pp. 62-67 in Bioethics for the People by the People, Darryl R. J. Macer, Ph.D., Eubios Ethics Institute 1994.

Copyright 1994, Eubios Ethics Institute. All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with Eubios Ethics Institute.

Neshama and Inochi as bases for Israeli-Japanese Bioethical Communication

Frank J. Leavitt, Ph.D.
The Faculty of Health Sciences, Ben Gurion University of the Negev, 84105 Beer Sheva, Israel

In August, 1939, only 54 years ago, when German armies were moving eastward, hundreds of Jewish refugees were trapped in Kovno, Lithuania. Being caught by the Nazis meant certain death. And there was nowhere else. Not only did the Americans and the English refuse to take any more Jewish refugees, the English were occupying the Land of Israel, and refusing to allow the Jews to enter even there.

The Jews appealed to Mr. Senpo Sugihara, the Japanese consul in Kovno. Twice the Foreign Ministry in Tokyo, refused permission to give the Jews visas. But Sugihara was impressed by the fact that the Jews were non-westerners like himself. He seemed to recognize characteristics of his own grandmother in the faces of old Jewish women. And he recalled an old samurai maxim: "Even a hunter cannot kill a bird which flies to him for refuge." Consul Senpo Sugihara disobeyed orders, risked his own career and issued the Jews visas which allowed them to travel to Japan and to live there safely until the end of the war (1).

I wish to begin this exploration of some common ground in Israeli and Japanese bioethics by thanking Senpo Sugihara and the Japanese people for a moral hospitality which other nations refused to perform. Indeed Sugihara's brave act was a paradigm for what I think are three of the most important concepts in cross-cultural bioethics.

In the first place, his act was an ethical act of the highest sort:disregarding selfish interests and seeking to do the ethical thing.

In the second place, his recognition of the non-western kinship of Jews and Japanese, symbolizes how important it is that we non-western nations develop our own answers to bioethical question, based on our own cultures, refusing to yield to western cultural imperialism.

In the third place, when Senpo Sugihara turned to samurai tradition he exemplified how ethics depends on values inherited from ancient traditions. For the thesis that philosophical and ethical concepts derive from pre-philosophical, prophetic sources, I recommend Cornford's work on the origin of Greek philosophical concepts in ancient religious tradition (2). And I myself have elsewhere touched all too briefly on the Scriptural background to our thinking about the freedom to express new ideas (3), about our obligation to conserve the environment (4) and about human rights and duties (5). If God had not informed Noah and Moses that we ought not murder, it would never have occurred to us that there is anything wrong with killing our fellow humans, and it would be much easier to yield to the pressure which is coming from some bioethical circles to terminate such supposedly resource-wasting undesirables as severely deformed neonates (6) and patients in the persistent vegetative state (7).

Bioethics, consists of two components: a scientific one and an ethical one. If the sources of our ethical concepts are indeed prophetic, then the bioethicist must imitate the great philosophers of the past who unlike todays specialized professional philosophers, were actively involved both in science and in religion.

The scientific component of bioethics, biological and medical science, is largely if not entirely, international and culturally neutral. I say not entirely because psychosomatic aspects of medicine and behavioural and social aspects of epidemiology are very much bound up with culture. But a very large body of biological and medical knowledge is culturally neutral. A surgeon can do a heart bypass operation, for example, without knowing the patient's religion.

But morality, the ethical component of bioethics, is largely but not entirely a product of ancient prophetic traditions of various nations. So ethics is largely relative to culture. But no entirely relative, because there are some basic moral principles, such as the prohibition of murder, which ought to apply to everyone. The vast majority of ethical matters, however, are very much culturally relative. The respective roles of men and women is society, for example, involve ethical questions to which different peoples may justifiably give different answers. My own tradition, the religion of Israel, symbolizes the difference between universal and culturally relative moral principles by distinguishing the commandments which God gave to all mankind, through Noah, from the commandments which God gave the people of Israel alone, through Moses (8,9). Not all nations are, like the Jews, are forbidden to eat rabbit for example. But all mankind are forbidden to steal or murder.

