Post by Rabbi Neil on Mar 6, 2019 16:49:08 GMT
I remember first being confronted with the issue of assisted suicide when I was a teenager. Our English teacher, Mr Farmer, showed us a movie starring Richard Dreyfus, in which he was seriously injured and ended up begging for doctors to help him end his life. I remember then how troubling the issue was. As a student Rabbi, I studied varying Jewish approaches toward suicide itself, but none really about assisted suicide. Now I have no choice but to address it.
Judaism puts the preservation of life above almost everything else (with the exception of a few things such as idolatry). Preservation of life, or pikuach nefesh, even overrides Shabbat, Kashrut, even Yom Kippur. The Torah is very clear on these matters, and enjoins us to “choose life so that you and your children may live” (Deut. 30:19). Indeed, traditionally, one who takes their own life in Judaism did not used to be given mourning rites because their act of suicide was considered to have been a rejection of God. Taking another person’s life, even at their own request, was seen as worse, and nothing short of murder.
One Biblical passage that is often quoted in support of assisted suicide is the death of Saul. In chapter 31 of the first book of Samuel, the Philistines kill three of Saul’s sons and Saul himself is seriously wounded. He turns to his armor bearer and tells him to take his sword and kill Saul with it so that the Philistines do not torture him. The armor bearer is afraid to do it, so Saul takes his own sword and falls on it. (I Sam 31:2-4) Many later Rabbinic authorities say that Saul behaved improperly at this point, but one commentator, the 14th century Besamim Rosh, says that if one is dying and in intolerable pain, then it is permitted to take one’s own life. This is clearly a minority opinion.
Talmud (Ketubot 104a) contains a narrative that I believe is also really important as well. In it, Rabbi Judah HaNasi is dying and the other Rabbis and his students decree a fast and pray to keep him alive. His maidservant went up to the roof and prayed that the lower realms might win out over the upper realms, in other words, that he be kept alive and not taken to heaven. However, when she sees how often he has to go to the bathroom, and how uncomfortable he was taking off and putting on his tefillin, and how much discomfort he was in, she changed her mind. However, the sages were still praying for him to remain alive, so she took a jug and threw it to the ground. The sages were shocked by the sound, stopped praying for a moment, and Judah HaNasi died.
There is a bill currently working its way through the legislature. It aims to copy the law from Oregon. In the law, a person with a terminal illness and who is going to die in the next six months, and who is suicidal must go and talk to their primary care physician. If, after the conversation, the physician understands that their life is intolerable, they can write up a prescription for a particular medication. The terminally ill person must go to the pharmacist themselves to pick it up – they cannot have someone else do it for them. Then, at home they may take the prescription at any time, their body will shut down and they will die. The final aspect of this is that on the death certificate, the cause of death is given as the terminal illness, not as suicide.
I have now twice been approached about this bill over the last few years. The data from Oregon is clear – the introduction of this bill dramatically reduced the rate of suicide in the state. This is for a number of reasons. Firstly, the requirement that the person with a terminal illness has to talk to their doctor about their hope to die can lead to counselling or even just a mental release. It can be an enormous relief to people to just talk about their desire to die with dignity. As well as this, though, people who suffer from terminal illnesses often feel like they’ve lost control of their lives. Having a bottle within their reach that they can take at any time can be extremely comforting to people. In fact, most people in Oregon who filled out the prescription didn’t take it, they just wanted to know that they could.
My difficulty with this law has always been the cause of death. If a person consumes something poisonous and dies, it’s suicide. Even though they were going to die in the next few months, they’ve still committed suicide. I don’t have an issue with that, just to be clear, but I have always disliked the fact that the cause of death isn’t honest. Until recently.
One of the things I had never considered is life insurance. When the cause of death is given as suicide, most life insurance policies would not pay out. What this means is that if a person who is going to die wants to die without suffering immense suffering, they have to give up any chance of life insurance payout that could support their loved ones in the future. The person would be kept alive, and suffering, because of an administrative clause. Making people suffer in order to check boxes seems deeply immoral to me.
