Jewish Medical Culture: Case Studies in End-of-Life Decision Making A Dissertation Presented to ...

230 Pages·2015·0.93 MB·English

Jewish Medical Culture:
Case Studies in End-of-Life Decision Making

A Dissertation

Presented to

The Faculty of the Graduate School of Arts and Sciences
Brandeis University

Department of Near Eastern and Judaic Studies

Sylvia Barack Fishman, Advisor

In Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy

by

Joshua N. Cypess

August 2015
The signed version of this form is on file in the Graduate School of Arts and Sciences.

This dissertation, directed and approved by Joshua N. Cypess’s Committee, has been accepted
and approved by the Faculty of Brandeis University in partial fulfillment of the requirements of
the degree of:

DOCTOR OF PHILOSOPHY

Eric Chasalow, Dean
Graduate School of Arts and Sciences

Dissertation Committee:

Sylvia Barack Fishman, Department of Near Eastern and Judaic Studies
Jonathan D. Sarna, Department of Near Eastern and Judaic Studies
Yehudah Mirsky, Department of Near Eastern and Judaic Studies
Lisa Fishbayn Joffe, Hadassah-Brandeis Institute
Copyright by
Joshua N. Cypess

2015
Acknowledgements

This dissertation could not have been written without assistance of numerous individuals
and institutions. I have benefited first and foremost from the love and support of my family: my
wife, Rebecca, and our three children, Benjamin, Joseph, and Sarah. I thank them for providing
an environment in which we can discuss ideas freely and take pride in each other’s
accomplishments.
Rebecca, with the acumen and brio of a world-class scholar and the superhuman hessed
and patience of a Biblical heroine, has provided invaluable help throughout the long years and
wide-ranging travels of my graduate-school odyssey. I would not have been able to realize the
vision of this project without her peerless aid. These words are not enough to thank her, but in a
dissertation, words are all I can give.
My brother, Aaron Cypess, is a doctor, a molecular biologist, and a ben Torah. He has
been a close friend and keen havruta for all of my life. He has always been there to listen to his
younger brother, whose perpendicular perception often felt intellectually isolated in a world
where what was obvious to everyone was not to him, and vice versa. Since early in our post-
Princeton years, while he embarked on his arduous path for an M.D.-Ph.D. and I was in
rabbinical school, he has shared with me his views on medicine and science. I could not have
undertaken a project such as this without his expert guidance, his earnest wish to help, and his
good sense of humor.
My mother- and father-in-law are both political scientists who have dedicated their lives
to using ideas in the service of the public good. Their daughter carries that mission with pride
and I am happy they have been part of my life. I know that they share my interests in social
science, policy, and philosophy beyond the dusty page.
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My advisers and professors in the Department of Near Eastern and Judaic Studies at
Brandeis University have provided mentorship, guidance, encouragement and patience. In
searching for a scholarly home in which to pursue my doctorate, I was proud to be accepted by
an institution with such a distinguished legacy, and I carry that pride forward as a responsibility
to uphold that legacy. My advisor, Sylvia Barack Fishman, welcomed me to the department
when I embarked on my graduate studies, and I have benefited immeasurably from her teaching
and her scholarship. Jonathan D. Sarna has encouraged me at every turn, providing valuable
feedback and advice, both formally and informally. The field of Jewish Sociology is small, and I
am fortunate to be mentored by two recipients of the Marshall Sklare award from the Association
for the Social Scientific Study of Jewry, in the institution built by Professor Sklare himself.
Together, Prof. Fishman and Prof. Sarna have shaped my thinking in lasting ways, and I hope I
will be able to contribute to their fields in ways that reflect well on all they have given me; with
my family, I have come to see them as personal as well as professional mentors.
I am grateful for the guidance of Yehudah Mirsky, who applied his remarkable breadth of
knowledge to enriching this project. He arrived in Brandeis at the time I was leaving
Massachusetts for New Jersey; although I wish I had been able to spend more time learning from
him and sharing ideas as a student, I look forward to doing so in future years.
Lisa Fishbayn Joffe of the Hadassah-Brandeis Institute served as outside reader, bringing
her expertise in legal studies to bear on our discussions as I sought to refine my work. In
addition, I thank the professors with whom I worked in seminars and as teaching assistants: Marc
Brettler, ChaeRan Freeze, Reuven Kimelman, Jonathan Levisohn, Antony Polonsky, and Eugene
Sheppard. Len Saxe, Ted Sasson, and Ben Phillips of the Cohen Center for Modern Jewish
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Studies offered me training in statistics and hands-on experience in sociology, for which I am
most thankful.
My work would have been dramatically different without the guidance of the faculty of
Sociology at Brandeis, from which department I received a master’s degree in 2012. It was
Shulamit Reinharz who created the joint degree in NEJS and Sociology and encouraged me in
my application to Brandeis; I am grateful that she saw the potential in me to join this venerable
community.
My studies with Peter Conrad have shaped my thinking in the Sociology of Health—a
field he has developed and nurtured, much as he has nurtured students like me; he is a lively and
friendly scholar who lived up to my image (I guess it came from Tuesdays with Morrie) of the
Brandeis sociologist.
Wendy Cadge, who advised my master’s thesis, has been a living example of an adept
thinker in my fields the Sociologies of Religion and of Health. Her knowledge in this complex
area is matched only by her abilities as a teacher.
Sociology is a well-regarded field at Brandeis with leaders on and off campus, and I am
happy to be able to be associated with such a storied and able legacy. I came to the department
