JORDAN MOSHE
So explained physician and world-renowned expert on Jewish medical ethics, Rabbi Akiva Tatz, who unpacked the medical, ethical, and religious dimensions of ending human life in a talk at the LinkShul Saltzman Family Community Centre last Wednesday.
Tatz said today’s medical reality regarding euthanasia is profoundly difficult to reconcile with Jewish teachings. “We’re living at a time that is very adversarial to the Jewish approach,” he said. “The medical profession today is moving towards terminating people’s lives to a degree that we definitely don’t agree with.
“The pendulum has swung to a position where the medical profession is much less concerned with keeping people alive than with quality of life. It’s regarded as kinder to let someone die because they’re suffering, and it’s no longer assumed that we want to save a life by default. Technology has led to society asking if it’s the right thing to prolong a life if a person won’t enjoy it.”
In fact, said Tatz, in Britain, keeping someone alive with a low quality of life is deemed unethical, and if one keeps a patient alive against their wishes, one can be sued for wrongful life and assault.
The criteria according to which medical ethics evaluates a case of euthanasia include autonomy, justice, beneficence, and non-maleficence, Tatz said. “Autonomy refers to the patient’s right to decide what will happen to him. Justice refers to the patient being denied treatment if someone else needs it more, and it can actually trump autonomy. Beneficence means one is obliged to do what’s best for the patient, and non-maleficence means not doing anything that harms the patient.”
More often than not, these conditions are easily satisfied, and the medical profession is willing to withhold treatment and allow a patient to die. “The real irony is that the Western world of today is much better at respecting autonomy when the patient wants to stop treatment, but not so good at respecting a patient’s wish to continue,” he said. “If a patient wants to die, doctors say it’s his autonomy, and allow it. But if the patient wants to keep going, they say it’s unethical and expensive. This is one of the tensions we experience.”
By contrast, Jewish law dictates that we do anything to save a life under all circumstances. “We are obliged to save any kind of life for any amount of time at any cost,” said Tatz. “That life is of infinite value is the default position.
“The Mishna says that if a person is buried under a collapsed building on Shabbos, you are obliged to break Shabbos to grant even a second more life, even if they are unconscious. Our view on saving life is extreme.”
However, there are criteria which, if met, can enable the withholding of treatment. “Under certain circumstances, we agree that it’s not fitting to continue treating a person,” said Tatz. “You need a terminally ill or hopelessly unconscious patient, uncontrollable suffering, and a wish on the part of the patient not to continue treatment. If these are met, says one of the greatest rabbinic authorities, Rabbi Moshe Feinstein, not only is it acceptable to stop treatment, but you’re obliged to do so. He rules it cruel to keep treating such a person.”
Tatz went on to define the parameters of each criterion according to halacha. “In modern medicine, terminally ill means imminently dying,” he said. “Halachically, the definition is one year. Old age is not a terminal illness – we’d all be considered terminally ill if we considered age such an illness. We mean a specific problem which is progressing and will end life within a year.” He adds that Israeli law defines the period as six months, a period determined by the Israeli government after consultation with a commission of 34 experts.
Where there is uncontrollable suffering, modern medicine enables us to relieve virtually any degree of physical suffering. While this might not be true of psychosocial or emotional suffering, we are able to solve physical pain with modern painkillers, making this criterion more difficult to satisfy.
“We should never be dealing with someone who wants to die because of uncontrollable physical pain in this age,” said Tatz. “The dilemma here is that, unfortunately, we might need to administer dangerous treatment to relieve pain.
“Still, we have a halachic ruling that if the only way to relieve pain is through dangerous means, it’s not just acceptable but obligatory. When someone is in agony, relieving pain is considered not just humane but treatment of the disease as well. You give the drug not to kill the patient, but to make their situation easier. If the suffering is truly intractable, then we move on to the last phase.”
Tatz points out that even if a patient is terminal and suffering physically, but wants to continue treatment, we do whatever we can. However, if they don’t want to continue for legitimate reasons, we respect it and withhold treatment.
The difficulty, however, lies in determining what a patient’s wishes truly are. Said Tatz, “The ideal is to ask a patient themselves. If we can’t, we ask the family member the person would have trusted – most commonly parents, children, and spouses. If that’s not possible, we ask the objective question what any person in the situation would want.”
If the above three conditions are met, treatment can be stopped. However, this means that medical treatment is withheld, but staples need to continue to be administered, even if it keeps the patient alive. Said Tatz, “Patients still need to be given basic medicines, fed, or get insulin if they’re diabetic. In other words, you can stop treating the disease, but can’t allow someone to starve, no matter how difficult it is to give them liquid or food. Unless they will die tomorrow, you are obliged to keep meeting their basic needs.”
He stressed that withholding treatment doesn’t mean stopping something already prolonging life, such as a ventilator or dialysis. “If the patient is on a machine and you turn it off, you’re killing them. However, you can withhold something not yet being given, such as stopping an intermittent treatment or not having the next treatment session.”
He concluded by saying that one version of euthanasia is acceptable in Judaism: the removal of an external stimulus preventing imminent death. “When a person is actively dying, and they’re in the throes of death, you are permitted to remove an external disturbance which is keeping them alive,” he said.
“Suppose there’s construction taking place nearby that’s keeping one alive, Jewish law allows us to remove it as it’s an external interference which prevents a person from dying then and there. If a life is being artificially prolonged by external stimulus, we can and should remove it.”
