Medicine, ethics and politics

Ministerial malpractice


In 1983, at age 23, Ron Houben was involved in a car accident that left him completely paralyzed and in a coma. The young Belgian had been a martial arts expert and engineering student; now doctors diagnosed his condition as persistent vegetative state. His eyes could move; he had periods of sleep and wakefulness, but he appeared unconscious; unable to reason or respond.

In reality, Houben knew what was happening around him but had no way of signaling he was a sentient being. He could not even blink an eyelid.

His mother's intuition led her to believe that her son was not a hopeless case, and over the years she took him to the United States five times for sophisticated tests.

She eventually connected with Dr. Steven Laureys of Belgium's Coma Science Group, who put Ron through a PET scan that detects energy given off by a radioactive element injected into the patient. The exam, which was not available when Houben was first diagnosed, showed that he probably could think and reason after all, even if he was immobile and uncommunicative.

This stunning discovery, made three years ago, has only now come to light. Laureys came up with a computer-assisted touch screen that allows Houben, now 46, to use the partial mobility he has in one finger of his right hand to type out his thoughts - with the help of an aide.

"I shall never forget the day when they discovered what was truly wrong with me," he wrote afterward. "It was my second birth. I was shouting, but no one could hear me."

Houben now sits in a wheelchair, his body twisted to one side as if in suspended animation, but his eyes are open and he can now "speak" via computer. He wrote that he maintained his sanity by dreaming himself away. "I was only my consciousness and nothing else."

His mother insists he is not depressed, that he is an optimist and that he wants to get the most out of his life.

Laureys claims that "up to 43 percent of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state."

Surely, this case will further sensitize medical ethicists, physicians and others involved in the care of similarly situated patients about when to end aggressive intervention and restrict treatment to palliative care alone until nature takes it course.

Medicine is both an art and a science. Physicians deal in probabilities. Sometimes they get it wrong; sometimes miracles happen.

Optimistically, Laureys's work may cause physicians to reevaluate the brain activity of patients who were diagnosed as being in a persistent vegetative state before PET became available. (The technology has long been available in Israel.) It's not apparent whether the failure to correct Houben's diagnosis any earlier can be attributed to medical malpractice.

WHAT'S EVEN worse than doctors getting a diagnosis wrong? Answer: A politician playing doctor.

Here at home, Deputy Health Minister Ya'acov Litzman has drawn a sharp rebuke from the head of the Israel Medical Association (IMA) for personally and repeatedly intervening in the care of a patient at Schneider Children's Medical Center.

Litzman ordered doctors to treat a lower-brain-dead baby with antibiotics. This patient's condition has nothing in common with being in a vegetative state or in a coma.

The standard protocol for lower-brain-dead cases, after evaluation by two physicians and with the approval of director-general of the Health Ministry, is to discontinue the respirator. Under Israeli law, however, the hospital must honor the wishes of the family if it insists that a lower-brain-dead patient continue to receive nourishment and stay on a respirator. But no one has a right to demand the patient receive antibiotics.

The Health portfolio is formally held by the premier. Litzman is a deputy minister because his United Torah Judaism Party is unwilling to assume responsibility for the actions of a Zionist cabinet, though it does consent to exercise governmental power.

The IMA declared that Litzman had "no right to intervene" in this case. We agree. Israel can't afford to have politicians or clergymen micro-managing medical cases any more than it can tolerate having transportation ministers supplant air-traffic controllers at Ben-Gurion Airport.

If Deputy Health Minister Litzman concludes that his fiduciary responsibilities to Israel's citizens cannot be reconciled with his deeply held religious convictions, let him draw the necessary conclusions.

On the 36th anniversary of David Ben-Gurion's death

Principle & pragmatism


Yesterday, according to the Hebrew calendar, marked David Ben-Gurion's 36th yahrzeit. A founding father of Israel and its first prime minister, he died on December 1, 1973 at 87.

