Naso: Informed Consent

I am, professionally, a purveyor of extraordinarily dangerous and unpleasant medicines.  Although they differ in mechanism of action and the nature of their side effects, the medicines I order are called chemotherapy.  They are the most dread members of the pharmacopoeia.  They have reputations  worse than the deadly, ugly, painful diseases they treat. 

Before administering these medicines, a patient must sign an "informed consent" form.  There is no way to adequately inform a patient about these ( or any other) medicines.  All medicines, from aspirin to Zolendronic acid, have a list of possible side effects that exceeds memory.  I always look them up, and even the most extensive list is incomplete..

Balancing the risk/benefit of taking these medicines is a calculation that is currently beyond the capabilities of any network of supercomputers.  It is, therefore, relegated to guess.  That guess  is stridently influenced by interested parties: payers (insurance companies) and drug manufacturing companies (who fund almost all  continuing medical education activities).  Risk/benefit maps onto profit/loss. 

Electing not to undergo treatment has a strong economic component.  The medicines and other aspects of care are extraordinarily expensive.  CAR-T cells, a newly approved treatment for lymphoma, costs one million dollars per treatment ( half for the cells, half for the transplant that is part of the procedure).  Avoiding such costs is a strong motivator. Often, that motivation is hidden from the patient.  It is not part of the informed consent.

"Prognosis" is often simplified to" hopeless", when the probability of meaningful response  is less than 10%.  The pain and suffering of choosing to continue treatment are often emphasized despite a lack of clarity regarding the probability of  pain and the difficulty communicating the nature of the pain. 

Signing the informed consent and allowing the chemotherapy to enter the body is an agnostic act of faith, a hope that the odds will be with you - but the odds are "with " no one. The odds are the  envoy of  Atheos (no Gd) 

This week's parsha contains an archetype of informed consent.  Before the suspected woman (Sota) enters into the ritual (a meal offering and trial by the ordeal of drinking dissolved ink and temple dust), she must consent, knowing that her belly may swell and her thigh wither ( it sounds like advanced ovarian cancer [a classic BRCA  association]). She can refuse the procedure ( at a price).  Or she can take her chances: Will the procedure catch her if she is guilty? Will it work as described and exonerate her of she is innocent?  One should always doubt these technical procedures. 

Some odds ( actually all odds) cannot be calculated. The truth can be approached. 

Bamidbar:  Into The Wilderness

This week, we start the fourth book of the Torah: Bamidbar.  The name means: in the wilderness. The book describes the travels and travails of the Israelites after the Exodus, their Odyssey to the Promised Land.  The people are going into the unknown.  They have escaped  from servitude, but they have also left civilization.  They have gone from a world of oppression to a place without rules, a place that might  not be able to sustain human life.

This journey into the insecure is everyone's life story.  A person does not clearly know where the path she chooses will lead.  The model-story, Bamidbar, says that may lead to the Promised Land- and then tells us that the hero cannot enter.  The path leads a new set of opportunities - for the next generation.  This is the song that never ends.

In the parsha, there is a preparation for the wandering/journey.  The people are divided into tribes and the tribes are grouped to the four directions of the compass. There is security in numbers and separating into groups increases the chance that at least some of the Israelites will survive an attack.  These are the four parties of the proletariat.  They surround the Levites who, in turn surround the Tabernacle and the secretariat of Kohanim. Direction comes from the cloud and fire that hover over the Tabernacle.

The parsha contains a significant political act: the firstborn are replaced by the Levites.  The prominence of the first born seems to have been a pre-Abrahamic edict, a custom born with creation that needs no justification.  The first book of Torah, Genesis, is devoted to undoing the seemingly natural prominence of the firstborn.  None of the patriarchs are first born. Now, within Israel the firstborn pay a  ransom  for that accident of birth, and their political role is replaced by the designated Levite tribe.

The firstborn is special to the family.  But All happy families are alike; each unhappy family is unhappy in its own way (Tolstoy).  The natural  firstborn system is subject to the heterogenity of families.  Creating a tribe  to perform the tasks can help steer the people in the desired directions.  

And the directions are always leading to the Promised Land.  And the directions are always changing. 

Come mothers and fathersThroughout the land

And don't criticizeWhat you can't understand

Your sons and your daughtersAre beyond your command

Your old road isRapidly agin'.

Please get out of the new one

If you can't lend your hand

For the times they are a-changin'.

Behar-Bechukothai. 

The first Rashi has become a moniker for oxymoronic juxtaposition.  What does the laws of the Sabbatical year have to do with Mt Sinai? Rashi emphasizes the validation of laws that are volcanically delivered in the archetypal communication from Gd through Moshe.  Mt Sinai validates the details of these laws that deal with the time value of money and ancestral property rights. 

The abrasive nature of the juxtaposition also derives from its totally theoretical aspects.  The Hebrews at Sinai, slaves for the past 410 years, without a memory of land holdings, are told these dovetailed laws of redemption, reversion and taxation of  sold land.  But they are in the wilderness, far from the land.  The fundamentals of these laws is are hard to grasp  in  a Manna based economy, in the abscene of any concrete experience

But then comes the rebuke, The section that foretells a holocaust like situation Its relevence to the Sabbatical year is  stated: the desolation of the land will repay the missed Sabbatical years prescribed in the first verses of the parsha.  The inanimate land will be avenged,  The source of the cornucopia will produced only toxic dust.  The people, who had tried to profit from an  ( forbiddedn) extra year  of planting will be disappointed, they will reap a famine.  The hunger causes people to leave the land, and there become paranoid Jews who run from rustling leaves, Jews who are robbed and scorned and cursed.  And persecuted and shot and gassed and burned . 

Does the fact that Gd kept this promise encourage faith in the source of Mercy?  Yes, somehow it does! 

Emor: The Elite

The parsha begins with instructions to the Cohanim, the (at this point, newly founded) Priestly Dynasty).  These special people have special rules. They are restricted in whom they can marry, whom they can mourn.  They are different, better, than an ordinary Israelite. 

The parsha ends with the transgression of the half-breed blasphemer. The lowest born of the community.  When Gd gives instructions about his fate, it is in the context of equality under the law: the sojourner is treated like the native born, an eye for an eye, distinguish between capital and commercial offenses. In this context, all are equal, regardless of ancestry(.com)

The mid-portion of the parsha, the holidays, is  the celebration of all Israelites for the good fortune of their membership. They have a day of rest, days of re- commitment, a day of atonement and days of joy. These are privileges of belonging. 

The presence of an elite is important for the plebeians.  It reinforces the hierarchical structure of the world that is the basis of organized religious observance.  The ordinary person is given limits on her aspirations.  Even among the elite, the flawed are excluded from  the performance.  The service is a ballet, a car commercial.  No defect can be tolerated. 

But everyone, no matter how low born, no matter how flawed, has a life.  The successes and failures in that life are on a different trajectory, a path that is more meaningful than the sacred performance.  The (official) American egalitarian ethos, with its recognition of the rights and potential of people with disabilities, is a great ethical achievement.  It does not contradict the idea of the flawless  male descendant of Aaron as the only one qualified to perform the Service. Somebody has to do it.  It preferable to know your relationship to that service from birth. 

Did the lack of opportunity motivate the blasphemer?  He was excluded from the elite, he excluded himself from the ordinary.  What beliefs had he grown up with? Was he re-enacting the rebellion against Egyptian authority, embodied in his Egyptian father?  Was he demonstrating the ambivalence of association he saw in his mother, who had married an Egyptian? He needed to sort things out better.  He could have been one of the best guys.