Doctor at the Crossroads
| May 16, 2018Rabbi Dr. Steinberg is the senior pediatric neurologist at Jerusalem’s Shaare Zedek Medical Center, where he also directs the medical ethics unit, and he also teaches medical ethics at Hebrew University’s medical school. In addition, he co-chairs Israel’s National Bioethics Council and sits on numerous other governmental and professional committees… Hard as it is to imagine, in his “spare time,” he also heads the editorial board of the Encyclopedia Talmudis (Photos: Amir Levy)
When it was his turn to speak at the Orthodox Union’s second annual Torah New York event at Citi Field last month, the renowned Israeli medical ethicist Rabbi Dr. Avraham Steinberg opened his session on end-of-life halachic issues with a bit of dark humor.
People have conflicting attitudes about prolonging life in its final stages, he said, and proceeded to illustrate the point with two stories. “They tell of three fellows who were discussing what they hoped people would say at their funerals. One says, ‘I hope they describe my good deeds,’ another says, ‘I hope they talk about my good heart,’ and then the third chimes in, ‘I hope they say, “Look, he’s moving!” ’ ”
On the other hand, Dr. Steinberg continued, “there’s the story of the doctor telling the wife of a long-suffering patient, ‘I’m sorry to say it’s only a matter of days until your husband will leave us.’
“To which she responds, ‘I’ve waited this long, I can wait a little longer.’ ”
The hourlong presentation that followed was a classic tour de force, putting on display the mastery of halachic sources and cutting-edge medical expertise that have made Rabbi Dr. Steinberg a go-to authority worldwide on issues at the interface of halachah and medicine. But truth to tell, the humorous lead-in was a bit stilted, and for a simple reason: Although he appreciates a good joke, Dr. Steinberg is a serious man whose work addresses issues that are no laughing matter, questions of life and death, and serious illness, and ethical dilemmas of the highest gravity.
He is, in fact, something of a rarity in the Israel of today: a genuine public intellectual whose influence is felt across the diverse gamut of Israeli society. A talmid chacham of note and a man of science, Rabbi Dr. Steinberg is as comfortable in a university lecture hall or Knesset committee meeting as he is in the homes of the leading poskim with whom he regularly consults. He’s the senior pediatric neurologist at Jerusalem’s Shaare Zedek Medical Center, where he also directs the medical ethics unit, and he also teaches medical ethics at Hebrew University’s medical school. In addition, he co-chairs Israel’s National Bioethics Council and sits on numerous other governmental and professional committees.
But the secret to his entrיe into so many circles may lie not only in his intellectual acumen and breadth of knowledge, but also in the personal chein he exudes and the calm, quietly upbeat demeanor that immediately sets one at ease with him.
Hard as it is to imagine, in his “spare time,” this consummately busy man also heads the editorial board of the sprawling Torah publishing project known as the Encyclopedia Talmudis. Sitting down with Dr. Steinberg for a conversation following the OU event, I wonder aloud: Where does a practicing physician and professor, an author and editor of 36 books and hundreds of articles, who has shepherded legislation through the Knesset and served as an expert witness in thousands of court cases, find the time to direct one of the world’s premier projects of Torah scholarship?
He readily admits that when he was first asked to take on a role at the encyclopedia ten years ago, he had no idea of how enormous an undertaking it would turn out to be. Feeling grateful for all he had personally gained over the years from the masterwork of research that is the Encyclopedia Talmudis, he agreed to get involved. A decade later, finding himself at the helm of something he refers to as “probably the most important Torah project of our generation,” he has no regrets.
The Encyclopedia got its start in Eretz Yisrael during World War II when, with the Nazis slaughtering Torah students in the thousands and destroying every last vestige of Europe’s yeshivos, the very future of Torah transmission to coming generations seemed imperiled. The project’s first editor-in-chief was Rav Shlomo Yosef Zevin, whose fluency in Shas and rare talent for writing with clarity and concision enabled him to distill the essence of many pages of a Torah work into a pithy few paragraphs.
That is the single most essential skill needed for a work that comprehensively summarizes everything that’s been written through the ages on a multitude of Torah topics, from Tanach to Chazal and down through the Rishonim and Acharonim. Unlike a standard encyclopedia providing a handful of references for each entry, it’s not unusual for the entries in this work to feature references to each sentence, and even individual words within a sentence, resulting in some entries featuring up to 2,000 references.
