Rabbi Adds Voice to Ethics Panel Advising Health Care Task Force : Insurance: Elliot Dorff hopes group headed by First Lady Hillary Rodham Clinton will provide a medical plan using a communitarian approach.

Rabbi Elliot Dorff has been giving the Clinton Administration an earful about ethics.

That’s not to say the University of Judaism provost from Los Angeles was reminding White House staffers to avoid accepting food, strong drink or envelopes stuffed with $100 bills from lobbyists. No, his advice was on a much higher plane.

Dorff, 49, an expert on Jewish law and ethics, was one of 32 ethicists who recently served on a panel advising First Lady Hillary Rodham Clinton’s Task Force for National Health Care Reform.

The task force’s main goal is to halt the soaring costs of treatment and provide medical coverage to all Americans, including the 37 million who are now uninsured.

The job of the ethics committee, which met almost weekly in Washington in late March and April before reporting its findings to the task force, was to identify the moral and ethical problems and issues that would be encountered in the process of establishing the national health care system.

The ethics committee’s report to the task force has not yet been made public, and Dorff said members of the panel were requested not to publicly discuss the contents. In a recent interview, however, Dorff talked in general terms about some of the ethical issues that had come up and offered his own views on some of them.

Most of the ethicists had secular backgrounds. Dorff, a Catholic priest and two Protestant ministers were the only ordained clergy on the panel.

Dorff, who is affiliated with Conservative Judaism, said he was pleased by the high level of idealism shown by the members of the panel.

“We were overcoming the notion that everybody’s out for him or herself,” said Dorff. “We have a responsibility to take care of each other. It was downright exciting to think in those terms again.”

Dorff’s Jewish views led him to take a stronger “communitarian stance” than did other committee members, he said. His position that a national health care system is the shared responsibility of all Americans is based on Jewish interpretations of community and justice.

“From a Jewish perspective, a community is not simply an aggregate of individuals who happen to join together for some specific purpose, such as paying taxes to support schools,” he said. “Instead, a community is an extended family of which we are part, whether we want to be or not. And our membership in such a community includes our duties to take care of each other.

“The Jewish tradition understands caring for someone else as tzedakah, as actions that are required by the norms of justice and not simply as charity which one may choose to give or not give,” he said.

More than 700 years ago, Dorff said, a noted rabbi named Nachmanides taught that a community was obligated to care for its sick; Nachmanides said this principle was directly derived from Leviticus 19:18: “And you shall love your neighbor as yourself.”

The task force is considering requiring all insurers to provide the same services nationwide. And although deciding exactly which services will be included on a standardized list might appear to be a matter of economics, ethical motivations also carry weight, Dorff said.

“We need to create a system that doesn’t break the bank and, at the same time, preserves the humanity and the dignity of all people throughout their lives, including the times when they are sick,” he said. “The other motivation is the enriched sense of community that we Americans should feel: that we should take care of each other when some of us are in need.”

Keeping people from experiencing pain should also be an ideal of an ethical health plan, Dorff said.

“Sickness is a degrading phenomenon,” he said. “Morally, you should keep people from pain to preserve their humanity and to express your love for them.”

Dorff’s committee discussed whether certain potentially controversial services, such as certain AIDS treatments and artificial insemination for infertile couples, should be covered under the national health care system.

As for abortion, the committee was instructed to avoid the topic, Dorff said.

“We were told that abortion is politically such a hot potato that ultimately the President and Congress are going to have to make that decision,” he said.

Creating a national care system involves thousands of decisions, and ethical considerations enter into most of them, Dorff noted.

For example, it has been suggested that an efficient way to administer the plan would be to give everyone in the country an identification card with a magnetic strip containing computerized information. But as with any credit card, the potential for abuses and invasion of privacy is great, Dorff said.

Dorff said the panel questioned whether illegal immigrants should be eligible for care under the system, and if so, would the Immigration and Naturalization Service have access to their files.

The task force’s plan to include health maintenance organizations, such as Kaiser Permanente, and paid provider organizations, such as Blue Cross/Blue Shield, in the national system also involves ethical concerns, Dorff said. Although HMOs are typically less expensive, they offer patients less freedom in choosing a physician. And that may reduce the opportunity for a patient to develop a continuing, trusting relationship with a physician.

“Medical treatment is not simply a function of the person’s body but also a person’s moral values or outlook on life,” said Dorff. A patient’s attitude toward transplants and life support systems, for example, can have a profound effect on the treatment he or she receives. “The advantage of a relationship with a private physician is that the patient has trust that the physician knows the moral views of the patient,” Dorff said.

Despite the complexities, Dorff said he is optimistic that a successful national health care system will emerge.

“As a human product, it will have its faults that will need to be adjusted as time goes on,” Dorff said. “But as far as I know, this is the first time Americans have worked together on these issues in a coordinated way. I have a lot of faith in what will happen.”

As a member of a subgroup within the ethics committee, Dorff helped write preliminary drafts of the preamble for the proposal to reform U.S. health care. In doing so, he said, he drew on ideals represented in the Constitution and the Declaration of Independence.

“This is going to sound corny, but it really made me proud to be an American,” said the rabbi, whose father was a Polish immigrant. “What was going on was exactly what Jefferson and Madison wanted: People coming from a variety of backgrounds and making their arguments and being persuasive or not. The only way the public could benefit was if all the arguments were heard in the first place. In that sense, it was American democracy at its best.”