Attendees engaged with panelists, left to right, Drs. Eric Cadesky, Brian Bressler and Jennifer Melamed at a Kollel event Jan. 29. (photo from Kollel)
A small but passionate group gathered at the Ohel Ya’akov Community Kollel Jan. 29 to engage with Drs. Brian Bressler, Eric Cadesky and Jennifer Melamed on the topic of Canadian Health Care Challenges Through the Jewish Lens, which focused on the legalization of marijuana, the treatment of addiction, the practice of harm reduction, the opioid crisis and medical assistance in dying (MAiD).
Cadesky, who chaired and moderated the event, is a family doctor in Vancouver and president-elect of Doctors of B.C.; until last summer, he was also medical coordinator at the Louis Brier Home and Hospital, a position he held for some eight years. Bressler is a gastroenterologist at St. Paul’s Hospital and a clinical assistant professor in the University of British Columbia’s department of medicine, while Melamed is co-owner of the Alliance Clinic, an addiction services facility in Surrey.
Bressler framed the conversation in terms of what he called the four principles of medical ethics for a healthcare provider: autonomy, respecting a patient’s choice and their right to understand and consent to treatment; beneficence, doing or recommending everything that could benefit a patient; nonmaleficence, taking into account all known risks to a patient and doing no harm, or the least amount possible, if harm is unavoiadable; and justice, making treatments available to all patients.
“I wouldn’t distinguish between those principles and Jewish ethical principles,” said Bressler. “I think they’re entirely consistent.”
Within this framework, the doctors’ dialogue with the audience took place.
One exchange was sparked by Melamed’s criticism of harm reduction clinics. “This is the dilemma we face,” she said, “is addiction insanity? Should we respect the patient’s autonomy even if the addiction has impaired that autonomy and they are not truly free to make decisions for themselves anymore because of the effects of the addiction?”
She said, “I refuse to accept harm reduction as the end result, as the highest result for my patients.”
Arguing that there “is really no such thing as a safe injection,” she said she believes such clinics are doing more harm than good.”
An audience member countered that recovery might be a realistic goal for working and middle-class patients, who have seemingly more to recover for; but, for addicts living in extreme poverty, who have a history of trauma and/or mental illness, they may not have a realistic chance of recovery. “With harm reduction, we keep them away from crime and treat them like human beings.”
The Kollel’s Rabbi Avraham Feigelstock said that, from a Jewish point of view, the community has a responsibility to do everything in its power to help a person recover. However, the question of how harm reduction clinics could go beyond their current purpose and move towards recovery was not pursued.
Discussing opioid use, Bressler expressed both a cautionary approach, based on his own practice (Crohn’s patients are at particular risk for addiction), and the opinion that it is important to focus on addressing the sources of pain, not just pain itself.
Both Bressler and Melamed were negative about the legalization of marijuana and its use in a medical setting. They said there was some evidence that marijuana was effective for a very limited number of conditions – neuropathic pain and nausea were mentioned – but that the risks of marijuana, such as cognitive impairment and a link to developing psychosis, were well-evidenced.
Melamed expressed concern about what she thinks will be the massive costs of policing marijuana intoxication, among drivers or industrial workers, for example.
When one person raised the potential of increased teen use of the drug, Melamed said teens were already using and she didn’t fear an increase, though she was concerned about the potential for increased use among adults.
Another audience member suggested the Jewish community should protest marijuana’s legalization.
The doctors took a less defined stance towards medical assistance in dying. Both Bressler and Melamed said they had personal and professional experience with it but did not take a stand in favour or against it, instead highlighting issues to consider. Bressler acknowledged the right of Canadians to MAiD but also pointed out that the practice conflicts with Jewish law.
Feigelstock said the general principle in Judaism is to prolong life but not necessarily to prevent death. “According to Jewish law, generally speaking, you may choose not to do things to prolong the life of someone who is dying,” he explained, “and you may give medicines to relieve suffering, which have the side effect of possibly shortening life, but you do not do something that will directly kill the patient. Every case must be dealt with separately, however, case by case; one cannot make general statements about what to do.”
Matthew Gindin is a freelance journalist, writer and lecturer. He writes regularly for the Forward and All That Is Interesting, and has been published in Religion Dispatches, Situate Magazine, Tikkun and elsewhere. He can be found on Medium and Twitter.