Introduction
The Hebrew Bible frequently confronts us with the finiteness of man’s existence. Not only Genesis 3:19b provides this irrefutable wisdom, when uttering the verse “For dust you are and to dust you will return”, a few books further also Ecclesiastes 3:1–2a reminds us of being mortal beings, stating: “There is a time for everything and a season for every activity under heaven: there is a time to be born and a time to die”. Death is an inescapable fact. It is an absolute truth. The certainty of death, however, is covered up with mysteries. Much as our death is certain, the circumstances in which we will die are not predictable. Death’s time, place and circumstances—as a result of old age, accident or illness—are beyond reach of human knowledge. “It is in God’s hands”, so would many religious people—whether Christian, Muslim or Jewish—say. As finite beings, we all are susceptible to death and illness.
Today, the realm of death and illness has changed. During the past decades, biomedical technology has developed significantly. As a result of this medical revolution, the power of humankind within the domain of life and death has increased. Making use of available biomedical technology human beings are not only able to control and cure diseases, but also to regulate their own life project, even their own death. Consequently, during recent years we are all the more confronted with ethical challenges and questions. Human beings, adhering to a specific worldview or religious tradition, deal with these ethical issues in various ways. One’s worldview, one’s conception of transcendence and immanence—in other words, the way everything
is according to a situated human being—influence one’s opinion on what
ought to be (Newman
2005, pp. 18–19; Gielen et al.
2009), for example what ought to be done when confronted with terminal illness and unbearable pain.
The aim of this article is to explore Jewish perspectives on a most pressing contemporary bioethical issue: euthanasia. This quest is considered within the broader framework of the specificities of Jewish (biomedical) ethics and its methodology. Therefore, this article will first shed a brief light on the Jewish religious tradition as such and attention will be paid to religious convictions and ethical reasoning of the three largest branches of Judaism: Orthodox, Reform and Conservative. After this short introductory note, the central topic of this article is addressed: how does the Jewish tradition cope with euthanasia? First, Jewish textual sources are quoted, which are usually referred to and interpreted when the ethical question of euthanasia is addressed. Next, we show how different rabbis—we made a selection of prominent rabbis and poskim (specialists of Jewish law) from the three largest Jewish branches—reach diverse, even opposite, conclusions with regard to euthanasia, based on their interpretation of these sources. In this way, the threefold aim of this article is met: (1) presenting a non-exhaustive overview of Jewish perspectives on euthanasia, which reflects (2) the characteristic text-centeredness of Jewish (bio-)ethical reasoning and (3) Judaism’s essential diversity and the specific features of its largest branches.
Although Reconstructionism is a full-fledged Jewish movement in the United States, within the scope of this article, we decided not to include Reconstructionist reflections on the matter at hand, as the Reconstructionist movement is substantially smaller than the Orthodox, Reform and Conservative branch of Judaism, considered on a world wide as well as American scale. The 2000–2001 National Jewish Population Survey (NJPS) indicates that only 2% of American Jews considers themselves to be Reconstructionist, in contrast tot 13% Orthodox, 26% Conservative and 34% Reform (Ament
2005). Yet, for Reconstructionist reflections on end-of-life practices and ethics, consult Teutsch (
2005) and ‘Behoref Hayamim’ (Reconstructionist Rabbinical College
2002).
Definition of Jewish Identity
Since the purpose of this article is to present Jewish religious opinions on euthanasia, this article covers only a small part of the Jewish world total, for only a minority of the approximately 14 million Jews worldwide can be characterized as religious. Often, it is assumed that because a person is a Jew, he/she adheres to the Jewish religion. S. Brachfeld (
2000, p. 9), however, indicates that only 15–20% of all Jews is religious. Yet, exact figures on this do not exist and only estimations can be indicated. Still, it can be argued that the Jewish religion in fact “divides the Jewish people today, perhaps almost as much as it divides Jews from non-Jews” (de Lange
2000, p. 2). The majority of contemporary Jews are only Jewish in an ethnical sense: their Jewishness has nothing to do with religion or with God. These non-religious Jews are secular Jews, whose daily life choices are not guided by the world of Jewish sacred texts. “Some of these Jews may be atheists; many may be simply indifferent to Judaism, about which they know very little. Many nonetheless continue to regard themselves as ‘good Jews’” (Neusner
1975, p. 6). Non-religious Jews perceive the Jewish faith as a “traditional, folkloristic, mystical or historical part of the ancient culture” (Brachfeld
2000, p. 9). Religious Jews, on the other hand, adhere to a specific world view and way of life and are embedded in a religious community (Neusner 2006, pp. 2–3). For them God is central, and their daily life choices are guided by the path God stipulated for them in prescriptions and commandments (
mitzvoth). Nevertheless, as will appear in this article, representing religious Judaism one-sided would do harm to its essential variety.
