1:1—The Right to Life and the Right to Die
Welcome to a new newsletter from Yashar Books, in which we send you complete chapters from a recent book of interest. This issue’s book is Rabbi David M. Feldman’s Where There’s Life, There’s Life. The book addresses emotional and ethical issues that arise for friends and relatives in the care of elderly and sick loved ones. With an aging “Boomer” population and the rise of what has become called “The Sandwich Generation”—people who have to care for their children and their parents—this book could not be more timely. Rabbi Feldman, long known for his scholarly writings, decided to write this book in a popular, easily read format rather than a scholarly style. In this book, he wants to address the average person struggling with life-and-death decisions and point out the inspiring attitude that Judaism has to offer. Please read below Rabbi Feldman’s chapter on suicide and the right to die. Given the sensitive yet fundamental nature of this discussion, this should be of great interest to you.
The goal of this newsletter is to spread Torah and to introduce you to books that you might find interesting, without the risk of you having to pay first. In that end, please feel free to forward this newsletter to anyone you think might be interested or to quote it entirely or in part in your blog, newspaper or magazine. Just please be sure to note the author’s name and the book’s title: David M. Feldman, Where There’s Life, There’s Life.
eference to needless suffering, above, turns our attention now to the role of pain. Although we can seek consolation, after the fact, for the presence of pain in our lives, and find that it may serve a purpose like character-building or something of similar value, it must be said that there is no virtue in enduring pain for its own sake or in knowingly allowing it to continue. Even if pain is seen as punishment, or purgation, we are bidden to actively overcome it, and doing so partakes of pikkuach nefesh. R. Eliezer Waldenberg (Tzitz Eliezer XIII, 87) specifically includes palliation of pain as part of the mitzvah to heal. How is this so? Because the therapeutic progress we aim for is impeded by the presence of pain, not to speak of its distracting and dismaying effect on life itself. Still in all, if we are unable to relieve the pain, it cannot be allowed to drive us from life.
I must admit that I have not always felt this way. My own introduction to Jewish medical ethics came at a young age, when I must have been both cynical and brash. It happened when I made a shivah condolence visit to a wife who had lost her husband after protracted disease, painful to the end. She narrated that just six months before, his doctor had offered an experimental drug that promised a cure, and wanted her consent to use it for him. She did, but the cure didn’t come, and his final half year was one of unrelieved pain and suffering. I then put the innocent question to her: “If you knew then what you know now, would you still have agreed to the use of the new drug?” “Yes, of course,” she said. Here came my impertinence. “But why? All he had from it was six months of extended pain, and no cure!” She looked at me with the disdain I deserved, and said, “I’ll tell you, young man. These six months may have brought him great pain. But that’s not all they brought. In these six months, he lived to see the marriage of one more child, and to delight in the arrival of one more grandchild. And I know without a doubt that the happiness of those milestone experiences penetrated and dissipated his suffering. They meant far more to his life and wellbeing than the pain could ever diminish.” I was properly chastised, and turned a corner in my understanding of the existential issues here.
It goes without saying that imposing pain unnecessarily on others must be avoided. As it happens, a Hebrew form of the word euthanasia was “coined” in the Talmud long before the Greek roots were used by Sir Thomas More to form the compound English term, except that here the meaning is not killing for reasons of kindness, but being kind in the necessary act of killing. Even the convicted criminal, R. Nachman taught (Sanhedrin 45a), deserves our compassion. If he must be executed, we give him a narcotic, that he not suffer pain as he dies. This is in fulfillment of “Love thy neighbor as thyself” (Leviticus 19:18), which includes, this Talmudic sage taught, “Choose for him a good death [mitah yafah, literally eu-thanatos].”[*]
Something about enforced pain by the Romans and much about suicide is gleaned from a striking narrative in the Talmud (Avodah Zarah 18a). The passage has to do with the martyr-death of R. Chanina ben Teradyon, along with the deaths of several other rabbis who were executed by the Romans for the sin of teaching Torah. Seeing it as a threat to their hegemony, the Romans had forbidden the teaching of Torah on penalty of death, but these rabbis heroically defied the ban. They cited the parable of the fox, who shrewdly seeks to entice fish out of the pond by pointing to some danger in the water. The fish reply that if their life is in danger in the water-their protective element-how much more is it in danger out of the water! The rabbis similarly reasoned that if their lives are threatened when they teach Torah, they are more threatened when they cease to teach it, “for the Torah is our life and the length of our days.”
