Friday, November 26, 2010

Liberated Learning

Grand Opening, Chanukah Concert & Community Lighting of Giant Menorah

Grand Opening celebration of Winnipeg's first Jewish Learning Centre

With much gratitude, joy and excitement, we invite you to attend the historic dedication of the new Jewish Learning Centre on Sunday, December 5th at 3pm.

The community-wide program will feature an exciting family concert, a special video presentation, a festive lighting of a giant menorah (the largest in Western Canada), and will conclude with our annual car menorah parade accompanied by a remarkable display of fireworks.

Come celebrate our very own modern-day Chanukah miracle!

For more information, please visit our newly designed website at or call us at 414-5624.

Thursday, November 25, 2010

Genetics and the Ethics of Patient Confidentiality | Lesson Six

Join us for Lesson Six: Secret Code

Genetic testing unlocks secrets that used to be unknowable. They can be used to identify parentage; they can be used to predict illness and death. But what happens if this information gets into the wrong hands—or is withheld from the people who need it most?

Does a potential spouse have the right to know that her husband-to-be will likely be dead before the age of fifty of an illness that does not yet have any external symptoms?

And as keeper of the “code,” what is the role of the doctor in all this? When must patient confidentiality be upheld and when must it be set aside?

We’ll talk about this during our last lesson of Medicine and Morals at the new Jewish Learning Centre!

What's the difference between a neurotic, psychotic and psychiatrist?

The first one builds castles in the sky, the second one lives in them, the psychiatrist? He collects the rent!

Review of Lesson Five

Dear Student,

Thank you for joining us for Lesson Five of Medicine and Morals: With You In Mind. The following is a brief summary of what we learned:

As humans, we stand apart from all other creatures because of our cognitive ability. When this ability to reason and discern is weakened or impaired, it is very tragic. Judaism obligates us to treat mental illness in the same way that we are obligated to treat physical illness. Halachah regards the recommendations of a qualified psychiatrist with the same esteem as the recommendations of other physicians, and takes account of mental well-being when issuing a ruling.

Kissing in Public by Rabbi Moss

Question of the Week:
I have an issue with religious Jews. They have this thing about not showing affection in public. You would never see a very religious couple holding hands walking down the street and certainly not kissing in public, as it is considered immodest. But I think this teaches children that affection is bad and romance is taboo. How will they ever get married if they don't see affectionate parents?

Here is a true story that happened to a family I know. They are observant and G-d fearing people, and indeed the parents never showed physical affection, even in front of their own children.

It once happened that this family was out driving in their van, parents sitting in the front, and their large brood in the back. While stopped at a red light, one of the children pointed out a scene that caught his eye. Right beside the car, on the side of the road, was a young couple engaged in a very public display of affection.

Thursday, November 18, 2010

Join us for Lesson Five: With You In Mind

Dear JLI Student,

The history of the treatment of the mentally ill is a sad one. In the seventeenth century, the mentally ill were often chained to walls, whipped, and housed in dungeons with vagrants and criminals.

Nineteenth century reformer Dorothy Dix was at the vanguard creating humane asylums for the insane, where patients were provided sunny rooms and opportunity to exercise outdoors. Yet a century later, many of these asylums were overcrowded and filthy, the chains of an earlier age replaced with surgical lobotomy, electro-convulsive therapy, and stupor-inducing drugs.

With the development of new psychiatric drug treatments in the seventies and eighties, it was felt that the asylums had outlived their usefulness, and most of them were shut down. Yet they were not replaced with appropriate housing alternatives. Today, more than 100,000 people in American jails are mentally ill. Some are held there without charges while they await a bed in a psychiatric hospital.

If excessive interference into the lives of the people who are mentally ill has often resulted in travesty, benign neglect has not yielded more humane results.

In this lesson, we explore some Jewish ethical guidelines for the development of compassionate treatment for people suffering from mental illness.

Looking forward to seeing you next Tuesday.

Wednesday, November 17, 2010

Review of Lesson Four

Thank you for joining us for Lesson Four of Medicine and Morals: New Beginnings. The following is a brief summary of what we learned:

The need to address the permissibility of the various reproductive technologies is of paramount importance. The Torah documents the deep pain associated with infertility. In addition, Jewish thought views procreation as a religious obligation. Each child who is born plays a fundamental role in developing the spiritual potential of our universe. Thus, for both empathic and spiritual reasons, there is strong incentive to find ways to assist people in their efforts to bear children.

