Whose Life is it Anyway? The Jewish View of Physician Assisted Suicide

Passover is our holiday of liberation. Many people are shackled by the prison of their own bodies. What does Jewish law say about Physician Assisted Suicide?

One of the headlines in last Thursday’s New York Times read: “Justin Trudeau Seeks to Legalize Assisted Suicide in Canada.” The headline and article caught my immediate attention.

On initial reading, the article makes it appear as if the new, young, daring — and brash — Prime Minister of Canada is trying to push the limits of what constitutes “dying with dignity” or what constitutes a “good death” under difficult circumstances. It seems as if he’s trying to allow people to make certain choices for themselves concerning end-of-life decisions.
Trudeau is young; he’s handsome. He has been known to make bold statements. He represents that generation of 40-somethings and 50-somethings who are used to getting things when they want, how they want, on their own terms. Face it, our generation is a very individual-centric community where our own needs often come first. Why should death be any different?

So many NYTimes readers may not have realized that Thursday’s article was misleading. It was written as if it is Trudeau himself who is seeking to overturn the ruling in the Canadian Charter of Rights and Freedoms (part of the Canadian Constitution) that deems Physician Assisted Death by Suicide unconstitutional. The NYTimes neglects to mention that Trudeau is only fulfilling a mandate of the Canadian Supreme Court (Carter v Canada) from last February 2015.

In February of 2015, the Supreme Court of Canada struck down the federal prohibition on physician assisted suicide, arguing that the old law violates the Canadian Charter of Rights and Freedoms. In this rule, the Supreme Court:

  • gave decision makers until February 2016 (later extended to June 2016) to prepare for the decriminilization of physician assisted death by suicide;
  • established guidelines for determining who can access physician assisted death by suicide and how it can be safely administered;
  • highlighted that it be used only for ‘grievous and irremediable medical conditions with enduring suffering.’

Trudeau had no choice. The Supreme Court ruling required that guidelines be established within a certain time-frame. The New York Times did not have all of its facts. The article only referenced the Supreme Court ruling briefly at the end.

Why am I so interested in this discussion? I no longer live in Canada (although I am a dual American-Canadian citizen). The topic of “whose life is it anyway?” and the issues surrounding the topic of physician assisted suicide are part of a debate that is now taking place all around the globe. As of October 2015, euthanasia (withdrawing life support) is technically legal in the Netherlands, Belgium, Ireland, Colombia and Luxembourg. (Although it is practiced in various forms in many other places). Assisted suicide is legal in Switzerland, Germany, Japan, Albania and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California. A distinction must be made: withdrawing life support is not the same legally as PAD (physician-assisted death-by-suicide). Someone on life support can request that life-support be removed. A person with cancer can stop chemotherapy or radiation. PAD necessitates a physician to do something physically to hasten death, to literally end someone’s life.

The topic of “a good death” first gained traction in the 1970s, when I was in high school. What took place in my hometown left a lasting impression on me that would affect my approach to bio-medical ethics as I pursued my professional goals. I grew up in Succasunna, New Jersey and went to Roxbury High School. It was a sleepy farm town about an hour and twenty minutes from New York City. The most exciting thing that ever happened was that sometimes, the cows and horses would escape from their farms. You’d wake up in the morning to find they had wandered down the road and were grazing in your front yard!

And then suddenly one day, we became front-page national headline news. On April 14, 1975, a young woman who graduated from my high school, Karen Ann Quinlan, attended a party and mixed sedatives and alcohol. She slipped into a coma from which she never emerged. It took five months for her physicians to proclaim that she was in a “persistent vegetative state.”

Her parents did not want her to suffer nor to endure any more physical hardship to her embattled body. They firmly believed that she would never return to a state of consciousness. So they requested that her physicians disconnect her from the life-support machines that kept her alive. When the physicians refused, her parents took the case to court. The “Karen Ann Quinlan Case” became the first “right to die” case in US legal history.

Eventually, the court ruled that “no compelling interest of the state could compel Karen to endure the unendurable” and allowed the life support to be removed. Ironically, Karen lived for 10 more years in a “persistent vegetative state” after she was weaned from the respirator. The remainder of her years were spent in a nursing home in New Jersey.

“The Karen Ann Quinlan Case” is now an important part of every bio-medical ethics book, religious and secular. It has become the historical benchmark for discussions on euthansia and physician-assisted suicide (PAD) world-wide.

