Physician-Assisted Suicide - A Halachic Approach
by Rabbi Yitzchok Breitowitz
Question: In recent months, Dr. Jack Kevorkian has
assisted a number of persons in ending their lives. These persons suffered
from a wide range of ailments from chronic, debilitating pain to Alzheimer's
Disease. Does Judaism ever sanction suicide and may a physician or any other
third party facilitate this process?
Answer: Taking one's life is regarded as halachically and morally improper. While we cannot personally condemn those who in the
midst of unbearable pain and suffering take their own lives, we cannot
encourage, condone, or participate in the commission of such an act.1
The preservation of life has always been regarded as a
cardinal value in Judaism. The Torah was given to man so "that he may live." The paramount necessity to
save life (pikuach nefesh) supersedes virtually all the commandments of the Torah (Shabbat, Yom
Kippur, Kashrut) except
for idolatry, sexual offenses, and murder. Because all human beings are formed
in the image of the Divine, all life is regarded as being of infinite value
regardless of its duration or quality. As all mathematicians realize, infinity
cannot be halved. If and when some human life is deemed to be less valuable
than others, then life as a whole has gone from being infinite to being
relative and the lives of us have become cheapened and debased.
Contemporary rhetoric, however, has taken a decidedly
different turn. In an time of rapid technological advance, aging populations,
and limited resources, "death with dignity" is a slogan that carries
considerable appeal justifying taking comatose patients off respirators,
allowing patients to starve themselves to death, and most recently,
encouraging "voluntary suicides" á la Derek Humphrey and Jack
Kevorkian. This article will explore the halachic parameters of this
issue.
Before proceeding to the sources, however, one preliminary
observation may be in order. The watchword of the "death with
dignity" movement is autonomy or self-determination. All well and good.
What proponents of autonomy fail to realize, however, (or more ominously, what
they realize and fail to express) is that as formerly-unspeakable options
become widely available, there is a tremendous societal pressure to have them
exercised. If and when assisted suicides become legalized and
socially-acceptable, one could easily visualize scenarios where persons who
truly would want to live given the chance and the encouragement will instead
opt for death, viewing their lives as worthless, nonproductive, and a drain on
their families. Subtly or explicitly, societal consensus will push people into
directions which on their own would have remained off-limits.2 What starts off as a "right to die" quickly turns into an obligation.3 Rather than enhancing autonomy and self-respect, the Derek Humphrey-Kevorkian
approach does precisely the opposite, ultimately debasing the sanctity of the
individual and the meaning of his existence. Judaism, which values and
cherishes all life, inescapably proceeds from the opposite premise as the
following halachic sources indicate.
Judaism regards the taking of
one's life as abhorrent and tantamount to murder. "One who intentionally
takes one's life has no share in the world to come." Even the mourning rituals of shiva are not observed and such persons are not buried in
proximity to other Jews (though within a Jewish cemetery). In practice, we
generally assume that most suicides are the result of unbearable stress, pain,
or depression and do not fall within the category of a premeditated,
volitional act that is subject to these sanctions. Nevertheless, the
sympathetic recognition of a category akin to "temporary insanity"
in no way lends normative sanction to the commission of the act. Life is
regarded as a sacred trust given to us by G-d and only G-d can take it away.
Indeed, contrary to much of the rhetoric in contemporary moral and political
discourse which stresses autonomy and control over one's life, Judaism teaches
us that our very bodies are not our own. They are a bailment. As a repository
for the soul, the body must be cherished and protected. Activities involving
reckless endangerment (e.g., bungee jumping and perhaps cigarette
smoking) are proscribed. It is forbidden to engage in self-mutilation. In a
fascinating essay, the late Rabbi Shlomo Zevin demonstrated that, under Jewish
law, Antonio's agreement to give Shylock a "pound of flesh" would be
null and void because Antonio's very body is not his own to give away. Granted
that there may be occasions when aggressive, life-prolonging treatment need
not be administered or may even be discontinued, the allowing of the
natural process of death to occur by withdrawal of treatment is a far cry from
actively terminating life. Even ignoring the fact that persons may change
their mind at a point where the process is irreversible, the "patient"'s
desire is simply irrelevant. Killing oneself is not regarded as being within
the legitimate scope of personal autonomy. It stands to reason that it is
immoral to assist, enable, or facilitate someone's committing an act which in
itself is immoral for that person to commit.
