“I Would Consult a Doctor, But What the Rabbi Says Goes”: Ultra-Orthodox Jews’ Relationships with Rabbis and Doctors in Israel

Journal of Religion and Health (2024) 63:1905–1933 https://doi.org/10.1007/s10943-024-02014-7 ORIGINAL PAPER “I Would Consult a Doctor, But What the Rabbi Says Goes”: Ultra‑Orthodox Jews’ Relationships with Rabbis and Doctors in Israel Rivka Neriya‑Ben Shahar1 · Fany Yuval2 · Aviad Tur‑Sinai3,4 Accepted: 8 February 2024 / Published online: 29 February 2024 © The Author(s) 2024 Abstract We examine relationships among ultra-Orthodox Israeli Jews, their doctors, and rabbis when medical decisions are made. Analyzing excerpts from sixteen focus groups with 128 ultra-Orthodox Jews, we determine how their belief system affects their decisions about whom to trust and follow when the doctor’s instructions contradict the rabbi’s advice. We argue that the strict behaviors described here with regard to relations among doctors, rabbis, and patients, function as social capital that raises the status of ultra-Orthodox Jews as members of an exclusive club that balances health decisions with the social demand to obey their religious leaders. Keywords Ultra-Orthodox Jews · Club theory · Listening guide · Medical decisions Introduction “We canceled the examination we were supposed to have today,” said an ultraOrthodox friend. “Why? Didn’t the doctor say the fetus might have a problem?” I asked. “Our rabbi said everything will be fine, so we relaxed and canceled the * Aviad Tur‑Sinai Rivka Neriya‑Ben Shahar Fany Yuval 1 Department of Communications, Sapir Academic College, Sderot, Israel 2 Department of Public Policy and Management, Chairwoman, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer‑Sheva, Israel 3 School of Public Health, University of Haifa, Haifa, Israel 4 Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel 13 Vol.:(0123456789) 1906 Journal of Religion and Health (2024) 63:1905–1933 examination.” This conversation exemplifies the unique perceptions and attitudes of ultra-Orthodox Jews with regard to the triadic relationship that plays out in medical consultations among themselves as patients, their doctors, and their communities’ religious leaders and authorities—their rabbis. To explore these relations, we combined a socioeconomic theory with a psychological one. Berman (2000) uses club theory to explain what may be seen as irrational behavior on the part of Israeli ultra-Orthodox communities. The communities’ remarkable mutual-insurance network, he found, compensates them for members’ strict religious practices. The ultra-Orthodox sacrifice time and money, among other things, to signal their strong commitment to the community and contribute to their group’s social capital (Bourdieu, 1986; Putnam, 1995). From another perspective, Gilligan’s (2015) listening guide is a sensitive qualitative method for analyzing interviews. Using it to understand the economic aspects of the costs and benefits of belonging to the group, we argue that the strict behaviors described here in relations among doctors, rabbis, and patients function as social capital that raises the status of ultraOrthodox Jews as members of an exclusive club. They balance member’ health decisions—perhaps the most vital and critical decisions in life—with the social imperative of obeying their religious leaders. Based on sixteen gender-separated focus groups comprising 128 ultra-Orthodox men and women, we explored several questions: Who guides the medical decisions of ultra-Orthodox Jews—their rabbis or their doctors? Under what conditions? In what order? Who has the last word? Bearing in mind that the ultra-Orthodox community is not homogeneous, we also traced recent dynamic changes in the community’s perceptions of the complicated relationship between doctors and rabbis. Our findings should be useful for those seeking to provide culturally sensitive services to any community. Literature Review Culturally Sensitive Care Within the Ultra‑Orthodox Community Culturally sensitive care is based on adaptations of healthcare treatments to sociocultural, linguistic, and religious backgrounds (Bilu & Witztum, 1993; Holt & McClure, 2006; Witztum & Goodman, 1999; Ypinazar & Margolis, 2006). Specifically, the intersection of religion and health care suggests that the beliefs of the mainstream healthcare system differ significantly from some patients’ attitudes and perceptions. One of the central insights of these approaches is that careful and sensitive listening to various discourses reveals alternative cosmologies of illness, health, curing, and healing (Kasstan, 2019; Yehya & Dutta, 2010). We chose several interesting studies from the many relevant case studies that explore the intersections of religion, religious authority, and health care in various religious contexts. Religious leaders as health advisers are unique neither to Israel nor to the ultra-Orthodox community. People often seek religious leaders’ advice and guidance at times of uncertainty. Covid-19 was an opportunity to observe religious leaders’ actions (in various ways) as health promoters. For 13 Journal of Religion and Health (2024) 63:1905–1933 1907 example, Viskupič et al. (2022), comparing the effectiveness of religious, medical, and political leaders in terms of their public-health messages about Covid-19, found that people tended to obey religious leaders even though the others’ messages were identical. Based on this study, Meyer et al. (2022) recommended that the U.S. healthcare system and pharmacists collaborate with religious leaders to overcome the hesitancy about vaccinations within Christian communities. The need for trust in the healthcare system is especially critical when people must make decisions about issues over which they may have misgivings, such as getting vaccinated. Patients from minority groups may find it difficult to trust the healthcare system. For example, studies have reported that Arab mothers in Israel distrust doctors and the Ministry of Health. They distrust the doctors because the healthcare system meters patients’ “face time” with doctors, leaving scant opportunity to establish a trusting relationship with them. In addition, Arabs argue that the Ministry of Health gives them poor-quality service and partial information (Shahbari et al., 2020). The Israeli ultra-Orthodox Jewish community provides an appropriate case study for the intersection of religion and health care. This strictly religious Jewish community comprises three main sub-communities: Lithuanians, Hasidim, and Sephardim (Jews originally from Arabic, Farsi, and Turkic-speaking countries). Together, they formed 13% of Israel’s population (Malach & Cahaner, 2022). Their religious and social life is bounded by the strict interpretation of halakha, Jewish religious law, and unquestioning faith in rabbinic authority (Brown & Leon, 2017; Soloveitchik, 1994). This community actively safeguards its cultural continuity by separating itself from other (...truncated)