Jewish Theological and Ethical Reflections on AIDS
Rabbi Elliot N. Dorff, Ph.D.
Rector and Professor of Philosophy
University of Judaism, Los Angeles
AIDS is simply a disease. Like all diseases, we should do all we can to prevent it, if we can, and to cure it when it occurs.
That seems so obviously right-and, in the end, that is exactly what the Jewish tradition says. The road to that point, though, is often tortuous, for the etiology and treatment of AIDS raise many other issues that are not so simple. Any proper discussion of AIDS must call us back to our understanding of disease in the first place and the roles of God and human beings in causing and healing diseases. Moreover, because AIDS manifested itself in North America first and still most vehemently among gay men, discussions about this particular disease inevitably get tangled in debates about homosexuality. And, that in turn, requires us to examine the way we relate to the Torah-what its degree of authority is for us, how we interpret it, and how we apply it to our own times. Oh, that this issue could be as clear and as simple as we thought!
We will begin, then, with Jewish perceptions of disease in general and move from there to Jewish understandings of homosexuality, with the underlying issues of the authority of the tradition on these and other matters. Finally, we shall return to the beginning, where, as I have promised, the end result will be that we should seek to prevent AIDS, if possible, and to cure it in those who contract it.
Disease in God's World
All the details of Jewish medical ethics stem from two basic principles about the body and one about physicians-namely, that the body belongs to God; that the body is part of an integrated human being created in the divine image; and that human beings have both the permission and the obligation to heal. In the sections below, I will describe each of these tenets and spell out some of their implications for how we approach AIDS.
1. The body belongs to God. For Judaism, God owns everything, including our bodies. "All the earth is Mine" (Exodus 19:5), God proclaims at Sinai, and Moses emphasizes this point to the second generation of Israelites about to enter the Promised Land: "Mark, the heavens to their uttermost reaches belong to the Lord, your God, the earth and all that is on it!" (Deuteronomy 10:14). God loans our bodies to us for the duration of our lives, and we return them to God when we die. Consequently, neither men nor women have the right to govern their bodies as they will; since God created our bodies and owns them, God can and does assert the right to restrict how we use our bodies according to the rules articulated in Jewish law.
One set of these rules requires us to guard the health of our bodies. Just as we would be obliged to take reasonable care of an apartment on loan to us, so too we have the duty to take care of our own bodies. Thus in Judaism rules of good hygiene, sleep, exercise, and diet are not just words to the wise designed for our comfort and longevity, but rather commanded acts that we owe God. Directives demanding that we take appropriate measures to assure our health -appear in Jewish codes of law, and, as such, they are considered as obligatory as are other positive duties such as caring for the poor.
Just as we are commanded to maintain good health, so we are obligated to avoid danger and injury. Indeed, JevAsh law views endangering one's health as worse than violating a ritual prohibition. So, for example, anyone who can survive only by taking charity but refuses to do so out of pride is, according to the tradition, shedding his or her own blood and is thus guilty of a mortal offense. Similarly, Conservative, Reform, and some Orthodox authorities have prohibited smoking as an unacceptable risk to our God-owned bodies. Ultimately, human beings do not have the right to dispose of their bodies at will--i.e., commit suicide-4or to do so would totally obliterate something that belongs not to us, but to God.
This tenet has direct implications for how we respond to AIDS in our day. To ensure the health of our bodies entrusted to us by God, we must take all appropriate precautions to assure that we do not become infected in the first place - or infect others. This means, among other things, that if people are not going to restrict their sexual intercourse to marriage, they must learn how to engage in safe sex It also means that medical personnel who routinely come into contact with blood must use whatever is available to prevent being infected through needle sticks and the like. Furthermore, blood banks must redouble their efforts to ensure that the blood supply for transfusions is free of the virus. Similarly, we must teach ourselves and others about the dangers of using hallucinatory drugs in the first place and, if one is going to use them nevertheless, about the special dangers in sharing needles. Finally, for those infected with AIDS, we must tend to their needs in every way possible - but short of helping them commit suicide.
2. The body is part of an integrated human being created in the divine image living within a community. Western philosophical thought and Christianity have been heavily influenced by the Greek and Gnostic bifurcation of the body and mind (or soul). In those systems of thought the body is the inferior part of human beings, either because animals also have bodies but the mind is distinctly human (Aristoft), or because the body is the seat of our passions and hence our sins (Paul in Romans 6-8 and Galatians 5). In Western philosophy "the mind-body problem,* in which philosophers try to determine how the mind is related to the body that is separate and apart from it, has thus become a "stock" issue. In Christianity, the bifurcation of the body and the soul produced the ideal of the monk, who denies the pleasures of the body as much as possible.