The (Heterogeneous) Specificity of Jewish Ethics
Indeed, characterizing religious Judaism is utmost delicate. Schulweis (
1995, p. 25) expresses this inner-Jewish heterogeneity through the symbol of “a broad river with multiple branches running into the sea”. The largest Jewish branches are Orthodox, Conservative and Reform Judaism. Before turning to this in detail, the characteristic properties of Jewish ethics are highlighted.
Jewish (biomedical) ethics—like all ethics—starts from an issue which is experienced as problematic. The specificity of Jewish ethics consists in providing an answer to this question by addressing religious authorities, whose writings are preserved in traditional Jewish literature. In other words, confronted with a (contemporary) ethical question, rabbis address the rich Jewish tradition (of textual sources) in order to provide an answer. Jewish ethical reflection arises out of specific cases: individual Jews—confronted with an ethical dilemma—can ask a rabbi for guidance. In this sense, Jewish ethics is case-based and concentrated on concrete human behavior rather than on general claims of faith and theology (Kellner
1978, p. 5): “It’s a tradition of ongoing questioning rather than one of absolute theological law passed down from above” (Goldsand et al.
2001, p. 221). Noticing this, Jewish ethics makes use of a bottom-up approach.
As Jewish revelation theology indicates, traditionally Judaism has been a law-based religion, with virtually all aspects of life governed by a comprehensive system of laws, called
halacha (Newman
1992). Literally,
halacha means ‘the way’ and is referred to as the Jewish religious law which can be defined as follows: “normative rules for conduct, laws that instruct the faithful on the sanctification of everyday life” (Neusner
2002, p. vii). The Jewish law consists of a corpus of texts, ranging from the Torah, the Talmud, Codes of Jewish law, to modern
responsa—written in question (
she’eilah) and answer form (
teshuvah)—which try to apply Talmudic discussions and regulations to contemporary circumstances and specific cases. Noticing this, Jewish legal and ethical reasoning consists of an interpretation of these sources. “The Jewish ethicist discovers within God’s revelation norms that can guide us in the present. The traditional rabbi, much like judges in a common law system, finds the proper precedents within this biblical and rabbinic literature and then applies them to the case at hand” (Newman
1992, p. 311).
Of course, in this process interpretation plays a crucial role, as well with regard to getting acquainted with the case at hand, as with regard to distilling relevant literature and principles. The complexity and the contextual nature of
halachic questions implies that there is a variety of (
halachically valid) answers to one question. The heterogenic characteristic of Jewish ethics is also influenced by the way in which the authority of
halacha is perceived. There exists—within Judaism—a range of opinions on the normativity and authority of these traditional texts. As a result, Jewish ethical reasoning depends on rabbis’ and ethicists’ concrete interpretive process and on the perceived status of
halacha, as either normative or advising (Ellenson
1995). Nevertheless, the ethical decision-making process is always—exclusively or not exclusively—
halachic (Mackler
2003, p. 45; Jage-Bowler
1999, p. 219).
Jewish Branches
The heterogenic characteristic of Jewish ethics has to be situated against the background of an inner-Jewish heterogeneity. In response to modernity and Enlightenment in nineteenth century Germany different movements have originated within the Jewish tradition, whose ascribing significance to the religious tradition when answering ethical questions is quite divergent. Yet, the three largest branches of the Jewish faith tradition—Orthodox, Conservative and Reform—even reflect an inner diversity. Nevertheless it is possible to describe some common tendencies, with regard to theological convictions and ethical reasoning, within each movement. Given that few contemporary Jews world wide and even in the United States consider themselves to be Reconstructionist (Ament
2005) we choose explicitly to stick to the three largest movements of Judaism and not to expand on Reconstructionist Judaism.
