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Medical ethics and halachic expert takes SA’s temperature

Rabbi Professor Avraham Steinberg is an expert in medicine, ethics, and the halacha, but when it comes to what’s best for patients, he believes a doctor’s knowledge overrides their views.

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JORDAN MOSHE

“While we do need to respect a patient’s autonomy as doctors, if something needs to be done in the interest of a patient’s well-being, we need to override their demands, and do what we must to save their lives,” Steinberg says.

In South Africa at the invitation of Chief Rabbi Dr Warren Goldstein, Steinberg will spend his time delivering lectures, and consulting with the rabbis of Johannesburg and the Beth Din on halachic medical ethics. He will also work closely with local mohalim under the auspices of the Brit Milah Regulatory Board.

His wisdom is sought after, not least because of his extensive learning and expertise. When Steinberg chose to pursue a career in medicine, it was not the desire to become a qualified doctor that drove him, rather, it was a determination to study a subject which could complement his Torah knowledge, inspire him to keep learning, and enable him to make balanced decisions on questions of medical ethics.

Steinberg is a Senior Paediatric Neurologist at Shaare Zedek Medical Center in Jerusalem, and Director of the Medical Ethics Unit. He is the author of The Encyclopedia of Jewish Medical Ethics, for which he was awarded the Israel Prize in 1999. He is also an associate clinical professor of medical ethics at the Hebrew University’s Hadassah Medical School in Jerusalem. He is head of the editorial board of the Talmudic Encyclopaedia, and a member of national and international societies of child neurology, medical ethics, and Jewish medical ethics.

In terms of medical ethics, Steinberg says doctors used to adopt a paternalistic approach to their patients, telling them what to do without inviting their opinions, but today, the pendulum has swung to the other extreme.

“Patients today dictate to their doctors what they want, and because of modern thinking which places the respect of an individual’s autonomy above all else, it has become almost unquestionable. This over-emphasis on a patient’s autonomy and rights needs to be weighed against the true value of human life, which is something doctors should always strive to honour.”

Born in a displaced persons camp in Germany to Holocaust survivors, Steinberg and his family arrived in Israel in 1949. His unique upbringing established the person he would become.

“My upbringing was not the standard one religious people tend to have,” he says. “My father had been a rabbi in Galicia (Eastern Europe), and the culture of learning there was completely different to that of the typical yeshivot.” So, instead of getting involved in detailed analyses of texts and intense focus on certain areas, his father taught him a method to derive applicable, practical knowledge from any text studied.

Steinberg explains. “When we learned the laws of kosher slaughter, my father would take me to the abattoir, so I could see it being practised. The text was made real and tangible.” This approach to study informed Steinberg’s career, the desire to learn things practically, not just through abstract theories.

He began his studies at Hadassah Medical School in Jerusalem, the only medical school in Israel at the time. To be accepted, candidates had to have studied at least one scientific subject, as well as either a humanities subject or an additional science subject. “As I hadn’t completed any proper schooling,” says Steinberg, “my knowledge of science was rather weak. However, biology was acceptable. I paired this with my knowledge of 50 memorised pages of Gemorah as my humanities subject, and was the first, and probably only candidate to be accepted into the school based on my knowledge of biology and Gemorah.”

Steinberg then specialised in paediatric medicine, and did his internship at Shaare Zedek Medical Center in Jerusalem. He went on to specialise further in paediatric neurology in the United States, publish his encyclopaedia, and subsequently returned to Israel.

He says ethical considerations in medical matters are not always straightforward. When his own father lay dying in hospital, comatose, and suffering from multiple-organ failure, he was faced with a difficult decision. “A drip was attached to my father that maintained his blood pressure,” says Steinberg. “It was effectively keeping him alive. When the drug ran out, his blood pressure would drop, and the hospital staff hurried to replace the drip, and he would stabilise again.”