Jewish sources recognize a distinction between our physical capacities and our mental, emotional, and conative ones (our "spirit"), but the soul is definitely not superior to the body. Indeed, since the Rabbis regarded the human being as an integrated whole, the body and the soul are to be judged as one:
Antoninus said to Rabbi [Judah, the President of the Sanhedrin]: "The body and soul could exonerate themselves from judgment. How is this so? The body could say, The soul sinned, for from the day that it separated from me, lo, I am like a silent stone in the grave!' And the soul could say, The body is the sinner, for from the day I separated from it, lo, I fly like a bird."
Rabbi [Judah] answered him: l will tell you a parable. What is the matter like? It is like a king of flesh and blood who had a beautiful orchard, and therewere in it lovely ripe fruit. He placed two guardians over it, one crippled and the other blind. Said the cripple to the blind man, 'I see beautiful ripe fruit in the orchard. Come and carry rne, and we will get therm and eat them.' The cripple rode on the back of the blind man, and they got the fruit and ate it. After a while, the owner of the orchard came and said to them: Where is my lovely fruit?' The cripple answered: 'Do I have legs to go?' The blind man answered: 'Do I have eyes to see?' What did the owner do? He placed the cripple on the back of the blind man and judged them as one. So also the Holy Blessed One brings the soul and throws it into the body and judges them as one."
(Babylonian Talmud, Sanhedrin 91 a-91 b)
Not only is this fundamental integration manifest in God's ultimate, divine judgment of each of us; it is also the rabbinic recipe for life. Although the Rabbis emphasized the importance of studying and following the rules of the Torah, they nonetheless believed that the life of the soul or mind by itself is not good, that it can, indeed, be the source of sin. One should instead engage in the study of the Torah combined with some worldly occupation. (Mishnah, Ethics of the Fathers 2:1).
Moreover, the human being exists not alone, but in community. Americans are used to thinking of communities as voluntary associations that can be created and dissolved at will. For Judaism, though, we are not only integrated within our own, individual selves; we are also inherently communal, integrated into our communities by unbreakable ties.
Finally, this integrated human being was created in the image of God. Thus in marked contrast to the American, pragmatic way of evaluating a person in terms of what he or she can do, Judaism assesses us each as who we are namely, as the unique creations of God. This imparts to each of us divine worth, regardless of our abilities or lack thereof, and regardless of our health or lack thereof.
This view of the human being as integrated within him/herself and within his/her community has major implications for health care in general and for the treatment of AIDS in particular. Specifically, caring for AIDS patients cannot be limited to treating the physical aspects of the illness alone; it must include attention to the patient's sense of self-worth, of dignity, and of hope. Moreover, since AIDS patients are unalienable parts of our community, we must regularly visit them. The commandment to visit the sick (biqqur holim) is, if anything, even more imperative in our day than it was in times past, for we no longer live in large, extended families. Family, friends, and even those who simply belong to the same community must therefore be especially attuned to the need to visit those who are sick, for they cannot count on multiple family members to be around to do that. Each person who visits the sick removes a sixtieth part of it, according to the Talmud (Nedafim 39b-40a), while those who fail in this duty add to the patient's disease and suffering. And finally, since AIDS patients, no less than any other human beings, are created in the image of God, we must value them as such, regardless of the degree of impairment they suffer as a result of their disease.
3. Human beings are not only permitted, but obliged to try to heal themselves and others. This is not the only possible-or even the most obvious-conclusion from the Torah. After all, the Bible says, on the one hand, that illness is one of the divine punishments for disobedience (e.g., Leviticus 26:14-16; Deuteronomy 28:22, 27, 58-61), and, on the other, that God is our healer (e.g., Exodus 15:26; Deuteronomy 32:39; Isaiah 57:18-19). From such passages we might conclude that medicine is an improper human intervention in God's decision to cause illness or cure it, indeed, an act of human hubris.
Although the Rabbis of the Talmud were aware of that line of reasoning, they counteracted it by pointing out other biblical passages. They understand Exodus 21:19-20, according to which an assailant must insure that his victim is "thoroughly healed," as giving permission for the physician to cure. They further argue that the command to "love your neighbor as yourself' in Leviticus 19:18 even permits curative measures that require inflicting a wound in the process. On the basis Deuteronomy 22:2 ("And you shall restore the lost property to him') they declare it an obligation to restore another person's body as well as his/her property. The Rabbis understood Leviticus 19:16 Do not stand idly by the blood of your neighbor") to impose an obligation to come to the aid of someone else in a life-threatening situation. Finally, on the basis of Leviticus 19:18, "Love your neighbor as yourself," they understood the obligation to provide health care to devolve not only on the physician, but also on the community. None of this denies God's role in healing, and so the traditional Jewish prayer book still has us praying to God for healing three times each day; it is just that doctors are God's agents and partners in making healing occur.
