HMS 5765-24: End Of Life Issues: Special series on Halacha in the news

Lessons in Memory of my brother Dale Alan Konigsburg

March 21, 2005 - Number 5765-24

End Of Life Issues: Special series on Halacha in the news

I know I promised a different topic this week but with Terry Schiavo in the news there has been a great deal of interest in Judaism and these end of life issues. Terri Schiavo is a Roman Catholic but there are also Jews who also need to know what our faith has to say about such issues.
First of all, the most important Halacha in relationship to all health issues is the commandment to "choose life". We are not asked if we wish to be born, and we are not asked when we should die. Such decisions are in G-d’s hand. We never give up when it comes to preserving life. G-d has placed great healing powers in our hands and we need to use them to help preserve life. That being said, Jewish Law also understands that there comes a time when healing is no longer possible, and then, we are permitted to let the natural progression of life take place, even if it means that the one who is ill will die. It is a mitzvah to bring healing, but when healing is no longer a possible, we can remove what is preventing the person from dying.
Judaism does not believe in active euthanasia, ala Dr. Kevorkian, but passive euthanasia is permitted. To this end, one may remove medical care that is preventing the person from dying. This does not mean that we also refrain from medications that will relieve pain and suffering. Only the medical aids that are keeping the person alive can be removed. This is based on a number of Talmudic references that permit the removal of impediments to death in the case of a patient who can not recover.
It is important that end of life issues should be written down in a document called "medical directives" Each state encourages patients to have such directives, together with a medical proxy, a person assigned to make medical decisions for the patient if the patient is unable to make these decisions for him or herself. The Conservative movement has such a document and it can be purchased through the United Synagogue of Conservative Judaism Book Service (www.USCJ.org).
The question in Judaism is the same as the question in the Schaivo case. Does the removal of impediments to death include the removal of food and water (sustenance and hydration)? The Law and Standards Committee of the Rabbinical Assembly, the committee that examined these laws was in agreement on almost all aspect of end of life care except the case of removing food and water. So difficult was this issue that there was no resolution of the disagreement and both options are included in the movement’s Medical Directives.
The case for removing food and water from a terminal patient was made by Rabbi Elliot Dorff of the University of Judaism in Los Angeles. He claims that most authorities do not permit withholding food and water from a patient so the burden of proof is on the one who fails to provide these necessities. To do this he notes that the kind of food and water given to the patient who can not eat or swallow, this food and water are more like medicine than food. Just as a blood transfusion is not "eating blood" a prohibited act in Judaism, intravenous food and water is not food at all but medicine and as such it can be withheld.
Rabbi Dorff does note, however that for people in a persistent Vegetative state (pvs) like Terry Schiavo, presents a more difficult case. Such people do not need all kinds of medical equipment to stay alive, but they do need food and water. While they may have no functioning in their higher brain, they sill have enough brain stem activity to stay alive. Saving a life in Judaism does not have us judge the quality of that life. A patient with PVS presents us with a very difficult case. If we were not able to provide the food and water intravenously, than that patient would die. This means that the food and water are like medicine and we can withhold it. While we consider brain death to occur when there is no brain activity at all, if the doctor were to say that lack of higher brain function (neo-cortex) could be the sign of death and if such patients are dead, than food and water can be withheld. Because of issues relating to the diagnosis of PVS and Alzheimer’s disease, food and water should be provided for a period of time in order to be sure of the diagnosis.
There is another side to this discussion, that of Rabbi Avram Reisner. We will look at his position next week.

Next week: End of Life Issues II – The Reisner Position