What's the Difference Between a Doctor and G-d?

If you walk into the new Jewish museum in London, there is a section containing a large screen. On the screen are a variety of ethical questions with different Jewish perspectives. If you push the "Jewish Orthodox button" I pop up with responses to those questions. On a particular medical question I begin my analysis with something like, "the difference between a doctor and G-d is that G-d doesn't think he's a doctor."

This prompted one irate anaesthetist who visited the museum to write me an angry e-mail expressing his moral outrage at my making fun of doctors like that. He insisted it was a cheap joke in poor taste. I insisted that humour notwithstanding, there was an implicit message. We engaged in detailed correspondence as a result. I don't think his protests to the museum to remove me bore any fruit. But what is the implicit message?

A doctor in the U.S. has blown the lid on one of medicine's best kept secrets. Ken Murray, professor of medicine at the University of Southern California recently published a widely disseminated essay in which he writes:

"Of course doctors don't want to die -- they want to live. But they know enough about modern medicine to know its limits. Almost all medical professionals have seen what we call, 'futile care' when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life."

The good doctor is talking about terminally ill patients who can resort to some treatment that will elongate life. He defines this treatment as "futile" as the end result will be the same, even if pushed off for a while and in the interim will most likely make those final days or months utterly miserable.

Only recently I was in conversation with an octogenarian who was diagnosed with cancer. Having endured countless infections and a lot of suffering over the past two decades, he was adamant that he won't take any of the treatments on offer. He would rather make the most of his final time, enjoying it to the best of his ability, before submitting to his ultimate fate. The alternative, he argued, is that he would take treatment which would quite possibly add several months onto his life, but at what price? Most of that time would be spent in hospital receiving the treatment, dealing with reactions to the treatment and making every day a living hell.

Indeed, according to Professor Murray, most doctors, if told they have a terminal illness, don't even think about trying to fight it. They get hold of the best pain-relief available and enjoy whatever time is left to them rather than putting themselves through whatever distressing treatment that is ultimately pointless.

A little while back my father was diagnosed with glioblastoma grade IV. In a word, it is the most aggressive form of brain cancer. The doctors gave him a year. They also gave him options. Combined chemo and radiotherapy is the most recommended course, although at his age they don't advise radiotherapy for more than three weeks. Being a robust 70-year-old and never having spent a day in hospital, he told them point blank, "Treat me like a 50-year-old and give me the six weeks treatment." So began the daily journeys to the hospital where my three siblings and I would fly in from our respective countries to form a rota and help my mother through the process.

When I flew in from London during my "shift" my father and I had a conversation about his treatment. I still remember his words: "It's all hevlai havolim (Hebrew for "nonsense") but halacha (Jewish law) says I have to do it, and so I am doing it."

In other words his personal attitude is not dissimilar to that of Professor Murray. Such a response is only natural and intuitive. "Let me roll with the punches," and, to borrow a favourite catch-phrase of my father, "let the chips fall where they may." But Jewish law mandates that one has to pursue medical treatment and to do everything within one's ability to preserve life. Doctors, according to Jewish philosophy, are not a law onto themselves, rather representatives of the Almighty who are there to assist in the preservation of life. The rest of course is in the hands of Above. "G-d heals," observed Benjamin Franklin, "and the Doctor takes the fees."

It is now more than eight months past the one year they gave him, and his most recent scan shows no re-growth. My father, a retired philosophy professor and acting rabbi, still attends his synagogue daily. He still sermonises on the Sabbath. He still edits essays for an online website. He just enjoyed the news of the first of his more than two dozen grandchildren getting engaged and now there is a wedding to look forward to in a few months time.

That isn't to say it hasn't come at a price. Radiotherapy never quite leaves your system. There are many struggles as an end result, but my father is still with us and we tend to fly in often enough to enjoy time with him, "enjoy" being the operative word. After my most recent visit in December, I reminded him of the conversation we had back in June 2010. He simply smiled. "Thank you for coming I really enjoyed our time together." Had he done things Professor Murray's way that enjoyment would probably never have happened. But he did it G-d's way. My quip on the museum screen doesn't seem so funny after all.