thinking like a rabbi, philosopher, and anthropologist and it was their task to craft me into a
sociologist whom they would be proud of, one committed to social science and to public service.
I hope to continue that unending task. I offer my thanks to David Cunningham, Karen V.
Hansen, Gila Hayim, Laura J. Miller, Chandler Rosenberger, and Sara Shostak.
The other members of the graduate community at Brandeis were of great importance in
my experience as a student. I am grateful to Meredith Bergey, Rachel Bernstein, Casey
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Clevenger, Zev Eleff, Brian Fair, Nicole Fox, Allyson Gonzalez, Alexandra Herzog, Vanessa
Lopes Munoz, Shay Rabineau, Emily Sigalow, Jill Smith, and Ken Sun.
The librarians at Brandeis provided essential support, and it was also a pleasure for me to
discuss ideas with them; I mention in particular Jim Rosenbloom and Nancy Zibman. I am
grateful to Joanne Arnish and Jean Mannion, department administrators in NEJS, who acted as
safety nets at every step.
My studies at Brandeis were made possible by a Mildred and Abe S. Bloomberg
Endowed Fellowship in Judaic Studies and a Fein, Pinanski, Sain Fellowship of the Hebrew Free
Loan Society from the Boston Area Combined Jewish Philanthropies. I acknowledge these
fellowships with the deepest gratitude.
The Halachic Organ Donor Society has made an enormous amount of material on Jewish
approaches to end-of-life medical issues available freely on-line. My work has been aided greatly
by this resource. In addition, I acknowledge the materials provided by the Dr. Falk Schlesinger
Institute for Medical-Halachic Research.
I am grateful to the many scholars outside of Brandeis whom I consulted and who offered
advice and guidance on my work. These include friends from Newton—Jay Berkovitz, Ruth
Langer, Benjamin Samuels—as well as David Biale and Michael Broyde, who answered
questions from afar, and old friends Zvi Novak, Don Seeman and Yuri Simon who have been
able to provide guidance and models of expertise in social science and philosophy.
The alumni of the Wexner Graduate Fellowship provide fellowship in the truest sense of
the term, offering intellectual and professional support across the world of Jewish leadership,
across all denominations, and in many academic fields touching on Jewish Studies. I am grateful
for the consistently lively and enriching discussions that I have with my Wexner colleagues, with
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special mention for those who survived graduate school: Sarah Bunin Benor Yossi Chajes, Beth
Cousins, Jonathan Crane, Danna Livstone, Michael Miller, Yossel Kanofsky, Moshe Simon
Shoshan and Shaul Kelner, whose strong work in sociology I hope to emulate. The Foundation
leadership is renowned for helping develop and nurture emerging scholars, and I learned how
deep that help could be; I owe my gratitude to Bob Chazan, Larry Moses, and to Maurice
Corson.
In their dedication to both Torah and Madda, Rabbi David Ebner and Rabbi Aharon
Lichtenstein of blessed memory embody the values that I aspire to most highly. I am humbled
and thankful to have had the opportunity to study with them. I undertook my studies at Brandeis
because of the mentorship of numerous professors and rabbis at Yeshiva University; I was
fortunate to study with Rabbis-Professors David Berger, Yossi Blau, J. David Bleich, Yaakov
Elman, Arthur Hyman, Ephraim Kanarfogel, Sid Z. Leiman, Michael Rosensweig, David Shatz,
Haym Soloveitchik, and Moshe David Tendler.
My approach to the study of culture was shaped during my undergraduate years at
Princeton University, the rigor of which was revealed over my many years of education in many
places. I acknowledge with gratitude James Boon, who instilled in me a love for the depth and
whimsy of anthropology; Peter Brown, who first showed me that a historian could be a social
scientist and who also demonstrated that the greatest of scholars could also be a mensch; John
DiIulio, who mentored me in social science and in the responsibility of scholars for public
service; and John McPhee, who taught this willful sophomore about the skill necessary to evoke
the beauty in non-fiction.
Every researcher comes to his or her work with a set of preconceptions and experiences
that guide his or her thinking. These experiences are especially potent when the topic is as highly
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charged as this one, dealing literally with matters of life and death. Given these circumstances, I
consider my nine years as a pulpit rabbi to have been formative in my thinking about these
topics. I was inspired to undertake this study by my pastoral role and responsibilities. Rabbi
Haskel Lookstein, my mentor at Congregation Kehilath Jeshurun in New York, modeled the art
of the rabbinate for me through his compassion and diligence. As I aided life-cycle events,
including a number of wrenching end-of-life cases, with my congregants, I internalized the
lifeworld as revealed through their simchas and struggles. I thank these congregants for allowing
me to be a part of their lives, as a teacher and as someone they could trust.
My mother and father raised me in a home that valued both scholarship and practice,
generosity to others, and the vibrant sharing of ideas. In their eyes, there is nothing greater than
the selfless gift, the hessed shel emet, of teaching; for them, no matter which profession one
chooses, one must always be a teacher. Our home treasured artists, linguists, scientists, and
Torah—and this is a model that my brother and I have aspired to recreate in own private lives
and in our lives of scholarship and leadership. This is why my brother became an M.D.-Ph.D.,
and I became a rabbi and, now, a scholar of Jewish Studies. The goal has always been one of
highly informed communal service. My gratitude to my parents for instilling this value in me—
and for ensuring that this lofty goal could be accomplished—is limitless. As parents and
grandparents, as well, their love and generosity have been boundless. I dedicate this
dissertation—indeed, my life’s work—to them.
Highland Park, NJ
July, 2015

