1. Medical and Bioethics By Rabbi Jeffrey Cohen
Jeffrey Cohen FRSA, Rabbi, D.Min, B.Com, BCC
currently a Visiting Senior Research Fellow in the Centre for Culture and Health at UNSW. His areas of research include the Ethical, Spiritual and Cultural issues at End of Life as well as Spirituality and Health.
In 2001 he was Visiting Research Associate in the Department of Semitic Studies at Sydney University. Prior to that he served as Chief Executive Officer of the Sydney Jewish Museum for five years.
From Dr Cohen served as Director of Pastoral Resources for Missouri’s Department of Mental Health and also served as Acting Director and Dean ( ) of the Institute for Pastoral Education, in St. Louis. While working for the Department of Mental Health he created an academic research project Pathways to Promise which developed relationship with 15 faith communities and evaluated faith based programmes for persons with mental illness.
Rabbi Cohen is a member of the NSW Department of Health’s Ethics Committee. He serves as President of the Council of Christians and Jews. And was the Literary Editor of the Australian Jewish News for four years.
He was recently elected a Fellow of the Royal Society for the Arts
Jeffrey is a Rabbi who also holds a doctorate from Eden Theological Seminary in the USA where his research was in the field of Pastoral Care.
Jeffrey Cohen received the UNSW Alumni Award for contributing to the improvement in the quality of life in He is Board Certified in Hospital Chaplaincy and Mental Health Chaplaincy and Board Eligible in Chaplaincy Education and Mental Health Administration. He has served as President of the Association of Mental Health Chaplains (now the Association for Professional Chaplains) and Vice President of the Congress on Ministry in Specialized Settings and has chaired the international planning for Pastoral Care Week.

2. Basic Ethical Principle
Foundation of Jewish Medical Ethics
Leviticus 18:5
“These are the mitzvot which one shall do and live by them: I am the LORD. ”
“shall live”
And not die by them
See also Lev 19:16
"Do not stand idly by the blood of your neighbor"
"Live by them and not die by them" (Lev. 18.5; San. 74a).
The practice of medicine is a mitzvah, a fundamental religious obligation incumbent upon the Jewish people
"I am Adonai, your healer" (Exodus 15:26)? Does this verse not teach us that all healing belongs to God? If so, then to employ the services of a physician in search of a natural cure for disease betrays a lack of faith in the mercy of Heaven. The biblical author criticizes King Asa of Judah because "in his illness he sought not God but rather physicians" (II Chronicles 16:12).
The bulk of Jewish thought assumes a positive and affirming attitude toward the practice of medicine. Jewish law, however, understands the permission to practice medicine as a mitzvah, a requirement to do so. Some authorities derive this requirement from the general rule concerning the preservation of life, or pikuah nefesh. This rule itself is based upon Leviticus 18:5: "These are the mitzvot which one shall do and live by them," to which the Rabbis add: "and not die by them.“
Others see medicine as an aspect of the duty to rescue those in danger: "Do not stand idly by the blood of your neighbor" (Lev. 19:16).
One commentator identified 3 main principles: "human life has infinite value; aging, illness and death are a natural part of life; and improvement of the patient's quality of life is a constant commitment." Other important principles are that human beings are to act as responsible stewards in preserving their bodies, which actually belong to God, and that they are duty bound to violate any other law in order to save human life (short of committing murder, incest or public idolatry). Compared with secular values, these principles suggest a diminished role for patient autonomy. The duty to treat illness or preserve health overrides any presumed right to withhold treatment or to commit suicide.

3. When does life begin Question is when is life viable
The fetus in the womb, says Rashi, classic commentator on the Bible and Talmud, is lav nefish hu, not a person, until he comes into the world. Feticide, then, does not constitute homicide, and the basis for denying it capital-crime status in Jewish law - even for those rabbis who may have wanted to rule otherwise - is scriptural.