The three branches can be situated on an axis, on which the Orthodox and Reform movement constitute the opposite extremes, while the Conservative branch occupies an intermediate position. The Orthodox branch, which originated in response to the Reform movement to protect the integrity of the Jewish faith, is situated on the right side of the axis, being the most traditional of the largest movements, as it considers the Torah as the direct and definite revelation of God’s will (Kellner
1978, p. 16). Orthodox Jews believe that God has revealed the Torah to Moses literally, word by word, “in a form identical to our printed text” (Mackler
2000, p. 7). Consequently, in their opinion, Torah and Talmud are divinely inspired and revealed and are essentially unchanging and immutable. Concerning ethics,
halacha is considered as being the will of God, normative for all Jews, living in all times and at all places (Kellner
1995, p. 17; Zemer
1999, p. 41).
Confronted with contemporary ethical issues, Orthodox rabbis or
poskim—
halachic specialists—address the
halacha as an absolute divine norm, believing that Jewish law has to guide Jews through their lives and daily life choices. Their traditional ethical decision-making process is often described as a legal model or as “halakhic formalism” (Ellenson
1995, p. 130), consisting of
halachic analysis resulting in interpretations that become normative and binding on Orthodox adherents. Yet, the Orthodox Jewish community is not monolithic, taking for instance the lack of a coordinating Orthodox Jewish body, and consequently, the lack of definitive, authoritative
halachic rulings into account. All rabbis have the right to investigate an ethical dilemma and to give a (binding) answer through an interpretation of the sources. The weight ascribed to this decision depends on different factors, for instance the reputation of the rabbi as specialist or
posek (in a certain
halachic domain) (Flancbaum
2001, p. 31). Anyhow, rabbinic authority is most central (Mackler
2003, p. 52).
On the other side of the spectrum, on the left side of the axis, Reform Jews hold to a dynamic and progressive revelation. Torah is mainly seen as a human writing, based upon human beings’ understanding of God’s will. Similarly, the Talmud is considered not to be divine, but human in origin, as a human analysis of the laws of the Torah as they were understood in Talmudic times (Jacob
1987, p. xx). As the “God-given authority” (Freehof
1960, p. 21) of rabbinic literature is denied, Reform Jews reject
halacha as eternal and universal norm which exceeds space and time (Freehof
1960, pp. 5, 20). Indeed, the early Reform movement was even “averse to the rabbinical literature, the Talmud and the codes, which were the source of the rabbinical authority” (Freehof
1960, p. 15), stressing its biblical and prophetic inspiration. The
halachic tradition was viewed as “rigid and arcane, a relic of another time” (Newman
2005, p. 133). In the contemporary Reform branch, this antinomian tendency “remains part of the Reform perspective” (Jacob
2004, p. 72), but it is weakened to a large extent. Nowadays, looking for an answer to a contemporary ethical question,
halacha is addressed. It can offer guidance to individuals but has no binding authority (Freehof
1960, pp. 21–22,
1969, p. 7; Cohen
2005; Newman
1995, p. xxi). Although a rabbi can give advice, “individual autonomy remains predominant” (Mackler
2003, p. 52; Plaut and Washofsky
1997, p. xv). At the same time, Reform thinkers warn for unbridled autonomy (Plaut and Washofsky, pp. xvii–xxi) and plead for a “harmony between discipline and freedom, between loyalty and individuality” (Freehof
1974, p. 6). Thus, the
responsa of the Central Conference of American Rabbis (CCAR) try to guide and advise Reform Jews with regard to their daily (autonomous) life choices (Freehof
1960, p. 22; Plaut and Washofsky
1997, p. xxviii).
The Conservative movement, which originated as a traditionalist response to Reform Judaism, occupies an intermediate position. It constitutes a compromise between the Orthodox and Reform branch. Torah and Talmud are regarded as both divine in origin, but significantly shaped “by human reception, transmission and interpretation” (Mackler
2000, p. 7; Mackler
2003, p. 48; Küng
1992, p. 429). In contrast to Orthodox Judaism, Conservative Jews do not consider Torah as a literal account of God’s words. The Jewish people’s divine experiences are the source and essence of
halacha, which is liable to changes and historical developments. Yet, although being a historical developed entity,
halacha plays a definite and normative role. Conservative Jews assume that qualified rabbis can reinterpret and change Jewish law, as the historical context of the Biblical times does not necessarily reflect our contemporary context. The rabbi is looked upon as a
halachic guide, who interprets Jewish law from a contemporary perspective, taking into account its historical development. In this sense, the ethical model triumphing in this movement is “tradition and change” (Küng
1992, pp. 430–432; Mackler
2000, p. 7). Within the Jewish Conservative community the Committee on Jewish Law and Standards (CJLS) of the Rabbinical Assembly, decides upon
halachic questions. The CJLS can proclaim official
halachic positions of the Conservative movement. Yet, also deviant opinions, without official recognition of the committee are tolerated. Moreover, as stated on the website of the Rabbinical Assembly, the advice of the local rabbi has to be taken into account. When deciding upon an ethical dilemma the individual’s and rabbi’s authority are usually balanced (Mackler
2003, p. 53).