It is not, however, clear to me where to draw the line, in specific cases, between universal and culturally relative moral principles. We are all forbidden to murder. Removing a heart from a living person with no intention of replacing it is obviously murder. Removing a heart from a dead body is not murder and may be a good deed when the heart is wanted for transplant to another's. But what is the definition of death? Need all nations agree on this definition? Or is it not more likely that some cultures will accept cortical death while others will demand brain-stem death and yet others will insist that a patient is still alive so long as his heart is beating, even though his entire brain is gone and he is artificially aspirated, while others still will go so far as to regard a patient in a persistent vegetative state (PVS) as dead? We would have a situation in which we all agree to prohibit murder, but we each define murder differently. And I am not quite sure to what extent such a situation is acceptable.

But let us deal with specific questions in the context of an attempt at cross-cultural, bioethical understanding. A bioethic, an ethic of life, is inseparable from the concepts in terms of which we understand life. Masahiro Morioka has published a scholarly and philosophical analysis of the concept of INOCHI, which is central to Japanese thinking about life (10). I would like to take a step towards an Israeli philosophy of life based on the pair of Hebrew words NEFESH and NESHAMA, which bear some striking similarities to, as well as important differences from, some of the things Morioka says about INOCHI. I'll first list some points from Morioka's analysis of INOCHI. I'll then attempt a brief comparative analysis of NEFESH and NESHAMA. Then I'll deal briefly with some specific questions.

Here are some points from Morioka's analysis:

I. INOCHI connotes both 'life' and 'breath' (11).

II. INOCHI corresponds to an ancient Chinese word, MING, meaning to order someone to do something (12).

III. Some see all INOCHIS, human animal and vegetable, as "equal in value" (13) and some see it as "cruel" to "deprive other creatures of their INOCHI" in order that humans may live (14).

IV. INOCHI has both individualistic and holistic aspects, both of which must be stressed (15) Boundaries may be drawn between the INOCHI's of individuals. But all are interrelated "in a web or network which spreads infinitely throughout the universe" (16), presumably uniting all creation in an organic whole.

Turning now to NEFESH and NESHAMA in Hebrew, the words are so closely related as to be almost synonymous. Like INOCHI, they refer to life. For example, the Mishna allows aborting an unborn fetus to save a woman's life. But once the baby's head and most of its body are born, we may not interfere. For, as the Mishna says, we may not "sacrifice one life (NEFESH) to save another life (NEFESH)." (17) The presumption is that a fetus is not an individual NEFESH distinct from the mother. It is not a distinct life. But once the baby is born, it is so.

Strikingly, NEFESH and NESHAMA also connote 'breath' as does INOCHI. Generally speaking, and with some important exceptions, Hebrew consonants carry semantic meaning while the vowels indicate syntactic form. And as is stressed in KABALA, i.e. Jewish mysticism, semantic connexions may be preserved even under change of the order of the letters. NESHAMA has the same consonants as NESHIMA, meaning 'breath'. And NEFESH has the same consonants, with a change of order, as NESHIFA, meaning an exhalation of breath.

The semantic connexion between words for life and words for breathing may have something to do with the tendency in Judaism to regard cessation of spontaneous breathing as the fundamental criterion of death, provided of course that the patient is also motionless and unresponsive. In recent discussions the fact that a centre which is in the brain-stem, the hypothalamus, controls spontaneous breathing has been cited to persuade at least some rabbinical authorities to accept brain-stem death as the criterion (18).

Morioka mentioned the holistic aspect of INOCHI. There is a certain basis for holism in Judaism. Maimonides wrote that all of existence is one individual, comparable to one person (19). But I do not think that this holistic view is really developed either in Maimonides or elsewhere in mainstream Judaism.

Spinoza, of course, had a well worked out holism, a monopsychism according to which our intellects, along with the intellectual aspects of animals, plants and stones, are all part of God's infinite intellect. But although Spinoza was born Jewish he became Christian, as can be clearly seen in the note to Ethics IV, 68. So he does not belong to Jewish tradition.

Mainstream Judaism recognizes the individual character of each person's soul and draws a clear line between human souls and those of other creatures. Thus although there are no hard and fast rules here, it is generally the case in Biblical, traditional and modern Hebrew that while NEFESH applies to all life, NESHAMA applies to human as distinguished from other souls. There are mystical schools of thought which go even further, denying NESHAMA even to most humans and allowing it only to the most perfect of holy men (20). Ordinary humans, like the animals, achieve only NEFESH. But I shall ignore this mystical doctrine here and concentrate only on the mainstream view which distinguishes between the higher type of soul, which belongs to humans, and the lower one, belonging to animals and perhaps to plants and simpler organisms as well.