4. Principles Pikuah Nefesh- saving a soul Defining death
Can one over-ride the other
pikuach nefesh (Hebrew: pikkuah nefesh) Obligation to save life. Pikkuah nefesh is based on the commandment in Lev. 19:16: 'Thou shalt not stand idly by the blood of thy neighbour.' The duty to save life supersedes any other law except those against MURDER, IDOLATRY and INCEST. Further than this, SABBATH laws must be set aside in cases of illness or childbirth. Hence it is permitted to ignite a fire on the Sabbath to keep an ill person warm, or to extinguish a light to help them sleep. 
Ultimately, the critical issue with organ donation is defining the moment of death. According to the Talmud, a person is considered dead when a feather held below his nose doesn’t move and when an ear pressed against his chest does not detect a heartbeat. However, defining death these days is not so easy.
Pikuach nefesh does not override murder; one cannot kill someone to save another’s life.

5. Definition of Death
1960’s Reform & Conservatives accept Brain Stem definition of death
1990’s Orthodoxy begins to accept Brain Stem definition
In the late 1960s, the Conservative and Reform movements both accepted cessation of brain activity as the Jewish definition of death.
Twenty years later the Orthodox chief rabbinate of Israel endorsed the same definition; in 1991 the Rabbinical Council of America, an Orthodox rabbinical organization, followed suit.
In 1992, Rabbi Shlomo Zalman Auerbach, a leader influential among the ultra-Orthodox both in Israel and the U.S., also accepted this definition.
There is a major disagreement between David Bleich and Moshe Tendler on whether Moshe Feinstein accepted Brain Stem Death (the latter argues his father in law did accept it)

6. Transplantation & Organ Donation
Current legal & ethical questions
How do we decide who gets priority?
Defined recipient
What happens with eyes?
Can organs be sold?
Can they be used without permission?
Rates of donation
Perception vs reality
Deuteronomy 4:9 commands, “Take heed to thyself and keep thy soul diligently,” and this verse was interpreted by the Talmud and by Maimonides to mean that a person is obligated to avoid dangerous situations. Can a person ever purposely endanger herself? This is one of the primary ethical questions in regards to organ donation, both for the donor and the recipient
There are many legal and ethical issues that are still debated.
Classic straw argument: If several people need a given organ, how do we decide who gets priority?
It is possible to buy organs in China and India  Can organs be sold?
Can they be used without permission?
However, the Jewish community still has a poor track record of post-mortem organ donation. Much of this has to do with the widespread and longstanding misconception that Judaism forbids organ donation
Study done of Jewish College students in Sydney (2005) found 40% knew Judaism permitted donation; 40% thought Judaism against it; 20% did not know whether Judaism had a position

7. Issues in Organ Donation
Underlying problem
Can only use organs thru brain stem death
Donations by deceased
Living Donors
Judaism looks for designated recipient
Only about 1% of all deaths occur in situation which allows for possible donation, primarily in ICU where life support being used or in ER- all others is cardiac death
Problem when deceased donor is primarily quick deteriation of the organ because of lack of oxygen
Living donors, primarily can donate an organ such as kidney (have 2) – serious risk to person since any invasive procedure has risks

8. Organ Donation Orthodox Conservative Reform
Halakhic Organ Donors Society
OU statement
Conservative
Supports donation
Reform
MATAN CHAIM: THE GIFT OF LIFE Organ & Tissue Donation (includes card)
Orthodox
–good overview
from 1995
USCJ statement
“When needed for life-saving transplantation, withholding consent for post-mortem organ donation must be considered forbidden.”
Joseph H. Prouser, "Chesed or Chiuv: The Obligation to Preserve Life and the Question of Post-Mortem Organ Donations" YD
Joseph Prouser, "Organ and Tissue Donation Card" YD
Joel Roth, "Organ Donation" YD
URJ (reform)
Mass mailing to members advocating becoming a donor
Organ Donation
"There still exists within our Jewish community perceptions that Judaism does not embrace the concept of organ donation and transplantation. In fact, the denominations are together in affirming the need for our participation in what is really a modern mitzvah rooted in the value of saving a life (pikuach nefesh)." (URJ Bio-Ethics Program Guide #9, "Organ Donation," 1997)

9. Euthanasia Need to distinguish Active vs passive Euthanasia
Shortening life
Prolonging death
Active vs passive Euthanasia
Traditional authorities also forbid assisted suicide--enabling a terminally ill patient to take her own life. However, authorities disagree about what prohibition the one who provides assistance violates.
Passive euthanasia--withholding or withdrawing therapy that can keep someone alive--is a more complicated issue. The Talmud forbids all acts that might hasten death, and this ruling was upheld by the medieval Jewish law codes.
The basic principle governing end-of-life issues is that nothing can be done to hasten death, but all hindrances to death can, and perhaps should, be removed.

