One of the headlines in last Thursday’s New York Times read: “Justin Trudeau Seeks to Legalize Assisted Suicide in Canada.” The headline and article caught my immediate attention.
On initial reading, the article makes it appear as if the new, young, daring — and brash — Prime Minister of Canada is trying to push the limits of what constitutes “dying with dignity” or what constitutes a “good death” under difficult circumstances. It seems as if he’s trying to allow people to make certain choices for themselves concerning end-of-life decisions.
Trudeau is young; he’s handsome. He has been known to make bold statements. He represents that generation of 40-somethings and 50-somethings who are used to getting things when they want, how they want, on their own terms. Face it, our generation is a very individual-centric community where our own needs often come first. Why should death be any different?
So many NYTimes readers may not have realized that Thursday’s article was misleading. It was written as if it is Trudeau himself who is seeking to overturn the ruling in the Canadian Charter of Rights and Freedoms (part of the Canadian Constitution) that deems Physician Assisted Death by Suicide unconstitutional. The NYTimes neglects to mention that Trudeau is merely fulfilling a mandate of the Canadian Supreme Court (Carter v Canada) from last February 2015.
At that time, the Court struck down the federal prohibition on physician assisted suicide, arguing that the old law violates the Canadian Charter of Rights and Freedoms. In this rule, the Supreme Court:
- gave decision makers until February 2016 (later extended to June 2016) to prepare for the decriminalization of physician assisted death by suicide;
- established guidelines for determining who can access physician assisted death by suicide and how it can be safely administered;
- highlighted that it be used only for ‘grievous and irremediable medical conditions with enduring suffering.’
Trudeau had no choice. The Supreme Court ruling required that guidelines be established within a certain time-frame. The New York Times did not have all of its facts. The article only referenced the Supreme Court ruling briefly at the end.
Why am I so interested in this discussion? I no longer live in Canada (although I am a dual American-Canadian citizen). The topic of “whose life is it anyway?” and the issues surrounding the topic of physician assisted suicide are part of a debate that is now taking place all around the globe. As of October 2015, euthanasia (withdrawing life support) is technically legal in the Netherlands, Belgium, Ireland, Colombia and Luxembourg. (Although it is practiced in various forms in many other places). Assisted suicide is legal in Switzerland, Germany, Japan, Albania and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California. A distinction must be made: withdrawing life support is not the same legally as PAD (physician-assisted death-by-suicide). Someone on life support can request that life-support be removed. A person with cancer can stop chemotherapy or radiation. PAD necessitates a physician to do something physically to hasten death, to literally end someone’s life.
The topic of “a good death” first gained traction in the 1970s, when I was in high school. What took place in my hometown left a lasting impression on me that would affect my approach to bio-medical ethics as I pursued my professional goals. I grew up in Succasunna, New Jersey and went to Roxbury High School. It was a sleepy farm town about an hour and twenty minutes from New York City. The most exciting thing that ever happened was that sometimes, the cows and horses would escape from their farms. You’d wake up in the morning to find they had wandered down the road and were grazing in your front yard!
And then suddenly one day, we became front-page national headline news. On April 14, 1975, a young woman who graduated from my high school, Karen Ann Quinlan, attended a party and mixed sedatives and alcohol. She slipped into a coma from which she never emerged. It took five months for her physicians to proclaim that she was in a “persistent vegetative state.”
Her parents did not want her to suffer nor to endure any more physical hardship to her embattled body. They firmly believed that she would never return to a state of consciousness. So they requested that her physicians disconnect her from the life-support machines that kept her alive. When the physicians refused, her parents took the case to court. The “Karen Ann Quinlan Case” became the first “right to die” case in US legal history.
Eventually, the court ruled that “no compelling interest of the state could compel Karen to endure the unendurable” and allowed the life support to be removed. Ironically, Karen lived for 10 more years in a “persistent vegetative state” after she was weaned from the respirator. The remainder of her years were spent in a nursing home in New Jersey.
“The Karen Ann Quinlan Case” is now an important part of every bio-medical ethics book, religious and secular. It has become the historical benchmark for discussions on euthansia and physician-assisted suicide (PAD) world-wide.
This incident in my own backyard sparked my interest in medicine and bio-medical ethics. It compelled me to explore the intersection of Jewish law and bio-medical ethics, to study the intricacies and nuances of the issues — and to figure out how my Jewish values inform medical decisions we confront. It spurred me to pursue pastoral care and chaplaincy work throughout my rabbinate.
I feel compelled to delve into the questions concerning the definitions of “life” and “death.” Who decides those definitions and makes those determinations? Who has the right to make decisions when it comes to our own bodies?
Ethicists fall along a huge spectrum. Depending on how one defines “who gives life,” that will determine the answer of “who determines what constitutes death,” and the ability to make decisions regarding death. For now, we will focus on the religious perspective.
From a classic, traditional religious perspective, all life comes from God. Our bodies are gifts from God. God requires that we, and by extension our physicians, are required to do all that we can care for our bodies and to preserve and prolong our lives. Therefore, by extension, only God has the ability to determine when it is our time to die. We are not allowed to do anything to hasten our death.
The Torah strongly states that God will “require a reckoning” for those who “spill the blood” of humans. For example, we see in the story of Noah:
Whoever sheds the blood of man, by man shall his blood be shed, For in the Eternal’s image, did God make him. (Genesis 9:6)
And the commandment to “not murder” is a priority as the Torah reiterates the 10 Commandments twice: (Ex 20:13 and Deut 5:17), as well as states this injunction against murder in numerous other places.
