ALTA FIXSLER FATHER PLEADS FOR LIFE SUPPORT TO END ‘AT HOME’

The Talmud says extreme suffering can be worse than death itself

FIRST AND foremost, life is sacrosanct in Jewish Law and efforts to preserve life and even prolong it for a brief period should be made, even if they involve the violation of the sanctity of Shabbat, for example.

There is a broadly-held perception that halachah (the Jewish legal framework) holds that all efforts — regardless of the suffering of the patient, emotional burden on the family or extreme financial cost — should be undertaken to preserve or extend life. In the case of a terminally ill patient, not all life-prolonging measures are halachically required and some may even be forbidden.

Many competing factors are at play and a combination of medical opinion and ethico-halachic considerations need to be integrated into practical actions. This is the reason why nonmedical personnel provide much value on medical ethics committees.

Some of these competing factors are: the withholding — as opposed to the withdrawing — of treatment; the responsibility of healing versus a patient’s autonomy; maintaining life versus heightened suffering; or even the use of feeding tubes.

For example, when medically intervening to extend life, but the extension is accompanied by tremendous suffering, the rabbinic decisors (“Poskim”) across time have differed in their interpretations of the underlying biblical and Talmudic passages which discuss the sanctity of life.

The Talmud states in several places (eg BT Ketubot 33b) that extreme suffering can be worse than death itself.

Rabbi Eliezer Waldenberg, in his multi-volumed and much-acclaimed medico-halachic work Tzitz Eliezer, wrote in an essay in 1984 that life must be preserved at all costs. Rabbi J David Bleich in his 2002 book Judaism & Healing concurs. However, these are actually only minority opinions.

Most of the key rabbinic decisors in the last 50 years maintain that near end of life, where suffering is extreme, one should let natural death to take its course and that one may not — or possibly must not — intervene. These rabbis include Rabbi Shlomo Zalman Auerbach, Rabbi Moses Feinstein, and Rabbi Zalman Nechemiah Goldberg.

When it comes to life support systems, there is a point at which the body would no longer be able to function again autonomously should these systems be connected and subsequently disconnected. In these cases, it may be determined that connection to life support should not actually be performed.

However, in a case where a life support system has been connected, there are differences of opinion about how and when, or even if, such a system can be disconnected. There are sound halachic arguments both ways.

The questions become so complex that a combination of deep rabbinic knowledge coupled with extensive medical experience or, at the very least, access to medical expertise is often the ethical route chosen to determine a course of action that respects the halachah, while balancing the family’s, patient’s and medical team’s knowledge, emotion and care.

May all those called upon to deal with these tragic questions be blessed with compassion and divine guidance.