JLI- Life in The Balance

Course Overview

Lesson One

An Ounce of Prevention: BRCA, Genetic Testing, and Preventive Measures

We all endeavor to take preventive measures and protect our health, but we often question whether we do enough. How do you draw the line between vigilance and panic?

In recent years, scientists started identifying hereditary gene mutations that are responsible for particular diseases. Certain mutations, called BRCA, are linked with significantly high risk of certain cancers,most notably, breast cancer and ovarian cancer. Women with a BRCA mutation have as high as an 87 percent chance of getting breast cancer and as has as high a 44 percent chance of developing ovarian cancer.

To protect against these hazards, several preventive options are available. Surveillance can detect the cancer in its early stages when it is possible to be treated effectively. The drug tamoxifen can be used to reduce the breast cancer risk. Some have opted for a bilateral mastectomy and an oophorectomy.

Sadly, the instances of BRCA mutations are statistically higher in Ashkenazi Jews.

This brings us to the following questions:

If a woman were BRCA-positive, would any preventive measures be considered

obligatory? Would Jewish law oblige women to test and determine if they are BRCA positive so that they can know if they need to engage in prophylactic measures?

We care for our health because we desire longevity and a better quality of life. Jewish

philosophy would add that it is a duty to do so. But how far is one required to go in achieving this end?

This lesson explores Jewish perspectives on preventive medicine and public health. It will

raise awareness about an important health matter and may potentially save lives.

Lesson Two

End-of-Life Dilemmas: Prolonging Life vs. Prolonging Death

Resuscitate? Do not resuscitate? How does one decide what to inscribe in a living will? The value of life is immeasurable, but is the same true for its increments? Perhaps the medical advances some see as life-supporting are in fact just death-prolonging?

It is common, today, for people to express advanced directives about whether they would prefer living at all costs, or whether they would rather be left to die in peace. Others appoint a health-care proxy to act on their behalf if they are one day unable to express their own wishes.

How can one issue advance directives that are in consonance with Jewish values?

This lesson discusses the important end-of-life decisions that everyone needs to make today and

offers Jewish perspectives on dying with dignity.

Lesson Three

Sanctity in Death: A utopsy and Medical Dissection

All acknowledge that life is sacred; Jewish sources add that there is also sanctity in death. Therefore, in Jewish law and custom, a corpse is handled with reverence and interred as soon as reasonably possible.

But a human cadaver can be very valuable to medicine and humanity. It can be examined to learn about the cause of death and the nature of disease. It can aid in exonerating the innocent or convicting the guilty. It prepares the next generation of health professionals, helps scientists judge whether advances in technology are safe, and ensures a high standard of care at our medical institutions.

Many states allow medical schools to use unclaimed cadavers for anatomical dissection.

Is this ethical? Is there an allowance in Jewish law to voluntarily donate one’s body to science? Is it ever moral to perform an autopsy over a family’s objections? When would Jewish law encourage that a postmortem be performed? Is there a difference if the autopsy is limited and minimally invasive?

This lesson will examine how Jewish law balances the dignity of the dead with the needs of society.

Lesson Four

Confronting the Organ Shortage: Should the Sale of Organs Be Legal?

Doreen Flynn has three daughters who suffer from a blood disorder that requires a bone marrow transplant. Flynn challenged the National Organ Transplant Act, which forbids compensating an organ or bone-marrow donor, and sought to have the right to pay donors for the bone marrow needed for her daughters. The U.S. Court of Appeals for the Ninth Circuit has recently agreed with her. Should the sale of bone marrow be legal?

What about the sale of kidneys? Currently, prospects for those in need of organ transplants are grim. For every 100,000 transplants needed each year, only 10,000 are performed. Permitting the sale of organs might significantly increase the number of organs available for transplant, potentially saving many thousands of lives.

But do we want to live in a society in which people sell body parts? Does that undermine human

dignity? Some argue that if a market in organs were to develop, ability to pay would determine who would have access to organs, while economic need would determine who would be motivated to sell theirs.

Does the great life-saving potential of legalizing the compensation of organ donors override implications regarding human dignity and equity?

Perhaps, there is a balance or viable form of regulation that would satisfy our conflicting moral values.