Rav Zevin composed a comprehensive list of some 2,500 entry titles covering every imaginable subject in Torah, and, Dr. Steinberg observes, “It’s amazing to see that to this day, we still use that list he made 70 years ago, with only small changes. When the project first got underway, the joke was that it would take so long to complete the Encyclopedia Talmudis that by the time they reached the last entry, ‘Tishah B’Av,’ it would state that once upon a time, Yidden fasted on this day but today, it’s a Yom Tov.”
After Rav Zevin’s passing, Rav Avrohom Farbstein, the rosh yeshivah of Chevron, took over, along with his son-in-law, Rav Refoel Shmuelevitz, son of Rav Chaim. During their tenure, the entries became much more extensive and detailed, with a lot of lomdus added. This slowed the pace of publication to the point that a new volume appeared only once every three years, and each new volume covered many fewer topics, leading to a drop-off in interest and sales.
But once he assumed the leadership of the encyclopedia’s editorial board, Dr. Steinberg pushed for a quicker pace of production without compromising on the quality of the material. He introduced more efficient ways for writers and editors to communicate, such as the use of e-mail and Dropbox, and advocated for its writers to adopt a more concise, to-the-point style of writing that would reach a larger share of the Torah-learning public.
Then, four years ago, came a transformative breakthrough: Dov Friedberg, the well-known Toronto philanthropist and patron of scholarly Torah projects, agreed to provide $7.5 million in funding toward completion of the encyclopedia’s remaining volumes, provided that the entire project be finished by 2024, and that the encyclopedia’s administration complement his contribution by raising another $5 million.
The pace of writing quickened from 15 entries per year to 100, and two new volumes were published in each of the last four years. The pace of sales has picked up, too, and now stands at four to five thousand copies of each new volume, bringing the total number of volumes sold since the encyclopedia’s inception to one million. Dr. Steinberg also launched the Talmudic Micropedia, an abbreviated, less scholarly but more user-friendly version of the encyclopedia, for which he serves as editor-in-chief.
or Dr. Steinberg, the Friedberg “challenge grant” has meant that at an age when many people’s lives begin to slow down, he is constantly on the go, in perpetual fundraising mode. Nevertheless, he says unequivocally, “Now that this is my responsibility, I won’t give it up, because this project is monumental, something unique and enduring. When, about half a year ago, we made the rounds of gedolim in Bnei Brak and Jerusalem, I was surprised not only at how important they consider it but at how much they use it. Many of them told us that whenever they have to give a shiur and there is an entry on that topic, they look at Encyclopedia Talmudis to make sure they haven’t missed anything.”
When he first joined the leadership team, Dr. Steinberg went to Rav Elyashiv, who knew him from his work in the field of medical halachah, to introduce his involvement in the project. The posek hador was surprised to learn that the encyclopedia was still being published, and the next day, he sent his grandson, Reb Aryeh, to buy the last several volumes, which he didn’t yet have.
The encyclopedia’s staff is comprised of 50 outstanding talmidei chachamim, with Rav Zalman Nechemiah Goldberg and Rav Meir Shmuelevitz, Rav Chaim’s younger son, serving as editor-in-chief and editorial board head, respectively. Dr. Steinberg says the writers wear an assortment of yarmulkes —chassidish, litvish, dati-leumi, Sephardi — and the only criteria to join the team is knowing how to learn and how to write.
The project recently marked a major milestone with the publication of Volume 40 out of a projected total of 70. With six years left in which to produce the remaining 30 volumes, Dr. Steinberg expresses a fervent hope that “HaKadosh Baruch Hu will give me the strength to oversee its completion.”
In retrospect, Avraham Steinberg’s personal biography hints at why he was the ideal person to spur the turnaround of a major but then-moribund project like the Encyclopedia Talmudis.
