Crises come and go, only to be replaced by the latest one(s). Some of us find that asking questions is an important way to discern relevance, values, and priorities as we seek to navigate the chaos with integrity. Although this presentation is from nearly three years ago, it illustrates how I ask questions and reflect on life’s various challenges.
Presented by Dalinda Reese on February 3, 2021 (online event, not recorded)
Abrahamic Faiths Forum, on the theme: “Community and Covid-19”
Martin Luther University College, Waterloo, ON
“The Obligation to Ask Questions — A Jewish Perspective”
[Intention:] “May the words of my mouth and the meditations of my heart be acceptable to You, Adonai, Source of Life, Who has called me into being – into being alive here and now, even in such a time as this. Hineini. Here I am.”
Thank you for inviting me to be part of this conversation on “covid-19 and community.” The topic of covid-19 in these days has been weighing heavily on my heart. It is a privilege to share with you in this particular setting, among this group with a generosity of spirit, who are open to differing perspectives and genuine conversations. Thank you.
Very important Disclaimers:
1) You may have heard that when two Jews get together, you have three different opinions. Well, I am one Jew, and I have more than three opinions, so clearly I cannot offer you THE Jewish perspective. At best, I can only offer you a Jewish perspective.
2) My thoughts and comments are informed by years of training and practice as a US physician; however, I need to be very clear here, these are my own opinions and do not represent the views of the medical profession. Also, to be clear: I am a US not a Canadian MD, I have retired from medicine, and this is not medical advice.
3) Even though I am a student here at Martin Luther University College, these are my own opinions and do not reflect the opinions of this institution. That said, I am grateful of the opportunity to study in an interfaith program in this particular academic setting – one that values honest inquiry even if it leads to difficult conversations.
4) I should probably also note that I am a citizen of both the US and Canada, as that undoubtedly influences what and how I look at things. And, yes, I did drive back to Michigan in October to vote – even though the quarantine on my return took 14 days out of my academic studies timeline.
I need to be explicit with these disclaimers since my comments will likely be uncomfortable. This has been a hard year. The covid-19 pandemic and the pandemic control measures have fully collided with my values, my training, and my life experiences as a human being, as Jew, and as someone intimately familiar with integrative medicine. Before I get to my many questions, I will need to share a bit about what informs my thinking.
About my Jewishness: I was not born into a Jewish home. Except for myself, all in my family of origin are genuinely committed Christians – and yet we continue to be a close family. I was not particularly contrarian, but I found it increasingly difficult to fit my many questions and life experiences into what I understood as a Christian world-view. I felt called to Judaism. When I recognized not only the freedom, but the obligation to ask questions, I knew I had found my home in Judaism. I may lack “Yiddish-keit” but I am fully Jewish. I am deeply committed to and in dynamic relationship with Judaism and the Jewish people who are known as both God-wrestlers (Israel) and as God-praisers (Jehudah). Our daily prayers include a reminder of the covenantal charge to love God, and to live in harmony with each other, with time, and with the land (otherwise the land itself will vomit us out! Lev. 18:28). Many Jews feel a deep responsibility towards this world we live in. And much as we would like to shake it, most of us share a passion for justice.[1]
I went into medicine wanting to know everything and be everything, but studying medicine was pretty overwhelming. So I narrowed things down. After medical school I completed a residency in Internal Medicine; then I promptly went into Anesthesia where I could have more control over the variables! Two decades of anesthesia practice nearly did me in. I was toast! My health fell apart and conventional medicine did not have much to offer me. Regaining my health meant tending to the multiple dimensions of my being. I actually trained to be a spiritual director at the same time I did a fellowship in Integrative Medicine, both during my own healing journey. That led me back to Michigan to a practice in Integrative Medicine in 2012.
It was during my years working in holistic medicine, that I really began to understand that life is a whole system – there is no such thing as an independent variable. We are deeply intertwined with our environment and with each other. I am awed by the magnificence of life. Our amazingly complex and dynamic immune systems constantly interact with our internal and external environments to keep us healthy. The microorganisms that live in and on us, infectious agents and toxins in the environments we inhabit, our nutritional health, stress levels, the connections we have with fauna/ flora/ living things/ and with other human beings – all of these things (and more!) influence and are influenced by our immune systems.
I need to comment on two concepts that are hugely important in healthcare whether you are giving or receiving care: Evidence Based Medicine and Informed Consent.
Evidence Based Medicine is like a three-legged stool, supported by three equally necessary pillars: 1) Research, 2) Clinical Expertise, and 3) Patient values. Even, or I should say especially, practicing as an integrative, holistic physician, I was attentive to practicing Evidence Based Medicine. I brought my ongoing training, my constantly expanding knowledge, and my accumulating clinical experience to my encounters with patients. These encounters meant understanding their values, their concerns, their questions, and what was important to them in their health journey. Especially if what they came in with didn’t fit common patterns or if their health didn’t respond as expected to a treatment approach, it meant revisiting assumptions and discerning if there was any good research that might be relevant (content, intent, measures, strengths, and limitations) and then translating that research into how it might apply to the person sitting in front of me. It didn’t stop there, it meant following and re-evaluating the intervention – was it making things better, worse, or no change? Did we need to look at the issues differently? Had we missed or overlooked anything?
And informed consent? Any physician (or lawyer, for that matter) will tell you the critical importance of informed consent. It is more than just getting a signature on a piece of paper. It is about discussing risks, benefits, and options for any given medical intervention or course of action. That means being up front about knowns and unknowns. It means being clear, answering questions, even studying the issues further if the information is confusing. How else can anyone make a good decision?