In considering the lessons to be drawn from Ben-Gurion's life, one involves his quest for the right balance between ideology and pragmatism. His admirers argue that Ben-Gurion was wise to jettison ideological consistency in the name of creating and consolidating the Zionist enterprise.

He was a socialist, though Marxist dialectics took a back seat to his Zionist pragmatism: settling the land and promoting aliya. Doggedly single-minded, he acquiesced to majority rule, but was no pluralist. He ruled his party and saw to it that it ruled the Histadrut, the Jewish Agency and the government. Ben-Gurion expected absolute allegiance to the cause in the way that he defined it.

HIS CRITICS on the Zionist Right, followers of the classically liberal ideologue Ze'ev Jabotinsky, denounced Ben-Gurion's willingness, by 1937, to accept an independent Jewish state in a small part of Palestine, when by Divine right, historical association and international treaty the Jews deserved all of Eretz Yisrael. The Jabotinsky people did not understand how Ben-Gurion could cooperate with the British while their White Paper barred the doors of Palestine to Jewish refugees. Nor could they forgive his June 1948 decision to sink the Irgun arms ship Altalena, carrying desperately needed weapons, to hammer home the point that the future state would have one unified command and he would be the commander-in-chief.

He was uncompromising not in his ideology, but in his pragmatism. He insisted on unity, seeing fragmentation as an obstacle to achieving Jewish independence. In a 1944 speech, he declared, "Anyone who questions the ultimate authority of the nation as a whole… undermines its dynamic potential." He personified that ultimate authority.

Ben-Gurion sought Arab assent for Zionism by holding talks with Mussa al-Alami, a pre-state Palestinian leader. He assured the Cambridge-educated Alami that his people would materially benefit by recognizing Jewish rights to Eretz Yisrael and agreeing to live in peace. But when Alami replied that the Arabs would rather see the country remain a wasteland for another 100 years than share it with the Jews, Ben-Gurion concluded that war was inevitable.

He speculated - somewhat optimistically, it turns out - that once the Arabs were decisively defeated and had witnessed the Jews developing the country, they might "possibly acquiesce in a Jewish Eretz Israel."

In the final analysis, Ben-Gurion believed that statecraft was the art of the possible, that ideology was something to be overcome if it stood in the way of pragmatism, that gradualism could deliver the very same outcomes as an all-or-nothing approach.

Where he also did not waver was in his philosophical commitment to the Zionist goal. He was faithful to a Jewish revolution "against destiny, against the unique destiny of a unique people." The Jews, he argued, were distinguished by their refusal - from Hadrian to Hitler - to surrender to historic destiny. For him, the meaning of Zionism was to teach the Jewish people that "non-surrender" was not enough: "We must master our fate; we must take our destiny into our own hands" by creating a state.

OF COURSE, if Ben-Gurion's legacy makes the case for setting aside the ideal for the practical, there is no shortage of contemporary politicians for whom "pragmatism" is nothing but a fig leaf for careerism, sloppy intellectual thinking, or even nefarious motives.

Take the particularly blatant example of Venezuelan dictator Hugo Chavez.

He is supposedly a Christian ("I preach the word of Jesus Christ") and a leftist, but he has pretentiously embraced two Muslim religious reactionaries. His dalliance with Iranian President Mahmoud Ahmadinejad is well-known, but his defense of Ilich Ramirez - aka Carlos the Jackal, a convert to Islam and a believer in the path of Osama bin Laden - is only now getting attention. Chavez's favorite anti-Semitic newspaper, Vea, is lobbying to have Ramirez transferred from France, where he is serving a life term, to Venezuela.

Historians will argue about the legacy of principled leaders who chose pragmatism over ideological consistency. But we do not have to wait for history's judgment to label as "wicked" the demagogue who cobbles together an incoherent platform of Marxism, Jew-hatred, Israel-bashing and populism.

This could be the start of the third intifada...

What price Schalit?

