For Halachic End of Life Issues the Best Solution is Personal Guidance

Rabbi Yuval Cherlow published this important article today (in Hebrew) in Yisrael Hayom about ethical issues related to the end of life, and how taking measures to extend life is not always the best choice halachically or ethically.

In my former career as a rabbi, I witnessed a number of cases where the family of the patient, in their zeal to wring out every last breath, insisted on extraordinary measures, even demanding that the staff perform CPR on a elderly woman dying of cancer. One of the attending physicians described the case as nothing less than “state-sanctioned torture.”

At the same time, I also witnessed doctors administering high doses of morphine to a sedated patient suffering from pneumonia, ostensibly to ease his pain. But it became clear that they knew that the dose would quickly end his life, and that the medical staff felt that they were “doing the right thing” because the man had been confined to his bed (but incredibly well cared-for) for a number of years.

Rabbi Cherlow in his article quotes the famous Rabbi Chaim Kanievsky, the well-known halachic authority (posek) who wrote the following:

Essentially, regarding the principal that “Anything that can be done to extend the life of the sick (even if only temporarily) must be done” in truth, is a saying that I also heard in my youth, and I do not know if it came from a reliable person. Yet, in my eyes this matter requires great scrutiny, for in [Shulchan Aruch] Yoreh Deah 339 it is clear that one is permitted to remove that which is impeding the death of the sick, and it is only forbidden to act directly [to actively hasten death.] If so, to be in a position of “sit [silently] and do not act” it would seem (in a case where action would increase suffering in the patient) that I have not found this to be forbidden. Quite the opposite – one should learn [from this] to refrain [from taking extraordinary measures to extend the life of the dying]… (Karyana D’igreta 190)

What’s the answer? As with so many other areas of life, it is difficult to give specific guidelines. So much depends on the specific ailment, the desires and needs of the patient (and not the family!), and the situation on the ground. That being said, the best answer is careful spiritual, ethical guidance.

In the United States, there is a concept of a Halachic Health Care proxy. This document allows a person to appoint an agent to make medical decisions on their behalf, as well as a rabbi who will guide that agent in areas related to halachah and Jewish ethics. This, to my mind, is the best way to address the myriad possible situations that can arise in the complicated period leading to the end of life. This will allow loved ones to make decisions that the patient would have wanted, following the halachic guidelines that they lived during their life.