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MARK WASHOFSKY
All I seek to do is to suggest that, in this instance, as with all other interesting questions, the appearance of halakhic simplicity is a literary product, the result of a conscious stylistic choice on the part of the author. In law, that is to say, as well as in literature, things are seldom as simple as they are made out to be.
THE CRITERIA FOR SETTING PRIORITIES
Rabbi Feinstein’s responsa propose a single and coherent system for allocating medical resources. They do so by offering a ranking, an ordering of three distinct criteria that the Halakhah suggests for setting life-and-death priorities. For purposes of analysis, let us consider each of them separately.
The first criterion is what we might term the principle of medical efficiency: when we have a choice, when we have not yet begun to treat either patient, we treat first the patient whom we believe we can cure rather than the patient who, according to medical prognosis, is unlikely to recover from this illness. Rabbi Feinstein, as indicated, declares this point to be pashut,“obvious,” and he provides no textual support for it. What in fact makes it pashut, 1 think, is that Halakhah views the practice of medicine as a mitzvah, a religious duty. Although the Torah nowhere explicitly commands us to practice medicine, and although some ancient rabbinic voices express a highly critical attitude toward physicians and the medical arts, most authorities define medicine as a species of mitzvat piku’ah nefesh, the commandment to save life." This means that the purpose of medicine, the very warrant for its practice, is to cure disease.!? It is to this end, after all, that we are permitted to administer harsh drugs and invasive surgeries to human beings. In the absence of any therapeutic value, even the most sophisticated
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