The Jewish View on
the “Death with Dignity” Initiative
Rabbi Boaz D. Heilman
Oct. 28, 2012
The “Death with Dignity” Initiative on this year’s ballot
raises many concerns, among them medical, legal, social, cultural, ethical and
spiritual. Whereas wide-spread
discussions can look at the whole spectrum of issues and concerns, a
specifically “Jewish perspective,” by definition, must focus only on the
spiritual aspects. These come down to
two questions:
1) If Life is
God-given and therefore sacred, does anyone have the right to actively end
life?
2) As with other
contractual agreements, if human beings are in a covenantal yet personal
relationship with God, should they not have the right to end this relationship
and exit of their own free will?
An examination of any issue through Jewish lens must take
into account halakha, a text-based
legal methodology that is founded on laws stated in the Torah, elucidated by
the early (1-6th centuries) rabbis in the Talmud, codified into Law
Codes (10th-15th centuries) and applied to human
experience through questions and answers collectively known as Responsa.
A second, more liberal, method of clarifying Jewish law has
been proposed, in which the personal, human experience predominates over strict
halakhic rulings. “Covenantal ethics,” as this system has been
termed, relies on a more direct relationship between human beings and God.
While halakhic rulings are taken into
consideration, a person who subscribes to this method of understanding Jewish
law is bound less by loyalty to halakha
as by his or her personal relationship with God.
In the view of Judaism, life is God-given. Moreover, human beings are endowed with tzelem Elohim—the image of God. This position is at the basis our entire talionis punitive system. Thus, in Gen. 9:6 we read: “Whoever
sheds the blood of man through man shall his blood be shed, for in the image of
God He made man.”
Exceptions to this law exist:
Killing in self defense is an obvious example.
More to the point of the argument surrounding the
“Death with Dignity” Initiative, suicide is prohibited by tradition, custom and
halakhic law as a violation of b’tzelem Elohim, the Divine Image. Even here, however, there are exceptions.
King Saul, the first king of Israel, takes his own life
after being mortally wounded in war against the Philistines. While there is much argument regarding the
permissibility of this act (Saul is not condemned by the Bible), it is generally
interpreted as an extreme exception to the rule. Yet the fact remains that Saul hastened his
own death. In extremis, a situation reflecting extreme pain, suffering,
torture or humiliation, is, in fact, an argument by which halakha permits the burial of a suicide in a Jewish cemetery (in a
sense, accepting the act as having been coerced upon its perpetrator and
therefore not truly a voluntary violation of
the Divine Image).
Kiddush ha-Shem,
the sanctification of God’s name (martyrdom), is another accepted—even
venerated—form of suicide. Throughout
Jewish history, there have been tens of thousands who preferred to take their
own lives rather than submit to torture, death or conversion at the hand of
persecutors. Massada, at which 1000
Jewish men, women and children gave their lives to God rather than submit to
the Romans, was the model for many other such mass suicides.
Additionally, there are three commandments which may never
be broken, even at pain of death.
Idolatry, murder and sexual immorality are seen as acts where death
would be a preferable option.
But all these cases are seen as specific examples, not meant
to be generalized to other cases. Halakhically, in the set of
circumstances described by the ballot initiative, these examples cannot be used
as precedent. They stand as sui generis, in a category all their
own.
The issue of assisted dying (the terminology used to describe
this act reflects a spectrum of opinions) comes up again and again in Jewish
texts, showing deep concern for the suffering endured by a person at the end of
life (whether as a function of old age, illness, or in extremis).
Jewish texts give three examples that can serve as a basis of
argument—both for and against this initiative.
The first of these refers to the martyrdom of Rabbi Haninah ben
Teradion, a rabbi of the second century who was arrested by the Romans for
teaching Judaism and condemned to be burnt at the stake. The Romans intentionally extended his
suffering by wrapping him with wools soaked in water:
Rabbi Haninah ben Teradion was arrested by the
Romans and, wrapped in a Torah, was burned at the stake. His disciples said: “Open your mouth so that the fire enters
you.” He replied, “Let Him who gave me
[my soul] take it away, but no one should injure oneself.” The Executioner then said to him, “Rabbi, if
I raise the flame and take away the tufts of wool from over your heart, will
you cause me to enter into the life to come?”
