When I was a girl I grew up with a rabbi whom we referred to as "the death and dying rabbi." His name, Rabbi Earl Grollman, was and still is, known in religious communities as an expert in matters pertaining to dying and talking to loved ones about death. He traveled across the country giving lectures and on many a Shabbat he used our bima to share new insights into confronting death and our own mortality. As a young girl, I did not understand why he focused so much on death and other seemingly irrelevant topics. Now I understand.
Now I understand that Rabbis spend significant time moving between life and death and back to life again in our pastoral capacity. Now I understand that because Judaism speaks so strongly about life, Judaism also delves deeply into how we think about death. Judaism encourages us to recognize our mortality and to reflect on the meaning of life and of death. Rabbi William Cutter reminds us that, "Death is what makes us mortal; recognizing death may be what makes us human."
In recent weeks, the story of Terri Schiavo has prompted renewed interest in matters of life and death. It was the top news story on every internet banner, and we watched as the country debated whether a feeding tube should be withdrawn from this woman who was in a "persistent vegetative state." Terri Schiavo had existed in this state since 1990, when at the age of 26, bulimia led to a severe potassium imbalance that stopped her heart depriving her brain of oxygen. Her case raised many questions: How do we define living? When does a person have the right to die? Who decides? How can one preserve dignity in life and in death? What does Judaism have to say about the issues?
As with most questions, Judaism does not provide a single answer. For every medical question about when life ends, and whether a patient is entitled to refuse treatment, there are a hundred other related questions with ambiguous answers. However, Jewish tradition can offer guidelines about how we face the death of our loved ones and even our own. Of the many responses of our tradition to questions of death and dying, there are three that speak to the recent end of life debate. First, whether or not it is permissible to remove an impediment to death. Second, whether or not it is permissible to actively engage in euthanasia. Third, the overriding value of preserving the dignity of life even in death.
Our tradition is filled with stories that shed light on human behavior and values. To the first point, I will begin with a story from the Talmud (Ketubot 104a).
When Rabbi [Judah] was dying the [other] rabbis declared a public fast and offered prayers that God have mercy on him [spare his life]. His maid went up to the roof and prayed: "The angels want Rabbi to join them in heaven and the people want him to remain with them. May it be the will of God that the people overpower the angels." However, when she saw how often he had to use the bathroom, each time painfully taking off his tefillin and putting them on again, she prayed: "May it be the will of God that the angels overpower the people." As the rabbis continued to pray, she took a jar and threw it off the roof. The rabbis stopped praying [because they were startled by the noise], and at that moment, the soul of Rabbi departed. Both the Rabbi and the maid were praised in the World to Come.
The relevance of this amazing story for the current debate on medical ethics is not hard to see. Among other interesting elements, the heroine is an anonymous maid, who is known for her clever speech elsewhere in the Talmud, and who is more merciful than all the sages—and they are the ones who tell the story. The rabbis believed that prayer could keep a sick person alive. But, Rabbi Judah HaNasi suffered greatly, as evidenced by his frequent trips to the bathroom. Their prayer was an impediment to his death. When the maid threw the jar from the roof, she stopped their prayers and succeeded in removing the impediment. The maid is praised in the Talmud for her merciful actions.
A midrash reveals a similar story, in which prayer is the impediment that is removed to allow a person to die. It happened that a woman who had aged considerably appeared before Rabbi Yose ben Halafta. She said, "Rabbi, I am much too old, life has become a burden for me. I can no longer taste food or drink, and I wish to die." Rabbi Yose answered her, "To what do you ascribe your longevity?" She answered that it was her habit to pray in the synagogue every morning, and despite occasional more pressing needs she never had missed a service. Rabbi Yose advised her to refrain from attending services for three consecutive days. She heeded his advice and on the third day she took ill and died. (Yalkut Shimoni)
The Shulkan Aruch, the classic Jewish legal code, lays the foundation for what to do for a gosses, an imminently dying person. Written in 1550, it states specifically that something that prolongs death may be removed. The commentator Moses Isserles writes, "if there is a hindrance to the departure of the soul—such as a woodchopper in the vicinity of a dying man's home [and the noise of the chopping prevents the soul from escaping], or there is salt on his tongue, it is permitted to remove it [the chopper or the salt], for there is no direct act involved, since he merely removes the hindrance."