Taken at the most basic level, this means that we are not permitted to harm ourselves or others in any way physically (including committing suicide). Physician-assisted suicide would be akin to murder, from a Jewish perspective.
(For a lengthy and more complete discussion of the Jewish view on Suicide and Assisted Suicide, please refer to: “Assisted Suicide,” by Rabbi Elliot N. Dorff, in YD 345.1997a, Jewish Committee on Law and Standards).
So what happens when the Supreme Court in the country in which you live issues the following ruling:
The prohibition on (i.e., AGAINST) physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice. The object of the prohibition is not, broadly, to preserve life whatever the circumstances, but more specifically to protect vulnerable persons from being induced to commit suicide at a time of weakness. Since a total ban on assisted suicide clearly helps achieve this object, individuals’ rights are not deprived arbitrarily. However, the prohibition catches people outside the class of protected persons. It follows that the limitation on their rights is in at least some cases not connected to the objective and that the prohibition is thus overbroad. It is unnecessary to decide whether the prohibition also violates the principle against gross disproportionality. (From Supreme Court Ruling, Carter v Canada)
This Supreme Court Ruling seems to be in direct contradiction to the traditional Jewish view on PAD!
There is one other Jewish law that we must raise at this point:
“Dina d’malchuta dina” — The law of the land is binding (from the time of Jeremiah, cited by Mar Samuel a talmudic scholar from Babylonia.)
IF the Supreme Court of Canada is saying that the prohibition on PAD is unconstitutional and is now requiring the government to put in structures that will affirm PAD (but not require PAD), then the entire community must abide by the “law of the land.”
It doesn’t necessarily mean that if someone is in an end-of-life situation, then PAD must be the option for them. PAD will be a choice for them to make, only at their decision, under the established guidelines.
However, this is still not so simple. We are entering murky territory. The Carter Ruling of the Supreme Court raises many questions:
First, the Jewish community (as well as other religious communities alongside of them) is diverse and heterogeneous. Some affirm the right of individuals to choose end-of-life options. Others affirm the traditional view that Judaism affirms life. It is this view that says that only God has the right to make decisions about life and death. There is no consensus.
Second, the Carter Ruling has many ambiguities that are not clearly defined, such as:
- “enduring suffering”. How is that defined? Who defines it? How long does the suffering have to continue? Is it suffering that exists in the middle of an episodic period of uncontrolled pain? What if new ways of managing the pain are discovered that might affect a change of decision?
- It does not refer to other options for “end-of-life” treatment. Ie. is the government investing in other high-quality palliative health care centers and pysco-social services to offer other options?
- What types of illnesses are eligible for PAD?
- What if a patients belief system is in contradiction with the physician’s/other health-care practitioners belief system?
- How are mechanisms put in place to ensure that this ruling will not be abused or misused or forced upon anyone?
CIJA, the Centre of Israel and Jewish Affairs, has tried to address many of these issues by submitting a brief to the Committee that was appointed to establish the guidelines as directed by the Supreme Court.
Many in both the Reform and Conservative Jewish Movements in Canada support CIJA’s position. They understand the notion of “dina d’malchuta dina”. They also understand that for many of their constituents, this new law will address the plight of those stricken by a debilitating illness with no possibility of relief. They also understand that there is absolutely no obligation for anyone to utilize this process. If someone is religiously opposed to PAD, they may opt for other end-of-life palliative options.
However, there are still others who oppose this new ruling. Many in the more traditional religious worlds however, cannot reconcile the voice of their traditions with the voice of the Supreme Court. The Catholic Church issued this statement in opposition to Carter v Canada to which the Orthodox Rabbis in Montreal and Ottawa signed on,
In fact, on April 19th, the Canadian Conference of Catholic Bishops (CCCB), The Evangelical Fellowship of Canada (EFC), the Canadian Council of Imams, along with representatives from the Salvation Army and some members of the Jewish community are coming together to hold a press conference to express their concerns: 1) Protection of vulnerable persons; 2) Conscience protection for health-care workers and health-care facilities; 3) lack of availability of quality palliative care for all Canadians.
There are no easy answers here. No “quick fixes.” As modern Jews living in the modern world, no matter if we are in Canada, the United States, Europe, Asia, Africa, we all struggle with the questions and the answers that surround “life and death.. We grapple with our ancient texts, hoping these sources will shed light on our own decisions. We speak with our rabbis trying to gain insight into Jewish law on a deeper level. And we need to speak with our loved ones. For what our loved ones desire in their hearts for themselves is the most important of all (I urge everyone to fill out a Living Will and make sure you each have a Health Care Proxy).
Birth is a Beginning, by Alvin Fine
Birth is a beginning
And death a destination
And life is a journey:
From childhood to maturity
And youth to age;
From innocence to awareness
From ignorance to knowing;
From foolishness to discretion
And then perhaps to wisdom;
From weakness to strength
Or strength to weakness
And, often, back again;
From health to sickness
And often back, we pray, to health again.
From offense to forgiveness
From loneliness to love
From joy to gratitude,
From pain to compassion
And grief to understanding —
From fear to faith;
From defeat to defeat to defeat
Until moving backward or ahead
We see that victory lies not at some high place along the way,
But in having made the journey, stage by stage,
A sacred pilgrimage.
Birth is a beginning
And death a destination
And life is a journey,
A sacred pilgrimage —
From birth to death
To Life everlasting.