Asking for long life is just the beginning

Among the liturgical and spiritual highlights of the High Holiday services, the prayer of Mi Yihyeh u-Mi Yamut perhaps stands out from among the rest. Literally asking who will live and who will die, these words, as part of the Unentaneh Tokef portion of the service, position the fragility of our human existence juxtaposed against the enormity of God, “the everlasting King.”

With these words and this prayer, we both salute the majesty of Heaven, and also accept our humility in the world which He has created. We have weaknesses, our existence is finite, and perhaps most importantly our fate can be altered in a matter of seconds.

Twenty years ago, we were served a most shocking and tragic example of that reality when thousands of people left their homes on the morning of 9/11, never to return home. And while that was a lesson which has defined our times and many of our lives, the fragile reality of human life is something that has been a constant, across generations and cultures.

It behooves all of us to be reminded of that humility at times when we might think that our technological prowess and scientific advancement have allowed us to be all powerful.  Certainly, when it comes to medical science, we sometimes think that we have conquered medicine by reducing mortality and discovering cures to diseases that used to wreak havoc on humanity.

Those scientific victories are worth celebrating, but hand in hand with that celebration comes the demand that we recognize our limitations.

Perhaps one of the greatest limitations comes with the disconnect between our physical health and our mental well-being — something that becomes all that much more apparent as we grow older in years. We are often witness to loved ones who are robbed of their physical abilities, ravaged by muscular and nerve diseases that take away limb and organ functions — and in an almost evil irony, their mental faculties remain completely intact.

Just as painfully, we are aware of the opposite effect; people with full mobility and strength whose ability to process information and make basic decisions is taken from them by illnesses such as dementia, where the person is literally trapped in a fully functioning body without the ability to communicate or comprehend.

Adding to the difficulty of these dueling challenges, we live in a world where medicine is able to lengthen life and delay mortality — even for those patients suffering from both physical and mental deterioration. We are all familiar with such cases, one of the most notable being that of former prime minister Ariel Sharon.

This changing dynamic in a medically modernized world has perhaps altered the very essence of what we are asking when we say, “Who will live and who will die?” Though it is beyond just asking to stay alive, the far more fundamental request is beseeching God to bless us with quality lives. Another oft-cited verse says, “Al tashlicheni l’et ziknah” — let us not be thrust into a time where we are aged. This is a prayer that has taken on a deeper meaning as mortality has been extended.

This new world of advanced mortality is an incredible blessing, but admittedly introduces many challenges — challenges that often fall onto other family members as loved ones approach death and are unable to make decisions on their own. Decisions over assisted respiration and feeding tubes, and when and how medicine can be used, and whether to discontinue treatment or extend it.

These issues serve at the very convergence of medicine, faith, and ethics, and have inspired the development of a new initiative, called Tzohar Through 120, which provides families with free support, insight, and relevant halachic guidance to make fully informed critical decisions at critical times.

On Yom Kippur this year, when we recite those fate-filled words, “Who Will Live and Who Will Die,” we must be deeply thankful that we live in a time where life can be preserved and death delayed in ways that were impossible only years ago. But our prayer — both personal and communal — must be equally infused with the request that our lives — may they be long — be defined not just by length, but by quality and the wisdom for us and our families to be prepared for whatever challenges and dilemmas may come.