Summarizing, within each movement
halachic literature is addressed when rabbis are confronted with an ethical dilemma. Diversity between the Jewish branches does not consist in a consultation or rejection of
halacha, but in the way
halacha and its interpretation is perceived, as binding or advising. Simultaneously, we must beware of giving a biased and simplistic portrayal, as Reform, Conservative nor Orthodox Judaism are entirely monolithic. The Reform branch has a non-
halachic side (Jacob
2004) and alternative approaches to Jewish ethics are found in all movements (Newman
1995, p. 138–147). Anyway, Jewish ethics is founded on the Torah as primary source—but not necessarily exhaustive or exclusive—and presupposes reference to the Jewish tradition (of interpretation) (Newman
2005, p. 117).
Jewish Religious Sources on Euthanasia
In order to give an overview of Jewish opinions on euthanasia it is essential first to quote some Jewish religious texts which are widely adopted and interpreted when rabbis are discussing euthanasia as an ethical topic. In the next section of this article an overview of Orthodox, Conservative and Reform opinions based on these textual sources is presented. Working in this way we meet the characteristic property of Jewish ethics, namely searching an answer to a concrete ethical concern starting from the textual tradition. Often, from one textual source diverse, even contradictory, opinions emerge through different interpretations.
The first important source, Semahot 1:1–4, is described within the literature of Jewish medical ethics as the laws of
goses. Within Jewish religious law a
goses is defined as a person who is expected to die within 72 h or 3 days and is recognizable by the death rattle (Jakobovits
1959, p. 349). Because of the weakened condition of the
goses and “in order to avoid any risk that an individual caring for a
goses would inadvertently shorten his or her life and be liable to capital punishment” (Kinzbrunner
2004, p. 564) the care of the moribund person was enclosed with some strict rulings, such as the prohibition to touch a
goses. The Jewish law considers a
goses as a living person in every respect and, being even in his last moments of life, he has to be treated according to this living status (Jakobovits
1959, p. 121; Sinclair
1989, p. 9; Sinclair
2003, p. 181).
A dying man is considered the same as a living man in every respect. […] His jaws may not be bound, nor his orifices stopped, and no metal vessel or any other cooling object may be placed upon his belly until the moment he dies, as it is written, Before the silver cord is snapped asunder, and the golden bowl shattered, and the pitcher is broken at the fountain (Eccl. 12:6). He may not be stirred, nor may he be washed, and he should not be laid upon sand or salt, until he dies. His eyes may not be closed. Whosever touches him or stirs him sheds blood. Rabbi Meir used to compare a dying man to a flickering lamp: the moment one touches it he puts it out. So, too, whosever closes the eyes of a dying man is accounted as though he has snuffed out his life. There may be no rending of clothes, no baring of shoulders, nor eulogizing, and no coffin may be brought into the house, until the moment he dies (Semahot 1:1–4).
The second important rabbinic source often cited and interpreted when rabbis and ethicists reflect on euthanasia is Bavli Avodah Zarah 18a, telling about the martyrdom of Rabbi Hanina ben Teradion who was executed by the Romans because of ignoring a Roman prohibition to study and teach the Torah.
Straightaway they took hold of him, wrapt him in the Scroll of the Law, placed bundles of branches round him and set them on fire. Then they brought tufts of wool, which they had soaked in water, and placed them over his heart, so that he should not expire quickly… […] ‘Open then thy mouth’ [said they] ‘so that the fire enter into thee.’ He replied, ‘Let Him who gave me [my soul] take it away, but no one should injure oneself.’ The executioner said to him, ‘Rabbi, if I raise the flame and take away the tufts of wool from over thy heart, will thou cause me to enter into the life to come?’ ‘Yes,’ he replied. ‘Then swear unto me’ [he urged]. He swore unto him. He thereupon raised the flame and removed the tufts of wool from over his heart, and his soul departed speedily (Avodah Zarah 18a).
