Rabbi Hershy Z. Ten
President, Bikur Cholim
Los Angeles, CA
A little more than a year ago, our country was swept up in the drama of a 29 year-old woman who planned to end her life. She had been diagnosed with terminal brain cancer and was told by her doctors that she had six months to live. Following her diagnosis she moved to Oregon to take advantage of its physician-assisted suicide law. Social media was rife with photos of this woman, including a video of her own testimonial and farewells, and on November 1, 2014 she ended her life.
Her images and words were both riveting and extremely emotional. Many believed that her actions were acceptable, reflecting their own humanity and belief that no one should be condemned to debilitating pain and suffering when there is no hope for recovery.
Last week, following in the footsteps of Oregon and three other states, Governor Jerry Brown signed into law the End of Life Option Act legalizing physician-assisted suicide in California. Simply put, terminally ill patients who are left with no available treatment options can request that their physician hand them a drug that will end their life. In such an instance, the doctor would be immune from civil or criminal liability.
Prior to the Governor’s action, Bikur Cholim wrote to him, articulating the Jewish perspective on physician-assisted suicide and requesting his veto. Our letter was endorsed by the Rabbinical Council of California, Agudath Israel of California, Agudath Israel of Los Angeles Bais Avigdor, and Chabad Lubavitch (Greater Los Angeles). It was also strongly supported by many leading Halachic and bio-ethics authorities, including Rabbi J. David Bleich (NY), Rabbi Moshe D. Tendler (NY), and Rabbi Shlomo E. Miller (Toronto).
Among other things, the letter stated, “In Judaism, the sanctity and infinite value of human life is a fundamental principle, as is a physician’s obligation to heal. However when all medical efforts fail, and the physician is left with no further treatment options, then their role changes from that of healer to one who provides supportive and palliative care combined with psychosocial support. No matter how valiant the intentions a physician-assisted suicide may appear, the deed constitutes an unconscionable taking of human life….Judaism demands that everything possible be done to alleviate a terminal patient’s suffering. Intractable pain relief is a paramount responsibility of the physician, and today’s medicine offers a variety of methods for its relief. There is no objection in Jewish law that prohibits the use of medication to control a terminal patient’s pain at any time….”
The question then, is this: If pain relief can be managed, why the need for assisted suicide? The answer lies in the consequences of pain management. Under many circumstances, extreme pain relief can suppress respiratory function to the extent that the patient can no longer breathe on their own without the assistance of a respirator. The patient is thus confronted with dependence on a machine for the remainder of their life. In this condition, many patients view themselves as useless and non-productive, or even as a burden on their family and society.
Today’s lexicon attempts to repackage assisted suicide with softer terminology such as “aid in dying” or “death with dignity”. However make no mistake; in Jewish law this is suicide, period. Our Torah deems anyone’s assistance in this act as an unconscionable taking of human life, and some Torah authorities have gone so far as to equate it with murder.
Independent of the conflicts this law presents to faith-based groups, there are many other opponents. For example, a considerable number of physicians have voiced serious concerns with how it diminishes the value of life while infusing the acceptability of assisted suicide into contemporary society. They view this as a dagger ripping apart the very fabric of their Hippocratic Oath and express concern that the doctor-patient relationship is being compromised.
Critics also fear the law’s potential incentive for coercion by family members seeking to expedite the dying process, insurance carriers driven by the bottom line, or federal and state government entities making decisions based on scarce public funding. There is no shortage of medications that aren’t covered by public and private insurance, yet all suicide drugs are. Given the choice, many a patient may choose to end their life in order to alleviate the financial and emotional burden on their family. The possibility of the most vulnerable of patients facing emotional and psychological manipulation, most especially the elderly, the poor, and those with no loved ones to protect them is a chilling scenario.
Today we cannot escape the influence of public policy on Jewish values. For many, this law may be solely about relieving pain and suffering. However, for this writer, the critical component is how Jewish patients live and die in America. As such, I’ve found myself wondering why this topic hasn’t received significantly more traction within the Orthodox Jewish community. Perhaps we as Jews don’t want to be painted as unsympathetic to those suffering under these circumstances, even though this is far from true. A basic commandment of Judaism is to show compassion and kindness to all in society, regardless of their faith, and our empathy to those who are suffering knows no bounds. However, publicly voicing a religious objection to an issue is too often labeled as “bigoted” or “out of touch”; thus we opt for silence rather than speak out.
In response to Governor Brown signing this bill into law, we advised his office that Bikur Cholim is extremely distressed by assisted suicide becoming legal. In addition to being contrary to Jewish principles, the law in its current form presents serious deficiencies, and our focus now is to engage the State Assembly during the regulatory process to include specific provisions and amendments that would appropriately protect patients when they are in their most fragile state.
Select regional and national Jewish organizations are seeking ways in which to deal with changing societal, and by extension, legislative attitudes towards this issue. Notably, Agudath Israel of California has been actively involved with the State Legislature, and stated it will continue to work on ways in which to improve and add safeguards to the current law.
Jewish medical ethics and healthcare policy will clearly be at odds in a variety of areas, and for this reason it is vital for us to speak in an unequivocally united voice. With this in mind, Bikur Cholim has moved forward in forming a Medical Ethics Council comprised of physicians, healthcare providers, and Halachic authorities to provide support for patients, families, and the medical establishment dealing with end-of-life issues. As Jews, we must remain true to our principals, beliefs, and tenets, and never lose sight that life is of infinite value.
L. Quaytman contributed to this article.
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