The Romans paid no attention to this homily and proceeded to execute the offending rabbis, but never without the harshest of added torture. In the case of R. Chanina ben Teradyon, he was placed in the fire for execution, but first his chest was covered with woolen sponges drenched in water. This would delay his death while the flames burned and thus prolong his agony. His disciples pleaded with him to overcome this evil device by opening his mouth wide so that he might be asphyxiated by the smoke, die more quickly, and be spared a few minutes of pain. He refused, says the narrative, on the grounds that such would constitute suicide. “Only He Who gave life can take it away. I may not do so myself,” he replied to his disciples in this incredible conversation.
“Well then,” the executioner intervened, offering an alternative. “Let me remove these moistened sponges around your heart” that the painful dying not be prolonged. That, R. Chanina indicated, is permissible. The first suggestion was an act of suicide, of hastening death by one’s own actions. That he would not do. The second was a case of removing an impediment, artificially supplied, which delayed the expected process of dying. That would be the allowable removal of a hindrance to “natural” death. The executioner did so, and R. Chanina’s agony ended. When the executioner himself died, the Talmud declares, he “went straight to heaven” for this act of exquisite mercy-implying, of course, that the act was not only permissible but praiseworthy. We are even told that the eminent R. Judah Ha-Nasi spoke enviously of him. Some of us, he said, strive throughout our lifetimes to earn a share in the World to Come, but some earn their place there in “a single moment” of great righteousness!
The narrative found its way into the codes of halakhah, where the implicit teachings were made explicit. To hasten death is not permitted. To “remove hindrances” to the “soul’s departure” is permitted and even mandated. While physicians, to state the matter in contemporary terms, may not disconnect life-support systems where that shortens life, they may do so to shorten the death process. Since death is a process rather than an event, and since “we begin dying the moment we are born,” and, more to the point, it’s difficult to tell the difference between prolonging life and prolonging death, the principle is often a moral one more than a practical one.
Compassion in the relief of pain is indeed the ethical imperative. The Hastings Institute, a pioneer agency for the study of medical ethics, now makes the point that advances in pain-relief technology-while greater progress remains to be made-have radically reduced the number of instances in which pain might justify recourse to euthanasia. The Institute was happy to hear that, from the standpoint of halakhah, pain relief is essential, but administering it in order to accelerate death is not allowed. That is, while hastening death remains forbidden-as either an active or passive intentional act-rabbinic authorities are unanimous in permitting the use of analgesics for the purpose of relieving pain. This is so, even if doing so knowingly shortens life, because the intent is mercy for life, not for killing. Intent makes all the difference.
To clarify further, we are bidden by the Talmudic teaching to stand in the tradition of our forefather Abraham, to be “rachamanim, bayyshanim, gom’lei chasadim-merciful, reverent, and doers of deeds of kindness.” So, the very phrase, “mercy killing,” needs to be parsed; the two words need to be disjoined. Mercy, mercy, in all things, at all times, except where it involves the evil of intentional killing. That’s a line that mercy cannot cross. Interesting is the commentary on the Biblical verse addressed to Noah’s descendants who were to rebuild the world, after the Flood. They were admonished against “the spilling of the blood of mankind, the spilling of the blood of one’s brother.” The added phrase, says the commentary, is to forbid murder even for “brotherly” reasons, for reasons of brotherly compassion.