Bavli Ketubot 104a is another Talmudic source often cited regarding euthanasia, a story about the death of Rabbi Judah HaNasi, the compiler of the Mishnah.
On the day when Rabbi died, the rabbis decreed a public fast and offered prayers for heavenly mercy. […] Rabbi’s handmaid ascended the roof and prayed: ‘The immortals desire Rabbi [to join them] and the mortals desire him [to remain with them]; may it be the will [of God] that the mortals may overpower the immortals.’ When, however she saw how often he resorted to the privy, painfully taking off his tefillin and putting them on again, she prayed: ‘May it be the will [of the Almighty] that the immortals may overpower the mortals.’ As the rabbis incessantly continued their prayers for [heavenly] mercy she took a jar and threw it down from the roof to the ground. [For a moment,] they ceased praying, and the soul of Rabbi departed to its eternal rest (Ketubot 104a).
Conclusions
Although human life is extremely precious for religious Jews, arguing that the Jewish tradition uniformly condemns euthanasia would do harm to one of the essential characteristics of Judaism: heterogeneity. After all, within Judaism and its diverse movements a central, coordinating Jewish authority that proclaims official Jewish statements is lacking. This Jewish plurality is reflected in the debate on ethical dilemmas, such as euthanasia.
Yet, in our review no advocates of euthanasia were found in the Orthodox movement. The overriding importance of preserving human life was illustrated by the sanctity of life approach of prominent American Rabbi Bleich. Similarly, other Orthodox rabbinic authorities, such as Jakobovits (
1959, p. 123), Feinstein (Tendler
1996, p. 60) and Tendler (
1996, pp. 138, 142), oppose (active) euthanasia. Indeed, Tendler and Rosner argue that “Jewish law opposes euthanasia without qualification and it condemns as sheer murder any active or deliberate hastening of death, whether the physician acts with or without the patient’s consent” (
1993, p. 20,
1996, p. 138). Reviewing liberal Jewish opinions, intra-branch diversity was found. In the Conservative movement, while Rabbis Dorff and Reisner are both fierce opponents of euthanasia, we noticed Rabbi Sherwin’s acceptance of euthanasia. In the same manner we recorded diversity of opinion in the Reform movement: while the Central Conference of American Rabbis holds to a prohibition of euthanasia, we found Rabbis Kravitz and Knobel as convinced supporters of it, referring to the same Jewish textual tradition. Without neglecting this inner-Jewish heterogeneity, it must be stressed, however, that pro-euthanasia opinions are exceptional voices, even within the Conservative and Reform branch of Judaism.
The fact that no advocates of euthanasia were found on the Orthodox side, is not very surprising, considering the fact that liberal Jews—Conservatives in a lesser degree than Reform Jews—consider the
halacha as mainly the work of human hands, having an advisory function, and being open to recontextualization in the light of contemporary realities. In contrast, according to Orthodox Judaism
halacha reveals God’s will, which is definitive and essentially normative. Thus, the fact that divergent interpretations of the same sources are found is not accidentally, but reflects the essential pluralistic character of Jewish ethical reasoning (Ellenson
1995). The way in which rabbis perceive the (status of the) Jewish textual tradition and the manner in which they reflect on it and distill essential principles from the texts—in confrontation with a contemporary case—influence their statement on an ethical dilemma. Perceiving
halacha as normative and binding or as guiding and advising affects rabbis’ coping with and opinion on a (contemporary) ethical question. The authority rabbis ascribe to the Jewish textual tradition, as well as the interpretive process itself gives evidence of pluralism, which even exceeds ‘denominational’ boundaries (Ellenson
1995, p. 135).
Apart from this Jewish inter- and intra-branch heterogeneity the debate on euthanasia discloses as well a continuous element: the text-centeredness of Jewish ethics. Indeed, ethical reasoning is based on the corpus of Jewish law, which consists of Torah and the tradition of rabbinic interpretation. Although rabbis and movements ascribe diverging degrees of authority to (interpretations of)
halacha, our analysis shows that it is never completely excluded or dismissed. Though we made mention of an antinomist position in Reform Judaism (Jacob
2004), ethical reasoning in Judaism predominantly presupposes reference to the Jewish textual tradition (Zoloth-Dorfman
1995) thus is—exclusively or not exclusively—
halachic.