“Yes,” he replied. “Then swear to
me.” [Rabbi Haninah] swore to him. He thereupon raised the flame and removed the
tufts of wool from over his heart, and his soul departed speedily. The Executioner then jumped and threw himself
into the fire. And a bat kol [a heavenly voice]
exclaimed: “Rabbi Haninah ben Teradion
and the Executioner have been assigned to the world to come.”
Though in this story Rabbi Haninah refuses to hasten his own
death, he does not refuse someone else from removing
the impediment to his death. Is this
the same as administering a fatal dose of medicine? That depends on how one views the
Executioner’s act. If he was merely
removing the impediment (the ancient world’s method of “unplugging” the
patient) then this act was permissible.
If it was meant to speed the process of dying, it was not
permissible. Most rabbis agree that the
former was the case. However, there is
no arguing with the next act of the Executioner. By throwing himself into the fire, he commits
suicide, and yet his soul is accepted in heaven—approved by the rabbis! They could have seen this as Kiddush ha-Shem (martyrdom); yet a fine
line is drawn here, one that could be used to illustrate one of the reasons
cited most often by terminal patients who have chosen to take their own life in
Oregon (one of two states in which this option is legal): the loss of meaning in life. The Executioner refused to hold on to a life
devoid of meaning and chose to end it instead.
A second story examines a similar act of participation in
the process of dying:
When Rabbi [Judah ha-Nassi, 2nd
century rabbi, compiler of the Mishna] was dying, the rabbis declared a public
fast and offered prayers that God have mercy on him [and spare his life]. His maid went up to the roof and prayed: “The angels want Rabbi to join them in heaven
and the people want him to remain with them.
May it be the will of God that the prayer of the people overpower the prayer
of the angels.” However, when she saw
how often he had to use the privy, each time painfully taking off his tefillin
and putting them on again, she prayed:
“May it be the will of God that the angels overpower the people.” As the rabbis continued to pray, however
[thus not permitting Death to enter and take Rabbi], she took a jar and threw
it from the roof of the house. [At the
sound of the shattering jar] the rabbis stopped praying, and at that moment,
the soul of Rabbi departed. Both Rabbi
and the maid were praised in the World to Come.
Was the maid simply removing an impediment to death (the
prayers of the students)? Or was she
actually enabling death to take its course?
Obviously she did not cause the death—that would be murder; yet her
actions enabled the process to complete its inevitable course. By breaking the jar, she caused death to
occur. It isn’t active euthanasia, yet
it isn’t passive non-intervention either.
In yet a third story, one can find an example perhaps more
fitting to our modern-day case:
It
happened that a woman who had aged considerably appeared before Rabbi Yose ben
Halafta (2nd century). She said, “Rabbi, I am much too old, life has
become a burden for me. I can no longer
taste food or drink, and I wish to die.”
Rabbi Yose answered her, “To what do you ascribe your longevity?” She answered that it was her habit to pray in
the synagogue every morning, and despite occasional more pressing needs she
never had missed a service. Rabbi Yose
advised her to refrain from attending services for three consecutive days. She heeded his advice and on the third day
she too ill and died.
Did Rabbi Yose
give the woman a “prescription” for ending her life? Once again, his actions could be interpreted
as removing an impediment to death (not unlike removing breathing and feeding
tubes from a terminal patient). Yet
there is no doubt that he also showed her a path of action (or rather,
inaction) which would result in the ending of her own life.
Though Reform
Judaism does not subscribe to Orthodox halakha,
it does have a committee whose mission is to develop a Reform halakha.
In a set of responsa from
1992, we find opposition to assisted dying for the following five reasons:
1. Sanctity of life
“We see no good reason, first of all, to
abandon the traditional Jewish
teaching concerning the inestimable value of human life. If the doctrine of life's
essential holiness means anything
at all, it means that we must stand in reverence before the very fact of life,
the gift of God that renders us human.
And this reverence does not diminish as human strength declines, for the dying
person still possesses life, a
life stamped indelibly with the image of God until the moment of death.”
2. Pain is not sufficient justification for
killing a human being in the name of compassion
“ Even in
debilitating illness, when our freedom
of action is severely limited, we yet sanctify the divine name by living our relationship with God, by striving toward nobility of conduct
and of purpose, by confronting our suffering with courage. To say this is not to ignore the agony of the dying but
to recognize a fundamental truth: that even when we are dying we have the power to choose how we shall live. We
can kill ourselves, thereby accepting the counsel of despair, or we can choose life, declaring through our
actions that despite everything life--all of it--is blessed with the promise of ultimate meaning and fulfillment.”