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ABSTRACT

Jewish Medical Culture:
Case Studies in End-of-Life Decision Making

A dissertation presented to the Faculty of the
Graduate School of Arts and Sciences of Brandeis University
Waltham, Massachusetts

By Joshua N. Cypess

As the technology of medical care has advanced in recent years, the ethical, religious, and
legal problems and questions surrounding it have multiplied. This principle is nowhere more true
than in decision making in the care of patients at the end of life. Increasingly, scholars in the
fields of ethics, sociology, and the sciences are beginning to recognize that the definitions of life
and death and the necessary responses to various medical conditions at the end of life are often
culturally contingent rather than strictly objective and verifiable. Within Jewish practice, end-of-
life decision making takes on a singular character. Responses by Jewish patients, rabbinic
authorities, and caregivers to issues as fundamental as the definition of death are inflected by the
particular history of Judaism in the modern age. Taken together, those responses constitute what
I call “Jewish Medical Culture,” the concept that lies at the heart of this work.
What is Jewish Medical Culture? It is a subset of Jewish culture that deals with health,
the body, and issues of life and death. For Americans who associate with the constellation of
symbols and definitions that come from a lived experience of the ethno-religious community of
Judaism, behavior is often guided by principles that may be traced to that community. This is
especially true in cases at the end of life, when the turn to religious principles may become most
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