The use of donor sperm raises halachic concerns. Some of the questions revolve around the issue of family: Does using sperm from another man infringe upon the relationship of husband and wife? Will such procedures weaken the desire to marry? Another concern is the possibility of incest should siblings unwittingly marry one another. Given the anonymous nature of sperm donation, this is not a spurious concern, and cases of this kind have been documented

Artificial insemination by husband and IVF using gametes of husband and wife would appear to bypass all these concerns. However, this is only the case if adequate precautions are taken to ensure that there is no inadvertent mix-up of gametes. At this time, fertility clinics are not governed by uniform standards to prevent errors. Some rabbis advocate having independent inspectors to ensure mistakes don’t occur.

In the process of preparing embryos for IVF, it is often the case that more pre-embryos are created than can be implanted. These pre-embryos can be very useful for embryonic stem cell research. Yet a national debate currently rages about the ethical acceptability of this research. Rabbis who have been consulted about this issue note that Halachah permits the destruction of a pre-embryo that will not be used by the parents. Thus, using these pre-embryos for research would be permitted and perhaps even better than outright destruction. “Adopting” pre-embryos by implanting them into other women, an idea advocated by some opponents of embryonic stem cell research, raises many halachic issues similar to those that arise when donor sperm is used to induce pregnancy.

We concluded the lesson by raising some important points: There is no obligation to engage in ART. The mitzvah is to attempt to bear children in the usual manner. Intervention is optional. Those who have not yet succeeded in bearing children should on the one hand stay hopeful and optimistic. On the other hand, they must know that when one cannot fulfill an obligation for reasons beyond their control they have fulfilled their religious obligation and are not held liable for this failure. Moreover, G-d considers it as if the mitzvah was actually done. Finally, they should find comfort in the thought that every person has the opportunity and possibility of finding meaning in life and even the childless can achieve an everlasting legacy through their actions and good deeds.

Some people will express this legacy through fostering or mentoring a child. The Torah considers aiding in the physical and spiritual development of others as analogous to giving birth to them.

We look forward to seeing you next week for Lesson Five of Medicine and Morals in which we will explore the Jewish attitude regarding the ethical treatment of the mentally disabled.

Friday, November 12, 2010

Grow Winnipeg Campaign; Weekly e*Torah

When You've Lost Everything; by Rabbi Moss

Question of the Week:
My life has fallen apart. My husband left me, I have been kicked out of my home and my career is over. And now I am losing my faith too. I used to believe so strongly, but now my thinking has changed. Was I deluded to think that G-d would help me?

Answer:I feel for you in what must be a huge test of your character. Your whole world has been shattered to pieces. Just to get up in the morning and face the day must take mammoth strength.

There is a name for your situation. The Kabbalists call it Ayin Baemtza - "transitional nothingness."

Between any two states of being lies an intermediary state of nonbeing. Like a seed that must become a tree, it first decomposes, nullifies itself and rots into oblivion. Just as it reaches the verge of complete nonexistence, the seed starts to sprout and reinvents itself into a new being. Only by losing its being as a seed and becoming nothing, can it reach a new being, a greater being, as a tree.

It has to be this way. To truly reinvent oneself, there must be a true and complete break from the past, a real nothingness, to make room for the new self to emerge.

You are presently going through an Ayin Baemtza stage in your life. The life that was is gone, the life that will be is yet to blossom, and you are left in a big black hole of confusion, pain and darkness. That is a very hard place to be. Because everyone knows that transitional nothingness is just a temporary state, a step between two stages in life. Everyone knows that except the one who is going through it themselves. For you the nothingness is real. It is hard - maybe impossible - for you to see any bright future ahead.

So what can you do to survive the transitional nothingness? What will keep you going until you transform into the you of tomorrow?

In your state of nothingness you need to hold on to something higher than yourself. Now, you need faith, not philosophy. Say to yourself: My life is in disarray, I don't know what's flying, I don't know what will be, but I am in G-d's hands. This is a process that for whatever reason I must go through. And with G-d's help, I will get through it.