10. Euthanasia II Orthodox position Conservative -2 positions Reform
Orthodox rabbi Eliezer Waldenberg, for example, does not allow the withholding or withdrawing of any sort of therapy, but he does allow the administration of pain medication, even if that medication could potentially have adverse affects.
Conservative rabbi Avraham Reisner permits the withholding of medication and the withdrawal of artificial respiration, but not the withdrawal of artificial hydration and nutrition, such as intravenous and tubal feeding.
Dorff, in accordance with Jewish bioethicist Daniel Sinclair, suggests that the concept of terefah is more appropriate. A goses is someone who is in the last hours of life, while a terefah is someone who has an incurable disease, but who may still live for a long time.
Ascribing the status of terefah to terminally ill patients allows Sinclair and Dorff to arrive at more lenient positions about euthanasia.
Reform rabbi Peter Knobel sums up how this affects the distinction between a goses and terefah: "The fundamental concept in the definition of a human terefah is, therefore, the inevitability of death in contrast to the goses who is alive in every respect." Knobel suggests that in certain cases where the pain experienced by a terminally ill patient diminishes her ability to live in the image of God, euthanasia may be permitted, even praiseworthy. In cases of extreme suffering, writes Knobel, "Active euthanasia is permitted when the person has waived his/her right not to be killed and it is consistent with the person's biography."

11. Bioethics Cloning Therapeutic Reproductive
A general consensus appears to be emerging in the Jewish community that therapeutic cloning—using cloning technology for medical research—is acceptable, but reproductive cloning—using the technology to copy someone—is not.
Some believe that cloning would fly in the face of lessons derived from the Holocaust, when Nazi doctors experimented on humans in an effort to create a “master race.” Some rabbis are particularly troubled by the notion of a human made in one’s own image, rather than the image of God.
Rabbi Jonathan Sacks said human cloning is dangerous and irresponsible because of the threat it poses “to the integrity of children so born.”
Rabbi Michael Broyde, a law professor at Emory University in Atlanta, believes that cloning can be proper—if done with appropriate supervision. Broyde bolsters his argument with the scenario of a sick person who could be cloned to insure a match in a bone marrow transplant. “Jewish tradition might regard this procedure as involving two good deeds: having a child and saving a life,” he wrote.

12. Stem Cell Research Based on “these are the laws you shall live by”
"The Judeo-biblical tradition does not grant moral status to an embryo before forty days of gestation. Such an embryo has the same moral status as male and female gametes, and its destruction prior to implantation is of the same moral import as the 'wasting of human seed.' After forty days-the time of 'quickening' recognized in common law-the implanted embryo is considered to have humanhood, and its destruction is considered an act of homicide. Thus, there are two prerequisites for the moral status of the embryo as a human being: implantation and forty days of gestational development. The proposition that humanhood begins at zygote formation, even in vitro, is without basis in biblical moral theology." Testimony of Rabbi Moshe Dovid Tendler, Ph.D , Stem Cell Research and Therapy: A Judeo-Biblical Perspective, Ethical Issues in Human Stem Cell Research, Volume III: Religious Perspectives, September 1999, p.H-3.
"In stem cell research and therapy, the moral obligation to save human life, the paramount ethical principle in biblical law, supersedes any concern for lowering the barrier to abortion by making the sin less heinous. Likewise, the expressed concern that this research facilitates human cloning is without merit. First, no reputable research facility is interested in cloning a human, which is not even a distant goal, despite the pluripotency of stem cells. Second, those on the leading edge of stem cell research know that the greater contribution to human welfare will come from replacement of damaged cells and organs by fresh stem cell products, not from cloning. Financial reward and acclaim from the scientific community will come from such therapeutic successes, not from cloning." Testimony of Rabbi Moshe Dovid Tendler, Ph.D., Stem Cell Research and Therapy: A Judeo-Biblical Perspective Ethical Issues in Human Stem Cell Research, Volume III: Religious Perspectives, September 1999, p.H-4.
Eliott Dorff notes that "Since genetic materials outside the uterus have no chance of developing into a human being, they have even less legal status in Jewish law than zygotes and embryos in the first stages of gestation, when the Talmud classifies them 'as if it were simply water.'"
See also

