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Striking a balance between the preciousness of life and prolonging suffering.
In the traditional Jewish prayer before each new month, we ask God “For life, a long life, a good life and a life of dignity.” When caring for loved ones at the end of life we are often confronted with the difficult decision of choosing between a “long life” or a good life and a life of dignity. While each situation is unique, this article explores some of the values and approaches of Jewish law to end of life.
Life itself has immeasurable value in Jewish law and thought. The Talmud writes the one should be careful not to move a dying patient in order not to hasten his death. Likewise, the Talmud (Avodah Zara 18a) tells of the tragic death of the sage Rabbi Chanania ben Tradyon who was burned alive by the Romans. As the fire consumed him, his beloved students cried out to him, “Open your mouth so the fire will consume you quicker!” The sage refused and explained, “Let the one who created me take me.” Even in such difficult circumstance he did not want to hasten his own death.
While Rabbi Chanania may not have been obligated to act this way in such extenuating circumstances, this story demonstrates an important principle. It is not up to man to end life; it’s up to God. Just as He gives life, it is up to God to take it back.
Jewish law differentiates between terminating care and withholding care.
Leaving it up to the Creator to take back life is a basic tenement of the Jewish approach to end of life care. Euthanasia, physician-assisted suicide and the like, run contrary to this basic value. Furthermore, Jewish law differentiates between terminating care and withholding care. If a patient is connected to a life sustaining machine, like a ventilator, and removing it will result in her immediate demise, it is forbidden. Removing the devise, often referred to as “pulling the plug”, according to Jewish law, is an act of terminating life and not allowed. However, this does not mean that there is an unequivocal obligation to put the patient on that device in the first place. Withholding medical care to the patient is not actively terminating life, therefore, at times it is appropriate.
In order to develop an approach to when withholding care is or is not appropriate, contemporary Jewish scholars looked to a story in the Talmud (Kesubos 104a) about Rabbi Judah, the Prince, Rebbe Yehuda HaNasi, for guidance. Rebbe Yehuda HaNasi was an important sage of the second temple period. He was called the Nasi, which means prince in Hebrew, because he was the leader of Israel at the time. He also compiled the Mishnah, the fist collection of the oral teachings of Jewish Law.
Rebbe Yehuda HaNasi was terminally ill and the Rabbis gathered and prayed fervently to prolong his life. His attendant was a pious and wise woman and she saw Rebbe Yehuda’s pain. She went to the roof and threw down a jug. The jug fell to the ground and shattered, making a loud noise. The noise startled the Rabbis who were praying for his recovery and they stopped praying for a moment. At that moment Rebbe’s soul departed.
This story demonstrates two important perspectives on end-of-life care. Every moment of life is precious and the merit of having a great sage in the world is immeasurable. For this reason, the Rabbis turned toward the power of prayer to prevent Rebbe’s soul from departing. His attendant saw something else; she saw his suffering and interfered with the Rabbis prayers in order to not prolong his pain.
So, whose perspective is correct? Contemporary scholars look to the comments of the Ran (Nedarim 40a)), a 13th century Talmudist, who writes, “It is permitted to pray that a terminally ill patient who is suffering should pass away” and cites the actions of Rebbe’s attendant as proof. The question remains: why did the Ran decided the law like Rebbe’s attendant if it was against the opinion of the Rabbis?
Some explain (see Tzitz Eliezer V:Ramas Rachel #5) that there is really no disagreement. In principle the Rabbis were correct and every second of life if precious. Therefore, the Rabbis tried to prolong Rebbe’s life with the power of prayer. However, the attendant was privy to Rebbe’s actual condition and saw the extent of his suffering, something that the Rabbis were not aware of. Therefore, she acted correctly in disrupting their prayers and allowing Rebbe’s soul to depart. We see from this discussion that although the value of life is immeasurable, there are limitations. When dealing with a terminal patient we take his or her suffering into account at least when it comes to prayer.
A terminally ill patient may refuse certain treatments if it will prolong his suffering.
The next question is if the Ran’s position about praying to end the life of a suffering terminal patient can be applied to withholding treatment in such situations as well. Rabbi Moshe Feinstein (Igros Moshe CM 2:73-74), one of the most prominent contemporary scholars of Jewish law, was of the opinion that there is a parallel and a terminally ill patient may refuse certain treatments if it will prolong his suffering. However, Rabbi Feinstein cautions that withholding care may increase the suffering of the patient, so therefore careful discretion must be made when making these decisions. Others question the comparison. Even when one prays, the ultimate decision is up to God if He will answer the prayer or not. However, withholding routine medical is allowing mortals to make a decision that will end a life.
Rabbi Shlomo Zalman Aurbach (Minchas Shlomo 1:91.24), another important contemporary scholar, made an interesting distinction between care that is basic or more advanced. He reasoned that just as we are not allowed to starve a dying patient, we cannot withhold basic necessities like oxygen, nourishment and fluids. However, aggressive medical treatments may not be required.
As we stated in the beginning of this article, end-of-life decisions are a difficult balance between preserving dignity, avoiding pain, and preserving life itself. We presented the broad strokes of the issues discussed in Jewish legal sources. Ending life is clearly God’s domain. However, how much must to done to preserve life when the patient is in pain and terminally ill is less clear. This could depend on the role of the treatments and other factors. May God grant us the clarity, respect and compassion to make these difficult decisions.