To be clear, this law is not perfect. Many people who reach the decision that they want to die with dignity are already too immobile to get the prescription themselves. This law would not cover such individuals. But it’s a really interesting step. And, I believe that it totally accords with the two Jewish narratives I mentioned earlier. King Saul essentially has a terminal illness. He knows he is going to die, and suffer terribly beforehand. His natural instinct is to avoid that suffering any way possible. His armour bearer doesn’t want to kill him – he is afraid of the consequences. And rightly so, since the start of the Second Book of Samuel has a conflicting account in which the armor bearer does actually kill Saul, and David is so enraged that he immediately orders his death! The point is that even Saul prefers a dignified death than one in which he suffers intolerably.
In the second story, the Sages are so busy being Jewish that they ignore their master’s pain. They prolong his pain because they want him to stay alive. His maid, however, acts with compassion. She understands that it would be better for them were he to stay alive, but it’s clearly better for him to no longer suffer. So, the question I have found myself recently asking is, “Should I be like the Sages, or like the housemaid?” Does it really matter what’s on the death certificate? If it reduces suicides, if it removes suffering, if it gives people dignity, is it really so important that the ink on a particular certificate is written in one way and not the other? If the core of Judaism is the preservation of life, is it really at all costs? Certainly, our tradition is that God gives life and God takes away life. Traditional Jewish law has also said that while we can’t actively hasten someone’s death, we can remove things that prolong their life. So, for example, we can turn off a life-support machine if it is prolonging someone’s life beyond its natural limits.
This, in essence, is a real question about the division between Orthodox and Reform Jews. An Orthodox Jew would say that our lives are not our own and that we never have the right to end our lives or to help someone end their life. I understand that position. I also believe that religion is meant to add to our lives, to increase holiness, to elevate our lives. If it does the opposite it perpetuates suffering, what is the point of it? If it endorses suffering, if its fundamental belief is that God wants you to suffer, is that really a Judaism that we want to follow?
Some might say that there is a reason for suffering. One common traditional Jewish belief is that we suffer in this world so that we might have a wondrous world to come. That is why the Rabbis said that bad people prosper in this world – to get all the good stuff out of the way before having a horrible world to come. It’s a nice philosophy that provides balance in the world, but it’s also extremely tolerant of suffering. It suggests that suffering is good for you. Suffering, indeed, is in some sense an early reward for good behavior. With that perspective, it not only tolerates suffering, but essentially celebrates it. That risks callousness. Another perspective from our tradition is that suffering is a demonstration of God’s love because we can use it as a reminder to change our behavior. It serves as the corrective that helps us draw closer to God. Once again, though, I would never turn to someone dying in a hospital bed, writhing in agony, and tell them that it’s because they need to be a better person. It seems, then, that the traditional Jewish position on the preservation of life, while designed to be compassionate, was not at all.
I love life. I wish that everyone loved life. But they don’t. I’ve spent time with enough people in my career who have asked me to help them die. I’ve always told them that I can’t – but that was from a legal perspective, not a halachic one. Sometimes, I’ve truly wished I could help. So, I’ve moved beyond my desire to have every form filled out correctly. I’ve moved beyond the need for death to be something administratively correct. I’ve realized that more than anything else, it needs to be human. It needs to be real. It needs to be compassionate. Death from terminal illness is tortuous enough, we need to not prolong that torture and say that’s what God wants. If we believe that Jewish law developed from humans and God, we need to be open to the possibility that the law can develop as we develop. What if God wanted us to be compassionate and in the past we understood compassion to be one thing, but now understand it differently?
The truth is that if a person with a terminal illness with some mobility is absolutely determined to end their own life, they are going to find a way to do it. No amount of halachic pronouncements will change that. I think it’s time that we were more like the housemaid and pierced the pretension of halachic insensitivity. If Judaism were predicated not just around life, but around quality of life, then it would be able to speak in a very differing voice. I think it’s time to find that voice. And even if not, if it were simply predicated around preserving life, the fact that this bill in Oregon drastically reduced the number of suicides means, in my opinion, that we have to support it, in order to save lives. When we know that a person is facing imminent death, we shouldn’t be like the armor bearer, frozen in fear. We don’t need to take a life, that was not a fair request by Saul. But we can certainly help those we love who are near to death anyway die with some dignity.