With these texts in mind, Jewish legal authorities such as the Conservative movement's Rabbi Elliot Dorff, take a liberal position on the permissibility of withdrawing life-support mechanisms in terminal cases, including artificially induced food and hydration. Citing these sources, Solomon Freehof, the leading writer on Reform practice, concluded that Jewish law sanctions passive euthanasia (the removal of an impediment), in the case in which the dying individual is incurable and/or in great pain. He instructs, "According to the spirit of Jewish tradition, just as a person has a right to live, so there comes a time when he has a right to die. Thus, there is no duty incumbent upon the physician to force a terminal patient to live a little longer."
In Judaism, though, a clear distinction is made between the removal of means that artificially prolong the process of death and the deliberate termination of life. While Judaism instructs us not to delay death which is imminent, the second response teaches us to prolong life and to uphold the sanctity of life. The legal tradition prohibits active euthanasia. The basis for Judaism's stance against assisted suicide takes us back again to the Shulkhan Aruch. It says, "A gosses (a dying person) is considered alive in all respects...One does not close his eyes until his soul departs. And whoever closes his eyes before death is regarded as one who sheds blood." In further commentary, "Thus, it is forbidden to hasten the death of the dying person. One who has been in a dying condition, we may not remove the pillow or the mattress from under him. He may likewise not be moved from his place." [These are both forbidden on account of moving the patient which may hasten death.]
The most cogent Reform position on the subject is the 1994 "On the Treatment of the Terminally Ill." The Reform perspective maintains, "We find that the tradition of learning which created these passages and which has studied them for fifteen centuries declares consistently and unequivocally against euthanasia. We do almost anything to relieve the suffering of the terminally-ill, but we do not kill them and we do not help them kill themselves." It is the feeling of the Reform position that the "quality of life" argument is unhelpful because it is too subjective. The responsa goes on to say that although compassion guides us, we believe that death is not the only response to suffering. At a certain point the role of the physician turns from curing to caring. Tremendous amounts of money and research have been devoted to curing. There is much more we can learn about how to care for the terminally ill.
It is clear that there are many individual considerations to weigh between these first two points of caring for someone's life but not delaying their death. The third response, the value of preserving the dignity of life even in death, will help us to navigate the first two. Terri Schiavo, like all of us, deserved to die with dignity. That seemed to get lost in the shuffle of the media, Congress, the President, and family. Politics and emotionally-charged story lines stood in the way of restoring and preserving her dignity.
The Schiavo story points us to the last response from our tradition, the one that is most important. The lesson we take is that we must clearly express our own wishes of how we want to be cared for in the final times of our life. If Terri Schiavo had made a clear Advanced Medical Directive, some of this pain might have been averted.
Living wills can be drafted in accordance with Jewish law and custom. If you are interested, resources are available. It is most important for people in their 20's and 30's to prepare these documents and to then review them as we grow older. In addition to indicating specific medical directives, Jewish tradition encourages the creation of ethical wills. This is a loving document, a statement of your legacy—what you achieved during your lifetime, the values you want to transmit to the next generation, your hopes and dreams for your family in the future. Jack Riemer, author of the book, So That Your Values Live On—Ethical Wills and How to Prepare Them, indicates that you don't need to be a professional writer to write an ethical will. "Words that come from the heart, enter the heart."
To recognize death is to make us human, Rabbi Cutter has taught. Judaism strongly believes that in death, as in life, we are partners with God, as caregivers and empowered decision makers for ourselves and for others. As liberal Jews, we look to the texts to guide us in making informed Jewish choices. If we reflect on how we want to live, we will help to preserve our dignity when we die. Perhaps, Mary Oliver's words sum it up best in a poem, entitled "To Live In This World:"
To live in the this world
you must be able
to do three things:
to love what is mortal;
to hold it
against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go.
Amen.