13. Sexual Ethics

14. Abortion Biblical basis- Exodus 21:22-23 Issues Ultra-orthodox
Rodef- pursuer
Viability of fetus
When does life begin
Ultra-orthodox
Orthodox/Conservative
Reform
Although there are different interpretations of halacha, certain principles are normative. First, abortion is not banned even according to the strictest halachic interpretations. In fact, there are circumstances in which a threat to a woman’s life not only permits, but requires, an abortion (M. Ohalot 7.6). Second, the fetus is not considered to be a person (nefesh), invested with the totality of human rights and obligations, until it is born. Within 40 days of conception, a fetus is considered “mere fluid” (Yeb. 69b; Nid. 3.7, 30b). While vested with some status after that point, a fetus is considered a part of the mother’s body, comparable to a limb. 
The Jewish position on abortion occupies a middle ground, neither condoning it nor categorically prohibiting it. Indeed, while Judaism disapproves of abortion on demand, in certain cases it not only permits, but requires it.
Exodus 21:22-23 discusses a situation in which two men are fighting. During the fight, one of the men accidentally hits a pregnant woman. The Torah says that if the woman is killed then, “a nefesh shall be given for a nefesh (a life shall be given for a life).” The man who struck her is considered a murderer and is punished accordingly. If, however, the woman miscarries but does not die, the man must pay monetary damages. He is not liable for murder because the fetus is not considered a nefesh, a human being
the Mishnah (redacted c. 200 CE), in Tractate Ohalot—that provides us with the underlying principle: “If a woman is undergoing a perilous pregnancy, the fetus may be destroyed since her life takes precedence over its life.” When a woman’s life is in danger, abortion is permitted.
Maimonides ( ), on the other hand, believes that aborting the fetus is permissible because the fetus is considered a rodef, one who “pursues” another with the intent to kill. According to Jewish law, it is permissible to kill a rodef in order to preempt his act of murder.
While many liberal authorities do permit abortion even for unwanted pregnancies when there is the potential of psychological damage to the mother, it should be noted that Judaism’s qualified support for abortion is not rooted in the language of “a woman’s right to choose.” A fetus is considered equivalent to a limb; just as Jewish law would prohibit someone from choosing to cut off their own limb, it would prohibit abortion without good reason.

15. Birth Control Expectation of having children Question of spilling seed
First commandment in Torah- be fruitful and multiply
Question of spilling seed
Genesis 38, 6-10
What is permitted and forbidden
In principle, birth control is permitted, so long as the couple is committed to eventually fulfilling the mitzvah to be fruitful and multiply (which, at a minimum, consists of having two children, one of each gender). The issue in birth control is not whether it is permitted, but what method is permitted, and under what circumstances.
Birth control is rather clearly permitted in circumstances where pregnancy would pose a medical risk to the mother or her other children. For example, the Talmud recognizes the use of birth control by very young women, pregnant women or nursing women. However, there is some variance of opinion as to what other circumstances might permit birth control. If this is an issue for you, you should consult a competent rabbinic authority.
Does the method that destroy the seed or block the passage of the seed are not permitted, thus condoms are not permitted for birth control. However, the pill is well-recognized as an acceptable form of birth control

16. Relationships
“The times for conjugal duty prescribed in the Torah are:
for men of independent means, every day;
for laborers, twice a week;
for donkey drivers, once a week;
for camel drivers, once in thirty days;
for sailors, once in six months.” Talmud, Ketubot 61b
Cannot change profession if it means less frequency or more onerous (like becoming a tanner)
In Jewish law, sex is not considered shameful, sinful or obscene. Sex is not a necessary evil for the sole purpose of procreation. Although sexual desire comes from the yetzer ra (the evil impulse), it is no more evil than hunger or thirst, which also come from the yetzer ra. Like hunger, thirst or other basic instincts, sexual desire must be controlled and channeled, satisfied at the proper time, place and manner. But when sexual desire is satisfied between a husband and wife at the proper time, out of mutual love and desire, sex is a mitzvah.
Sex is permissible only within the context of a marriage. In Judaism, sex is not merely a way of experiencing physical pleasure. It is an act of immense significance, which requires commitment and responsibility. The requirement of marriage before sex ensures that sense commitment and responsibility. Jewish law also forbids sexual contact short of intercourse outside of the context of marriage, recognizing that such contact will inevitably lead to intercourse.
The primary purpose of sex is to reinforce the loving marital bond between husband and wife. The first and foremost purpose of marriage is companionship, and sexual relations play an important role. Procreation is also a reason for sex, but it is not the only reason. Sex between husband and wife is permitted (even recommended) at times when conception is impossible, such as when the woman is pregnant, after menopause, or when the woman is using a permissible form of contraception.