Is God also responsible for our illness in the first place, as the Torah states? The biblical Book of Job already calls God to account for what is, to all appearances, unjustified suffering; indeed, in chapters 38-42 of that book, God Himself declares that Job had not sinned and that sickness can therefore not be seen as the product of sin. The Rabbis of the Mishnah, Talmud, and Midrash later wrestle with the same issue, and so do medieval and modem Jewish theologians. God is understood to be both good and just, and yet innocent people suffer; no explanation of how to reconcile these assertions has been uniformly accepted within the Jewish community. The vast majority of Jews, though, would say, with Job, that the very fact that a person is afflicted with a -disease does not mean that he or she has sinned.
One other thing should be mentioned about the Jewish approach to medicine. While segments of Christianity see pain as salvational, basing themselves on the suffering of Jesus on the Cross, Judaism does not have any such doctrine. On the contrary, illness is seen as inherently demeaning, and so we must do all we can to prevent it. When somebody does fall ill, we must reassure the patient of his/her ongoing divine value despite any disability occasioned by the disease. Moreover, even if we cannot Waal cure, we rnust try to alleviate pain and suffering.
These doctrines have immediate implications for AIDS. First, we must engage in vigorous educational efforts to teach people of all ages how to prevent contracting AIDS in the first place. While progress has been made in delaying death from AIDS, the disease is still, as of this writing, lethal. Our duty to preserve life - our aim and that of others - demands that we teach teenagers and adults about safe Sex~ according to Jewish tradition, should be confined to marriage, but if people are going to engage in sex outside of marriage, they should at least take precautions to prevent AIDS and other sexually transmitted diseases. Similarly, our duty to preserve life demands that we discourage people from using hallucinatory drugs altogether, but if they fall short of that ideal, we must urge them at least not to share needles. "An ounce of prevention is worth a pound of cure," for illness is inherently degrading, demoralizing, and debilitating; when there is no cure, prevention becomes even more imperative.
Second, we must engage in thoroughgoing research in an attempt to cure AIDS. The Jewish tradition has had a virtual love affair with medicine over the last two thousand years; many rabbis were also physicians. The strong penchant in Judaism to use our God-given talents to find cures must apply to AIDS as well. In doing that, we are not somehow circumventing a divine punishment that God has inflicted; we are, as Jews have understood things for many centuries, instead aiding God in the process of healing.
Third, until we have a cure for AIDS, we must attend to AIDS patients medically with as many palliative measures as we have, diminishing their pain as much as possible. The illness they suffer must not be seen as punishment for any past sins, and they should not be forced to endure pain as a form of penance. On the contrary, AIDS patients should be seen as people unfortunately afflicted with a debilitating disease and thus people who need whatever medical help we can provide. Finally, we must also attend to AIDS patients in all the non-medical ways that buoy their spirits and their will to live. We have, after all, not only the right, but the duty, to cure if we can; we always have the duty to care.
Jewish Understandings of Homosexuality: A Window into Jewish Positions on the Authority of the Tradition
Even though AIDS originated in Africa among heterosexuals, in North America the disease is connected in the common mind with gay men, for they were the first people who contracted AIDS in large numbers and remain the largest single segment of the population afflicted with it. Thus a Jewish approach to AIDS must inevitably confront Judaism's approach to homosexuality.
The record, frankly, is not wonderful. The Torah includes a prohibition against male homosexuality (Leviticus 18:22; 20:13), and even if the Torah originally meant to prohibit only that gay sex which was part of a cultic practice (a possible interpretation), the later rabbinic tradition extended the prohibition to all gay and lesbian sex Most of the verses in the Torah are interpreted at length in the rabbinic tradition, but the ones applying to homosexuality are not. It is simply taken for granted that Jews should not engage in homosexual relations - indeed, that Jews do not do so, that only happens among non-Jews.
Both the fact and the norm have been severely challenged within the Jewish community in our own day. Nobody can seriously argue today that the Jewish community lacks homosexuals. Indeed, one of the most poignant articles written about the topic came from an Orthodox rabbi, writing under a pseudonym, who himself is gay and who described what his life has been like as an Orthodox gay man - who, by the way, is HIV positive. (See Yaakov Levado, "Gayness and God: Wrestlings of an Orthodox Rabbi," TZkkun 8:5 [September/October, 1993], pp. 54-60.) The question is therefore no longer whether Jews are homosexual; the question is rather how to respond to that.