The only child of survivors who spent the war years in Siberia and Uzbekistan, Avraham Steinberg was born in 1947 in the German city of Hoff. His father, Rav Moshe, had been a rav in Galicia before the war, and after he and his wife were interned in a postwar Displaced Persons camp near Hoff, he became the city’s rabbi, serving there for two years before moving his family to Eretz Yisrael to become the rabbi of Kiryat Yam, part of a group of towns (“krayot”) on the outskirts of Haifa. Over the years, he was offered more prominent rabbinic posts but turned them down, preferring the small-town quiet that enabled him to sit and learn undisturbed and to author several seforim, including Chukas HaGer — a halachic work on conversion that is still today required reading for dayanim.
The Steinbergs were a generations-long rabbinic family in Galicia, where Rav Moshe’s own father, Rav Yitzchak, led the prominent kehillah of Yaroslav.
Rav Meir Shapiro was the rav in a nearby city, and when he opened Yeshivas Chachmei Lublin, he said to Rav Yitzchak, “I know you have a gifted son, and I want you to send him to my new yeshivah.”
But Rav Yitzchak wouldn’t hear of it. “Yeshivah?” he answered. “Since when do we here in Galicia hold of yeshivos? He’s my son and I’m responsible for teaching him. Why would I send him to you to learn?”
And so too when it came time for Avraham’s Torah education, it was a foregone conclusion that his father would be his primary rebbi. Dr. Steinberg describes the way his father taught him as “a very different learning experience from what a boy would have in a yeshivah. When we learned Chullin, that meant going to the shlachthoiz to see how shechitah is done and to learn practically how to check for treifos. I remain indebted to my father forever for those precious years.”
Avraham elected not to follow his father into the rabbanus, choosing instead to pursue a career in medicine, which he felt would be an ideal way to combine earning a livelihood with fulfilling the mitzvah of healing people. At the time, the country’s only medical school was Hadassah, and in order to be accepted to its program, candidates had to be tested in two subjects — one each from the sciences and humanities. For the science portion of the test, he chose biology, and for the humanities portion he opted to be tested on Gemara. As it happened, Hadassah did have a prepared entrance test covering 50 blatt in Gittin, but there was no one in Hadassah who knew enough Gemara to be able to check his answers.
Finally, a solution was found: Professor Yeshayahu Leibowitz, a famously controversial personality on the staff of the medical school, was given the task of marking the Talmud test. When the test paper was returned to him, Dr. Steinberg recalls, he found that Professor Leibowitz had marked it up with all sorts of very blunt, caustic comments, yet had also awarded him a score of 100. Only later did Dr. Steinberg learn that Leibowitz believed test marks should reflect the level of effort a student invested rather than the correctness of his answers.
The confidence and predilection for the study of halachah that young Avraham had gained under his father’s tutelage was to stand him in good stead when, as a fifth-year medical student, he founded Assia, a quarterly journal devoted to medical-halachic issues that is still going strong. That same year, he was chosen to head the Schlesinger Institute, a first-ever research program in medicine and Jewish law.
This was an exciting time, the dawn of an entirely new field of medical halachah. Even the most basic questions about how to be a physician while meticulously observing halachah and what halachah has to say about a whole range of medical procedures were being explored for the first time. It was during this period that the young Dr. Steinberg was given open-ended access to a first-rank posek, Rav Eliezer Waldenberg, author of Tzitz Eliezer, a multi-volume work of sh’eilos v’teshuvos with a particular focus on medical-related issues.
Rav Waldenberg lived across the street from Shaare Zedek, the hospital where Dr. Steinberg was doing his training, and which was run entirely according to halachah.
“He would come to the shul in the hospital for Shacharis, Minchah, and Maariv,” recalls Dr. Steinberg, “and for us this was a terrific treat. In those days, there were no seforim in which to look up even basic questions in medical halachah, so everything was brand-new, and we were able to come to him three times daily with our sh’eilos.
“If my question was a simple one or something he had already once dealt with, he’d answer right away,” Dr. Steinberg continues. “But if it was something new, he’d ask me to write down all the relevant details of the case and at Minchah or Maariv later that day, he’d return with a teshuvah that could run 20 pages. I published many of those teshuvos in Assia even before they appeared in Tzitz Eliezer.”
Those early experiences with Rav Waldenberg were a prelude to what was to become a defining relationship in Dr. Steinberg’s life: His years spent basking in the presence of the towering posek hador, Rav Shlomo Zalman Auerbach, which Dr. Steinberg calls “a once-in-a-lifetime opportunity.”