17. sexual pleasure is a wife’s right and a husband’s obligation
a man may not compel his wife to fulfill the marital obligation
if a husband refuses to perform his marital obligation in a loving, romantic, and sexually pleasing way, his wife actually has the right to demand a divorce
The Torah sees the world and everything in it as essentially good: “And God saw all that He made, and found it very good” (Gen. 1:30). This goodness includes sexual activity. After creating human beings, God blesses them and tells them, “Be fertile and increase, fill the earth and master it” (Gen. 1:28). Thus sexual activity is a basic part of God’s creation; as such it must be good.

18. Fertile Technology Basic Principle Artificial Insemination IVF
“Be fruitful and multiply” [First biblical commandment]
Artificial Insemination
IVF
Surrogate Motherhood
One of the first commandments in the Torah is to "be fruitful and multiply," and procreation has always been an important value in Jewish tradition. Modern medical technologies--such as artificial insemination, in vitro fertilization, and surrogate motherhood--can help people who have difficulty conceiving and bearing children.
"Artificial" insemination (AI) is the oldest form of non-traditional conception, and is usually divided into two categories: artificial insemination using a husband's sperm (AIH) and artificial insemination using donor sperm (AID). Problem with AID- is it adultery??? Also, some authorities are concerned that the offspring of an AID conception might end up marrying his or her sibling, committing unintentional incest.
IVF- In the end, most Jewish authorities agree that an egg fertilized outside of a womb does not have any human status and can be discarded.
Surrogate motherhood raises a host of halakhic (Jewish legal) and moral problems. In general, a surrogate is paid to incubate and give birth to a baby for another couple, and many rabbis are disturbed by this "commodification" of a woman's body and the reproductive process. Others are concerned about the effect that it might have on the marriage of the couple trying to conceive. For these and other reasons, many rabbis--across denominational lines--reject surrogacy.
Others, however, believe that the legal and moral objections can be allayed and approve of surrogacy when it is the only possible way a couple can have children. However, there are lingering questions for these authorities as well, such as which woman is considered the child's mother. 

19. IVF Basically accepted AIH AID Status of spare embryos
Artificial insemination has been dealt with a length by a spectrum of poskim (rabbis qualified to decide matters of Jewish law). While artificial insemination by a donor is generally strongly condemned, the use of a husband's sperm for artificial insemination in cases of necessity was accepted by most Rabbinical authorities
A significant majority of authorities accepted in vitro fertilization under the same rubric and limitations as artificial insemination, including the fulfillment of the mitzvah of procreation.
In the United States, the Orthodox, Conservative and Reform denominations of Judaism have all endorsed the research. Leading Orthodox rabbis in Israel and the United States say embryonic stem cell research is acceptable both because the research can potentially save lives and because traditional Jewish sources consider embryos less than 40 days old to be unformed beings.
Rabbi Moshe Dovid Tendler, in testimony for the National Bioethics Advisory Commission, argued strongly in favor of the use of pre-embryos for stem cell research. Nevertheless, it is important to realize that this conclusion is not unanimous
Reform--- Jewish tradition teaches us that preserving life and promoting health are among the most precious of values. These values have informed our affirmative commitment to medical science throughout the ages. Judaism has always encouraged scientific and medical advances. As Nachmanides taught, the practice of healing is not merely a profession, it is a mitzvah, a righteous obligation. A recent CCAR responsum applies this principle to human stem cell research: "If we define the administration of lifesaving medical therapy as pikuach nefesh, we should not forget that physicians could not save lives were it not for the extensive scientific research upon which our contemporary practice of medicine is based. Since research into human stem cells partakes of the mitzvah of healing, surely our society ought to support it" (CCAR Responsum , Human Stem Cell Research, Rabbi Mark Washofsky). Indeed, our tradition requires that we use all available knowledge to heal the ill, and "when one delays in doing so, it is as if he has shed blood" (Shulchan Aruch, Yorei De`ah 336:1).
AIH [Artificial insemination of the Husband's sperm] is generally regarded as a halakhically permissible procedure through which paternity can be established and the mitsvah of peru u-revu ["be fruitful and multiply," the biblical obligation to have children] or at least la-shevet ["to be inhabited," the rabbinic obligation to have children] can be fulfilled. By and large most poskim [decisors of Jewish law] have assimilated IVF [invitro fertilization] to AIH and have permitted its utilization ... Virtually all contemporary posekim have concluded, first, that the egg and sperm providers do have a parental relationship with the IVF generated offspring; second, that the procedure, if undertaken for procreation by an otherwise infertile couple does not violate the prohibition against hashhatat zera [wasting sperm/seed]; third, that one may fulfill, through any resulting offspring, either the mitsvah of peru u-revu [the biblical obligation to have children], or at the very least, the "lesser" mitzvah of la-shevet [the rabbinic obligation to have children]