Steinberg was unsure how to handle the situation, so he consulted with the renowned orthodox Rabbi Shlomo Zalman Auerbach, who ruled that while he could not remove the drip, he was permitted to refrain from replacing it when it ran out. “My family and I prepared ourselves, said our final goodbyes to my father, and gathered at his bedside to recite viduy (deathbed confession). The drug ran out, and my father passed away.”

This experience would enable Steinberg to develop a procedure for dealing with practical end-of-life matters for other families. Together with Auerbach, he published it, and it remains a basis for discussion.

Under his guidance, the Israeli government has taken halachic perspectives into account in drafting legislation, including the dying patient act, the brain death act, and the surrogacy act. He has also submitted more than 4 000 expert witness opinions in court cases in paediatric neurology and medical ethics.

From malpractice suits to car-accident cases, Steinberg says that every case is unique and requires a nuanced approach. Moreover, as head of the preimplantation genetic diagnosis (PGD) board at Shaare Zedek, he is involved in judging the merits of every case brought to the hospital concerning intervention in the genetic development of unborn children.

Today, at 71, this prize-winning senior paediatric neurologist, author, and expert in Jewish medical ethics shows no signs of slowing down, in fact, he continues to gain momentum.

“I wear more hats than I can count,” laughs Steinberg. “Whatever issues are of interest to me, I become involved in. That’s all there is to it.”

He maintains that there is no reason why the fields of halacha and medicine cannot operate hand in hand, supporting one another where necessary. “We need to show people that there is an ethical foundation to halacha. There are nuances in Jewish law. It is sensitive to our needs, and needs to be taken into account. Halacha can be a part of legislative processes, medical matters, and others, and is certainly capable of meeting all the criteria we could possibly have.”

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Kramer quits COVID advisory over “community flouting protocols”

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One of the community’s top COVID-19 advisors this week lashed out at the community for flouting rules and putting lives at risk. Professor Efraim Kramer said he could no longer contribute to the safety of the community during the pandemic in light of this brazen behaviour.

“In a nutshell, I’m fed up,” Kramer told the SA Jewish Report. He said while the first surge “brought out the best in the community”, the second wave “brought out the worst in us”. His frustration has been mounting for some weeks in light of the number of deaths in the community. Last week, two members of his family passed away from COVID-19.

“I don’t care if I upset people. My aim is just to save lives. I don’t want to implicate anybody. The final straw came this week when President Cyril Ramaphosa allowed faith gatherings to take place, and people went to shul the next day. Where was the consultation? No meetings were held on how best to re-open shuls.”

Kramer is the head of the Division of Emergency Medicine at the University of the Witwatersrand (Wits), and Professor of Sports Medicine at Pretoria University. He has specialised in emergency medicine for 30 years, and was FIFA’s tournament medical officer at the Soccer World Cup in 2018. Along with other experts, he has advised the office of the chief rabbi on matters related to COVID-19 and shuls.

“I have written at least eight different protocols for things like weddings, Barmitzvahs, yom tov [gatherings], and shuls and it seems that everyone is doing what they like,” he said. “Come December, in the middle of a raging pandemic, people got in their cars or on flights and headed straight for hotspots. They flew home knowing they were infected. The results have been devastating, people have died. We’ve done this to ourselves. We’re doing it to our own.”

He said the communal leadership was “paralysed”. In a strongly worded message he sent to Chief Rabbi Dr Warren Goldstein and members of the Union of Orthodox Synagogues, he wrote, “Please note, with regret, that I have withdrawn from all community COVID-19 commitments and communications due to the total disregard and ignoring of the various safety protocols developed for the shuls and the community by many. I will no longer consult on any COVID-19 issue because it generally amounts to nothing as most people are still intent on doing their own thing anyway, in spite of advice to the contrary. But then, who am I to give advice anyway.”