This incident in my own backyard sparked my interest in medicine and bio-medical ethics. It compelled me to explore the intersection of Jewish law and bio-medical ethics, to study the intricacies and nuances of the issues — and to figure out how my Jewish values inform medical decisions we confront. It spurred me to pursue pastoral care and chaplaincy work throughout my rabbinate.

I feel compelled to delve into the questions concerning the definitions of “life” and “death.” Who decides those definitions and makes those determinations? Who has the right to make decisions when it comes to our own bodies?

Ethicists fall along a huge spectrum. Depending on how one defines “who gives life,” that will determine the answer of “who determines what constitutes death,” and the ability to make decisions regarding death. For now, we will focus on the religious perspective.

From a classic, traditional religious perspective, all life comes from God. Our bodies are gifts from God. God requires that we, and by extension our physicians, are required to do all that we can care for our bodies and to preserve and prolong our lives. Therefore, by extension, only God has the ability to determine when it is our time to die. We are not allowed to do anything to hasten our death.

The Torah strongly states that God will “require a reckoning” for those who “spill the blood” of humans. For example, we see in the story of Noah:

Whoever sheds the blood of man, by man shall his blood be shed, For in the Eternal’s image, did God make him. (Genesis 9:6)

And the commandment to “not murder” is a priority as the Torah reiterates the 10 Commandments twice: (Ex 20:13 and Deut 5:17), as well as states this injunction against murder in numerous other places.

Taken at the most basic level, this means that we are not permitted to harm ourselves or others in any way physically (including committing suicide). Physician-assisted suicide would be akin to murder, from a Jewish perspective.

(For a lengthy and more complete discussion of the Jewish view on Suicide and Assisted Suicide, please refer to: “Assisted Suicide,” by Rabbi Elliot N. Dorff, in YD 345.1997a, Jewish Committee on Law and Standards).

So what happens when the Supreme Court in the country in which you live issues the following ruling:

The prohibition on (i.e., AGAINST) physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice. The object of the prohibition is not, broadly, to preserve life whatever the circumstances, but more specifically to protect vulnerable persons from being induced to commit suicide at a time of weakness. Since a total ban on assisted suicide clearly helps achieve this object, individuals’ rights are not deprived arbitrarily. However, the prohibition catches people outside the class of protected persons. It follows that the limitation on their rights is in at least some cases not connected to the objective and that the prohibition is thus overbroad. It is unnecessary to decide whether the prohibition also violates the principle against gross disproportionality. (From Supreme Court Ruling, Carter v Canada)

This Supreme Court Ruling seems to be in direct contradiction to the traditional Jewish view on PAD!

(For the rest of this article, please click here: Rabbi Sharon L. Sobel writes on the Times of Israel about Physician Assisted Suicide. 

I am honored to have received the request from the TOI Editor to write this article).


Dying with Dignity, Strength, Gratitude and Love: A Lesson for Us All

My friend and congregant Lisa is passionate about hearts.

She finds them in the clouds, she sees hearts in the pattern in the cracks on the sidewalk, she has the uncanny ability to find the one beautiful autumn leaf that is formed into the most perfectly shaped heart.

Lisa radiates love and light. The heart as a symbol of love, life and hope perfectly represents Lisa’s upbeat and positive approach to daily living.

“Find Your Heart” – Artwork and Book by Pedie Wolfond

And as a way to help others understand her approach, Lisa has started to collect hearts, post inspirational sayings on Facebook expressing her philosophy and sharing her writings.

Perhaps the most important and precious heart Lisa has ever found, she discovered over 25 years ago. Lisa connected with the one true heart that would ever root itself within her own heart and make its permanent home there: she met her soon-be-husband Doug while she was teaching at a small private pre-school in Commack.

Immediately, Lisa and Doug each knew that their relationship was special and that their two hearts were meant to be together. Thus began a 25+ year love affair which many of us can only hope to achieve: they share the same values and core beliefs, they have raised two beautiful and wonderful boys and share the same parenting goals. They encourage each other to grow and learn as individuals, enriching their marriage and their family in the process. They celebrate each other’s achievements and support each other every step of the way.

Truly, Doug, Lisa, and their sons, Evan and Jordan – have hearts that “beat in sync” and even in harmony.

So a few months ago, when Doug was diagnosed with metastatic colon cancer the family was initially devastated. However, their strong family bonds, Lisa’s deep spirituality and positive attitude, enabled the family to be together in powerful and meaningful ways. The nurturing heart embraced them all.