When in an Ayin state, it is not the time to be changing belief systems, or making important life choices. The ground you are standing on is too unstable for you to be able to think clearly. It would be sad - no, it would be tragic - if in your frustration you made choices that you will later regret, but not be able to reverse.

I offer no solutions to your predicament. But I offer you one piece of advice. Just hold on to G-d, the one thing that even in your nothingness you haven't lost. You will get through this black hole and your life will be reborn. The seed is planted. Have faith, and your new tomorrow will blossom soon.

Wednesday, November 10, 2010

The Ethics of Reproductive Technologies | Lesson 4

Join us for Lesson Four: New Beginnings

Dear Student,

Most people look forward to marrying and becoming parents at some stage in their adult lives. The difficulties in finding a suitable spouse are well known. However, many people are unaware of the difficulties that can dog the attempt to have children.

Up to fifteen per cent of couples experience infertility. Modern technological advances provide new hope for these couples, who in a previous era might have been relegated to life-long childlessness. Yet these new procedures present many ethical dilemmas as well.

In our lesson, we focus on artificial insemination and the challenges it creates, as well as how modern rabbinic authorities have endeavored to find workable solutions.

We also examine traditional Jewish perspectives toward childbearing and childlessness, as well as words of support for those traversing this difficult journey.

Looking forward to seeing you next week.

Review of Lesson Three

Thank you for joining us for Lesson Three of Medicine and Morals: Rolling the Dice. The following is a brief summary of what we learned:

There are two distinct states in life, and they generate very different views. When one is healthy, life feels like it stretches on indefinitely. We term this state chayei olam, literally, eternal life. But when debilitating illness strikes, life can suddenly begin to feel very tenuous. We term this state chayei sha’ah, literally, life of a moment. When one is in the state of chayei sha’ah, one is sometimes willing to take chances that would normally be considered outrageous for the opportunity to achieve a possible recovery to full health. Is one allowed to undergo such risk, jeopardizing the limited time one has left?

We learned the passage in the Talmud which rules that a terminally ill patient may risk their chayei sha’ah in the hopes of achieving a normal life. This is based on the incident related in the Bible where a group of famished lepers surrendered to an occupying force in the hope of receiving food, despite the possibility of being put to death as a result. This is the precedent which allows one to undergo a risky procedure if terminally ill. As long as death is imminent and inevitable without intervention, and a complete reprieve from death is possible, one may undertake the risk.

We looked at some important qualifications on the permissibility of pursuing risky treatments. According to many opinions, chayei sha’ah is defined as a state in which one has no more than twelve months to live, given the severity of the condition. There are different opinions as to how much risk one may undergo. The most stringent opinion is that it is only permitted to take risks if the chances of cure are even or better; the most lenient opinion allows even treatments with a remote chance of success so long as doctors believe that a cure is possible. To be considered cured, one must not be restored to full health, but simply no longer be at risk of imminent death from the dangerous condition.

We also considered the permissibility of experimental procedures when it is unknown whether they can be of any help to the patient and in which there is a lack of data that can allow us to assess the degree of risk or the effectiveness of the treatment. While some authorities only endorse treatments that have some track record of success, others permit experimental medicine even for a remote chance that it will save the patient’s life, seeing this as not significantly different from the case of risky treatments. Furthermore, so long as the procedure is halachically sanctioned, a parent or guardian may authorize the procedure for a patient incapable of doing so.

One is never obligated to undergo risky or experimental treatments. This is a decision that people must make for themselves, based on their own willingness to live with uncertainty.

Finally, we noted the importance of making sure that every moment of life is properly valued. We pointed out the important Jewish ethic of visiting the sick and offering comfort to the dying, making every moment of their life as meaningful as possible.

We look forward to seeing you next week for Lesson Four of Medicine and Morals, in which we examine the Jewish ethical perspective on infertility treatments.

See you then!

Tuesday, November 2, 2010

Canadian physicians can get CME credit

Below is a written confirmation from the Royal College to certify that Canadian physicians can get credit for attending MM. This JLI course was approved by SUNY Downstate for its enduring material (30 hours) and not for class time (9 hours). In Canada, there is currently no such thing as credit for 'enduring material', instead physicians in Canada will get a max of 30 MOC Section 1 credit for the full program (live discussion - lead by you, the discussion leader; pre-event reading - the remaining additional reading that is included in the student textbook; and the exam).

