that the drug, in combination with an antibiotic, might prove effective. Later studies have not confirmed these findings and, in fact, have shown no statistically significant change between current treatments and the drug combination. So we should not count our chickens before they hatch. In fact, there has actually been harm done through suggesting this is a cure: Two people used the drug to treat themselves, with one dying and another in serious condition. Physicians are hoarding the drugs, and people who need the pharmaceuticals for known treatments are not able to get it.
In this pandemic that is unsettling the world, all hands are on deck to find a cure and a vaccine. The question is whether Jewish people can use experimental treatments. To answer this, one must first understand the Jewish view of medicine.
“…Be fruitful and multiply: fill the Earth and subdue it, and rule over the fish of the sea, the birds of the sky and every living thing that moves on the Earth (Genesis 1:28).” The obligation to “subdue it, and rule over [it]” empowers us to seek medical assistance (The Lonely Man of Faith by R. Soloveitchik).
In fact, the Talmud goes further, describing the need to seek medical intervention: “In danger, one must not rely on miracle” (BT, Kiddushin 39b). The implication of these warnings is clear that one must do whatever is available and possible to try to intervene with known medicine and treatments. There is an inherent duty as a Jew to seek medical attention that is preventative and curative.
Rabbinic scholars divide treatment into two categories: those that are refuah bedukah (treatment where efficacy is proven) and refuah she’einah bedukah (treatment where efficacy is unproven). Proven treatments must always be used. For example, a person with strep throat must take appropriate medicine to cure strep throat.
On the other hand, experimental treatments are not required to be used, as there is no known efficacy. The rabbis of the Talmud and later authorities believe a person should not intentionally place himself in danger; but if a person is going to die, the calculus shifts. In this case, experimental treatments are permissible but not mandatory.
Patients must be informed of the risks and benefits in order to make an informed decision on whether to partake in experimental treatments.
In these trying times, we might hope for the miracle of a cure, but we must be careful not to cause harm through rash action. This is going to be a marathon and not a sprint for our physicians, nurses and researchers. Our Jewish values direct us to put our trust in researchers and scientists following best practices regarding experimental treatments, with the hope of finding a treatment that is refuah bedukah.
Jill Abromowitz Gutmann is a Jewish bioethicist, Rebbetzin of Temple Kol Ami and mom to four daughters. She has worked as an ethicist for the Centers for Disease Control and Prevention, the Israeli Ministry of Health and the Jewish Hospital in Cincinnati, Ohio, and has taught Jewish Ethics for Melton International, the Florence Melton School of Metro Detroit and of Auckland, New Zealand.