The following is an opinion piece submitted to Ha’Am by Rachel Fox who is a third-year Neuroscience student at UCLA.
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Our tradition teaches that all are made in the image of G-d, but provides little explicit guidance when it comes to the medical termination of a life. How does Judaism balance the value of B’tzelem Elohim, that each individual life is part of G-d with the existence of unimaginable suffering that may prompt a doctor to consider “pulling the plug?” There is a dichotomy in Jewish thought about leaving terminally ill patients on a ventilator: preservation of life is of utmost importance, however, it is also recognized that suffering should not be prolonged. In order to best treat patients in this type of situation, it is important to emphasize life-saving treatment as well as understand the patient as a unique individual to determine if it is more beneficial to continue treatment or allow death to naturally occur.
Halacha prompts us to consider the difference between withholding and withdrawing treatment, particularly in intensive care unit patients where physicians and their families are considering end-of-life plans. Similar to the well-known philosophical problem of choosing to divert a train to save 10 people versus allowing the train to continue its course and kill one, Jewish text differentiates between an active and passive role in patient death. An active role would constitute “pulling the plug” and ending life support, while a passive role would be to continue life support. But where can the line be drawn as for how long treatment should last? If suffering is too great for the patient, is it still a mitzvah to preserve their life, or is it better to preserve their image as the person they were prior to their illness?
Every doctor takes the Hippocratic oath where the first statement is to “Do No Harm”, in which undue death can be thought of as an ultimate harm to a patient. The Mishnah outlines that one is forbidden from doing anything that will hasten the onset of death, since modifying a person’s body is seen as bringing on death, which is considered murder. Further, life is valued above all else in Judaism, and actions done to save a life override virtually every prohibition. Every life is imbued with the honor to do mitzvot and serve their divine purpose. It would follow that the life of a Jew, which was created in the image of G-d and destined to “be a light among nations” should be preserved. All life, not just Jewish life, is valued as a light that should be preserved, and this view is held to the utmost importance. In the AMA Journal of Ethics, it is believed that in situations where there is a dilemma between prolonging life or alleviating suffering, the idea of noninterference should be followed, meaning that natural death should occur instead of intervention (Linzer, 2013).
Rabbi Moshe Feinstein states that one has the right to withhold treatment from a terminally ill patient with a poor prognosis and poor quality of life, but withdrawing treatment that could cause death is not allowed (Baeke et. al, 2011). This highlights the key difference between withholding and withdrawing treatment. Human life holds a significant value and one should never withdraw treatment that could lead to death. However, there are exceptions to the traditional thought that a person’s life should be treated at all costs, such as if a person has to choose between death or a dangerous surgery that might decrease their quality of life. It is apparent that there needs to be consultation on individual cases to determine whether it is best to not further intervene and have the patient die naturally or to intervene with a procedure that potentially could harm the patient further. The relationship between the patient, physician, and Rabbi is valuable to religiously sensitive medical care as the patient is obligated to choose a physician, the physician is obligated to choose treatments for the patients, and the Rabbi is obligated to decide if the treatment is in accordance with Halacha.
Judaic values encompass the pursuit of righteousness and serving the moral and spiritual obligations that are outlined in the Talmud. This value extends to the realm of death, as in Halacha, one is not allowed to actively cause someone’s death. Thus, an act such as detaching a patient from the ventilator is forbidden because that causes their death and is considered murder, but the question of whether to preserve life or alleviate suffering still stands. In Israel, citizens are encouraged to fill out living wills that state exactly what they want to be done or not done to prolong their lives, and these living wills are renewed every 5 years. In a rapidly evolving world, it is imperative to balance the traditional value that all life needs to be prolonged while considering individual cases on whether the continuation of additional treatment will help the patient.
For physicians, friends and family members, and members of the care team, it is imperative to understand the complex intersection between religious and medical thought. This mandates identifying a care plan for terminally ill patients that aligns with medical and religious values, considering the patient and family’s wishes, and understanding that each patient is unique. To better navigate this circumstance as well as other bioethical issues, we need to study past and present teachings and collaborate as a wider medical system to perform the best care for patients and their families.
Cover image pxhere.com
The views expressed in this post reflect the views of the author(s) and not UCLA or the ASUCLA Communications Board.