Arab press reports, echoed in Israel, claim that Gilad Schalit's long ordeal in Hamas captivity may be nearing its end, perhaps even this weekend to coincide with Id al-Adha, the Muslim holiday marking the end of the Haj.

There are other hints something is afoot. Shimon Peres was in Cairo yesterday to see President Hosni Mubarak. Guido Westerwelle, the new German foreign minister, is here today to meet Prime Minister Binyamin Netanyahu. The Germans are acting as brokers between Hamas and Israel. Lastly, perhaps to stabilize conditions pending a prisoner exchange, Hamas said it had reached agreements with the other Gaza terror groups not to attack Israel without coordination.

That news came after Kassams slammed into Sderot on Saturday. But the IAF's retaliation against weapons factories and a smuggling tunnel in Gaza prompted Hamas's own military wing to threaten further attacks. And Islamic Jihad denied it was party to any arrangement in the first place.

Since the conclusion of Operation Cast Lead in January, 270 rockets and mortars have been lobbed at Israel from the Strip.

WHEN IT comes to Schalit, it's hard to know where the spin ends and the news begins. According to the London-based Arabic newspaper Al-Hayat, Israel is poised to free hundreds upon hundreds of Palestinians in exchange for our young soldier.

From the time he was taken in June 2006, Hamas has been holding firm to its demands that it will free Schalit only in exchange for 1,000 of its operatives held by Israel. The present haggling, Arab reports imply, is partly over whether, once at large, the masterminds of the Sbarro, Moment Cafe and Dolphinarium bloodbaths, and of the Netanya Pessah Seder massacre, will be required to seek asylum outside Gaza and the West Bank. Some reports have Israel refusing to release these men or east Jerusalem prisoners sought by Hamas. If true, that probably means no deal.

Plainly, Netanyahu is loath to have his
government approve a lop-sided prisoner exchange that requires setting free some of the most dangerous terrorists Israel has ever encountered. Yet he may be telling himself that any such deal would be the absolutely, positively, honest-to-goodness, very last time Israel capitulates to Hamas or Hizbullah.

Hamas begs to differ. It's already offering a $1 million bounty to any Arab citizen of Israel who abducts another Israeli soldier.

An ill-considered prisoner deal could also bring down Mahmoud Abbas's already tottering Palestinian Authority in the West Bank. That would set the stage for Hamas to fill the political vacuum. As it is, with Hamas breathing down his neck, Abbas is being more obstinate than ever, even hinting that he might pursue popular resistance instead of negotiations. Fatah "redeemer" Marwan Barghouti, incarcerated for orchestrating numerous murders, has put out the word that any future negotiations with Israel ought to be accompanied by terrorism. If Israel yields to Hamas, as an offset, Barghouti could be released to "help Abu Mazen."

TOO BAD Israelis can't look to Egypt to play a constructive role. For the sake of expediency Cairo is ready to disregard the principles set down by the Quartet as a prerequisite for Hamas participation in a Palestinian unity government.

Mubarak's regime is once again turning a blind eye to Palestinian arms smuggling beneath the Philadelphi Corridor which has now reached pre-Operation Cast Lead levels. Mubarak is also doing everything possible to harden Abbas's heart, telling the Egyptian parliament Saturday that Israel alone was to blame for the paralysis in the peace talks.

He insultingly called on Israel to stop "Judaizing" Jerusalem and demanded it reconcile itself to the Arabs' refusal to recognize its right to exist as a Jewish state. With a straight face, Mubarak demanded that Israel end its blockade of the Strip - as if Cairo did not maintain an identical (surface) embargo between the Sinai and Gaza.

AS MUCH as we Israelis ache to see Gilad Schalit home with his family, the emotional blackmail of campaigners who say the country should do "anything" to achieve his release could unleash on our home front the very same sociopathic killers Israel's security forces worked so hard to capture in the first place.

We urge the premier to leave no stone unturned in trying to bring Gilad home, while placing the national interest above all.

How NOT to honor Shabbat & promote Judaism

Shabbes! Shabbes!