As Dr. Steinberg reminisces about all the times he spent in Rav Auerbach’s humble Shaarei Chesed home, he mentally travels back to a magical time in his life. “If I came to him with a complicated sh’eilah that he said he needed to think about, I would get a call after a few days: ‘Shlomo Zalman Auerbach speaking here, please come.’ After we spoke, I would summarize his psak in writing to be sure I had understood correctly — and leave it in his mailbox for his corrections.
“At the beginning of my summary, of course, I addressed him with titles befitting a gadol hador, such as ‘Rashkebehag,’ ‘Mofeis Hador’ and so forth. But when he made his corrections, he would make sure to erase all the titles — except for ‘Harav Hagaon.’ Once, I summoned the courage to ask, ‘It’s Torah and I just want to understand. If all those titles I write are no good, why is ‘Harav Hagaon’ okay?’
“A shy smile danced across Rav Shlomo Zalman’s lips as he replied, ‘Nowadays, everyone is a gaon, so it’s not a problem…’ ”
Modesty and personal warmth were the constants woven throughout Dr. Steinberg’s encounters with Rav Shlomo Zalman. A term he’d use often was “choshvani,” meaning “this is what I think,” because, Dr. Steinberg explains, while he stood firmly behind the conclusions he had reached, he understood that others might see the matter differently. Dr. Steinberg’s ready access to Rav Shlomo Zalman was enhanced by the fact that the gadol refused to be served by the layers of gabbaim that often surround people of his stature, insisting instead on doing everything himself.
He also emphasized punctuality, believing that coming late to an appointment and squandering someone’s precious time is no less theft than stealing another’s money. Dr. Steinberg would arrive for meetings with Rav Shlomo Zalman a half-minute before the designated time, not wanting to burden him by coming too early but also concerned about being tardy. But one time, he recalls, he showed up for a 10 a.m. meeting at half a minute to ten, as usual, only to grow concerned when he found Rav Shlomo Zalman waiting for him near the half-open door.
Rav Shlomo Zalman calmed his visitor down, explaining that all was in order — he was waiting only because no one else was at home, and being a bit hard of hearing, he feared he wouldn’t hear Dr. Steinberg’s knock on the door.
Dr. Steinberg likes to cite Chazal’s saying, ein baal haneis makir b’niso — a person doesn’t recognize the good fortune of his situation until he’s no longer in it — to make a little-appreciated point: Virtually all of the major, once-unimaginable advancements in medicine — organ transplants, respirators, fertility technology, and much more — occurred within the last 50 years.
And it required gedolim of the stature of Rav Moshe Feinstein, Rav Shlomo Zalman Auerbach, and Rav Yosef Sholom Elyashiv to address the halachic ramifications of these revolutionary innovations, grasping them in all their details and effects and using their vast Torah knowledge to apply the relevant halachic concepts to the case at hand. Dr. Steinberg marvels at the hashgachah inherent in the fact that we had those titans of Torah to serve as our halachic guides during that entire period of trailblazing innovation.
Although Dr. Steinberg considers Rav Shlomo Zalman to have been a preeminent and pioneering figure in medical halachah, he acted on numerous occasions as a liaison between patients and the medical establishment and leading poskim such as Rav Elyashiv, Rav Ovadiah Yosef, Rav Shmuel Wosner, and Rav Moshe Halberstam — depending on what the sh’eilah was, and for whom it was being asked.
Eventually Rabbi Dr. Steinberg himself developed wide-ranging expertise that has made him one of the preeminent authorities in the field of medical halachah. That reputation was further burnished with the publication of his magisterial seven-volume, Hebrew-language Encyclopedia of Jewish Medical Ethics, for which he received the high honor of an Israel Prize in 1999.
But despite his impressive scholarly achievements, Rabbi Dr. Steinberg is not ensconced in some ivory academic tower far removed from the realm of public policy. On several occasions, he has stepped directly into the fray in order to defend the integrity of halachah or to bring its influence to bear on the larger secular society.
Several years ago, Dr. Steinberg, who chairs the joint oversight committee of the Israeli Chief Rabbinate and the Ministry of Health that licenses and oversees Israeli mohelim, was asked to opine on the practice of post-circumcision metzitzah b’peh (MBP). After several newborn deaths following a bris that included MBP, the practice has become a lightning rod of controversy in the United States in recent years.