When caring for Jewish patients for healthcare professionals it is essential to be aware of the influence of the Jewish (textual) heritage on concrete medical decisions. After all, religious Jews’ daily life choices (must) fit in with God’s path. As they wish to follow God’s example (
imitatio Dei) (Shapiro
1978, pp. 127–151; Mackler
2003, p. 6) rabbis and
poskim (experts of Jewish law) are central authorities for them. Indeed, in virtually all aspects of life—for instance regarding medical decision making—the influential role of rabbis may not be underestimated. After all, rabbis’ casuistic reasoning typifies Jewish ethics. In this way, a concrete rabbinic decision on a given case may differ from abstract, theoretical
halachic considerations. Especially among Orthodox Jews, rabbinic involvement in and rabbis’ (binding) advice on everyday life and moral conduct, might appear in healthcare settings (Coleman-Brueckheimer et al.
2009). Nurses and physicians might not be familiar with this. Showing understanding for this (possibly) influential role of rabbis, is part of showing respect for a patient’s autonomy. Throughout the different branches of Judaism, the role of rabbis is variously perceived. While Orthodox rabbis’ decisions are assumed to be binding,
responsa of liberal rabbis are ascribed a rather guiding and advising character. Although Judaism’s movements can be distinguished by characteristic tendencies, they are hardly monolithic. Therefore, when dealing with Jewish patients, it is not only essential to be acquainted with Judaism’s diverse branches, exposing the essential Jewish heterogeneity, but as well with a patient’s specific religious context.
As mentioned previously, Jewish voices in favor of (active) euthanasia are rather exceptional and uncommon (Gesundheit et al.
2006). Indeed, emphasis on the supreme value of human life and thus on its preservation is central in Judaism (Jakobovits
1959; Tendler and Rosner
1993; Glick
1999; Rosner
1986,
1999; Freedman
1999). Tendler and Rosner even mention a “unanimity of halakhic opinion that active euthanasia is never condoned” (
1993, p. 23,
1996, p. 142). Likewise, the CCAR mentions the “unequivocal voice of the halachic literature” (Plaut and Washofsky
1997, p. 340) in this matter. For healthcare professionals it is important to take the delicacy of this issue for Jews and their hesitance toward quality of life judgments (Schostak
1991; Mackler
2003, p. 108; Zohar
2006, p. 2) into account. On the other hand, among contemporary (Jewish) academic scholars the prevailing Jewish emphasis on life-saving is challenged and debate on the significance of improving a patient’s quality of life is stimulated (Brody
1999; Green
1999; Zohar
2006). Brody and Green for instance argue that the idea that Judaism is committed to the strict doctrine of sanctity of life is a thorough misrepresentation and does not do justice to the nuanced way of thinking of rabbinic casuistry. Orthodox authorities acknowledge that Judaism is concerned about a patient’s pain and suffering, thus his/her quality of life (Tendler and Rosner
1993; Tendler
1996), yet determining “whether life is worth living” (Rosner
1991, p. 44) on the basis of quality of life considerations is for them a bridge too far.
Anyway, it is utmost important to provide care which is sensitive to a patient’s religion, world view and culture. The huge importance of culture-sensitive care, which evidently entails respect for a patient’s autonomy, is demonstrated by the reflections of Jotkowitz et al. (
2010a,
b) and Gesundheit (
2010) on the Canadian Golubchuk case. They point correctly to the importance of training of healthcare professionals “in communication skills and cross-cultural medicine” (Jotkowitz
2010b), a requirement which is indispensable given the multicultural and multireligious outlook of contemporary societies. Indeed, religion and world view have influence on the way people deal with illness and ethical dilemmas, for instance in health care (Gielen et al.
2009; Coleman et al.
2007; Wenger and Carmel
2004; DeKeyser Ganz and Musgrave
2006; Margalith et al.
2003; Musgrave et al.
2001; Ejaz
2000; Leichtentritt and Rettig
1999; Carmel and Mutran
1997). Consequently, hospitals’ need felt to deal with a culturally diverse patient population is high, which is clear from the steady inquiries to our center
1 to provide training and clear guidelines in this regard. Nowadays, a holistic approach of patients, paying attention to their (cultural) background and religious convictions, which may impact considerably on medical decision making, is utmost appropriate, as it undoubtedly contributes to providing optimal care.