This clear distinction between humans and simpler animals is what makes Judaism different from the approach, outlined in Morioka's paper on INOCHI. In the remainder of this essay I shall try to sketch some of the ethical implications of this distinction.

It would seem, indeed, that if the animal soul is radically different from the human then there are no grounds for the idea that animals have rights. For how could we be expected to respect the rights of creatures with which we have nothing in common? Maimonides in fact argued that souls of humans and of animals bear no resemblance to one another and that there would be no reason for the Biblical prohibition of cruelty to animals were it not for the fact that if we behave cruelly to animals we, ourselves shall become hard and cruel (21). The prohibition of cruelty to animals is, according to Maimonides, not for the animals' sake but for out own sake. So Maimonides's philosophy seems to have no place for animal rights.

With all due respect to Maimonides, however, I think there is room in Judaism for another point of view. Rights in Judaism, as in other scripturally founded philosophies such as that of John Locke5 are implied by duties. To have a right is simply to have a moral claim to the freedom to exercise a duty. So whatever has duties has rights. It has just those rights which are necessary to the duties which it has. We have a right to health, for example, because we need to be healthy in order to carry out our moral duties. One who may be expected to carry out no moral duties, such as an evil madman bent on cruel, mass torture, has no right to be health. A creature has rights only in so far as it may be expected to perform duties.

The simpler animal, however, most certainly have duties. In Genesis, I,22, the fish and the birds are commanded, i.e. given the duties to be fruitful and multiply, and to fill the earth and the waters. And I shall assume that mammals also have this duty. And since they have this duty they also have what ever rights are necessary to carrying out the duty. It is for this reason, I think, that Jews are forbidden to castrate or neuter animals. The duty to procreate entails a right to functioning sex organs. Animals obviously also have a right to live. For what is not alive cannot fill the earth.

It is because of the ability to respond to duty, which we share with simpler animals, that there is something very profound in the connexion Morioka makes between INOCHI and MING, the idea of ordering someone to do something (12). Notice that in Scripture God does not create by intellectual contemplation. He creates by giving commands. Rather than saying with Descartes "I think, therefore I am" perhaps we ought to say "I can carry out God's commands, i.e. I can do good deeds. Therefore I am". Our existence, while different from that of simpler creatures, is not totally different. We share the ability to respond to Divine command. Here NEFESH and NESHAMA overlap.

But what distinguishes the minds of animals, NEFESH, from the minds of humans, NESHAMA, is that animals have the ability to carry out duties while humans have not only this but also the ability of intellectual enquiry and contemplation. This point should be clear whether or not one accepts a metaphysics of souls and minds. Dogs, horses and donkeys can respond to commands, and that is what is essential to carrying duties. None of them has the ability to participate in intellectual enquiry. I have not yet met a horse who could wonder whether it is really true that every even number is the sum of two primes.

Although animals have rights their rights are limited. It is a central principle in Judaism that human life takes precedence over almost everything else. There are of course certain extremely degrading actions, such as adultery with another person's spouse, which we may not perform even to save our lives. But there are many ideals which may be suspended when human life is at stake. Among these are animal rights. We may, therefore, slaughter animals in order to eat them, but not for our mere gluttonous pleasure but (and I think everything Maimonides wrote about diet will back me up on this point) only to the extent that we need meat in order to be healthy. I do not think that a person who has found that he can be healthy without eating meat has any right to eat meat, when his doing so would be a mere means of entertainment.

Similarly with respect to biomedical experimentation with animals. This is permissibly to the extent, and only to the extent to which it is necessary for human health. Judaism tends to take a middle-of-the-road approach on biomedical issues, and with respect to animal experimentation, we ought neither permit it absolutely nor forbid it absolutely but judge each case according to the circumstances. In this spirit it is a very positive development that there are such journals as "ATLA: Alternatives to Laboratory Animals" (22) which is devoted to "the development, validation, introduction and use of alternatives to laboratory animals in biomedical research and toxicity testing." Rather than moralizing for or against animal experimentation these people are looking for practical ways to achieve the same results without using animals. And where animal experimentation is unavoidable we ought to be looking for means to carry out such experiments with an absolute minimum of pain. Such practical efforts will do more good than a world of metaphysical speculation about animal rights.

