A Jewish Perspective on the Ethics of End of Life Decision Making
My congregation – Temple Emanuel of Davenport, Iowa – has started hosting a series of panel discussions on contemporary ethical issues. For these panels we bring in local experts on varying aspects of the issue. After introducing the topics and the “players,” each program starts off with me offering a 10 minute presentation on the topic from a Jewish perspective. This year we experiments with two such programs; one on the Ethical Challenges Facing the Media and the other on the Ethical Challenges Facing End of Life Decision Making. While my presentation of the Jewish perspective on the topic of media ethics was made from an outline (and therefore far exceeded my 10 minute limit), for time and efficiency sake, I decided to prepare my presentation for end of life decision making in a full text format. It is that text which I share with you now. However, before I do so, let me offer a few disclaimers: 1) This presentation is far from exhaustive on the topic, nor could it be considering the presentation’s time limit of 10 minute. 2) For research sources, I relied heavily on responsa literature coming out of the Reform movement. While a more evenhanded approach would have been to pull from responsa across the Jewish spectrum, being a Reform rabbi primarily speaking to a Reform congregation, I felt, and feel, completely justified in restricting my sources to those coming out of Reform Judaism. 3) As an adjunct professor at a local university, I try to be sensitive to issues of plagerism, however I am not always certain of some of the fine lines which define it. I have tried to give appropriate credit to my sources in my footnotes. If I have an any point crossed that line into the universe of plagerism, I apologize in advance for it was never my intention to “steal” intellectual property from another.
Several years ago one of our congregants suddenly collapsed and was rushed to the emergency room. She had several arterial blockages which the doctors tried their best to clear. However the damage was so extensive that there was considerable loss of oxygen to the brain. So she was placed in intensive care and put on a respirator. She never regained consciousness and it was not long before it was clear to the doctors that she never would. At best, her brain activity was minimal. So her loving family was faced with the very difficult and painful decision as whether or not to artificially keep her alive by means of the respirator although there was infinitesimal, if any, hope of her ever recovering, or remove her from the respirator and place her life into the hands of God.
So the family sought my advise, as their rabbi. I told them that they needed to choose what they thought would be best for their loved one and for themselves, and that whatever that decision would be, Judaism would support it. So they decided to take her off the respirator.
After they had made that decision, but before they had actually taken the action, they were visited by the local Chabad rabbi. When they told him their intentions, he was emphatic in expressing his opposition, claiming that in the eyes of the Jewish religion, what they were proposing to do would be nothing short of murder.
Two rabbis and two dramatically different opinions on a very personal and difficult subject. Which one of us was right? Actually, both of us could make that claim. For when you look at the traditional literature on such difficult end of life questions, you can find argumentation in both directions. You see, we think of these questions as being relatively contemporary but in Judaism rabbis have been debating these issues for centuries, indeed for almost two millennia; as far back as the MISHNAH, which was put in its final form approximately 1,800 years ago.
Before we can look at where we disagree, we need to spend some time looking at our areas of agreement.
Firstly, there is unanimous agreement among the rabbis that life is more than just a biological function. Rather it is a gift from God. As such, it must be viewed as sacred and therefore must be treated with great care. Needless to say, Judaism fundamentally rejects murder – the taking of a life. This is as old as the Torah itself. It is one of the Ten Commandments.
The rabbis later extended the Torah’s definition of murder to include suicide. The Talmud makes this point very clear when it tells the story of Rabbi Chananiah ben Teradion, a second century rabbi who was part of the Bar Kochba rebellion against Rome. The Romans captured him and condemned him to be burned at the stake. His loving students urged him to breathe in the flames so that he could die more quickly. He refused, giving the reply, “It is best that He Who hath given the soul should also take it away; let no man hasten his own death.”
Yet another point of mutual agreement is the prohibition against the practice of euthanasia or assisted suicide – taking positive steps to advance death regardless of whether or not the individual is terminally ill. There is uniformity among the rabbis that this is but another form of murder, even if the “victim” is a willing participant, choosing to terminate their own existence.
There is also agreement that while taking positive actions to advance death is prohibited, that there is a clear distinction between such positive actions and indirect actions, primarily using negative means, in order to remove barriers which might hinder a natural death. So, for example, the rabbis agree that it is acceptable to stop praying for the recovery of someone who is terminally ill. While we today may think of that as a minor matter, for the rabbis it was not, for they fully believed that prayers make a real difference. In fact the Talmud relates a powerful story to this effect. Rabbi Judah HaNasi – the redactor of the Mishnah – was dying with great suffering. Yet the other rabbis insisted upon standing at his window, offering continual prayers for his life. Finally, in empathy for her master, Rabbi Judah’s servant woman climbed onto the roof and dropped a clay jug right over where the rabbis were gathered. The crashing of the jug on the ground startled the rabbis, interrupting their prayers. No sooner did they stop praying then Rabbi Judah was released from his suffering and died.
It is on this point of making a distinction between positive actions that advance death and those actions which serve to remove the barriers to natural death that the rabbis part company. They do so over the very difficult question of boundaries. When does one’s actions cross over from actively terminating a life to removing that which artificially prolongs life and interferes with a natural death? This can plainly be seen in a debate across time between two famous commentators, Moses Isserles (1520-1572) and the Taz, David HaLevi Segal (1586-1667). Isserles held that it was permissible to remove salt from the tongue of a terminally ill patient on the grounds that it was a stimulant which was preventing him from relaxing into death. The Taz challenged Isserles’ position, claiming that the removal of the salt was an overt act which hastened death.
It was on this question of boundaries – when do we cross over from actively terminating a life to removing an impediment to death – that the Chabad rabbi and I disagreed in the situation that I described in the beginning of these remarks. To reference the debate between Moses Isserles and the Taz, I stood on the side of Isserles while he stood on the side of the Taz. So as you can see, their debate continues today as we find ourselves struggling in our search for ethical answers for these end of life decision.
Not only will it continue, but it will grow in intensity and complexity as medical technology continues to advance our ability to prolong the length of life but not to the same degree, the quality of life. As a rabbi, I visit the sick and the shut in of our community on a regular basis. Among those I visit are those who are suffering from horrible diseases such as Alzheimers, which methodically strips them of their intelligence, their personality, their ability to communicate, until they reach a point when their body is here but all that made them who they were as human beings is no longer with us. I leave those visits deeply depressed for I miss the people who inhabited those bodies and I deeply dread the very real possibility that such would be my ultimate fate as well. And I cannot help but ask myself the fundamental question: When does life end? When the body no longer functions or when the individual who populates that body no longer exists and for whom there is no hope of return? Tough and frightening questions present themselves to us today and will continue, and multiply, in the coming years. We will need to struggle with the ethics of our responses.
Euthanasia, American Reform Responsa, Central Conference of American Rabbis, 1950.
 Ibid. Tractate Avoda Zara 18a, Babylonia Talmud.
 Euthanasia, American Reform Responsa, Central Conference of American Rabbis, 1980.
 Ketubot 104a, Babylonian Talmud; Allowing a Terminal Patient to Die, American Reform Responsa, Central Conference of American Rabbis, 1969.
 Allowing a Terminally Ill Patient to Die, American Reform Responsa, Central Conference of American Rabbis, 1969.
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