Sometimes it seems as if there's an evil mastermind out there determined to make Jewish tradition, observance and ritual seem repellent, retrograde, even ridiculous to as many unaffiliated and secular Jews as possible while making even the traditionally observant cringe with embarrassment.

What better way to heighten alienation from all things Jewish than to rebrand Judaism as the sole province of a scowling ultra-Orthodox minority - and to do so in Jerusalem before the entire world. Last Shabbat, hundreds of "fervently Orthodox Jews" spent the afternoon rioting outside the Intel computer chip fabrication plant in Jerusalem, "desecrating the Sabbath in order to save it."

Hassidim and mitnagdim, comrades-in-arms, scuffled with reporters and cameramen whom they had lured to their demonstration and roughed up a haredi vice-mayor of Jerusalem whose zealousness was called into question.

The next day, Intel discovered that someone had broken into the company's chapel, smashed windows, broken furniture and left prayer books strewn about.

At issue were fears that Intel would induce, not obligate, Jewish employees to work on Shabbat. The company believes that the waiver it has long held to operate on Shabbat remains valid at its Jerusalem factory in Har Hotzvim, a hi-tech compound near an expanding haredi district. Intel says that for both technical and business reasons, the factory's fabrication work must carry on 24/7. The company's computer chips are a major Israeli export.

Clearly, Israel needs Intel more than it needs its benighted opponents.

THE ASSAULT on Intel has been instigated primarily by the virulently anti-Zionist Eda Haredit. This week, comparatively moderate Hassidic, Lithuanian and Sephardic ultra-Orthodox leaders have been negotiating with the company, offering to muzzle their acolytes in return for a verifiable Intel commitment to employ only non-Jews to work the Shabbat shifts.

Even if an agreement can be reached by sundown Friday, the Eda Haredit is still intent on sending its soldiers into the streets after Saturday morning services to howl, "Shabbes, Shabbes!" and seek violent confrontation.

For a living, the Eda Haredit provides kosher certification for vendors, stores, hotels and restaurants. Its imprimatur is ubiquitous - so in a sense, consumers who patronize establishments beholden to the Eda are funding its "Shabbes" activities.

The Intel riots were only the latest acts of intimidation by haredi extremists against the ideal of a Jerusalem that is tolerant, pluralistic, tradition-friendly and Zionist.

It doesn't take much to provoke haredi unrest: rumors of an autopsy; the arrest of an abusive mother - or a murderous father; the opening of a free parking garage; vehicular traffic on a boulevard haredim call their own.

By flamboyantly running amok in Israel's capital, the extremists perpetuate the sense of Jerusalem as unlivable, ungovernable and unreasonable.

WEDNESDAY SAW another manifestation of haredi bullying as "fervently Orthodox Jews" became enraged when a female medical student in the women's section of the Western Wall compound donned a tallit and held a Torah scroll.

Among the ultra-Orthodox, these activities are the preserve of men. Her actions also contravened a court-mediated policy that, for all intents and purposes, has converted the Kotel into an Orthodox shrine. The Wall reverts back to the nation on Holocaust Remembrance Day, Yom Hazikaron and for occasional military ceremonies.

The medical student is a member of Women of the Wall, which meets on Rosh Hodesh at Robinson's Arch, an enclave close to the Western Wall where women's - even egalitarian - services are tolerated. But this time, the Women of the Wall unwisely decided to push the envelope and moved their services to the Kotel's segregated women's section, where their un-Orthodoxy infuriated those who "tremble before God." The rabbi of the Wall, a government employee, denounced the defilement of his turf. So police whisked away the prayer shawl-wearing, Torah scroll-carrying woman before a riot could ensue.

While we sympathize with the desire to make the Western Wall prayer area a spiritually inviting place for all Jews, seeking confrontation with the entrenched Orthodox establishment is an exercise in futility.