In a recent exchange in the Op-Ed pages of the New York Times, Dr. Thomas A. Preston, a cardiologist, called into question the supposed difference between so-called physician-assisted suicide on the one hand and administration of morphine to relieve pain, on the other. The latter, he claimed, leads just as certainly to shortening one’s life. To which Dr. Kenneth Prager responded emphatically-there’s all the difference in the world between the two. He referred to his own experience in the practice of pulmonology over many decades, in which he would calibrate the dosage of morphine as needed to relieve the pain. If death sometimes nonetheless followed as a result thereof, there had been no intent to kill, only an intent to palliate pain. Intent is everything; again, it is where killing is morally distinct from murdering. True, the victim is “just as dead” whether the cause was an act of murder or an act of unintentional killing, but the perpetrator avoids killing himself spiritually by keeping far from an act of willful murder.
My Catholic colleagues point out that we are more liberal than they on abortion, they more liberal than we on euthanasia. This may or may not be so, but I am proud of the salutation “l’chayyim,” expressing this Jewish reverence for life, and confidently urge it on those who must face difficult decisions. Its point, as offered in Chapter 1, is a profounder sanctification of life. It issues from an abhorrence of murder, as well as awesome reverence for the image of God within us. Nonetheless, this foundational principle is not absolute; it leaves room for necessary, if limited, martyrdom. Remarkably, murder of the innocent is a cardinal sin, one of the three the avoidance of which requires martyrdom instead. I may set aside the entire Torah to save a life (ya’avor v’al yehareg) but, rather than commit murder of an innocent life, I must rather martyr myself to avoid that (yehareg v’al ya’avor). This means, at least in theory, that I must surrender my life to protect the principle of not taking life! (And even this extreme of “surrender of one’s life” is still above “taking one’s life.”) So it’s not the number of lives forfeited, but the preservation of the principle not to take an innocent life. In the face of widespread human violence, and yes, even in view of catastrophic natural disasters, all of which seem to cheapen life, we are bidden with our actions to hold it sacred and inviolate.
Aside from the high moral ground in holding life inviolate as a principle, there are eminently practical grounds for resisting the surrender thereof in, for example, suicide or assisted suicide. A right to die, legislatively enacted, would not be a favor to us. Under such a law, we would be forced to consider choosing that right. As an example, the following scenario could become routine: A son says to his father, “Dad, Uncle Ted didn’t put us through this ordeal when he was about to die. Why don’t you be a good dad and do what he did?” An active termination of life could follow, by his signaling the physician to that effect. Or, even an inactive one: The father unclenches his fists, gives up the fight and the will to live, and the right to live. Here, too, the children have enabled a premature death. In all such situations, how do we keep the right to die from becoming the duty to die? Once the choice is given to us, how do we resist the pressure to go ahead and make that choice? Or, escape the guilt for not doing so?
Prof. Leon Kass offers a related point in his book, Toward a More Natural Science: “For, the choice for death is not one option among many, but an option to end all options. Socially, there will be great pressure on the aged and the vulnerable to exercise this option.” Writing recently in Commentary magazine, he argued further that once there looms the legal alternative of euthanasia, it will plague every decision made by any seriously-ill elderly person-not to speak of their more powerful caretakers-even without the subtle hints and pressures applied to them by others.
There is, in fact, much to be learned from the public discussion of euthanasia. The saddest part of the first Kevorkian case is the suicide note of Janet Adkins, mentioned above, which was printed on the front page of The New York Times. She wrote that the threat of worsening Alzheimer’s disease made her fear becoming a burden to her family. The threat, that is. She therefore asked that her life be snuffed out long before she would enter the dependent stage. But that very idea is an ominous one. Anyone’s fear of becoming a burden is manifestly undeserved, and should not be encouraged; it should not be determinative in our attitude to life and death. People with severe or with lesser afflictions, who have “paid their dues,” and presumably have given life and help to others, deserve our nurture and care, without being made to feel they are a burden. That would be an indictment of the rest of us. The mitzvah of bikkur cholim, of visiting the sick, fulfills many vital purposes. Among them is the assurance it gives to proud people, who have now been rendered dependent, that they share our right to life and are entitled to our return of respectful caring.