For the Orthodox community, homosexual intercourse is strictly prohibited. The individual, homosexual person may still be a member of the community, but he or she is sinning in a most egregious way, committing what the Torah calls "an abomination" (Leviticus 18:22). Because Judaism never prohibited desires themselves but only actions, sexual attraction to someone of the same gender is not itself a sin, but acting on that attraction is. Thus Orthodox homosexuals have either remained in the closet or have left the Orthodox community. Those with AIDS are especially prone to feel cast out by the community, unless there is clear evidence that the person contracted the disease through an infected blood transfusion.
On the other end of the spectrum, homosexuals in the Reform (and the small, Reconstructionist) movements find themselves completely accepted. Thus the organization of Reform synagogues 25 years ago accepted its first synagogue with specific outreach to gay and lesbian Jews, and both of these movements ordain gays and lesbians as rabbis.
It is in the middle, Conservative movement that most of the controversy still rages. The rabbinic and synagogue organizations of the movement passed resolutions in the early 1990s declaring that they: "(1) Support full civil equality for gays and lesbians in our national life; (2) Deplore the violence against gays and lesbians in our society; (3) Reiterate that, as are all Jews, gay men and lesbians are welcome as members in our congregations; (4) Call upon our synagogues and the arms of our movement to increase our awareness, understanding, and concern for our fellow Jews who are gay and lesbian " They did this, though, "while affirming our tradition's prescription for heterosexuality," and so gays and lesbians are not admitted to the rabbinic and cantorial schools of the movement, and only a small minority of Conservative rabbis will perform commitment ceremonies for gays or lesbians.
These positions on homosexuality reflect the varying approaches among the movements to the classical texts and traditions of Judaism. For the Orthodox, who comprise less than 7% of North American Jewry, God gave the Torah on Mount Sinai exactly as we have it in printed versions of the Torah today, and God also gave there the Oral Torah that was ultimately written down in the Mishnah and Talmud. We therefore have no authority to change the Torah's proscription of homosexuality or the Talmud's extension of that to all gay and lesbian sexual relations.
For the Reform movement, who make up about half of the remainder of Jews, God's revelation was written in the ancient texts only as it appeared to Jews at that time and place. God continues to reveal Himself and His will to us, though, and so the classical texts do not have an authoritative claim upon us now. Instead, each and every individual Jew must use his or her conscience and personal autonomy in interpreting and applying those texts and in hearing the word of God.
The Conservative movement constitutes the other half of North America's non-Orthodox affiliated Jews. Like the Reform movement, Conservative Jews study the Jewish tradition using all the historical techniques that scholars normally employ in studying any historical phenomenon. Since an historical study of the tradition indicates that it developed and changed over time, and since the Conservative movement wants to continue an historically authentic form of Judaism, it is open to considering and implementing changes now. In that way it differs from the Orthodox Like the Orthodox movement, however, the Conservative movement considers modern Jews obligated by Jewish law, and the burden of proof is on the one who wants to change Jewish law rather than on the one who wants to maintain it as it has come down to us. That is, the Conservative movement wants to conserve Jewish tradition, both in its continuity and in its openness to change, and hence its name. Such decisions, however, must be made on the communal level, not by individuals alone (as in Reform). Thus the Conservative Movement's commitment to the law of the past, its understanding that sometimes Jewish law and theology have changed and must change now, and its conviction that these decisions must be made communally together make the Conservative Movement the place where the issues surrounding homosexuality are most vigorously debated.
The important thing to note, though, is that even those Jews who still think of homosexuality as an abomination would not infer from that that people infected with AIDS through homosexual sex should simply suffer and die for their sins. Men a person is sick, tie cr she deserves 99 the medical aid and social support we can muster, regardless of how he or she contracted the disease.
A Message of Compassion, Care, and Hope
Untimely, then, the message that emerges from the Jewish tradition about AIDS is the simple truth with which I began this essay. AIDS is a disease. We therefore should do all we can to prevent it, and, failing that, we should we do all we can to cure it. Until a cure is available, we owe it to AIDS patients to provide them with comfort care, including whatever medical ministrations WILL help them cope with the disease and whatever social and personal support we can provide. We must do our best, in other words, to remind ourselves and AIDS patients that no disease removes a person from the community that instead it is precisely when one is in need that the community has the greatest obligation to function as a supporting community.
For Judaism, this is not only what a compassionate human community should do; it is what God Himself does. We therefore must come to the aid of the sick and, ultimately, bury the dead and help those who mourn, in order to model ourselves after God.
"Follow the Lord your God" (Deuteronomy 13:5). What does this mean? Is it possible for a mortal to follow God's Presence? [No.] The verse therefore means to teach us that we should follow the attributes of the Holy One, praised be He. He clothes the naked ... ;so you should clothe he naked. The Torah teaches that God visited the sick; so you should visit the sick. The Holy One comforted those who mourned ; you too should comfort those who mourn. The Holy One buried the dead ; so you should bury the dead. ( Babylonian Talmud, Sotah 14a)