Here it is in the words of Kimberley Ross of the RCPSC:
"It is not necessary to have the event reviewed with an Accredited CPD Provider since this activity meets our guidelines for recognition: 1) it was co-developed with a physician organization and 2) has been assigned AMA PRA Category 1 credits™. I was recommending that accreditation applies to the entire process from the pre event preparation to the full day interactive event and the exam with a maximum of 30 hours assigned for the activity. Canadian physicians can then choose to record the actual number of hours they spent on this group learning activity under Section 1 of the Maintenance of Certification program. It is not the enduring materials that are eligible for accreditation but the full program."

Join us for Lesson Three: Rolling The Dice

Dear Student,

The history of medicine is filled with tales of quacks who had nothing to sell but hype and hope. People who are desperate enough figure they have nothing to lose, and are often willing to try almost anything.

But in fact, they do have something to lose. Often, they lose the chance to find closure, to make amends, to tie up loose ends, to die on their own terms. And so risky and experimental treatments need to be governed by certain rules.

What does Judaism have to say about risky and experimental treatments? When are they justified? When are they simply irresponsible?

Join us for Lesson Three of Medicine and Morals as we study the ethics of rolling the dice on life.

Review of Lesson Two

Dear Student,

Thank you for joining us for Lesson Two of our Medicine and Morals course. The following is a brief summary of what we learned:

With the sharp rise in demand for organ transplants, medical practitioners have in recent years sought to develop creative ways to respond to the growing need. This lesson explores how Jewish medical ethics has grappled with these new challenges.

The Torah accords great respect to the deceased body. There are several halachic principles that would seem to preclude organ donation, such as the obligation to bury a body as soon as possible after death, the prohibition against desecrating the body, and the prohibition against benefiting from any part of the body. These laws would seem to preclude the possibility of organ donation from a cadaver.

However, the Torah obligation to preserve a life that is at stake, piku’ach nefesh, might trump these principles. We presented three different views regarding cadaveric organ donation. Some forbid it, arguing that once a person is deceased, the obligation to perform the mitzvah of piku’ach nefesh is no longer relevant. Others say that to the contrary, the obligation to perform piku’ach nefesh means we may harvest organs even without the consent of the deceased. A third opinion that we cited considers cadaveric donation praiseworthy, though not obligatory.

There is halachic debate as well regarding the issue of harvesting organs from people who are brain-dead. Judaism strenuously opposes any action that would hasten the death of a dying person. Because there is some doubt regarding whether brain death is to be considered true death, most halachic decisors oppose heartbeating donation.

What about the live organ donation? Would we be obligated to donate a kidney to save a life? We examined two verses that are the source for the obligation to expend money as well as exert personal effort to save another’s life. Yet one cannot be obligated to undergo risk or to sacrifice a limb in order to save a life. Should a person wish to undergo a risky procedure to donate an organ, some authorities permit this, while others forbid it. If, however, donation is not risky, all agree that it is laudable and praiseworthy to donate an organ.

We look forward to seeing you next week, for Lesson Three of Medicine and Morals when we will discuss the ethics of risky and experimental treatments.

Join us for Lesson Two: Flesh of My Flesh

Dear Student,

You’ve seen the ads in the paper, of young mothers and loving fathers, begging for a chance at life. And you’ve heard the testimonials of people who, out of the goodness of their heart, chose to donate a kidney to a perfect stranger.  Perhaps you even know an organ donor or organ recipient. 

And yet the demand is much greater than the supply. In 2009, over 100,000 people in the U.S. were waiting for an organ transplant. Yet less than a third of them received the much-needed organ.  

What are the ethics of organ donation? Are there ways to increase the number of organs available for transplant? Is it ever right to compel people to donate organs? 

Join us this week for Lesson Two of Medicine and Morals: Flesh of My Flesh, as we explore this timely issue together.

Location change for Wednesday morning class

Due to a time conflict with another Chabad program, our Wednesday morning JLI class will no longer be taking place at the Chabad Torah Centre. Instead, it will be held, G-d willing, at Susan Holt's house at 419 Hosmer Boulevard, on Wednesday mornings from 10:00am until 11:30am.

Thank you for your understanding and I look forward to seeing you there tomorrow morning.

Organ Donation & Jewish Law | Lesson 2