Kramer said he had received countless complaints from members of the community afraid to attend large simchas which had been taking place “as if things are normal”. On Wednesday, he received another complaint from a community member who lamented that while a caterer was following protocols, guests were dancing, hugging, and behaving as if it was a pre-COVID-19 wedding.

“I drive past a shul every day and see countless cars outside. There have been minyanim taking place. The shuls have relaxed their protocols. I went into a bakery last week, and things were haywire. People were on top of each other using the same tongs and there was no safe distancing. It was a disgrace. As a doctor, I can’t fight this anymore. I’m going back to hospitals where at least the patients appreciate what I’m doing.

“While many people are being very careful, there are those who don’t care about the next guy. They think they are ‘holier than thou’ and Hashem will listen to their prayers. When you add up all the incidences, you get a picture of a community that doesn’t care for one another anymore. And where is the leadership when this is happening? How come nothing was said when shuls continued to open when it was against the law to do so and unsafe?”

Barry Schoub, emeritus professor in virology at Wits and the former director of the National Institute for Communicable Diseases, said, “This is very disappointing news. Professor Kramer has been an absolutely invaluable member of our community medical advisory team and has devoted an incredible amount of his time and energy in drawing up protocols, inspecting shuls, and looking after the safety of functions. He is an international authority on mass gatherings and has world-class credentials which have been so valuable in managing the COVID-19 epidemic. I’m sad at the decision he has taken, but I do understand the intense frustration he is feeling at the attitudes he has come across in a small minority of our community and the disregarding of protocols to safeguard our community by a small minority of shuls and minyanim.”

Leading pulmonologist Dr Carron Zinman said she understood Kramer’s frustration. “We’re all frustrated by people’s complete disregard for safety protocols as it’s so simple to follow the rules. We’re absolutely exhausted, and are tired of watching people struggle for each and every breath knowing that they should have worn a mask/should have kept a safe distance/should have avoided the gathering, and could have avoided getting COVID-19. You realise that you can give the same advice till you’re blue in the face, and people will choose to do what they want. We don’t act as judge, and never compromise our standard of care, going all out to fight for our patients’ lives.”

Said Chief Rabbi Dr Warren Goldstein, “I was disappointed and surprised to receive Professor Kramer’s resignation on the eve of the president’s announcement allowing for the reopening of shuls, which have been closed for more than a month. I have asked to meet with Professor Kramer to understand his specific concerns because the reports I have received since the reopening of our shuls in August 2020 indicate that the overwhelming majority of shuls have been outstanding and totally dedicated to the implementation of the health and safety protocols drafted by our full medical team.

“As a community, we will continue to be guided by Professor Barry Schoub and Dr Richard Friedland, who remain on our medical team, as we go forward to ensure the highest standards of safety for our community. On behalf of our community, I want to thank Professor Kramer for his months of tireless volunteer work to train and prepare our shuls to function safely in this pandemic.”

Wendy Kahn, the executive director of the South African Jewish Board of Deputies, said, “We have no knowledge about Professor Kramer’s resignation or the reasons for it. We commend him for his amazing contribution to our community.”

Rabbi Yossi Chaikin, the chairperson of the South African Rabbinical Association, said he was “shocked, surprised, and upset” when he received Kramer’s message. “We are so grateful for his service, and he is so respected. He sat with every rabbi and advised us. And even though he was very strict, we listened to him!

“I know that all shuls have followed his protocols with proper distancing, screening, hand sanitising, and masks – this is being enforced. I also know there have been private minyanim not under our jurisdiction where I believe there were minimal to nil protocols. On behalf of the rabbonim and shuls, I say that we are doing the best we can. It’s sad that people have acted this way leading to this decision, but we will continue to be vigilant.”

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Joburg – city of architects and dreamers

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In spite of its reputation for being the “engine room” of the country, Johannesburg has many elegant, experimental buildings designed by Jewish architects.

