Psychiatric drugs to enhance conformity to religious norms, and conscientious objection
An article in the Israeli newspaper Haaretz reports on the (alleged) frequent use of psychiatric drugs within the Haredi community, at the request of the religious leaders, in order to help members conform with religious norms. Haredi Judaism is the most conservative form of Orthodox Judaism. It is sometimes referred to by outsiders as ultra-Orthodox. Haredim typically live in communities that have limited contact with the outside world. Their lives revolve around Torah study, prayer and family.
In December 2011, the Israel Psychiatric Association held a symposium entitled “The Haredi Community as a Consumer of Mental-Health Services”. One of the speakers was Professor Omer Bonne, director of the psychiatry department at Hadassah University Hospital. Professor Bonne is claimed to have said that sometimes yeshiva students (yeshiva is a religious school) and married men should be given antidepressants even if they do not suffer from depression, because these drugs also suppress sex drive.
Homosexuality and masturbation (referred to by Haredim as ‘compulsiveness in sex’) is not accepted by Haredim. Sex is not something that is to be enjoyed. (In the Gur sect within Haredi Judaism it is strictly prohibited to enjoy sex.)
Professor Bonne’s justification for providing the antidepressants to Haredim is that this helps to avoid “destructive conflicts that would make students depressed”. The medication “enables them to preserve their place, image and dignity within the system, to continue to maintain proper family and social relations, and to find a match and raise a family.
A first question that arises is whether, from a religious point of view, medication is an acceptable, or the best means for complying with religious norms. One may think that what matters most from a religious perspective is one’s strength to resist temptation rather than living in accordance with religious norms without there being anything to resist. If this is so, then this counts against using drugs as a means to conform. However, religious people already use ‘tricks’ to resist temptation, such as seeking distraction whenever ‘inappropriate’ sexual urges arise or having members of the opposite sex wear unrevealing dress. One question then is whether the use of a pill is morally different from these non-biomedical tricks. It seems not. Also, it may be that some people can only conform to religious norms by using medication; if one doesn’t have the strength to resist temptation, maybe taking the pill is the next best option.
A second question that arises is whether psychiatrists should provide such ‘treatments’ if requested by the patient. The answer will depend on what role one ascribes to psychiatrists, and medical doctors in general. One view is that medical doctors should provide any medical services the patient demands, as long as these are legal and beneficial. Providing Haredim with antidepressants is legal. Is it beneficial for the ‘patient’? This is controversial. Perhaps the drugs could indirectly reduce depression by enabling the patient to think, feel and act in accordance with the expected norms in his community. However, antidepressants have serious side-effects and it is not clear that these are outweighed by the advantages of the drug (if there are any advantages at all). Also, perhaps having a good sex life is good for you, and the Haredim are mistaken to think otherwise.
But suppose there were safe drugs that reduced sexual desire. Should psychiatrists offer them to Haredim (or other religious groups with similar values) upon request? Since such treatment would be legal, and would potentially be beneficial to the individual ‘patient’, it seems that the psychiatrist should provide the drugs.
Perhaps one could say that helping people adhere to religious norms falls outside of the psychiatrist’s sphere of duty, and that, as a consequence, psychiatrists do not have to provide such ‘treatment’ even if requested by the patient. However, the aim of the drug could be described in several ways: to help maintain the Haredi community, or to increase people’s wellbeing, for example, by increasing their authenticity, or by reducing anxiety and depression. The latter clearly falls within the professional responsibility of psychiatrists.
So should a psychiatrist then provide such treatment? Many psychiatrists may feel uncomfortable at this thought.
Could the psychiatrist refuse to provide the treatment as a form of conscientious objection? Is it permissible for a psychiatrist to refuse providing a legal treatment that may be beneficial for the patient on the ground that she strongly objects to the values she would thereby promote? According to Savulescu (2006), “values and conscience … should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patient. The door to “value-driven medicine” is a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine.” (p. 297).Following this reasoning, it seems that a psychiatrist has no ground for conscientious objection and should provide the treatment to Haredim. But this seems intuitively incorrect. Intuitively, it seems that individual psychiatrists should be able refuse treatment because they do not want to be complicit in maintaining religious norms that they profoundly disagree with.
Does this mean that psychiatrists work should be value driven after all?
Conscientious objection is typically discussed in a context of objections to provide abortion services, contraceptives, terminal sedation to dying patients, or pediatricians who object to providing the HPV vaccine to young female patients in the belief that it will encourage underage and unmarried sex. It is, however, interesting to think about conscientious objection where intuitively we feel the practice, though legal and possibly in the interest of the individual patient, is nevertheless morally objectionable because it sustains morally objectionable religious values.
Ettinger, Y. Rabbi’s little helper. Haaretz (6 April 2012). Available at: http://www.haaretz.com/weekend/week-s-end/rabbi-s-little-helper-1.422985
Savulescu, J. (2006). Conscientious objection in medicine. BMJ, 332(7536), 294–297. doi:10.1136/bmj.332.7536.294