Ethics expert calls for apolitical approach to medicine
“Should I take a patient off a medical ventilator?” “How do I balance a mother’s desired method of childbirth with what’s best for her baby?” “Do I give a patient a drug even though it has side effects?”
Professor Alan Jotkowitz advises young doctors faced with these ethical situations to do, as he says, “what you think is the right thing”.
Jotkowitz, the director of the Medical School for International Health at Ben-Gurion University (BGU) of the Negev, was speaking at a South African Israel Chamber of Commerce event at the Houghton Hotel on 21 November. The event was held in partnership with the South African Union of Jewish Students and ORT Jet.
Jotkowitz, also the director of the Jakobovits Center for Jewish Medical Ethics and a senior physician at Soroka University Medical Center, does his best to use his work at the centre as a role model for others.
“We try to model the idea that what unifies us as doctors is more important than the politics that we all have as individuals,” he said. “I’m involved in making medicine sort of apolitical, not just on a local level, but on an international level, and trying to keep it that way.”
In his department at Soroka, he makes sure that Jews and Arabs have the same waiting time for treatment. “I feel bad that you have to wait, but there’s no difference between patients. We treat all patients the same at Soroka. What’s beautiful about Soroka is that we all work together as a team. The staff is about half Arab and half Jewish, we work together, and we keep politics out.”
Jotkowitz has been talking about this model with his colleague and closest friend, an Arab physician he worked with for 20 years at the hospital. “We dream about this being a model for the rest of Israeli society,” he says.
He counts wars and rockets being launched into Beersheba as some of the tense moments at the hospital, but says those have been few and far between, and they have had no impact on patient care.
Jotkowitz went to medical school in the United States around the time AIDS was first identified in the country. In 2001, he fulfilled his dream by moving with his wife to Israel.
“Remarkably, my wife [a dermatologist] and I had been in the same jobs for the past 20 years in Israel,” says the grandchild of Lord Rabbi Immanuel Jakobovits, who wrote a book titled Jewish Medical Ethics. “I’m now dean of the medical school at the BGU, talking about how I work at Soroka in the hospital as a doctor. So, I juggle a lot of things.”
Known for its commitment to excellence in research and teaching, the Beersheba-based BGU is a more than 50-year-old public university. Jotkowitz says the institution is at the forefront of global health. “We have 40 students a year who come to BGU from around the world to learn global health. We want our graduates not necessarily to work in Israel, but to work in low-income countries.”
Before COVID-19, the university had joint programmes with Ethiopia, India, Sri Lanka, Nepal, Mexico, and Peru. “Our students went there, and their students would come back to us,” he says.
Jotkowitz says medicine is the only field where if you make a mistake, a legal issue arises. “I’ve been active in supporting a movement calling for change from a legal system to an educational system. When doctors make mistakes, they should be able to tell patients they made an error, and it should be dealt with as an educational issue so the mistake doesn’t happen again.”
Jotkowitz has been involved in two cases where a mother refused to have a caesarean section even though her baby had cord strangulation.
In the one case, the doctors respected the mother’s decision, and her baby was born with severe cerebral palsy. In the other, the doctors disregarded the mother’s wish, and her baby was born healthy.
Jotkowitz believes people should have autonomy provided that they don’t infringe on others’ right to health. “A person has a right not to get vaccinated, except if they’re going to endanger other people,” he says, pointing out that boosters shouldn’t be administered until the whole world is vaccinated.
He refers to a study conducted via Google Earth to explain why he believes China’s initial secrecy about the virus cost the world time to react efficiently.
“It looked at the parking lots of hospitals in Wuhan, and showed they were filled three months before the Chinese revealed that the epidemic had started.”
Jotkowitz says Israel struggles with the differing viewpoints of secular and Jewish medical ethics on issues such as euthanasia and abortion.
“There’s no abortion on demand in Israel,” he says. “For a woman to get an abortion in Israel, they go to a committee of two doctors and a social worker. Ninety-eight percent of abortions are approved.
“Israel is the only country in the world where we’re not allowed to take a patient off a ventilator. It’s a problem because there are patients who should be taken off. The simple answer, which I tell my students, is that the patient should get what they want. I contend that you can take the patient off the ventilator and put them on detached, non-invasive ventilation, and then the patient will eventually die on their own. I’ve talked to lawyers and the ethics committee, and I’ve pretty much got a consensus on that approach.”
No angels or demons in schoolyard bullying
When King David Junior School Linksfield principal Ruth Isaacson listens to two children each telling their side of a story that potentially involves bullying, she usually doesn’t find any angels or demons.
“You find that there has been some provocation,” she said on 23 November during her school’s webinar entitled ‘Bully-proofing Your Child by Building Resilience and Grit’. “What we try to do is to remain neutral, listen to both sides of the story, and point out what can be done differently, and what could have been done differently.”