Lisa also believes it’s important for the greater community to be part of the healing process. We’re told in our Jewish tradition, that when you visit the sick, “you take away 1/60th of their pain.” We know from studies, that there is great power in reciting prayers for healing for those who are ill – even if they are not aware they are being recited. So Lisa reached out to every resource available: the Jewish community, her own friends and family.

Every day, she would post positive messages and quotes on Facebook, she would surround Doug with symbols of healing and other positive images. The family was able to share wonderful bonding experiences together over the summer.

At the same time, Evan and Jordan were still able to experience the summer as teenagers, having fun with their friends and girlfriends. Doug started chemotherapy treatment not too long ago and things seemed to be moving forward toward a better future.

At the end of last week, Doug took a turn for the worse. And then two nights ago, everything came crashing down. They were told that the cancer had further metastasized and basically, there was nothing more that could be done. Doug’s situation is very serious.

Doug did not want to be poked and prodded. He wants his remaining time to be comfortable. The family made the decision for Doug to enter hospice care two nights ago.

When I went to visit yesterday, I wasn’t sure what I would find. The family had been so full of hope for Doug’s recovery. Doug, Lisa and the boys are young. The future still has so much in store for all of them. Were they ready to accept that Doug was now on a new journey, one where his physical body would die sometime in the near future?

My visit yesterday with Lisa, with Doug and the boys was extremely powerful and moving.

How do you prepare those around you for the fact that you are now on the final journey of your life and that death is imminent?

How do you prepare yourself for this final journey when you know you will be leaving this earthly world?

How does one prepare to say “goodbye” to our loved one who is making this final journey?

She and I sat talking outside in the healing garden while Doug slept.

Waterfall in the healing garden at Good Shepherd Hospice
Waterfall in the healing garden at Good Shepherd Hospice

I was in awe of Lisa’s tremendous strength at this most difficult and painful time.

Doug’s heart is so deeply embedded within Lisa, and she and Doug have spent so much time speaking about what is taking place now, that Lisa has been preparing herself for this moment. She knows this will not be an easy time. She knows that she cannot possibly know what she will feel when “the time comes.” However, she knows that she will always feel Doug’s beautiful heart with her always. 

I was able to spend time alone with Doug. Obviously, this is not where Doug hoped his illness would lead, but he also knows that he cannot change things. Doug’s heart is so open and full, full of love and gratitude: he expressed love and gratitude for all the blessings he had in his life: his beautiful family, gratitude for his wonderful supportive congregation and me, for his co-workers, for everything in his life. We spoke of ways to make this part of the journey meaningful for him and his family, to say “goodbye” and “I love you”. We spoke of what it might mean when he’s physically gone, but we hope his beautiful heart and spirit will still be felt by those close to him. We spoke of these things and so much more.

His attitude, his dignity, his approach, his tremendous sense of love, gratitude and acceptance brought me to tears. I felt as if he was the one leading the way for all of us. He was showing us that everything was going to be ok. He would be the one in the driver’s seat, and then he would hand the steering wheel to someone else at the designated time, when it was time for him to “go off into the sunset.”

As Lisa, Evan, Jordan and Lisa’s mother came into the room, we spoke of these things for a bit longer.

Lisa, Evan, Jordan and Doug held hands – and I took a photo.

The Walters' Family Hands
The Walters’ Family Hands

Lisa has always loved my blogs. I had asked if I could write something about Doug’s and her tremendous strength during this time (without using their names) and her reply was: “Please – use our names.” And Doug gave his permission as well. They both feel if they can help someone else going through something similar, that it is so important and worthwhile to do so.

I asked everyone to hold hands and make a circle of love. I sang two different mi sheberach prayers – prayers of healing. I asked for healing of mind, body and spirit for all of them. I asked for them to find the strength for this journey with the love, support and nurturing embrace of each other.

El na r’fa na la – God please heal her now,
R’fu-at ha-nefesh, r’fu-at ha-guf, r-fu-ah shleimah – healing of the soul, healing of the body, complete healing.
Heal us now.

Doug and Lisa, Evan and Jordan – we wish you comfort and strength on this journey. Know that we are here for you however you need us, whenever you need us. Doug, you are going to a place where we cannot accompany you. We wish you peace and smooth sailing. We will take care of your family. Your heart will live within all of us, beating strong and loud, lighting the way toward the future. Inspiring us to live as you would want us to live.

L’chi lach – to a place that I will show you.
Lech l’cha – to a place you do not know.
L’chi lach – to a place that I will show you,
And you shall be a blessing, And you shall be a blessing, And you shall be a blessing,
L’chi lach.
(Debbie Friedman, based on Genesis 12:1-2)