Health care and economics can make for a volatile mix, and involving political rhetoric on the subject is a sure guarantee of fireworks. The difficult balance between health costs and access to health care was highlighted by a recent decision of the Ontario Divisional Court. A retired high-school teacher who spent close to $500,000 for a lifesaving liver transplant in England was denied any reimbursement for his medical expenses. At the time of the surgery the procedure was considered experimental with a very low chance for survival. While the patient is alive and well physically, his economic situation leaves much to be desired.
It is well known that pikuach nefesh, the saving of a life overrides all precepts of the Torah – with the exception of the three cardinal sins of idolatry, adultery and murder.Furthermore Jewish law states that one must give up all of one’s assets to avoid violating a negative commandment of the Torah (positive commandants require the spending of up to 20% of one’s income). Thus Judaism teaches that one must quit one’s job if it would entail violating Shabbat, or even the less significant laws of kashrut. It would thus appear almost sacrilegious to worry about monetary considerations when one’s life hangs in the balance. It seems quite cruel for a government to fight hard in order to be able to deny payment for life saving surgery of one of its citizens. Yet appearances can be deceiving.
The obligation to sacrifice everything and anything to save one’s life applies only to the person whose life is in danger. For such individual money must not be a factor. Thus assuming that no public money is available to fund a particular procedure necessary to prolong life, one would be obligated to deplete one’s life savings and then some. Yet what is true for any given individual is not necessarily true for other members of society or for society as a whole. Here we must take a broader view. While building a hospital on every street corner would surely save more lives, it would come at a great cost to a rich and diverse cultural life. While one can argue over what the priorities of government should be, political leaders have the right and responsibility to allocate funds in ways that meet the needs of many through the various stages of life. They may decide to invest money in an opera house rather than high tech medical equipment. Spending hundreds of thousands of dollars for surgery in Europe is wonderful but at what cost to other initiatives? How many could possibly be saved at home with that money invested in another operating room.
In our particular case when Health Canada felt the treatment was unlikely to succeed (thankfully they were wrong) there is even further reason to deny payment. Dr. Abraham Abraham in his classic work on Jewish medical ethics Nishmat Avraham rules that an individual, in order that he should not give in to despair, would be allowed to spend his own money seeking all kinds of cures even though they have no proven medical effectiveness. Others however have no obligation to financially help such an individual; if they choose to do so amounts spent would not count towards the amount that one is obligated to give towards the mitzvah of tzedakah. Furthermore Dr. Abraham writes, public institutions would be enjoined from spending money on such unproven cures. Thus if Health Canada has properly determined that a treatment is not medically sound governments would have no legal or moral right to spend money reimbursing individuals who were able to “prove” Health Canada wrong.
Rabbi Jay Kelman is a Founding Director of Torah in Motion www.torahinmotion.org an adult education Institute based in Toronto. Prior to a career in Jewish education
Rabbi Jay worked as a Chartered Accountant. rabbijay@torahinmotion.org