Depending on the severity of the situation, Isaacson tells the children, “I need to have a meeting with you in three days’ time. I want to check to see how the days are going, and whether you have had better days.”
She said giving children accountability changes the dynamic because they won’t bully another child when another meeting is on the horizon.
The webinar focused on equipping children with skills to face bullying. Bullies are present in every life stage, and all children will have to deal with conflict at some point in their lives.
“The idea of this webinar came about because we’re still trying to educate children not to use the term ‘bullying’ loosely,” said Isaacson. “If children understand what bullying is and what it’s not, they can alert their parents and teachers who will help de-escalate the situation and provide preventative tools for future encounters.”
Using the right language is crucial in determining if a behaviour is bullying, agreed Jo Hamilton, an educational psychologist who’s interested in teaching children how to manage conflict situations. She’s written a book, The Ultimate Assertiveness Toolbox for Kids, on the subject.
“A huge difference exists between bullying, and everyday mean, unkind, thoughtless, competitive, nasty behaviour,” said Hamilton. Bullying is distinctive because it’s intentional, repetitive, and creates an actual or perceived imbalance of power, she said.
“An actual imbalance of power is where the person who’s bullying is taller, stronger, older, or has more facilities at their means,” said Hamilton. “In a perceived imbalance of power, as with social power, they seem more powerful.” For example, bullying may give rise to the bullied person thinking, “If I say or do something, [that] will [turn] the whole [class] against me.”
Luke Lamprecht, a child protection and development specialist, believes the idea that the bullied become bullies, and that bullies have poor self-esteem, are both a bit of a myth.
“My experience of the bullies I’ve been sent [to work with] – and these are proper, taunting, harassing bullies – is they have an extremely strong sense of themselves,” he said. “They’re just unable to take the perspective of another, and that for me is the really challenging part to manage.”
Having worked for several years in a girls’ school, Hamilton has seen how girls are often raised to be kind, thoughtful, and caring, but believes they should also be raised to be assertive and respectful to themselves.
Lamprecht’s experience of working mainly with boys and running a boxing gym in Hillbrow has shown him that boys are quite different. “It tends to be quite explosive, immediate, kind of ‘Let’s shake hands afterwards and get on with it.’”
This candidate Master of Science in child health said children, especially boys, are often seen by their peers as weak or a snitch when they seek help. “The idea of becoming a man is somehow performative in the world. You have to perform. You have to see how many times you can be beaten down and stand up again. What we don’t recognise is that if we don’t intervene, both the victim of the bullying and the bully are denied services.”
If parents help their children to take responsibility, they’re giving them tools to become better socialised, said Isaacson. “By not dealing with the situation, they’re actually starting that process of isolating their child,” she said. “We know kids sort each other out. They’ll stay away from a child who is too confident, picks on kids, or feels quite empowered to do so.”
Isaacson and Lamprecht acknowledged the importance of the maternal function of hugging and loving unconditionally, and the paternal function of instilling discipline.
Asked by a parent watching the webinar what to do when a boy is mean to your daughter, Lamprecht responded, “You tell your daughter to inform that boy to never talk to you like that again, because boys don’t talk to girls in mean ways. Boys are kind, and they talk to girls in kind ways, and girls like kind boys.”
Lamprecht said it’s “mad” that girls have to interpret nasty behaviour by boys as a sign that they like them. “We cannot allow that to be perpetuated because the long-term consequences are really dire,” he said. “Parents of boys should tell their boys to not speak to girls in mean ways, and give them a flower if they like them.” He believes children model their behaviour on their parents and a world that’s fraught with competitiveness.
Isaacson said, “Our social workers are also looking at kids being one to two years behind [because of the pandemic]. There’s a lag in social and emotional development. Something to do is maybe have discussions with your kids when there isn’t a crisis. Don’t wait until your kid comes home absolutely distraught. Rather have the discussion about how we should react if somebody provokes us or says something mean.”
She related how she once phoned a parent whose child was reacting badly to some provocation. “The mother said she had told her child to think about what might be happening in the other child’s life that’s making him behave in a way that isn’t so nice. I thought that was quite an exceptional level of parenting. The most important thing is the role-modelling, the kindness, just hearing your child out, and also being sympathetic and empathetic towards not only your own child, but also other people’s children.”
A new play opens debate on playing Wagner
Many Jewish musicians will not play or listen to the music of Richard Wagner because he has been promoted as Hitler’s favourite composer, but for most this is an unspoken agreement.
Victor Gordon, the late award-winning Pretoria playwright, has pulled the Band Aid off this debate in his play You Will Not Play Wagner. It has been turned into a Zoom film with award-winning actress Annette Miller, who previously played Golda Meir in Golda’s Balcony, as its lead and premiered internationally on 16 November.
