October 15, 2019

Confronting Jewish Ethical Challenges at the End of Life

Decisions concerning medical care in the final stages of life present a range of Jewish ethical and legal conundrums. 

Messy and complicated, they have vexed ethicists, medical professionals and religious leaders.

While Jewish tradition maintains that human life is of infinite value and that its preservation and extension override virtually every other religious imperative, relieving pain and allowing for the soul’s peaceful departure are also values well established in Jewish tradition. 

Of course, there is a moral distinction between hastening death and removing obstacles to its natural progression, but in practice the difference isn’t always easy to discern.

Here is a general overview of issues that arise at life’s end — and how Jewish authorities have weighed in on them. 

Jewish thinkers often emphasize that specific cases vary substantially and must be considered individually. 

Most Orthodox authorities generally consider nutrition, hydration and oxygen — even if artificially provided by a feeding tube or ventilator — to constitute essential human needs that never should be discontinued as long as they are effective. This position is reflected in the 1990 paper on end-of-life care by Conservative Rabbi Avram Reisner. However, the Conservative movement’s religious law authorities also endorsed a paper by Rabbi Elliot Dorff. He advanced several possible justifications for removing artificial nutrition and hydration for the terminally ill. Among them is the contention that a medically administered treatment that conveys food and water to the patient by tube is more properly regarded as medicine than as simple food and water.

As for hospice, it is a form of medical care for people suffering from terminal illnesses with a life expectancy of six months or less. 

Jewish thinkers often emphasize that specific cases vary and must be considered individually. 

Jewish hospice programs typically are equipped to provide hospice services while abiding by Jewish traditions. Because hospice focuses on a patient’s quality of life rather than aggressive medical treatment, some Orthodox rabbis do not believe hospice conforms with Jewish tradition. 

Do-not-resuscitate orders, known as DNRs, are legally binding directives signed by doctors ordering medical professionals to withhold CPR or advanced life support in the event a patient’s heart stops functioning. 

A patient needing CPR is in acute distress and could be saved, even for a brief period, with proper treatment. But given the often low success rate of resuscitation and the high likelihood of adverse effects for the elderly or those weakened by terminal illness, some authorities permit DNRs under certain conditions. 

Advance directives are documents specifying a person’s wishes concerning medical care in the event they are unable to make such decisions for themselves and/or appointing a health care proxy to make decisions on their behalf. 

As for experimental therapies, most Jewish authorities would require a patient to submit to a therapy if it is known to be effective at curing their condition. 

This is not the case regarding experimental treatments whose success rate and potentially adverse side effects are not known. 

Jewish authorities from across the denominational spectrum support the right of a patient to refuse treatment that is risky or of unproven value. 

Dorff writes that it is permissible to undertake a hazardous therapy if it presents a “reasonable chance” of cure, even if it simultaneously poses a risk of hastening death if it fails.

As for refusing treatment, Jewish tradition generally requires that every effort be made to sustain and extend life, but that position is not absolute. 

In cases where diseases are incurable, and medical interventions would be risky, painful, of uncertain efficacy or serve merely to prolong a life of unbearable physical or psychic pain, there is support in Jewish tradition for an individual’s right to reject such treatment. 

Taking active steps to hasten death are prohibited in Jewish law, but praying for death is another matter. Jewish bioethicist J. David Bleich has formulated it this way: “There is no contradiction whatsoever between acting upon an existing obligation and pleading to be relieved of further responsibility.”

A longer version of this story ran on myjewishlearning.com.