Johannesburg Heritage Foundation’s Flo Bird and Brian McKechnie recently took viewers on a virtual tour of many of these buildings, downtown and uptown. Some of them have fallen into disrepair, but they are still a testament to innovation, and continue to contribute to the lives of those who live and work in them.

The tour, unusually, linked the buildings to their creators’ graves at Westpark Cemetery, with epitaphs contributing to our understanding of who they were.

“This tour was inspired by encountering the graves of architects whose work I loved,” Bird said, pointing out that a virtual tour allows us to traverse the large Westpark Jewish Cemetery with ease.

It started with Morrie (MJ) Jacob, who died in 1950. Jacob designed the Doornfontein Synagogue (1905) otherwise known as the Lions Shul, named for the bronze lions on either side of the stairs. In its day, Doornfontein was a desirable address for Jews. Though today the shul is squashed up against Joe Slovo Drive with an ugly fence, it’s still loved for its beauty and unusual touches like minarets, stone columns, and basilica-like space.

Another one of Jacob’s buildings, Cohn’s Pharmacy in Pageview (1906), is an example of the city’s obsession with corner buildings, which tended to be far more elegant and accentuated than those in the middle of the block. Jacob’s Jewish Guild War Memorial building in the old city centre (1922/23) is a pile of an Edwardian building which also celebrates its corner status.

Israel Wayburne (1983) is known, among other things, for employing famous activist and communist Rusty Bernstein. He’s responsible for a number of the maisonette flats (two down, two up) in Yeoville.

“Each building contributes to an interesting and varied landscape [compared, say, to monotonous Fourways],” said Bird.

One of his most well-known buildings is, in fact, the ohel at Westpark, which has a religious and aesthetic function (in spite of an unsightly drainpipe addition at the front). “Luckily Issie doesn’t have to see it as his grave is on the other side of the building,” Bird commented.

Louis Theodore Obel (1956), who was in partnership with his brother, Mark, was a graduate of the University of the Witwatersrand (Wits) – as were many of the architects mentioned. Obel and Obel made a great contribution to art deco architecture, including the Barbican Building (1930), which was the tallest building in Johannesburg at the time, Astor Mansions, one of Joburg’s first skyscrapers, and Beacon Royale flats (1934), at the bottom of Yeoville on Louis Botha Avenue.

Maurice Cowen (1990) contributed to the decorative facades of many of Joburg’s best-known schools, including Parktown Girls and Jeppe Boys, and the panels gracing 1930s-era Dunvegan Chambers, Roehampton Court, Shakespeare House, and Broadcast House in the Johannesburg CBD. The latter was the original home of the South African Broadcasting Corporation. The crazy antennae designed for the top of this building didn’t have any real function, McKechnie said, though it copied the antennae on top of the BBC, and there was briefly the idea of using it to dock airships.

Another Wits graduate, Leopold Grinker (1973), was an anti-establishment figure who disliked modernism. Grinker’s Normandie Court (1937) in Delvers Street, Newtown, combines art deco with his obsession with the streamlined form of ships. So too does Daventry Court in Killarney (also built in the 1930s), which was Killarney’s first modern block of flats.

Harold Leroith (also a Wits’ alma mater) is best known for designing Temple Emanuel in Parktown (1954). This minimalist, modern building has concrete recesses which make it sculptural and provide shade for its windows. It also shows concern for materials like stone and face brick.

Leroith also designed Redoma Court, which architects consider one of Johannesburg’s best buildings, and the iconic, shiplike San Remo (1937) Both are sadly in a dilapidated state in Yeoville.

Monty Sack, an architect and artist and another Wits graduate, (2009), incorporated the work of artists in Killarney Hills built on top of Killarney Ridge, built to house actors for the studio of American financier Isidore Schlesinger.

Sidney Abramowitch (2016) passionately lobbied to save Joburg’s historical buildings such as the Markham Building, and is known for designing Innes Chambers in 1963, now used by the National Prosecuting Authority. This unusual building with Y-shaped columns representing the scales of justice, was covered with mosaics, which recently had to be painstakingly restored.