I wish someone would find a cure for cancer a lot of people are dying of cancer, and Askenzi Jews unfortunately have the BRCA gene, and also a cure for dementia and other horrible diseases that people suffer from with a lot of pain
There is a religious organization called in English " to make your life longer in years", so there are Rabbis to answer these compicated questions, with medical and hospice care and I don't believe if you die in this lifetime( it is only your body dies your soul lives on) there is a believe under the radar that is the Jewish version of reincarnation in Hebrew the wheels of the soul, most or all people these days got reincarnated many times, even though this concept is not in main stream Judaism, this is my answer for children dying young, and may answer other questions here to, it sad when a person has dementia in India they take Tumeric to not get dementia, and sometimes unfortunately dementia could run in families but you can do things hopefully to stop it
****** One of the things I'VE LEARNED IN LIFE. In DEATH - it will make no difference on your age - your gender - your social status - or - where your at - when G-D - allows - or chooses - to REVOKE YOUR BIRTH CERTIFICATE!
What we have to take into account is that our souls have a secret, subconscious life of their own, which runs parallel to our conscious physical life. Both are real. Sometimes what seems like a low or no quality life from our perspective can be a very high quality life for our soul and vice versa,
We had a baby that went into a coma after 3 days and was placed on life support. We consulted a world renowned rabbinical authority in end of life issues, who guided us when and when not to consent to a DNR. Our son left this world five month later, and though it was an incredibly painful time, we never doubted that we did the best we could for both his body and soul.
The problem is that when the Bible was written, medical science was in its infancy and there was no real way to "prolong life" once someone got very sick or reached a certain age. Now we can keep people "alive", if you could call it that, for years as Zombies. This has changed the dynamic and to ignore this fact is to ignore a very serious problem that just did not exist in Biblical times. To state it broader, technology as a whole has changed the dynamic not just of medicine and aging but the very way we live, work and even breathe. Religion is only relevant if it can change with the times.
That's what Reform leaders said to Orthodox Rabbis regarding their allowing divorce. Reform, at the time, was following the Christian doctrine that divorce is a no, no. Yup, how times have changed. But the Torah never does.
Right, recently in this week Torah portion it is written you don't add or subtract from the Torah, it always stays the same, in Judaism you learn about divorce laws before learning about marriage laws, and actually the Torah is much more advanced then people think, Judaism is the mother religion so to speak then came Christianity and Islam, unfortunately for the Jewish people I like being Jewish
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The day after my father died, my mother announced that she was going to die on a particular date 6 months in the future. She would tell me this everytime I visited her, 2-3 times a week, in the nursing home. Two days AFTER her chosen date of death, my mother came out of the coma, asked what was happening around her and the date. She was greatly disappointed to know that she lived after her chosen. We spoke for about 2 more hours and then she slipped back into her semi coma state and died several days later.
My mother was ready to die. There had been no quality of life for her due to her illness, even drinking water was difficult. She only held on because of my father. My brother was upset with me for not overstepping her DNR . I DID THE RIGHT THING.
Your article, A long life, a good life, brought to memory a pesuk from Psalms. A well-known and proven quantum physics experiment proves that our universe and life are nothing more than probability waves and become reality only on observation. Einstein and other physicists refused to accept this finding, now proven without question. The name of the experiment is the double split-screen test.
Could Hashem have referenced this finding in Psalms 62:10: "Men are mere breath; mortals illusion; placed on a scale altogether, they weigh even less than a breath."
What do you believe the Creator created us in His image and likeness?
What you are stating has NOT been "proven" as a scientific fact. It is only a "theory" as most scientific concepts actually are. If a tree falls in the forest and no one hears it, is that a real event. WRONG QUESTION. It does not matter whether or not someone hears a tree fall. What matters is if the tree falls and something CHANGES in the comos, then there is an effect. If a squirrel is in the path of a falling tree then it will be squished, yuck! Nevertheless there is an effect no matter how gruesome therefore it "happened" in our "reality" and we have to deal with it, whether or not the event was "real".
Elena, a scientific or human absolute truth is always subject to revision. All human theories are always revised when new theories are proposed. The flat earth theory was a scientific truth at that time. While G-d periodically gives scientific absolute realities, His Torah is valid with the scientific fact that matter, atoms, or mass cannot magically attach consciousness or sentience. Could Hashem have created our mind consciousness to observe probability waves and see a holographic matrix reality?
All of us will eventually know the truth.
The attendant for Rabbi Yehuda Hanasi was absolutely correct. It is the quality of life, not the mere days or hours of life that matters.
When my dear mother was nearing the end of her days, she named me her healthcare proxy, knowing full well that quality of life was paramount over the mere number of days one lives. She had pneumonia and slipped into a semi-coma. Her doctor informed that although she signed a DNR, I had the power to override her decision and could have her hospitalized and given aggressive treatment. My mother suffered, and I do mean suffered, from Parkinson’s and hated the lack of quality in her life. Everytime she said she wanted to die already, my father would cry and beg her to hold on, so she did. That burden frustrated her.
This is an inquiry about Jewish Approaches to Dealing with Dementia. I am seeking to learn of the Torah's/Judaism's approaches to the early-stage dementia that I have. I've started to post these at the Jewish-Dementia site I created deMENSCHia at demenschia.com, and I would be glad to get thoughts related to this. My intention is for this to become part of an ongoing conversation about dementia and other cognitive conditions http://www.TheAlzheimersConversation.com within the Jewish community.
Many thanks,
David
The story of Rebbe Yehuda HaNasi with alacrity confirms that in the end we will learn that every positive and negative human action, whether willingly or not, has been worked to serve the Master Plan of the One and Only Master of the Universe: HaShem.
May My God redeem this world soon.
Amen