Former Israeli Prime Minister Ariel Sharon, who has been in a coma from a stroke for five years, is being moved to his ranch in the Negev Desert. How should Jews decide whether to keep family members in similar medical states alive?
It is not our legitimate choice to take someone's life, it is God's
However if someone has indicated that they dont want major efforts to keep them alive in a situation where they are seriously compromised- for example not wanting major surgery if one is in a persistant vegetative state- that is a legitimate decision to make
One can let the desease take its natural course
But the decision must be made by the person themselves while they are competent. It is not anyone else's life to decide on.
Answered by: Rabbi --- Not Active with JVO Suspended
As you have phrased the question, already I feel error has crept in. After all, how can we truly decide “to keep (anyone) alive?” While it is true that the current state of science and technology give us an unprecedented amount of influence over whether someone lives or dies, the ultimate “decider” is not the family member, nor is it George W. Bush; the “decision,” so-called, is out of our hands. We can neither “create” life from lifeless material (and certainly not ex-nihilo!), nor can we truly “keep someone alive” whose time has come. As the Talmud puts it “the angel of death: what difference does it make to me if (the person is) here or there?” When one’s moment comes, people have no say in the matter any longer.
In the Jewish tradition, of course, there are two “exceptions” to this general principle: the first is murder, which we all have the ability to accomplish. Rather than leaving a person’s lifespan to its natural course, it is within our ability to shorten our fellow human’s time in this life, either through acute trauma or through a more disingenuous fashion. Rather than allowing the natural course of events to take place and life to slowly ebb away as it otherwise would, some of us intervene in some fashion, thereby hastening the inevitable demise. Such action does not change the final outcome, which by dint of our biological physicality is an inevitable death, but rather steals away moments or hours that otherwise would have been moments of life, the value of which none of us can really know. In Jewish law it is forbidden even to dig someone’s grave or subject them to loud noises if those actions would hasten their death.
The other “intervention” we control is our efforts to save a life in danger. Just as the Talmudic rabbis derived that great principle from the words of the Torah itself (ve-rapo yeirape – he shall surely heal the sick), permitting and even considering it obligatory for those with the ability to save life where they can, even us “normal” people are not permitted to “stand idly by the (spilling of) our brothers’ blood.” We must, in a sense, stretch ourselves to be heroic and preserve life that exists while yet the breath of life is within the body.
Between “first do no harm” and “choose life” lies the shadowy middle ground where one is alive but not totally living. This is the difficult area of which the questioner speaks. Yet the trouble is never meant to be burdensome to any person alone. Consultations in this most troublesome period with a competent physician (or medical team) and with a rabbi are not merely permitted, but encouraged or required. No human being needs to shoulder the burden of being God alone; a number of individuals are to be brought on board in such circumstances, to share the enormity of speaking God’s voice through the collective expression of best practices. While this process is never cut and dried, it has the advantage of embodying the multi-faceted decision-matrix that our ancestors knew provided the best way limited human minds might reach past their boundaries and “channel” the often untapped wisdom that God bequeathes us when we work together.
Judaism does not allow for euthanasia, even for someone in a comatose state. A person is a person, created in the image of God, regardless of the situation. No distinction is made between a goses, a dying person, and anyone else. The laws of Shabbat are to be set aside to provide medical care for a dying person, just as for anyone else, and one who kills a dying person, even if it is to spare the person pain and suffering, is liable for murder. (BT Sanhedrin 78a; Yad, Hilkhot Rotseach 2:7, M. Semachot 1:4; Yad, Hilkhot Avel 4:5; Alfasi, BT. Mo`ed Katan, fol. 16b; SA YD 339:1). However, there is a difference between providing medical care that actually preserves life, and medical care that has no effect, provides no “cure” or even relief of suffering, and only artificially delays the natural process of dying. To illustrate this point, the Talmud (Ketubot 104a) tells the story of Rabbi Yehudah ha-Nasi, the great sage, who was dying. His students and fellow sages gathered at his house and prayed night and day on his behalf, thereby delaying his death. Finally his maidservant could no longer stand to see his suffering. She threw a plate out the upstairs window to the ground below, shattering the plate. The praying crowd was startled by the noise and ceased their prayers for a moment and in that moment, Rabbi Yehudah ha-Nasi died. The Talmud looks favorably upon the maid’s actions, as she interrupted the artificial prolongation of his life and allowed the natural process to go forth.
Ultimately, the sources tell us that we may not do anything that will hasten a person’s death, but by the same token, we may not do anything that will prolong a life beyond its natural time. In other words, we may not engage in active euthanasia such as administering a lethal dose of medication that has no other purpose. However, if the dying person is in pain, it is permissible to administer a dosage that will relieve the pain, even if that dosage will have the effect of ending the life. Similarly, it is permissible to operate on a person to relieve suffering, even if that might shorten the patient’s life. The criterion, the rabbis tell us, is that the primary purpose is to relieve suffering, not to end the life. (# R. Ya`akov Emden (18th century), Mor uKetsi`ah, ch. 328, R. Eliezer Waldenberg, Resp. Tsits Eliezer, v. 13, # 87). By the same token, it is permissible to withdraw medical treatment if it is no longer therapeutic – that is, if it has no possibility of actually doing the patient any good. It is in that case no longer considered medical treatment, but simply an impediment (like the students’ prayers for Yehudah Ha-Nasi) to a natural death.
The question might be asked – ‘does permitting the withdrawal of medical treatment extend to withdrawing nutrition and hydration’? The answer, unfortunately, is not clear-cut. Some authorities, both traditional and modern, come down on the side of considering food and water to be normal and necessary aspects of human life, whether healthy or ill, and it is immaterial how it is administered. Others, however, consider the fact that it is artificially administered to mean that it is a medical intervention, and can therefore be removed. (R. Moshe Feinstein, Resp. Igrot Moshe, CM, v. 2, # 74, sec. 3; See Nishmat Avraham, YD 339, pp. 245-246; Avraham Steinberg in Sefer Asya 3 (1983), p. 448; R. Immanuel Jakobovits in HaPardes 31:3 (1957), pp. 18-19. Among Conservative thinkers see R. David Feldman, Health and Medicine in the Jewish Tradition (New York, 1986), p. 95, and R. Avram Reisner in Conservative Judaism 43:3 (1991), pp. 52 ff.) Ultimately, while the preference would be not to remove feeding tubes, the decision has to be made on a case by case basis, with the wishes of the family, in consultation with the doctors, being the final determination.
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