“The film opens a discussion on a topic that’s usually not discussed – intergenerational trauma, community, and the assumptions about Wagner,” says Tali Nates, founder and director of the Johannesburg Holocaust & Genocide Centre.
“Should Wagner’s music be played or not? Why is Wagner in the conversation and not others who were much more antisemitic than him? All these critical thinking questions need to be discussed, and I think this play or film allows us to do that.”
The film is dedicated to the memory of Gordon, who was also an artist, musician, community leader, and strong literary advocate for Israel. It was directed by Lilia Levitina.
The play was Gordon’s second international production, and was performed live in both Israel and Australia. He adapted it for Zoom just before he succumbed to COVID-19 in June this year.
Gordon, a retired pharmacist, wrote his first play at the age of 13. He also developed an interest in painting and music, and would go on to sell just under 100 paintings and play jazz semi-professionally for more than 40 years.
He was aware of the informal ban on Wagner’s music in Israel because of the German composer being promoted during the Nazi era as Hitler’s favourite composer. Although this unofficial ban has been unsuccessfully challenged by acclaimed conductors Zubin Mehta and Daniel Barenboim, Gordon wrote a play to explore the dramatic possibilities inherent in the debate around this subject matter.
Set in New York and Tel Aviv during the COVID-19 pandemic, the film focuses on the days leading up to the final of the Esther Greenbaum Conductors Competition. Greenbaum is a Holocaust survivor and the competition’s patron who puts up the prize money for the winner.
She would like the character, Ya’akov, a millennial Israeli upstart, to beat the other five composers, each of a different nationality, in the final. To her surprise, Ya’akov chooses to play music by Wagner in the final.
Ya’akov, who believes the taboo on Wagner’s music in Israel must change, engages in an emotional argument with Greenbaum and the competition’s organiser, whose name is Morris, during a Zoom meeting.
Morris says Ya’akov’s choice will not be tolerated by the general public while Israel remains home to one Holocaust survivor. Ya’akov stands by his selection because he has not transgressed the competition rules and believes the anti-Wagner tradition is “stupid”.
He questions whether a problem would have arisen had he chosen a composer like Mikhail Glinka or Modest Mussorgsky, who never hid their dislike of Jews. He says Wagner had Jewish friends and made great music which presents a unique challenge for any conductor.
Greenbaum argues that Wagner had an influence on Hitler and the philosophy of the Third Reich.
Having ended the meeting in a hysterical state, Greenbaum tries to get her final Zoom meeting with Ya’akov off to a better start, but it soon becomes extremely heated.
When Ya’akov says a live experience with Wagner’s music made him the composer he is today, Greenbaum says that is not her experience. As a mere child, she was forced on pain of death to play Wagner for her concentration camp’s orchestra. “Were I not able to play the violin – were it not for Wagner’s music – I would not now be alive,” she says.
Ya’akov argues we should not forever remain victims of the Nazis and playing Wagner would be the ultimate victory over them.
Nates, a historian who lectures internationally on Holocaust education, says it’s not important whether playing Wagner in Israel would amount to treachery or triumph. “The discussion and the dialogue are the most important,” says Nates, whose father and uncle were among the many Jews saved by businessman Oskar Schindler during the Holocaust.
“The film is so powerful because it’s not just telling a Holocaust story, a survivor’s story, or an artefact’s story. It’s not telling one story. It tells about memory, intergenerational memory, and coming to terms with history. It connects history and personal history, and memory and the importance of collective memory and collective trauma.”
Nates was impressed with how Gordon changed the configuration of the play into a film, but she says it doesn’t cover all aspects of the Holocaust, “which has a complicated history with many layers”.
She says the complicated relationship between Hitler’s admiration of Wagner and the missing pieces of this part of history means playing Wagner in Israel has become a pop culture taboo.
“One of the key historians of Wagner and the Holocaust wrote a book that basically questioned the assumption that Wagner’s music was played by the orchestra of Auschwitz. It was 100% not played by the orchestra in the camps, but it is pop culture belief that it was.”
Investigative journalist refuses to take Lotto abuse
Veteran investigative journalist and media trainer, Raymond “Ray” Joseph, has always believed that journalists should fight for justice with their pens not the courts. But that was before suspended chief operating officer of the National Lotteries Commission (NLC), Phillemon Letwaba, allegedly defamed him and his family in a recent interview.
Joseph, who has been a journalist since 1974, is a freelancer for the GroundUp investigative news site, and has won awards for his work on dodgy spending by the NLC. “It’s like a microcosm of state capture, and I’m right in the middle of it,” Joseph told the SA Jewish Report in the past. The scathing reports have raised concern over how money meant for “good causes” – poverty relief and charity – is in some cases being dispersed in highly questionable ways. Letwaba is also suing Joseph and GroundUp in relation to some of these articles.