My familiarity with Evidence Based Medicine and with Informed Consent, will always color my thinking. The medical mandate to “First do no harm” is also seared into my consciousness.
Turning to the Torah, Leviticus 19:16 states: “Do not stand by while your neighbor’s blood is being shed.” Commentary in the Talmud (Babylonian Talmud, Sanhedrin 73a) makes clear the ethical obligation we have to intervene when we see our neighbor drowning, being attacked or at risk of losing life and limb.
And here is where the collision comes into stark relief. I retired from the practice of medicine in the fall of 2019 to pursue other interests. None of us knew what 2020 would hold. I have personally fared well. I am well-resourced to weather this pandemic. But as one who understands the importance of weighing risks/ benefits/ and options before making any decisions and the need to continually revisit the evidence to see if that approach is working, I have been profoundly disturbed. I have been witnessing direct effects and indirect “collateral damage” from covid-19 and our response to it. What is my ethical obligation? Where and how am I to intervene?
I acknowledge the many who have died and been afflicted by covid-19. I acknowledge and appreciate all the tireless efforts by frontline and health care workers. I also see and recognize the many unsung others who have been scrambling to make things work – to make the best of challenging times with constantly changing directives. But, I have so many questions! How well do we understand and continually evaluate the pandemic and the “collateral damage” from the pandemic control measures? We know that lack of social determinates of health disproportionately increases the severity and risk of death from covid-19 and from other causes. Fear, isolation, and loneliness can be deadly. Food security, shelter, community, meaningful employment, access to quality education and healthcare are unaccounted casualties due to pandemic control measures. There is no question that people are being exposed to the SARS-Cov2 virus that causes covid-19, some are getting sick with covid-19, some are getting hospitalized, and some are dying of covid-19. It is also true that Canadians (and people around the world) are suffering, sick, and dying due to causes other than covid-19. Some are suffering, sick, and dying as a result of lockdown and other pandemic control measures. I have oh so many questions:
- Who is deciding what data to measure, how to measure it, what is not important enough to be measured, how to evaluate the data, how to determine the relevance, and who is deciding how that data should be applied? Where are the multivariate risk assessments? What information might be missing or overlooked?
- What have we learned about this virus and how it interacts with our immune and inflammatory systems?
- In the public sphere, what endpoints are we looking at to see if what we are doing is helping – and how is it expected to help?
- How has our approach to the pandemic, including lockdown measures, changed the prevalence, distribution, morbidity, and mortality of covid-19?
- How are the anticipated health risks of pandemic control measures being addressed?
- How we allowing for and monitoring any unanticipated health risks? And how are we addressing these?
- Given that there are modifiable risk factors for severity of covid-19 (e.g. adequate levels of Vitamin D, human connection, exercise, bio-social determinants of health) how are these being addressed? Why are these known modifiable risk factors not a major focus of our healthcare dollars?
- What about clinical expertise? A multistate group of clinicians, actively practicing ICU doctors in the US have compiled and presented compelling empirical evidence of effective drugs and protocols for early and prophylactic treatment of covid-19. (https://covid19criticalcare.com/i-mask-prophylaxis-treatment-protocol/electronic-press-kit-dec4/). Why is this evidence being downplayed? Why is that not part of the risk/ benefit/ options discussion that any patient can have with their physician? Why is there such an inordinate push for the experimental covid-19 vaccine as the only or the best option?
- Why is a face-to-face risk/ benefits/ options discussion with your physician who knows your health, your concerns, and your values not required prior to getting seasonal vaccines – let alone, prior to getting these covid-19 vaccines that actually fall into a new category of drug and that are unlike other vaccines?
- How many of those receiving the covid-19 vaccines understand that they are essentially part of an ongoing experimental drug trial? Do we recognize that phase 3 trials have been followed for several months but that longer term data has not been completed? How clearly do we understand that covid-19 vaccines use a new and different technology as compared to other vaccines? Is it clear that the covid-19 vaccine may decrease the severity of a covid-19 illness, but that even if you get the vaccine you can still get infected with the (SARS-Cov2) virus and you can still spread it? How many people are aware of the CDC data that 5 days into the vaccine rollout, showed that 2.78% of those who received it had reactions severe enough that they we unable to go to work the next day or had to seek out medical care? How many of us are aware that the long term and cumulative risks of the covid-19 vaccines are simply not known and cannot be known at this time?
- How are our values and priorities being taken into consideration? How is the pandemic challenging these? When we are in a reactive, survival mode – stressed, overwhelmed, and exhausted, how can we be present enough to what is going on around us to respond in meaningful ways? Might these pandemic experiences be changing our beliefs, our conscience, and our conduct? If so, how?
- The “old normal” clearly had its problems and injustices. Who is profiting from this pandemic, at what cost to others? Who or what is thriving on the confusion and chaos? Are the shouts of the loudest voices distracting us from what might be more important? Whose voices are being allowed expression and consideration in the visioning and creating of our future?
- What if the whole narrative about this pandemic is too narrow? How can we expand the narrative to honor what we hold sacred? How can we expand the narrative to include time-honored wisdom from our faith traditions? Can we expand the narrative to reflect more holistic and beneficial paradigms that respect all of life?
These ponderings have been weighing on this Jewish heart and mind, longing for genuine dialogue. Let me finish my comments with another query: If these types of questions go unheeded, what then am I obligated to do? How then am I obligated to respond as a Jew, as an informed person, and as a fellow human being on this amazing journey called “life”?
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[1] Rabbi Sidney Schwartz, Judaism and Justice: The Jewish Passion to Repair the World, (Wookstock, VT: Jewish Lights Publishing, 2006).