2015 Jewish Perspectives on Medical Ethics

2015 Jewish Perspectives on Medical Ethics

When May We Drop the Clay Pot?

It's possible that one day many of us may have to make critical end-of-life decisions for a loved one — and chances are such decisions may have to be made for us as well. Yes, we naturally say that we want to preserve life, but at what cost to both the patient and ourselves?

2015 Rabbi Michaels at B'nai IsraelRabbi James R. Michaels, the director of Pastoral Care at Charles E. Smith Life Communities, has daily experience counseling individuals throughout our campus who struggle with complicated and often painful issues as health begins to fail for a family member. He recently shared his accumulated insights at B'nai Israel Congregation in Rockville with a large audience of seniors, including a group from Ring House, in a lecture titled "Jewish Perspectives on Medical Ethics." Here are highlights from the presentation:

Dropping the Clay Pot

Rabbi Judah haNasi was very ill and in pain. The prayers of all his students and the greatest leaders of the age were only effective enough to preserve his life, but not to reduce his suffering. When his handmaid saw his suffering, she went up to the roof of the building where the rabbis were praying and threw down a clay pot. When it shattered, they were momentarily distracted from their prayers. The angel of death used that moment of silence to snatch Rabbi Judah’s soul.  (Ketubot 104a)

The handmaid’s action is praised. This was a situation where nothing more could be done for Rabbi Judah haNasi, neither to cure him of illness nor to relieve his suffering, and she stopped the treatment from being given. This becomes the paradigm for modern discussions of medical ethics.

Current Jewish Views of End-of-Life Treatment

Rabbi Lord Immanuel Jacobovits, the late chief rabbi of England, and founder of the modern study of Jewish medical ethics, cites the parallelism in the verse, “Behold, I set before you this day life and good, death and evil.” (Deuteronomy 30:15) The text, he says, indicates that death is evil. All measures should be employed to forestall death, even if it entails suffering.

Rabbi Moshe Feinstein: When additional treatment can extend life slightly, but not reduce suffering, Jewish ethics does not mandate such treatment.

Rabbi Eliezer Waldenberg: Pain and suffering themselves can shorten life. Based on the statement in the Talmud, “A groan breaks half a person’s body.” (Ketuvot 62b)

*Note, however, that these are not blanket permissions. The answers were given in response to a very specific case.

Rabbi Yitzchak Breitowitz says that we’re obligated to preserve life, but we’re also obligated to prevent suffering. He notes that several responses from Israel stress this conundrum. They are not as well known as the opinion of Rabbi Lord Jacobovits. This leads to the common misconception that we must keep patients alive in all circumstances. 

Conservative Jewish Views:  Rabbis Elliot Dorff and Avie Reisner agree with Rabbi Breitowitz

A patient may reject CPR and/or issue a DNR (Do Not Resuscitate) order when subsequent measures would be unlikely to restore the patient to a meaningfully healthy life. Terminally-ill patients may choose hospice or home care. Both are valid health-care options. Hospice should not be considered suicide or euthanasia.

The two rabbis differ on whether one may elect to shorten life through experimental regimens, or through the extensive use of pain medication. They agree, however, that external mechanisms (e.g. ventilators) may be removed if they do not offer the possibility of restoring the patient to a normal life.

Now...Let's Get Practical

Rabbi Michaels emphasizes the over-riding necessity of making your wishes clear to your family while you are well and able to express your preferences.

For more information, read Flourishing in the Later Years: Jewish Pastoral Perspectives on Senior Residential Care, by James R. Michaels and Cary Kozberg.


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