“Enough is enough,” Joseph told the SA Jewish Report in an exclusive interview. “He told demonstrable lies and attacked my family. It’s a bridge too far. Picking on me is one thing, but picking on my family is another thing completely.”
Joseph says that Letwaba defamed him during an interview with senior journalist Stephen Grootes on popular 24-hour news channel Newzroom Afrika.
In Joseph’s summons, which has been issued by the Cape High Court and has been served on Letwaba, he attaches a transcript in which Letwaba said Joseph was a “major beneficiary” of lottery funds. Letwaba claimed that more than 12 organisations linked to Joseph were no longer receiving lottery funds and suggested Joseph was attacking him because of this.
Amongst other points, Letwaba also claimed that Joseph, his wife, and family were direct beneficiaries of lottery funding. He said Joseph “is an old man who came out of retirement to come and focus on the character of the COO and attack the integrity of the NLC … I’m saying we have been dealing with lies since 2014 just because one individual who is the major beneficiary of the NLC decided to declare war against the NLC.”
In his summons, Joseph claims that Letwaba’s remarks are not only untrue but defamatory. “They were understood by the reasonable audience to mean that I knowingly breached journalistic ethics, was a vengeful and malicious journalist, and had embarked on an untruthful campaign against him and the commission.”
Joseph says that after hearing Letwaba’s accusations, the average person would consider that Joseph was acting out of spite for “losing benefits”. Letwaba has refused to publish an apology and a retraction. Letwaba has until early December to file a notice of intention to defend the action, and until February next year to file a plea.
Joseph says that this kind of intimidation reminds him of “the bad old days” when journalists and their sources had reason to fear. “It’s not nice worrying for your security and safety, and that of your family, never knowing what’s going to happen. I have reason to be concerned – I’m not paranoid. I have received anonymous threats and been through the gamut.”
He says Letwaba served papers on him and GroundUp for defamation more than two years ago, “but has made no attempt to get the matter before court. We have tried, because we want to face him in court, but it’s very hard for a plaintiff to force the matter. But now, my lawyer is in charge of the process. Once and for all, he will see us in court, and answer for his allegations under oath.” He adds that when one sues, one can ask for documents as part of the legal “discovery” process, which will make it “a whole new ballgame”.
He emphasises that he’s not suing for the money, but rather “to get this man before court to explain his behaviour for an extended period of time, and to force him to bring proof of serious allegations. I want him under cross examination, showing evidence and documents. In this work [journalism], your reputation is hard currency. I’m exercising my right to defend my good name. That’s all you’ve got as a reporter. Because they can no longer attack the facts, they are now attacking the journalist. It’s unpleasant, but it’s not unique to me. If you want to attack a journalist, come with proof. Come with the evidence. I don’t write what I can’t prove. But on TV, he made these wild allegations.”
People have been telling him to sue for ages, he says. “It’s tough. Constantly being attacked wears you down. But at the same time, all these attacks have done is made me more determined than ever. And GroundUp is committed to seeing this thing out. I’m privileged to have a brave editor [Nathan Geffen] who doesn’t scare easily. GroundUp’s commitment to the story has kept it alive. I’m privileged to have had the time and space to pursue the investigation.”
He has faith that he will see justice both in his work and this case. “I have patience. It’s a long game. I’ve been investigating for three years. I’m no shrinking violet. I will follow through the investigation, as long as it takes. It’s not over till it’s over. This makes me more determined, and I’ll keep on keeping on.”
Geffen told the SA Jewish Report that “a culture of impunity is developing, and not just in South Africa, where corrupt or dishonest people believe they can make any assertions publicly no matter how false or defamatory. Ray has been doing his job diligently, exposing lottery corruption and mismanagement. It’s not acceptable for those he has implicated, like Phillemon Letwaba, to respond by making absurd and false defamatory allegations. Ray is taking a stance against this behaviour and we [GroundUp] support his decision.”
Banner4 days ago
“Let my people in” – chief rabbi takes on travel ban
News4 days ago
Community urged to be cautious as wave gathers speed
Israel4 days ago
SA Jewish leadership confront Israeli PM over travellers’ ordeal
Featured Item4 days ago
Heartbreak and loss as the world slams doors on SA
Featured Item4 days ago
Tackling tough topics with teens needs ‘courageous conversations’
Featured Item4 days ago
Mental illness – ‘a pandemic of its own’
Voices4 days ago
Of doggie dreams and the kindness of strangers
Israel4 days ago
Citizens take government to court over Miss SA bullying