May we always be guided to act with compassion. May our deliberations on matters of life and death be guided by love, and not administrative diligence. And may we care for all those in pain, and help relieve their burden. And let us say, Amen.
Judaism puts the preservation of life above almost everything else (with the exception of a few things such as idolatry). Preservation of life, or pikuach nefesh, even overrides Shabbat, Kashrut, even Yom Kippur. The Torah is very clear on these matters, and enjoins us to “choose life so that you and your children may live” (Deut. 30:19). Indeed, traditionally, one who takes their own life in Judaism did not used to be given mourning rites because their act of suicide was considered to have been a rejection of God. Taking another person’s life, even at their own request, was seen as worse, and nothing short of murder.
One Biblical passage that is often quoted in support of assisted suicide is the death of Saul. In chapter 31 of the first book of Samuel, the Philistines kill three of Saul’s sons and Saul himself is seriously wounded. He turns to his armor bearer and tells him to take his sword and kill Saul with it so that the Philistines do not torture him. The armor bearer is afraid to do it, so Saul takes his own sword and falls on it. (I Sam 31:2-4) Many later Rabbinic authorities say that Saul behaved improperly at this point, but one commentator, the 14th century Besamim Rosh, says that if one is dying and in intolerable pain, then it is permitted to take one’s own life. This is clearly a minority opinion.
Talmud (Ketubot 104a) contains a narrative that I believe is also really important as well. In it, Rabbi Judah HaNasi is dying and the other Rabbis and his students decree a fast and pray to keep him alive. His maidservant went up to the roof and prayed that the lower realms might win out over the upper realms, in other words, that he be kept alive and not taken to heaven. However, when she sees how often he has to go to the bathroom, and how uncomfortable he was taking off and putting on his tefillin, and how much discomfort he was in, she changed her mind. However, the sages were still praying for him to remain alive, so she took a jug and threw it to the ground. The sages were shocked by the sound, stopped praying for a moment, and Judah HaNasi died.
There is a bill currently working its way through the legislature. It aims to copy the law from Oregon. In the law, a person with a terminal illness and who is going to die in the next six months, and who is suicidal must go and talk to their primary care physician. If, after the conversation, the physician understands that their life is intolerable, they can write up a prescription for a particular medication. The terminally ill person must go to the pharmacist themselves to pick it up – they cannot have someone else do it for them. Then, at home they may take the prescription at any time, their body will shut down and they will die. The final aspect of this is that on the death certificate, the cause of death is given as the terminal illness, not as suicide.
I have now twice been approached about this bill over the last few years. The data from Oregon is clear – the introduction of this bill dramatically reduced the rate of suicide in the state. This is for a number of reasons. Firstly, the requirement that the person with a terminal illness has to talk to their doctor about their hope to die can lead to counselling or even just a mental release. It can be an enormous relief to people to just talk about their desire to die with dignity. As well as this, though, people who suffer from terminal illnesses often feel like they’ve lost control of their lives. Having a bottle within their reach that they can take at any time can be extremely comforting to people. In fact, most people in Oregon who filled out the prescription didn’t take it, they just wanted to know that they could.
My difficulty with this law has always been the cause of death. If a person consumes something poisonous and dies, it’s suicide. Even though they were going to die in the next few months, they’ve still committed suicide. I don’t have an issue with that, just to be clear, but I have always disliked the fact that the cause of death isn’t honest. Until recently.
One of the things I had never considered is life insurance. When the cause of death is given as suicide, most life insurance policies would not pay out. What this means is that if a person who is going to die wants to die without suffering immense suffering, they have to give up any chance of life insurance payout that could support their loved ones in the future. The person would be kept alive, and suffering, because of an administrative clause. Making people suffer in order to check boxes seems deeply immoral to me.
