An Israeli Ethicist Helps Physicians Untangle the Dilemmas of Covid-19

Israelis can be a rough-and-tumble, self-reliant lot, but a strange thing happened as the coronavirus crisis has dragged on through March and April and into May: they sought counsel about an unseen enemy that follows no ethical rules.

Israelis have been inundating a prominent ethicist with requests for moral guidance during the coronavirus crisis, from doctors who want to quit work to people angry about Ikea opening while cemeteries remained closed.

“Normally, I get just five questions a week, but over the last two months I’ve received hundreds,” Yuval Cherlow said.

Everyone gets an answer, but sometimes it’s not what they want to hear. Questions come from people frustrated by lockdown restrictions, decrying them as illogical and hoping this gives them the moral high ground.

“But we’re dealing with a virus that doesn’t follow our rules of logic,” said Cherlow, who sits on a Health Ministry ethics committee and has lectured widely on ethics, including at a 2018 conference of the United Nations cultural body UNESCO.

While Cherlow is a yeshiva head and director of the Center for Jewish Ethics at Tzohar, an alliance of Orthodox rabbis, he receives questions from a wide spectrum of Israeli society and draws on secular ethics as well as religious ideas.

“We’ve had doctors saying they are afraid and asking if it’s ethical for them to quit,” Cherlow told The Times of Israel. “People have said they are afraid for their families and for themselves. It’s not just about looking after themselves, it’s a conflict between two commitments they feel.”

“One doctor put it this way: ‘Who do I have a bigger commitment to? Patients or my children?’” he said.

Cherlow told the questioner that quitting in the crisis would be like abandoning a bunker during war.

“I compared their situation to soldiers. Over the years they got benefits as doctors, with training and a salary, so they have a commitment to give back when needed, as soldiers do in a battle,” he said.

He also reasoned that a doctor’s young family is more equipped to fight the virus, if they catch it, than patients at hospital who are in need of care.

But Cherlow’s answer was different when a hospital cleaner asked the same question, because, as a contract worker, and someone who has received less training and investment from the state, he has a smaller level of obligation.

“His commitment is lower,” Cherlow said. “He is part of the war so he has a commitment to the hospital but if his danger is high, for example because he lives with his parents, he could easily say he doesn’t want to do it.”

In the end the cleaner decided to continue working. “He didn’t quit because, weighing the factors, I outlined that he does a very important job, and this recognition was important to him,” said Cherlow.

Over the last few days, so many parents have been asking him whether it’s ethical to send children back to school despite the chances of them spreading the virus that he published a Times of Israel blog post on the subject. Risk is part of life and there is “no ethical or moral obstacle to a parent deciding to send his or her child back to school,” he concluded.

Some have contacted him to discuss the ethics of the government’s response to the outbreak, including from some journalists who were exempt from cell phone tracking to protect confidential sources.

“I replied that if it was a personal privilege for reporters it would be unethical,” he said. “But reporters do work of public importance and they need to be able to keep sources secret to do their job, so it’s justified.”

He receives questions about financial ethics from businesses that are hard hit by the crisis, and educational institutions that needed to close after people paid for classes.

He also gets inquiries about some of the ugliest effects of the lockdown. “In the last ten days there are more and more questions from women saying they are suffering from violence,” he said in an early May interview.

Some come from women who doubt their ethical right to take action against the violence, and receive swift reassurance from Cherlow. There are also messages from social workers, who want ethical advice to consider alongside professional guidelines.

One query related to a woman experiencing violence who insisted that she didn’t want her husband removed from the home. The social worker was considering whether to use his professional powers to “force” the husband out of the home, or whether this would undermine the woman’s freedom of choice.

“I said that from the ethical perspective the assumption is that she is the decision maker,” Cherlow said. “But when there are good reasons in extreme situations, it may be that you are 100 percent sure she doesn’t really have freedom of choice. If she is living under this kind of threat the ethical thing is to send the husband away from the home.”

As well as dispensing ethical advice, Cherlow has been busy calling people out when he feels they are trying to frame non-ethical questions in ethical terms.

“One of the main crises for people is the fact that the virus doesn’t obey ethical rules, and because of this, people have been feeling that the reality they have been living isn’t fair,” he said, explaining that this means coronavirus regulations can often seem unfair even if they are justified.

Many bereaved families were furious on Israel’s Memorial Day last week, when cemeteries were shut, even though other restrictions, such as those governing retail, had been relaxed. Cherlow commiserated but refused to acknowledge an ethical element.

He explained: “Was it ethical to keep cemeteries closed but open Ikea? I said it’s not an ethical question, but a medical one. If people hug each other for comfort in cemeteries but don’t do that in Ikea, it’s a medical issue. Part of our mission is to say what is an ethical question and what isn’t.”

In a similar vein, when synagogues were closed (they are now open under social distancing rules), frustrated worshipers who may have expected a sympathetic ear from Cherlow, as an Orthodox rabbi, ended up disappointed.

People turn to him saying it is illogical that demonstrations are allowed but synagogue services still aren’t. “It has an ethical factor, given there are values attached to demonstrating and values of freedom of religion,” he said. “But practically speaking it’s different. In synagogues people are close together, meeting three times a day, while demonstrations are occasional and less concentrated.”

The solution adopted by the state regarding prayer (until mid-May when the restrictions were lifted) was that people can gather for services, but outdoors. Cherlow considers it a good compromise, but with a problem.

The outdoor services are limited to 19 worshipers, and many communities have given men preference for the limited amount of space, while women rarely participate.

He acknowledged that Orthodox religious law doesn’t give women the same obligation to pray with a quorum as men and doesn’t count them toward the quorums, or minyanim. But Cherlow said that there is an ethical imperative to ensure that all citizens, men and women, feel equally empowered to be part of communal religious life if they wish.

“The government law is OK, but practically, people are organizing minyanim and aren’t leaving capacity for women to pray at the services, and this is an ethical issue,” he said. “We need to find a solution in which 50 percent of the population doesn’t feel excluded from minyanim.”