Unfortunately, the health system has not implemented the passive-euthanasia hospital committees advocated by the 2006 Steinberg Commission. Representing the full range of the ideological spectrum, this 59-member group attempted to form a halachicly defensible national consensus over these life-and-death issues. In the absence of its implementation, this assisted-suicide bill was recently proposed, which, as far as I can tell, does not meet the standards of any Jewish denomination. We will briefly outline major trends within Jewish thought, hoping to facilitate a more informed conversation.
Tragically, many terminally ill patients can remain alive, yet suffer greatly from their sickness, or alternatively remain in a comatose or vegetative state, for many years. Expensive medications and cardiopulmonary resuscitation (CPR) machines extend life's duration but cannot guarantee a dignified quality of life. The heated debates surrounding figures like Karen Ann Quinlan, Dr. Jack Kevorkian, Terri Schiavo and Benjamin Ayal highlight the severity of the moral issues.
Classic Jewish discussion of these dilemmas begins with the premise that humans do not possess full autonomy over their bodies. Jewish law prohibits not only murder and battery, but also suicide and self-infliction (Bava Kama 91b). As such, all Jewish denominations have traditionally maintained strong opposition to active euthanasia, or even the more moderate model of assisted suicide proposed by this new bill, in which physicians facilitate, but do not actually perform "mercy killings." As one 1994 Reform responsum declared, "Such an action is the ultimate arrogance, for it declares that we are masters over the one thing - life itself - that our faith has always taught must be protected against our all-too-human tendency to manipulate, to mutilate and to destroy."
While certain sources sympathize with (though do not condone) a person who, like King Saul, hastens his own death under the duress of suffering (I Samuel 31:4-5), this clemency is not extended to their accomplices.
There exists a similarly wide consensus that one may employ any palliative measure to reduce suffering, such as those promoted at hospices. This even includes gradually increasing morphine injections, as long as one intends to reduce pain and not to hasten the patient's death.
However, Jewish bioethicists significantly disagree regarding "passive euthanasia," which can constitute either withholding or withdrawing treatment of the terminally ill. In the 16th century, Rabbi Moshe Isserles codified three major principles regarding the treatment of a patient approaching death (goses). (1) One should not cause them to die more slowly. (2) One may not do any action which hastens the death. (3) One may remove something which is merely hindering the soul's departure (YD 339:1). Unfortunately, these principles remain subject to different interpretations, and the examples given in the code, including placing salt on the tongue and synagogue keys under the pillow, remain difficult to correspond with modern technologies, to say the least.
Regarding the withholding of medical treatments, rabbis Eliezer Waldenburg and J. David Bleich contend that the value of every moment of life remains infinite and absolute. One must therefore administer, even under the most miserable of circumstances, all life-extending treatments, even against the patient's protest (Tzitz Eliezer 9:47). Others, like rabbis Shlomo Z. Auerbach (Minhat Shlomo 1:91) and Moshe Feinstein (Igrot Moshe CM 2:74), assert that one may withhold life-prolonging treatment in cases of intense anguish. Accordingly, one may fill out a halachic living will to enable, under certain conditions, the withholding of life-prolonging treatments, such as resuscitation (DNR) or intubation (DNI). Orthodox authorities almost universally contend that food, fluids and oxygen constitute natural substances that should not be withheld. While many non-Orthodox bioethicists support this position, others view feeding tubes as medical treatments which the patient (or caretakers) may autonomously choose to withhold.
Once doctors administer a life-prolonging mechanism, it becomes more difficult to withdraw this treatment, even as one may cease futile therapies for the underlying disease. Rabbi Chaim D. Halevi classified an artificial respirator as a mere impediment to death that doctors should disable to prevent continued suffering (Aseh Lecha Rav 5:30). While this position enjoys support in some non-Orthodox circles, the nearly universal Orthodox position, advocated by rabbis Auerbach and Feinstein, contends that one cannot remove an artificial respirator as this will directly hasten the death. One would not, however, need to reconnect the machine if its functioning was interrupted to service it or suction the patient (Igrot Moshe YD 3:132). As a compromise, the Steinberg Commission proposed to operate all respirators on a timer, thereby allowing it to shut off automatically, should the hospital committee deem this act of omission appropriate, given the patient's condition.
While no agreement is perfect, one hopes that the two years of work by the Steinberg committee will help create greater national consensus on these sensitive issues.
The writer, on-line editor of Tradition and its Text &Texture blog (text.rcarabbis.org), teaches at Yeshivat Hakotel.
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