Moses Maimonides, an illustrious figure in Jewish history, medicine, and philosophy (1), dedicated much of the last 10 years of his life to medical writings(2), in the course of which he also studied mental illnesses and provided what may be the first description of psychosomatic medicine (3). In his medical letter to the ill-fated nephew of Saladin the Great in Cairo, who suffered from manic-depressive disorder, Maimonides discusses the possible intake of alcohol by his Muslim patient—the only available treatment for depression at the time. Maimonides analyzes the conflict between his patient’s religious prohibition of drinking alcohol and his own professional responsibility. This letter illustrates Maimonides’ attitude regarding the patient-physician relationship, forges a synthesis of religion and medicine, and demonstrates intercultural respect and psychological sensitivity to his Muslim patient. Maimonides artfully incorporates sources from Jewish and Islamic culture and leaves the final decision to his patient.

We offer here this new English translation of his medical letter (4) to let Maimonides speak for himself. In our brief comments afterward, we elaborate on Maimonides’ ethical messages for modern readers.

Maimonides emphasizes at the beginning his patient’s insight as the key for the patient-physician relationship and the success of the treatment; Maimonides is the "servant" for the patient, his "master" (the Sultan’s nephew). By quoting the Koran, Maimonides presents the religious foundation of his medical mission according to his patient’s belief system. For the patient’s confidence, the physician must also be familiar with his spiritual and religious world.

For Maimonides, preventing suffering and providing medical and spiritual support to those who need it is also a religious duty. By partially sharing with his patient his own medical condition, which does not hinder him from his manifold activities, he encourages his patient to cope in the same way with his medical issues. Maimonides and his Muslim patient share a deep belief in the Creator, rooted in their respective religions.

Drinking wine might be justified medically to treat depression, but Maimonides is fully aware of his patient’s religious prohibition of drinking alcohol (Koran 2:219; 5:90—91). Following his overriding obligation as a physician, Maimonides frankly discusses the benefits of alcohol with his patient, who is the religious leader of an Islamic kingdom.

Based on the physician’s professional obligation, anchored also in Maimonides’ religious writings, the physician is bound to advise his patient according to his medical knowledge, even if it contradicts the patient’s religious tradition. Withholding medical information from his patient would violate the physician’s obligation to inform his patients. Maimonides elaborates on the ethical complexity of a religiously questionable treatment for his Muslim patient but leaves the final decision to his patient. This key role of the patient’s autonomy is in accordance with Maimonides’ religious philosophy.

Maimonides distinguishes between medicine and religion: The goal of medicine is well-being in this material world. Religion focuses on the spiritual future in the world-to-come, where the benefits are "not evident in this world." Saving lives and promoting human well-being in this world are not to be neglected in favor of religious commandments. According to Jewish tradition, saving life must be given preference over religious commandments. Therefore, Maimonides permits the enjoyment of wine within certain limits and encourages his sick Muslim patient to consider the benefit of alcohol in treating his illness.

Important ethical values are presented in Maimonides’ medical letter: The physician’s personal qualities include modesty, honesty, and obligation to his profession. The patient’s autonomy to decide about his treatment must be fully respected, including with psychiatric patients, reflecting a remarkably modern attitude in a medieval physician, at a time when paternalism was the prevailing attitude. In his patient-physician relationship(5), Maimonides demonstrates familiarity with his patient’s religious world by quoting the Koran. By frankly addressing both the religious issues of his Islamic ruler and the physician’s professional duties, Maimonides deals with his medical and philosophical values together with his patient. He analyzes the conflict between medicine and religion by defining their different features and goals. For Maimonides, saving life is itself a religious duty that supersedes virtually all other religious obligations. Since Maimonides respects many common values of various religions, these concepts of Jewish law are consequently also relevant for his Muslim fellow man. The intercultural bridges between this outstanding Jewish scholar and his Muslim patient are remarkable for the 12th century, a period when religious persecution defined the political and social atmosphere in Christian and Muslim countries. In his clinical work, Maimonides successfully combined medical, religious, philosophical, and psychological talents, creating a respectful intercultural discussion for the benefit and well-being of his patients. For these special achievements, Maimonides, an outstanding medieval rabbinical authority, philosopher, and physician, remains a bioethical role model for contemporary clinicians.