20. Homosexuality Biblical basis Various views today
Lev. 18:22; Lev. 20:13; Deut. 23:17
Are the laws equal for men and women
Various views today
Reform
Conservative
Orthodox
There are several passages of the Hebrew scriptures that have been used against homosexuality, these are:
Leviticus 18:22-No man is to have sexual relations with another man, God hates that.– capital offense
Leviticus 20:13-If a man has sexual relations with another man, they have done a disgusting thing, and both shall be put to death. They are responsible for their own death.
Deuteronomy 23:17-No Israelite, man or woman, is to become a temple prostitute.
Reform- the New York Federation of Reformed Synagogues discusses that the Bible is not homophobic, but that these three laws are outlawing homosexual acts. They believe that at the time the Bible was written, it was not understood that homosexual acts could be consensual and part of a loving relationship.
Accepts GLBT at all levels including Rabbis and Hazzanim
Conservative
Accepts them in congregations. Currently reviewing question of whether they can begin studies to become rabbis-up to now, “no questions” but if come out after ordination are not expelled from professional rabbinical assembly
Orthodox
Jakobovits writes: Jewish law [...] rejects the view that homosexuality is to be regarded merely as a disease or as morally neutral.... Jewish law holds that no hedonistic ethic, even if called "love", can justify the morality of homosexuality any more than it can legitimize adultery or incest, however genuinely such acts may be performed out of love and by mutual consent. [Encyc. Judaicia}
Lamm invoked the principle of Jewish law termed ones, denoting an "accident" or event beyond one's control. In this way, homosexuality could be redefined as an act performed under psychological duress, and it would be wrong to persecute or judge homosexuals for their actions. Rather, he advocates an approach of "both compassion and efforts at rehabilitation." {Encyc. Judaicia Yr Book 1974]
Steven Greenberg is the only openly gay person who identifies himself as an Orthodox Rabbi. his book Wrestling with God and Men

21. Ritual Uncleanliness Taharat Ha-Mishpaha
Basis- Leviticus: 15:19-30, 18:19, 20:18
Not just says of low but 7 additional days
Nothing to do with physical uncleanliness
Mikva
TAHARAT (Tohorat) HA-MISHPAHAH ( "family purity"), the term popularly given to the laws of niddah, which involve a married couple's abstinence from sexual relations during the period of menstruation until the wife's immersion in the mikveh.
The Torah describes niddah, the ritual impurity due to menstruation, and the prohibition of having relations with a niddah (Leviticus: 15:19-30, 18:19, 20:18). Niddah, as defined in the Torah, lasts for seven days. The Torah also describes a long or irregular discharge of blood, called zavah (Leviticus 15:25-30), which requires that seven blood-free days be counted from the last day of the irregular discharge of blood before immersion.
two sets of time, the "first five days", and "seven days of taharah", after which she must immerse properly in a mikvah (ritual bath). The immersion itself must take place in a "mayan" a spring or well. Certain rivers or lakes can therefore be used for immersion, but one should always check with a mikvah expert to be sure as to the status of a particular body of water. Standard bathtubs cannot be used. Alternately, rain water can also be used, and is the source of most mikvah water today. Though a certain amount of rainwater is required, this can be augmented with regular tap water
Orthodox- advocates observance
Conservative- is becoming more observed
Reform- abrogated