Only when the political system is reformed so that religious zealots lose their disproportionate influence can this particular wrong be righted. Of course, when deliverance comes, Zionist decisors of Halacha, animated by the desire to harmonize tradition with the practical needs of running a modern Jewish state, will have taken charge of the spiritual direction of the country.

Abe Foxman is worried. Maybe, just maybe, he's right

Crossing the line


There is a perennial debate among Jewish intellectuals in the United States about whether Jews are more naturally suited to be liberals or conservatives. Norman Podhoretz's latest book Why Are Jews Liberals? laments the fact that so many are; Leon Wieseltier's New York Times book review replies: How could Jews be anything else? Each side musters proof-texts from Jewish sources and history to make its case, though there isn't universal agreement on how to define "liberalism" and "conservatism."

In any event, there is one thing liberals and conservatives agree upon: In the course of Jewish history, Jews have done best in societies characterized by political, social and economic stability, and suffered where opposite tendencies prevailed. So, regardless of political orientation or denominational affiliation, it's plain that upholding the legitimacy of the American political system and preserving its stability is a Jewish interest.

That is why we were struck by "Rage Grows in America: Anti-Government Conspiracies," newly issued by the New York-based Anti-Defamation League. Conservatives would argue that lack of faith in the government is called "democracy in action." The sections of the report that draw our concern, however, spotlight the activities of a minority on the Right who have crossed the line from criticism of President Barack Obama's policies to denying the legitimacy of America's political system itself.

As is often the case, the excesses on the Right were precipitated by bad behavior on the Left. Recall, for example, how MoveOn.org compared George W. Bush to Hitler. Now, it is rightists who are accusing a president of plotting to destroy the American way of life.

Even the comparatively mainstream Rush Limbaugh has flirted with Hitler-Obama analogies. The more volatile Glenn Beck screams that Obama is taking the United States "towards socialism, totalitarianism beyond your wildest imagination."

BUT IT is destabilizing conspiratorialists who trouble us. They say Obama is a closet Muslim, or assert that his Hawaii birth certificate is a forgery so he is constitutionally ineligible to be president.

Among the conspiratorialists are demagogues pushing claims that the Federal Emergency Management Agency is constructing concentration camps, and that a (supposed) "door to door" gun confiscation campaign is a precursor to martial law.

The ADL study draws attention to some lesser known demagogues including Texas-based Alex Jones whose broadcasts and Web sites promote the theory that the 9/11 attacks were an "inside job" by the American government, part of an elaborate plot involving international bankers, the Federal Reserve, the Council on Foreign Relations and the Bilderberg Group to create a New World Order. (Of course, 9/11 conspiracy theories also thrive on the extreme Left and in Arab circles.)

On a recent program, Jones warned that a public health education effort aimed at children to curtail the spread of H1N1 virus was actually a psychological warfare scheme to brainwash them to become informers against their parents. He said the government will use fears surrounding H1N1 to stage a pandemic in order to declare martial law. The H1N1 vaccine, said Jones, is a plot to sterilize the masses. The ADL report also points to some 200 militias across America training for the day when the government turns against its citizenry.

Some will dismiss the report as alarmist or argue that ADL national director Abraham Foxman is pandering to his liberal constituents. We worry, however, that Foxman's claim of "a toxic atmosphere of rage" in America is not hyperbole, but a true assessment of the political system's condition.

REGRETTABLY, there are fresh signs that "toxic rage" exists here in Israel, too, among an increasingly radicalized segment of the settler population. It's manifested by a worrisome breakdown in army discipline among soldiers whose first allegiance is not to the state.

On Monday, several enlisted men from the Nahshon battalion held a political protest on base evidently out of pique that the IDF had dismantled an illegal outpost earlier in the day. The issues at stake transcend partisanship.

Demagogic Knesset members and post-Zionist rabbis who encourage servicemen to disobey their officers, or deny the legitimacy of the political echelon to direct the military are undermining the State of Israel.

Disrespect for legitimate authority, demonization of elected officials and demagoguery are bad for the Jews… even when it takes place in their own state.