After a thorough review of the many studies on the topic, and upon consultation with Rav Elyashiv, Dr. Steinberg issued a report concluding that “according to those halachic authorities who hold that MBP is an essential part of the mitzvah of milah, there is no necessity to cease this procedure unless there will be clear-cut scientific evidence for endangering the baby by MBP in a statistically significant rate from the halachic and scientific points of view. This has yet to be proven.”
Dr. Steinberg notes dryly that “the infectious disease specialists in the Ministry of Health think we’re crazy because metzitzah b’peh violates all their principles. But as it happens, the current head of the health ministry, Rabbi Yaakov Litzman, is a chassid and thus very strongly pro-metzizah, and he disregards what all his personnel say. The day may come, however, when another minister of health will direct otherwise, and then the fight will flare again. Or perhaps a DNA-based connection between the mohel and infected babies will be proven, in which case even Rav Elyashiv would agree that we must be concerned for transmission.”
Metzitzah, of course, is far from the only issue in medicine on which the frum community is at odds with the reigning medical establishment. Dr. Steinberg speaks with deep concern about the prevailing attitudes among doctors and hospitals toward treatment at the end of life.
“The humanistic approach puts the highest value on the principle of autonomy, so that in some countries like the Netherlands, Belgium, and Canada, physicians euthanize — in clear language: kill — patients upon their request, and sometimes even upon the request of a next-of-kin. In other places, such as the state of Oregon, physician-assisted suicide is legal. And at a minimum, most Western countries allow withdrawing a ventilator, thereby causing the patient to die; and allow withholding of food and fluid, which also leads to the death of the patient, unrelated to his terminal illness. All this is forbidden by halachah, which puts a higher weight on the value of life.”
During his trip to the United States for the OU’s Torah New York program, Dr. Steinberg also visited the West Coast to take part in an ethics conference at Los Angeles’s Cedars-Sinai Medical Center, focusing on the issue of patient autonomy versus physician’s responsibility to prolong life. He says that “the indoctrination in the ‘religion of autonomy’ is so strong that when I first presented the halachic view, the doctors had difficulty even grasping what I was saying. But later, after we discussed the issues in smaller breakout sessions, they agreed that at least from the standpoint of ethics, if not law, my position was the correct one.”
In Israel, the medical landscape is significantly better than elsewhere, due to the existence of the Dying Patient Law, which is much more closely aligned with the halachic view of the end of life, thanks in no small measure to the pivotal role Dr. Steinberg played in its passage. After controversy flared in Israel in 2000 about whether a respirator could be withdrawn from an ALS patient, the minister of health asked Dr. Steinberg to chair a committee to study the matter.
Knowing that the issue would generate considerable emotion and a multiplicity of opinions, he formed a committee comprised of Jews, Christians, and Druze. He also divided the group into four subcommittees, consisting of members drawn from the medical-scientific, legal, philosophical-ethical, and halachically observant Jewish communities, respectively. Each subcommittee was tasked with producing a draft piece of legislation, which Dr. Steinberg then used to write the proposed law he eventually submitted for the Knesset’s consideration.
After close to two years of intense debate, the Steinberg committee submitted its recommendations to the Knesset, which enacted the Dying Patient Law of 2005, based largely on that committee report. This law departs significantly from analogous laws around the world by striking a balance between the value of life and patient autonomy instead of giving carte blanche to the latter. Interestingly, Dr. Steinberg notes, the law was not a matter of debate between the representatives of Israel’s diverse religious communities — the split was only between religious and nonreligious Knesset representatives.
Rav Shlomo Zalman and the other gedolim Dr. Steinberg knew so well are no longer with us, his close connections with them now mere memories from the past. But he carries on, making a compelling case wherever he can get a hearing for the uniquely Jewish view of life and what it means to be human. The world may refer to this arena as “Jewish medical ethics,” but ultimately, for Rabbi Dr. Avraham Steinberg, that’s just another way to speak of the Jew’s most basic obligation — to follow the ratzon Hashem as expressed in halachah.
(Originally featured in Mishpacha, Issue 710)
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