Legal Advisor to Torah MiTzion
In the footnotes to his encyclopedia, Steinberg recounts the death of his own father. Rabbi Shlomo Zalman Aurbach, considered one of the greatest halachic authorities of the modern era, who directed him to discontinue norepinephrine, a drug that stabilizes blood pressure, after Steinberg’s father’s respiratory system and kidneys failed. However, Steinberg adds that all the natural needs of the patient, such as food and oxygen, must be provided. Treatment such as antibiotics, that prevents complications common to non-terminally patients, must also be continued.
According to Prof. Steinberg:
The balances that receive expression in the Terminally Ill Patients Law, 5766-2005 match the opinion of the majority of poskim on these issues. The fact that the patient has a life expectancy of less than 1 year brings him into the category of a choleh be’chayei sha’ah (terminally ill patient), whose wishes the Halacha respects, including the wish to avoid prolonging his suffering.
All the poskim are of the opinion that doctors and others are obligated to do everything possible to save the life of a dying patient, even if the patient will only live for a brief period. Any action that results in hastening the death of a dying patient is unethical and forbidden, and is considered an act of murder – even if the outcome is ethically desirable. However, most poskim consider that there is no obligation to institute life-prolonging or resuscitative treatments to prolong the suffering of a comatose patient whose situation is deemed hopeless by the doctors.
A significant number of the poskim consider that while the value of life is a sacrosanct and lofty value, it is not absolute. Thus, for example, certain values may exceed the value of life, such as the three aveirot for which a person is commanded to give up his life rather than transgress, or going out to battle and death by Kiddush Hashem. It is even permitted to kill a person pursuing his fellow with intent to kill him. Then there are the four forms of death prescribed for transgressing different types of aveira. Even suicide may be permitted in certain circumstances.
And the same applies in the case of an incurably ill person in severe pain, agony or distress: Halacha sanctions the removal of an impediment (a knocking noise, such as wood chopping, or salt on the patient’s tongue) which may artificially delay the patient’s demise in the final phase, provided no act is performed which hastens death, such as moving the dying person from one place to another. It is clear that if the value of life was an absolute value, not only would there be no permit to remove the life prolonging act, but it would be necessary to ensure the continuity of this act in all circumstances.
As mentioned in our last column, Prof. Vardit Ravitsky was a member of the Israeli public committee on the dying patient during 2000- 2002. In her fascinating article published by the British Medical Journal, she explains that this distinction between withholding treatment at the end of life (which Halacha generally perceives as a permitted noninterference in the natural process of dying) and withdrawing treatment (interventions involving direct contact with the body or immediate environment of the dying person) “stems at least in part from the religious approach that humans should not have an active role in the dying process, which should remain in the hands of God… The difficulty of accepting withdrawal is not based on a belief that the life of a suffering dying patient should be prolonged at all costs but on a cultural approach that is ethically opposed to human intervention to terminate life…”
“The halachic literature reasons using a metaphor of the dying person as a ‘flickering candle’ and the idea that one should not be ‘placing one’s finger on the candle… this clearly excludes an understanding of the forbidden hastening of death in consequentialist terms: the deed’s wrongness is not determined by its result – namely the fact that the patient is dead at a certain earlier moment – but rather by its symbolic characterization as extinguishing the candle. This means that withdrawal of treatment is forbidden, even if the death of the patient at that point in time is an ethically appropriate outcome.”