In the little time remaining, I shall very briefly address the question if human patients who give no evidence that they are functioning at the level of NESHAMA, i.e. at the level of rational intellectual thought, but seem only to be functioning at the level of NEFESH at best. They respond, let us assume, very rudimentary to certain stimuli, but their responses seem to involve no rational thought. It is well- known that proposals are often made to perform euthanasia, or at least to discontinue treatment for patients in the persistent vegetative state, and it has been argued that patients in advanced dementia are no different. It has even been claimed that a patient whose responses are "limited to scratching her bandages, moaning when fed, occasionally following people with her eyes, and rare smiles when she received a comforting rub" has only "biological existence" and has "lost the constitutive human qualities which ultimately justify the physician's intervention" (23).

I can only reply briefly. Western culture sees rational consciousness as the defining human characteristic. Not only did Descartes deduce: "I think, therefore I exist". He claimed that once he stops thinking his very existence ceases (24). Later on Kant, who saw reason as something highly sophisticated, abstract and logical,formulated his doctrine of morals exclusively in terms of our obligations to our fellow rational being (25). Someone who does not fit Kant's idea of a "rational being" has no claim whatever to ethical rights in Kant's philosophy. A physician can have no obligation to treat him.

Although Descartes's and Kant's philosophies were highly influential in Europe, Judaism cannot accept them. We do not define someone's being human or not human in terms of the degree to which he meets some philosopher's standard of rationality. The word for a human being in Hebrew is BEN ADAM, meaning "a child of a human". Humanity is defined genetically. You are human if your parents were human, regardless of how well or poorly your mind is functioning. Nor do we pretend to know the meaning of life, or the value of the most rudimentary and perhaps highly painful consciousness in fulfilling God's command to live on this earth during a stretch of time which is, after all, only a speak on the face of infinity.

In conclusion I stress that although I have attempted to base myself on Jewish sources I take responsibility myself for my errors.

References Note: I apologize for the many self-references. Since this paper has had to be very brief, I have included them to allow the reader to follow the thoughts through in more detail.
1. Tokayer, M, & Swartz, M, The Fugu Plan: the untold Story of the Japanese and the Jews during World War II, London, Paddington Press, 1979. pp. 30f, 40-43, 27f.
2. Counford, F.M., From Religion to Philosophy, London, 1912.
3. Leavitt, F.J., "Genuine Genius", Nature 360:505, 1992.
4. Leavitt, F.J., "The Case for Conservation", Nature 360:100, 1992.
5. Leavitt, F.J., "Inalienable Rights", Philosophy 67:115-118, 1992.
6. Keown, J., "On Regulating Death", Hastings Center Report 22:39-43, 1992.
7. Mitchell, K.R., Kerridge, I.H., Lovar, T.J., "Medical Futility, Treatment Withdrawal and the Persistent Vegetative State", Journal of Medical Ethics 19:71-76, 1993.
8. Leavitt, F.J., "What is an Integrated Cross-Cultural Bioethics?" Eubios Ethics Institute Newsletter 2:58-59, 1992.
9. Leavitt, F.J., "An Israeli Approach to Cross-Cultural Ethics: Correction and Elucidation", Eubios Ethics Institute Newsletter 3:3, 1993.
10. Morioka, M., "The Concept of Inochi: a Philosophical Perspective on the Study of Life", Japan Review, 1991, 2:83-115.
11. Ibid., P. 87.
12. Ibid.
13. Ibid., P. 99.
14. Ibid., P. 93.
15. Ibid., P. 108.
16. Ibid.
17. Mishna, tractate Ohalot.
18. Glick, S., "On Brain Death and the Slippery Slope", The Journal of Clinical Ethics, Summer 1993, 200.
19. Maimonides, M., Guide to the Perplexed, I, 72.
20. Scholem, G.G., Major Trends in Jewish Mysticism, New York, Schocken Books, 1961, 240f.
21. Maimonides, M., op.cit., n.19 supra, III, 17.
22. ATLA: Alternatives to Laboratory Animals, Published by Fund for the Replacement of Animals in Medical Experiments, Nottingham, England.
23. Emanuel, E.J., "Should Physicians withhold Life-sustaining Care from Patients who are not Terminally Ill?" Lancet, 1988; I:106-108.
24. Descartes, R., Meditationes de prima philosophia
(1641). Edition Adam & Tannery. Latin p. 27, French p. 21.
25. Kant, I., Groundlegung zur Metaphysik der Sitten, passim.
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