Having said all of the above, it must be noted that there is a category in Jewish law of patur aval asur, meaning a transgression which is unpunishable but nonetheless forbidden. Its obverse is asur aval patur, something that is forbidden but nonetheless unpunishable. This is how Jewish law ultimately deals with the deed of suicide. As a deterrent, we are told that the sin of suicide calls for the punitive denial to the person of funeral obsequies, such as eulogies and even shivah observance. After the fact, however, the perpetrator is judged to have been under such psychological pressure, so depressively distraught, that he was not in command of his actions. The deed is therefore forgiven, and the funeral and post-funeral honors are to be granted.
Yes, the act of suicide could have been a conscious and knowing one, a philosophic rejection of values of right and wrong. But, especially if the deed could not be rationally controlled, the person committed an act that remains forbidden but he must be forgiven. Consider the unexpected phrase for suicide-it is m’abbed atzmo la-da’at “to do away with oneself consciously,” with that last word adding the factor of full awareness. For those cases of serious deterioration of quality of life, however, or in the presence of intractable pain, the theoretical categorization of suicide remains asur as a policy, but when it is genuinely unavoidable or uncontrollable, then he or she is patur of wrongdoing; the deed cannot be held against the hapless person. For one’s “share in the World to Come,” the hope is that divine judgment will be as compassionate as that of the earthly court.
Indeed, there are undeniably situations where death could be called preferable to continued life in distress. The midrash alludes to this idea by means of a similar-in-sound, but not similar-in-meaning, pair of words. The text in Genesis 1:31 says “and God saw all that He had made, and behold it was very good,” where the concluding Hebrew phrase is “tov m’od.” The midrash allows one to read it as “tov mot,” meaning that “death is good.” A philosophic perspective, but not a sentiment to act upon. As has been said, suicide provides a permanent solution to a temporary problem. A town in New Jersey recently reported the episode of a suicide pact shared by four teenagers. At the pre-arranged cue, they all honored the pact and took their own lives. Whatever it could have been that led them, or other university students recently in the news, to this deed was certainly something of a temporary, passing nature. But their lost lives are forever irretrievable. In the face of such tragedy, we may marshal greater sympathy for the young who make this mistake. But the principle of no chance to reconsider is the same for them as for older or more compromised lives.
For, even if death is indeed seen to be good, we are not allowed to bring it about in ourselves, just as we are not allowed to bring it about in others. Homicide does not become permissible just because we deem someone unworthy of living, and suicide is not that different. Again, details of the halakhah make it clear: Having come to the conclusion that the life of a loved one is unbearable, may one pray to God that He bring the life to an end? Surprisingly, the answer is yes, as we saw in the previous chapter. When death does come, may we offer thanks to God for that outcome? The answer is again yes. We may pray for the relief that death brings; we may thank God when that relief comes. What we may not do is bring about death actively; we cannot do it b’yadayim, with our own hands.
The famous example of Masada might come to mind in objection to the above. The defenders of the fortress Masada, the last outpost in the Jewish war with Rome, are said to have chosen to take their own lives rather than submit to the depredations of the Romans. But scholars, such as Trude Weiss-Rosmarin and others, deny this ever happened. They remind us that the lone source available to us for the whole narrative was that of the historian Josephus, who needed to acquit himself for having fled the scene. Nonetheless, Masada has become a symbol of fearless resistance and remained so into modern times. But it must be noted that the event and its assessment evoked no reflection at all in halakhic literature.
The negative attitude to suicide is actually the other side of the coin of our vaunted principle of pikkuach nefesh. The mandate of this principle is to do almost everything to save life-including to protect it from our own aggression.
[*] This consideration could be added to the others that militate against the claim that “the Jews killed Jesus.” Not only was the Sanhedrin not allowed to meet at night, nor was it allowed to meet on a holiday such as Passover, but certainly it was not permitted to (violate “love thy neighbor” and) give over an accused person to a crucifixion or to a painful death. The agony of the Passion as celebrated by its producer in a recent movie is ethically and literally worlds removed from the universe of Jewish practice.
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