To be clear, this law is not perfect. Many people who reach the decision that they want to die with dignity are already too immobile to get the prescription themselves. This law would not cover such individuals. But it’s a really interesting step. And, I believe that it totally accords with the two Jewish narratives I mentioned earlier. King Saul essentially has a terminal illness. He knows he is going to die, and suffer terribly beforehand. His natural instinct is to avoid that suffering any way possible. His armour bearer doesn’t want to kill him – he is afraid of the consequences. And rightly so, since the start of the Second Book of Samuel has a conflicting account in which the armor bearer does actually kill Saul, and David is so enraged that he immediately orders his death! The point is that even Saul prefers a dignified death than one in which he suffers intolerably.
In the second story, the Sages are so busy being Jewish that they ignore their master’s pain. They prolong his pain because they want him to stay alive. His maid, however, acts with compassion. She understands that it would be better for them were he to stay alive, but it’s clearly better for him to no longer suffer. So, the question I have found myself recently asking is, “Should I be like the Sages, or like the housemaid?” Does it really matter what’s on the death certificate? If it reduces suicides, if it removes suffering, if it gives people dignity, is it really so important that the ink on a particular certificate is written in one way and not the other? If the core of Judaism is the preservation of life, is it really at all costs? Certainly, our tradition is that God gives life and God takes away life. Traditional Jewish law has also said that while we can’t actively hasten someone’s death, we can remove things that prolong their life. So, for example, we can turn off a life-support machine if it is prolonging someone’s life beyond its natural limits.
This, in essence, is a real question about the division between Orthodox and Reform Jews. An Orthodox Jew would say that our lives are not our own and that we never have the right to end our lives or to help someone end their life. I understand that position. I also believe that religion is meant to add to our lives, to increase holiness, to elevate our lives. If it does the opposite it perpetuates suffering, what is the point of it? If it endorses suffering, if its fundamental belief is that God wants you to suffer, is that really a Judaism that we want to follow?
Some might say that there is a reason for suffering. One common traditional Jewish belief is that we suffer in this world so that we might have a wondrous world to come. That is why the Rabbis said that bad people prosper in this world – to get all the good stuff out of the way before having a horrible world to come. It’s a nice philosophy that provides balance in the world, but it’s also extremely tolerant of suffering. It suggests that suffering is good for you. Suffering, indeed, is in some sense an early reward for good behavior. With that perspective, it not only tolerates suffering, but essentially celebrates it. That risks callousness. Another perspective from our tradition is that suffering is a demonstration of God’s love because we can use it as a reminder to change our behavior. It serves as the corrective that helps us draw closer to God. Once again, though, I would never turn to someone dying in a hospital bed, writhing in agony, and tell them that it’s because they need to be a better person. It seems, then, that the traditional Jewish position on the preservation of life, while designed to be compassionate, was not at all.
I love life. I wish that everyone loved life. But they don’t. I’ve spent time with enough people in my career who have asked me to help them die. I’ve always told them that I can’t – but that was from a legal perspective, not a halachic one. Sometimes, I’ve truly wished I could help. So, I’ve moved beyond my desire to have every form filled out correctly. I’ve moved beyond the need for death to be something administratively correct. I’ve realized that more than anything else, it needs to be human. It needs to be real. It needs to be compassionate. Death from terminal illness is tortuous enough, we need to not prolong that torture and say that’s what God wants. If we believe that Jewish law developed from humans and God, we need to be open to the possibility that the law can develop as we develop. What if God wanted us to be compassionate and in the past we understood compassion to be one thing, but now understand it differently?
The truth is that if a person with a terminal illness with some mobility is absolutely determined to end their own life, they are going to find a way to do it. No amount of halachic pronouncements will change that. I think it’s time that we were more like the housemaid and pierced the pretension of halachic insensitivity. If Judaism were predicated not just around life, but around quality of life, then it would be able to speak in a very differing voice. I think it’s time to find that voice. And even if not, if it were simply predicated around preserving life, the fact that this bill in Oregon drastically reduced the number of suicides means, in my opinion, that we have to support it, in order to save lives. When we know that a person is facing imminent death, we shouldn’t be like the armor bearer, frozen in fear. We don’t need to take a life, that was not a fair request by Saul. But we can certainly help those we love who are near to death anyway die with some dignity.
May we always be guided to act with compassion. May our deliberations on matters of life and death be guided by love, and not administrative diligence. And may we care for all those in pain, and help relieve their burden. And let us say, Amen.