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'Quality,' 'value' of life not same, ethicists say


The chief rabbi of the British Commonwealth, speaking this week at a seminar for Maryland physicians, agreed with a Roman Catholic ethicist that the value of human life must not be judged on the basis of its "quality."

Lord Immanuel Jacobovits, who also heads a center on medical ethics in Israel, offered the example of an infant severely retarded because of a birth defect such as Down syndrome. Any consideration of "the quality of life" in such a case "has no bearing whatever on the value of human life. Every life is of infinite value," he said in answer to a doctor's question.

He appeared on a program Wednesday in Pikesville with Dr. Edmund Pellegrino of Georgetown University.

An incapacitated child who has "no quality of life as commonly defined" could -- by virtue of that very existence -- enrich the parents' experience, the rabbi said.

"If the parents become more noble . . . more refined, more caring, more sensitive," Lord Jacobovits said, that child's contributions to society might be superior to those of a healthy child.

Dr. Pellegrino, representing the Joseph and Rose Kennedy Institute of Medical Ethics at Georgetown, warned the audience of physicians at the Pikesville Hilton Hotel that there is "a great temptation to talk about the quality of someone else's life."

Such talk can be "exceedingly dangerous" -- especially in the case of infants, he said.

He and Lord Jacobovits also agreed that a physician's overriding concern -- to protect and improve human life -- does not mean he "has a duty to prolong life at all costs." Under the moral codes of both the Catholic and Jewish traditions, they said, treatment can be withdrawn in carefully defined circumstances.

But "when in doubt, treat," Dr. Pellegrino said.

The two ethicists affirmed each other's views on most of the thorny issues raised by the doctors.

At one point, Dr. Pellegrino replied to a question about the possible rationing of scarce treatment when a patient continues to smoke after being warned not to. "We, as physicians, are not to be the moralizers of society," he said.

This drew a distinction from Lord Jacobovits. "I agree with the conclusion that medical aid cannot be withheld for moral reasons," he said, using the example of AIDS. But he added, "I don't agree . . . that doctors are not moralists. We have a duty to make a better world."

Dr. Pellegrino then explained, "I was using 'moralist' in a pejorative sense." He said he agreed with the rabbi that "a physician should be a critic of society."

Other panelists for the seminar on ethical concerns in health-care reform, sponsored by Sinai Hospital, were Dr. Simeon Bardin, chairman of Sinai's Patient Care Advisory Committee, and Rabbi Mitchell Ackerson, director of chaplaincy service at the hospital.

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