Emor 5783 – Medical Assistance in Dying
Saving lives is the supreme Jewish value. We are told we can violate almost any commandment in order to save a life. We can eat a ham sandwich, steal, or violate Shabbat in order to save a life. The only exceptions are murdering someone else, sexual immorality, or public idol worship.
This week’s Torah reading, Emor, contains a reiteration of the commandment forbidding murder. We are told:
וְאִ֕ישׁ כִּ֥י יַכֶּ֖ה כׇּל־נֶ֣פֶשׁ אָדָ֑ם מ֖וֹת יוּמָֽת׃
If a person kills any human being, that person shall be put to death.
And, of course, the prohibition on murder is also one of the Ten Commandments.
The prohibition against killing any human being extends even to ones’ self. Under traditional Jewish law a person is not allowed to commit suicide. Once upon a time people who committed suicide were not buried next to other Jews. We no longer do that, since we now realize that if someone takes their own life it is not because they were making a philosophical statement rejecting God, but rather they were under duress, suffering from depression or some other malady.
But what if a life is full of nothing but pain, suffering, and fear? What if someone is approaching the end of their life and wishes to meet their end with dignity? Can suicide ever be permitted under Jewish law? And can someone be permitted to help someone who has decided to end their own life?
Suicide is not forbidden under secular law in most countries, including Canada. There are still about 20 countries around the world where suicide is illegal, and an unsuccessful suicide attempt can land you in jail. Which seems incredibly dumb to me. A few years in jail will likely do nothing for a depressed person other than encourage them to make sure they are successful with the next attempt. What’s needed is compassion and treatment, not punishment.
The reason for intervention when someone is attempting to take their own life in countries such as Canada and the US where there are no laws prohibiting it is because it is assumed that with treatment the person would actually prefer to live.
“Medical Assistance in Dying” has been legal here since 2016. But what about under halacha, Jewish law? What does our tradition say about helping someone end their life?
Under Jewish law, suicide is forbidden, and therefore helping someone end their life is all the more so forbidden. Yet some rabbis are starting to wonder whether we need to change our views.
The traditional prohibition on suicide is not only based on the prohibition against murder. It is also based on a Jewish view of the body that is at odds with the secular view. The secular view is that your body is yours to do with what you want. The Jewish view is that God owns everything – including your body – so there are limits on what you can do with your body, just as if you were a tenant in a rented apartment there are limits to what you can do with your space. That also explains why piercings are allowed under Jewish law, but permanent tattoos are forbidden. Piercings are temporary – take them out and the hole will close. Permanent tattoos are different. It’s like when I was in the US Army and we were told you could get disciplined for getting a sunburn, because it was damaging government property.
The Talmud forbids suicide even in a case when someone has a terminal illness, or is on the brink of a painful death. There is a famous story of Rabbi Chanina ben Teradion, who was being executed by the Romans. He was wrapped in a Torah scroll, with tufts of wool soaked in water put over his heart so that he would not die quickly. Bundles of straw were set around him, and set on fire. His disciples begged him to open his mouth and let the fire enter him so as to put an end to his pain and suffering, but he responded, “Let Him who gave me [my soul] take it away.” But when the executioner offered to remove the tufts of wool, he permitted it.
From this episode we learn two things, which have become accepted as halacha: we may not intentionally hasten death, but we are permitted to remove an impediment to dying. The difference is a subtle, but important, one.
Besides the theological concerns, there are many practical concerns that worry rabbis when it comes to helping people end their lives.
Rabbi Ismar Schorsch, former chancellor of the Jewish Theological Seminary, said,
Beyond the weight of Jewish tradition on this grievous subject, I fear that approval of physician-assisted suicide will repeatedly contaminate the judgment of patient and family alike with base economic considerations. The temptation or pressure to choose death in order to save money will all too frequently drive the decision. My heart goes out to all those engulfed by inhuman suffering. But to curtail life directly is an act of a different moral order from ceasing to prolong it indirectly. The abuses that will surely flow from euthanasia will compromise not only the mission of the medical profession but the moral fabric of society itself. And where the social consequences are of such a deleterious magnitude, I believe the welfare of society outweighs the autonomy of the individual.
I do believe that we need to be very concerned about financial issues clouding end of life decisions. Especially in America, where they do not have universal health care, it’s not only that the children may be impatient to inherit, but the person themselves may feel they want to leave something of their estate for their children instead of having everything go to medical bills. No one should ever feel they need to end their life because of financial pressure. We as a society need to do better. We certainly do not want someone who is suffering from a terminal illness to feel they have a duty to die for the sake of other people.