Therapeutic Exceptions: The foregoing does not
necessarily commit Judaism to a "life at all costs" position. There
are a number of situations where, in the face of grave suffering, steps may be
taken that would or could hasten death. First, pain-relief medication such as
morphine may be administered in spite of the risk that it may induce cardiac
arrest, provided that the dose is not definitely lethal and is not
administered for the purpose of life termination. Second, a patient may
undergo a life-threatening, hazardous procedure which holds out even a slight
hope of cure, though there is no obligation to do so. Third, halacha permits the invocation of prayer that G-d take the person out of their pain
and misery. Fourth, under narrowly-defined circumstances,
life-sustaining (or death prolonging) treatment such as chemotherapy, or
antibiotics may be discontinued; DNR or "Do Not Resuscitate" orders
may be entered.4 As noted, however, all of this falls far short of actively terminating life.
The Saul Precedent: The end of the Book of Samuel I
recounts that King Saul, after falling in war, took his own life (fell upon
his sword) when his arms bearer refused to slay him.5 (Interestingly, in the beginning of Samuel II, there is a conflicting account
where an Amalekite convert claims credit for this act seeking to curry favor
from David but David promptly has him executed). The exact interpretation of
the Saul precedent is a matter of considerable controversy. Some halachic authorities simply posit that Saul's action was halachically improper
and does not represent a normative or acceptable position. At the other
extreme, there is the opinion of the Besamim Rosh [a collection of
responsa originally attributed to the illustrious Rabbi Asher of 14th Century
Germany and Spain but which has been shown to be the later work of a far less
eminent authority] who adduces from Saul that if one is in a terminal
condition, i.e., death is imminent, and one is suffering unbearable
pain or anticipates such pain (Saul feared both being tortured and
humiliated), one is allowed to take one's life. The Besamim Rosh's approach would indeed lend support to some of the Kevorkian suicides though
not all since many of the "victims" were not in terminal states and
could have lived relatively pain-free. In any case, it must be emphasized that Besamim Rosh's position has unequivocally been rejected by the
overwhelming majority of halachic literature and indeed, by the bitter
crucible of Jewish history and experience.6
Even in the darkest moments of our existence - the Holocaust - suicide was rare and, among halachic Jews, virtually nonexistent. It
was always the Jewish way to affirm life, to seek the glimmer of hope within
the darkest gloom, and while none of us may dare stand in judgment and condemn
personally those who could not withstand the awful vicissitudes of life,
neither can we condone or encourage that which is regarded as a desecration
and a profanation of the Divine. As the great Talmudic sage Rabbi Chananya Ben Teradyon was being burned at the stake by the Romans
for the "crime" of teaching Torah and was suffering excruciating
pain, his students urged him to open his mouth and let the flames enter so
that he could die more quickly. He responded, "Let He who gave me life
take it."
It is the task of all of us to attempt to fathom the
redemptive potential of existence- to nurture, to love, to encourage, to
strengthen, to provide hope. Ever cognizant of our limitations, however, let
us not invade the exclusive province of the Divine.
"My G-d, the soul you have given me is pure. You
have created it, you have formed it, You have breathed it into me, you
preserve it within me and you will in the future remove it from me and will some day return it to me."
(Daily Prayers, emphasis added)7
Notes
1. Note that although the sources in this
article are grounded in halachic texts, Judaism regards its
proscription, against suicide as being of universal application. These laws
are part of the Noachide
Code, applicable to Jews and non-Jews alike. All human beings are created
in the image of G-d and all human life must be accorded reverence, respect,
and sanctity.