3. Quality of life is impossible to determine
“The quality of life by its nature is virtually impossible to
determine. That is to say, the decision
that ‘my life is no longer worth living’ is an inescapably subjective one; it
cannot be quantified, verified, or tested against any principle.”
4. Our role is to heal the sick or care for
them, not to kill them
“We believe that compassion toward the dying is a moral
responsibility. But we also believe that this responsibility can and must be
discharged without resort to assisted suicide
and active euthanasia.”
5. Expectation of the end of life is not exact
“Even if it is possible to determine
precisely when a patient has reached this final extremity (and we are well
aware that medicine is not a precise
science), the patients who concern us here clearly have not reached it.”
In
conclusion, there are two ways to determine the Jewish view/s on the
issue of assisted suicide. In the first,
in accepting our relationship with God as our Creator, we also accept the
concept of the sanctity of life. Life is
God-given; only God has the right to take it back, and only God can determine
the time and way in which death comes to us.
Part of this covenant includes—and holds as sacred—the proposition that
“we must hope for and await God's deliverance
to the very last moment of our lives.”
The second
way follows from a perspective that sees the covenant between God and humanity
as a partnership agreement. As partner
with God, an individual has the right to make decisions in light of his
or her understanding of the texts as well as in light of his/her perceived relationship
to themselves, to their family, community, and God.
The Jewish view is neither unanimous nor compulsory (except to those who choose to see it
as such). But it does elicit
consideration and thought about our role and course of action both in life and
in death. This discussion is as old as
Judaism itself and will continue for as long as human beings continue
reflecting on the meaning of life.
Bibliography and supplemental readings:
The Text of the Initiative:
Initiative Petition Information
Sheet http://www.mass.gov/ago/docs/government/2011-petitions/11-12.pdf
CCAR Responsa: On the
Treatment of the Terminally Ill (5754.14)
Peter Knobel, “Suicide, Assisted Suicide, Active Euthanasia:
A Halakhic Inquiry” in Death and Euthanasia in Jewish Law: Essays and Responsa, Edited by Walter
Jacob and Moshe Zemer, Freehof Institute of Progressive Halakha; Pittsburgh and
Tel Aviv: Rodef Shalom Press, 1995
In opposition of the Initiative:
• The proposed safeguards
against abuse are insufficient. Enforcement provisions,
investigation authority, oversight, or data verification are not included in
the act. A witness to the patient’s signed request could also be an heir.
• Assisted suicide is not
necessary to improve the quality of life at the end of life. Current law gives
every patient the right to refuse lifesaving treatment, and to have adequate
pain relief, including hospice and palliative sedation.
• Predicting the end of life
within six months is difficult; sometimes the prediction is not accurate. From
time to time, patients expected to be within months of their death have gone on
to live many more months — or years. In one study, 17 percent of patients
outlived their prognosis.
• Doctors should not participate
in assisted suicide. The chief policy making body of the Massachusetts Medical
Society has voted to oppose physician assisted suicide.
In support of the Initiative:
1. Carol
Trust, executive director of the Massachusetts chapter of the National
Association of Social Workers, said in a statement.
“I encourage Massachusetts voters to grant terminally-ill patients this
choice.” She added, “Our support of Death with Dignity is guided by our Code of
Ethics. We continually strive as social workers to promote the rights of our
clients to self-determination and dignity.”
2. History and Opinion:
“May Doctors
Help You to Die?” Marcia Angell, New
York Review of Books, Oct. 11, 2012
Other interesting notes:
1. Quality of Elderly Care: Portland, Oregon
offers the best senior living benefits in the U.S., according to a survey
released in 2005 by Bankers Life and
Casualty Company. Seattle, WA has
the second spot. Boston is 8th.
2. In Oregon, primary end of life concerns were: loss of autonomy (90.9%), inability to engage in activities that give their life
meaning (88.3),
and loss of dignity (82.7%). “Being a burden:” 36%.
3. An independent study published in the October
2007 issue of the Journal of
Medical Ethics reports there
was "no evidence of heightened risk for the elderly, women, the uninsured,
people with low educational status, the poor, the physically disabled or
chronically ill, minors, people with psychiatric illnesses including
depression, or racial or ethnic minorities, compared with background
populations."
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