But I also believe Rabbi Schorsch, and the many rabbis who rule the same way, are not being sufficiently sensitive to the needs of the individual. How can you tell an individual in uncontrollable pain, who is going to die in a few weeks anyway, that they are forbidden to hasten the process and end their suffering for the good of society? If I were in that position, I’m sure I would give a very vulgar opinion of what society could do.
People with a terminal illness are not committing suicide, and that’s why terminology is important. Medical assistance in dying is an appropriate way to phrase it. As one terminal patient, Jack Newbold, said,
I’m not committing suicide, and I don’t want to die. I was upset by media reports that I intend to ‘kill’ myself. I’m not killing myself; bone cancer is taking care of that. I may take the option of shortening the agony of my final hours.
Another person in that difficult position, Louise Schaefer, said,
All I am asking for is to have some choice over how I die. Portraying me as suicidal is disrespectful and hurtful to me and my loved ones. It adds insult to injury by dismissing all that I have already endured; the failed attempts for a cure, the progressive decline of my physical state and the anguish that has involved exhaustive reflection and contemplation, leading me to this very personal and intimate decision about my own life and how I would like it to end.
There are many additional ethical concerns, too many to go into in a sermon, but I want to talk about one more. What inspired me to talk about this subject today is I heard a discussion on CBC a few weeks as I was driving between a woman with a family history of Alzheimer’s and a physician who treats Alzheimer’s patients. Canada is still debating how to handle Medical Assistance in Dying for mental health reasons. The woman with the family history watched her mother’s decline, and is concerned that by the time she would be eligible for such assistance she would be deemed mentally not competent to make that decision. So she wants the ability to decide ahead of time if she gets to a certain point, she would get assistance in dying even if at that later time she was not mentally competent. Which on the one hand, sounds reasonable, we allow people to make advance directives about their health care.
But the physician strongly disagreed. She said it’s not appropriate to make a decision for a future self, because you do not know how that future self will feel. She said that many of the Alzheimer’s patients she works with seem content with their lives, even as their mental declines have limited the scope of what they can do. A friend of mine whose mother has advanced Alzheimer’s told me that her mother seems to be in a very “Zen like” state. She doesn’t remember the suffering she went through a few hours earlier, and she’s not worried about suffering in the future. She’s living very much in the moment.
It does seem that we should not let people make a decision for a future self because they are afraid of what that future might be like. They cannot really know.
The Conservative Movement’s Committee on Jewish Law and Standards passed a paper in 1997 on “Assisted Suicide,” written by my teacher Rabbi Elliot Dorff. In that paper, Rabbi Dorff argued the traditional view that suicide is forbidden and helping someone commit suicide is forbidden, but we should be compassionate and supportive to people struggling at the end of life. He revisited that paper in 2020, and wrote a new paper titled, “Assisted Suicide/Aid in Dying Reconsidered: “God’s Compassion Embraces All God’s Creations” (Psalms 145:9). He was moved to revisit the subject after several jurisdictions, including California and Canada, passed laws permitting Medical Assistance in Dying. In the new paper Rabbi Dorff rules that in certain isolated cases, providing assistance in dying may be permitted, but it’s a case where it is still theoretically forbidden by Jewish law, but we do not rule that way in a specific case. A physician can provide the medicines to end a life, but should not administer them, that should be done by the person themselves.
His paper provides a long list of conditions that must be met. My own view is we should be a little more flexible.
There is an example of assistance in dying in the Tanakh. At King Saul’s final battle, once the battle is lost Saul decides to fall on his own sword, lest the enemy run him through and make a mockery of him. When falling on his sword did not finish him off, he asked someone passing by to finish the job as he was in great agony, and the person helped Saul in that way by finishing the job.
The rabbis in the Talmud did not choose the story of Saul as the basis for the laws on assistance in dying – instead they relied on the story of Rabbi Chanina mentioned earlier. But they also did not condemn Saul and his helper for what he did.
I suggest that we view helping someone in pain end their life before their disease ends it as an act that is called “patur,” which means “exempt.” It’s not exactly completely permitted ahead of time, but it is understandable, justifiable, and doing so does not result in any condemnation or penalty. There is a principle in Jewish law that there may be extreme times when we permit things that are normally forbidden, הלכה ואין מורין כן “it’s the law but we don’t rule that way.”
The role that rabbis and the community have in such difficult circumstances is to provide the dying person with our love, support, and compassion.
May the Compassionate One take pity on any of His children in such a situation,
Amen.