2. Indeed, several years ago, former
Governor Richard Lamm of Colorado openly expressed the view that when people
reach a stage where they are a net drain to society and consume more than they
produce, they should essentially just "walk into the sunset." How
easy it is to move from a stance proclaiming "death with dignity" to
a position that regards the value of human life as no greater than its
contribution to the gross domestic product.
3. One striking example occurred recently
in Minnesota where both the patient and her family wanted aggressive,
life-prolonging measures to be applied and the physicians went to court to
have those measures discontinued. This is hardly the deference to
self-determination to which the proponents of the "right to die"
supposedly adhere.
4. According to most, but not all, halachic authorities, this dispensation would not encompass the withholding of food,
water, or oxygen, contrary to the current state of American law.
5. Two other recorded instances of suicide
in the Old Testament should be briefly
mentioned. In Judges ______, Samson declares, "Let my soul perish with
the Philistines" as he pulls down the columns supporting the temple. His
death occurs in the context of vanquishing the enemy and is analogous to a
soldier who gives his life fighting for his country, clearly not a suicide as
that term is normally understood. The second instance appears in Samuel II.
Ahithofel, who sided with Absalom against David, discovers that the rebellion
has failed and kills himself. Ahitophel is clearly assigned a villainous role
in the Biblical narrative and his behavior can hardly be regarded as
normative. Indeed, the Talmud Sanhedrin 90-b states that Ahithofel does not
have a share in the world to come.
6. Other interpretations view the Saul
narrative in a much more limited way. Some posit that Saul, as leader of the
beleaguered Jewish forces, felt that were he captured alive by the
Philistines, the anticipated torture and public humiliation would have a
devastating impact on combat morale. He thus took his own life to protect the
overall war effort. A second interpretation states that Saul was afraid that,
as a result of Philistine torture, he would be coerced into idolatrous
worship. Since a Jew must indeed be willing to give up his life before
submitting to idolatry or renunciation of Judaism, it is argued that one may
even actively commit suicide to avoid the greater evil of apostasy or
conversion. Under either of these interpretations, pain and suffering alone,
no matter how severe, do not furnish justification for suicide in the absence
of "combat necessity" or "religious persecution."
7. Some other instances of recorded
suicide:
-
The Babylonian Talmud in Gittin records that a
number of young Jewish children captured by the Romans during the conquest
of Jerusalem jumped off a ship and drowned. The Talmud praises their act
as saintly. The context of the passage indicates, however, that the
children would be subject to sexual abuse (including homosexual activity).
Since sexual offenses are recognized as among those for which a Jew must
give his life, this incident falls under the "religious
persecution" rubric. Similar incidents, occurred with female Beth
Yaakov students during the Holocaust.
-
During the crusades,
a number of Jewish communities committed mass suicide rather than be
captured by Christian troops. The most famous of these was the suicide of
500 Jews in York during the Third Crusade in 1189. Here too, the rationale
was the avoidance of forcible conversion to Christianity due to inability
to withstand torture. Indeed, some authorities not only condoned suicide
but the murder of children. Others found this practice utterly abhorrent
and sinful. See Daat Zekainim, Genesis 9:5.
-
The famous story of Masada where a group of zealots led by Elazer Ben Yair, realizing that their
situation was hopeless, took their own lives rather than surrender to the
hands of the Romans. To the extent the suicide was "political", i.e.,
better to be dead than surrender, which is the way the story is commonly
interpreted, it is generally regarded as halachically improper. To
the extent the decision was taken to avoid torture and protracted pain,
its permissibility would hinge on the acceptance of Besamim Rosh's position. If it was done to avoid forcible religious apostasy, the act
would have halachic sanction based on the Saul precedent. Not being
privy to either the halachic authorities, if any, who advised the
zealots or the actual deliberations within the fortress, we can never know
for sure.
Sources: Jewish Law |