Years ago, when medical treatment was based in apothecaries, leeches and prayer, a person suffering from any major disease or injury had essentially no choice over how, when or if they would die. Medicine did not provide enough avenues of care for them to have any say. However, in today’s day and age, medical innovations have increased the ways in which patients can be treated, and in many cases, avert death. Through advances such as feeding tubes and ventilators, patients now can choose how they want to be treated during their end-of-life care. However, these innovations create many issues both social and religious, as they are not guarantees towards life, but, rather, a means of sustaining any semblance of life that may be left.
In 1991, the government enacted the Federal Patient Self-Determination Act, which states that doctors must communicate with their patients a full report of their options in terms of their medical treatment and respect whatever decision the patient decides, regardless of what they personally believe. They are to express the complications, limitations and reality of a patient’s care, including whether or not extended care may be futile. As a doctor, this reality brings up many ethical questions. If a patient and/or their family decide to refuse treatment, they are going against the very fabric of values that holds the medical profession together. Doctors now have to properly balance respect for the wishes of their patient, regardless of their own beliefs, with the best avenue of treatment, while also thinking about medical limitations.
Another problem that this brings up is the reality that long-term care has a significant cost, and there is an increasing lack of resources. As more and more people choose to pursue end-of-life care, healthcare becomes gradually more and more unaffordable. Insurance prices increase and are becoming significantly more expensive, and those who need care but cannot pay for it are left with nothing. Doctors and hospitals now have to consider not only what to do for the patient, but also whether or not providing the care is even affordable.
In the realm of halakha, end-of-life care has become a very complicated and controversial topic. We are taught as Jews that life takes precedence. The pursuit of life has priority above most halakhot, and we are even given the ability to violate many halakhot when necessary. The Talmud in Yoma 85a states that even if someone is found barely alive with no hope, we must continue to do anything and everything that we can do in order to save their life. This means that regardless of restrictions or ineffectiveness, care must be provided at all costs.
On the other hand, Sefer Chasidim notes that in Kohelet 3:2, King Solomon writes, “There is a time to give birth and a time to die.” There are moments when we must recognize that we have to let a person go, that their soul is now locked in this person’s body unless we recognize their time to die. This philosophy is reiterated in the Shulchan Aruch (YD 339:1, Rema). Many Jewish authorities argue that this does not justify the removal of life support. However, it may mean that extreme measures such as resuscitation or intubation for a patient with no hope may be foregone.
Many halakhic authorities also say that despite the immense worth we give to life, there is no obligation for a patient to continue care if it means that they will have to suffer by enduring emotional or physical pain.
Technology has provided a choice for patients: the decision to choose life or to relinquish themselves to death. These innovations, while life-saving as they may be, provide many ethical dilemmas that we as a society have yet to solve. Both the Jewish community and the medical community are still in the process of fully understanding how to rectify the ramifications and limitations with the hope and possibility that this technology provides. At the end of the day, medical care comes down to the patient and what is best for them. This care must be taken with the utmost seriousness and respect. It must seek to look beyond consequence and find the importance of care behind the confusion.