Lastly, the tour touched on the work of Gerald Gordon (2016), also a Wits graduate, who the group described as “an outstanding brain who was unable to limit himself to any single factor”. Gordon, who incubated many of South Africa’s best-known architects in his many years of lecturing at Wits, is best known for designing mountain houses on Linksfield Ridge, such as 7 New Mountain Road (early 70s), which literally cling to the edges of cliffs.

He’s also known for developing a new construction method he named “thin-skin architecture” which uses no bricks and is extremely strong because of its monocoque construction (a type of construction used in cars and aeroplanes).

Like many others, the brilliance and bravery of these Jewish architects leaves a legacy that can’t be eradicated.

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Nominations open for a historic Jewish Achiever Awards

The Absa Jewish Achiever Awards 2020 is now open for nominations.

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JORDAN MOSHE

Just when you thought nothing familiar and fabulous was going to happen, the SA Jewish Report is calling you onboard to begin its journey to this year’s Absa Jewish Achiever Awards.

COVID-19 may have brought live entertainment and events to a grinding halt, but this year’s awards will be held in a format that will make history and give ample recognition to those who have achieved great things.

This is the 22nd year of this unique awards ceremony in which Jewish individuals are acknowledged for the powerful, influential, and life-changing roles they play in South Africa. The Absa Jewish Achiever Awards acknowledges those who deserve recognition for their contributions to society, paying tribute to the men and women who have enhanced our community.

Scheduled to take place in mid-October, the annual extravaganza evening will go ahead in spite of a host of virus-related challenges.

“For the first time in the event’s history, we will be holding an online-offline event,” says Howard Sackstein, the chairperson of the SA Jewish Report. “While the actual event will be streamed live for people to watch without being present, guests will still be able to take part in this incredible event.”

Sackstein explains that while tables can be purchased as usual, the seating is virtual, as guests will experience a gourmet dining experience in the comfort of their own homes while watching the live event.

“Those who buy tables will have their meal delivered to their home, from cocktails to dessert,” says Sackstein. “We will also feature a virtual red carpet, with guests taking photos of themselves at home and sharing them online.”

While they tuck into their meal at home, guests will enjoy a livestream of the event, enjoying the evening’s entertainment and awards.

The awards are another area where exciting changes have been made.

“While guests are eating and watching the event, award winners will be announced live and have their awards handed over to them at home by a team waiting to ring their doorbell. This means that guests will actually see the handover of the award, and feel as though they are still part of the event without actually being there.”

Some of the award categories have also been transformed. In spite of the challenges posed by our trying circumstances, members of our community remain determined to stand out and make tangible contributions, and the awards need to reflect this, Sackstein says.

“Beyond being online, the event must be experiential in that it is relevant to the times in which we are living,” he says.

“COVID-19 has ensured that the Absa Jewish Achiever Awards has changed, and certain award categories have been adjusted to reflect our reality. Business leadership in the time of COVID will replace the usual Business Leadership Award, the Professional Excellence award will become the Professional Excellence in COVID award. Other categories will be similarly adjusted.”

Changes like these are essential, Sackstein says.

“Awards which ignore our circumstances would be meaningless,” he says. “We have moved to recognise those doing remarkable work and their efforts at this very moment which are most relevant to our community.

“We are celebrating our heroes. Heroes emerge in moments like these. Ordinary people have really grasped the mantle of leadership and provided such a remarkable example that we should all emulate.”

Every member of our community is encouraged to participate in acknowledging the tremendous efforts of those who have risen to the occasion of COVID-19 and beyond.

“While a lot of people are depressed and fatalistic about our reality, others have seen the opportunities it offers and striven to make our lives so much better,” says Sackstein. “We have to recognise and celebrate them, using them as an example of what we can do in these difficult times.”

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