Assisted dying – mercy or murder?

There is a way to respect the sanctity of life of those with a terminal diagnosis while withholding or removing impediments to a peaceful death.

By JONATHAN LIEBERMAN NOVEMBER 18, 2024 02:03

In such circumstances, the ventilator becomes a ‘bridge to nowhere’ (Illustrative). (photo credit: Marcelo Leal/Unsplash)

A bill proposing the legalization of assisted dying for terminally ill patients is being presented to the UK Parliament in the coming weeks.

The bill has sparked intense debate in the UK, with strong opinions on both sides. If passed, the UK would become the latest nation to legalize assisted suicide for terminally ill adults. The bill has strict criteria for eligibility, yet the proposal has reignited longstanding ethical, medical, and religious concerns.

There is a growing global acceptance of assisted dying, with over 200 million people worldwide now having legal access to it in some form.

Switzerland has permitted assisted suicide since 1942, with Dignitas, a nonprofit organization offering this option to people from around the world, including 571 Britons between 1998 and 2023. Canada, Spain, Colombia, Austria, the Netherlands, Belgium, and 11 US states have also legalized physician-assisted dying.

Advocates of the bill argue that it offers a compassionate option for those enduring painful, terminal illnesses, ensuring individuals have control over their dying process. They also believe it respects the personal choice of individuals facing inevitable death and mitigates the physical and emotional toll that terminal illness often brings.

However, the proposal has also met substantial opposition. Critics argue that legalizing assisted dying undermines fundamental medical and ethical principles and will, inevitably, detract from attempts to improve palliative care.

A man wearing a protective mask walks next to an NHS sign at Cullimore Chemist, amid the coronavirus disease (COVID-19) outbreak, in Edgware, London, Britain January 14, 2021. (credit: REUTERS/PAUL CHILDS)

Readers will know from the strapline below that I wear two hats. I am a working physician in the UK and an Orthodox rabbi promoting a modern 21st-century approach to Judaism.

In both roles, I am disturbed and fearful about this step.

What do Jewish and Medical ethics say about euthanasia?

I trained at the famous Royal Free Hospital School of Medicine more than 40 years ago, and when I symbolically took my Hippocratic Oath, it included the words: “I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.”

These words were a fundamental tenet of the healer for over 2,000 years. The words “First, do no harm” were drilled into us by moral, upstanding, and fine teachers, and it must remain, perhaps now more than ever, the guiding light of doctors in the so-called enlightened 21st century.

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How have we got here? How have we arrived at such a throwaway society where everything is disposable, including, it seems, life itself?

It is sadly the case that some unfortunate patients endure pain and suffering. Still, our job as physicians is to work night and day, leaving no option untried to palliate that pain and alleviate that suffering. Throwing in the towel and ending a life is not an alternative, especially when that life is sacred and holy and contains a spark of godliness – which brings me to my other hat.

Judaism is very sensitive to the suffering of the dying. It is forbidden in Jewish law to extend death.

In the Talmud (circa 500 CE), the story is told of the death of Rabbi Judah the Prince. He was the foremost Jewish sage of his era and was suffering from an intestinal disease. His disciples, overcome with the dread of losing their beloved teacher – but seemingly unaware of the degree of his suffering and the hopelessness of his terminal illness – continued to pray for his recovery.

It was only the rabbi’s housemaid, who, seeing his torment and the inevitability of his imminent death, was determined to silence the prayers of his followers, which she believed were preventing him from dying peacefully.

She cleverly threw an earthenware vessel to the ground, and the noise stunned the praying crowd so that they ceased their prayers for an instant, during which Rabbi Judah’s soul departed. The handmaid acted to remove an impediment to a peaceful and quick death – in this case, the prayers of his students.

TODAY, THIS translates to the injunction to sensitive and sensible medics not to overtreat but to think carefully before attempting heroic but futile attempts to extend life because this is really extending death.

So, it is clear that Judaism does not ignore the calls for a timely passage into the next world.

However, the importance of the sanctity of life in the Jewish religion cannot be overstated. Judaism is a religion that treasures every second of life. Although Judaism accepts the notion of a hereafter, the entire corpus of Jewish law and lore focuses on life in this world. It stresses the importance of sanctifying every moment of existence by carrying out good deeds, adhering to God’s laws, and deriving as much happiness and pleasure as possible within the bounds of halacha.

While we do not prevent a timely death, there is a very important flip side to this ancient concept. The Talmud prohibits actions that are intended to hasten the death of a terminally ill patient “who is regarded as a living person in all respects.”

The Talmud enumerates such prohibited actions. One may not move the patient, close his eyelids, or bind his jaws – actions that should not be carried out until after death. The patient is likened to a flickering candle that becomes extinguished with the slightest perturbation.

Clearly, the rabbis warned physicians to beware of the temptation to extinguish the flickering candle of life by, for example, administering a higher dose of morphine than is necessary to alleviate suffering. When such drugs are used with the intent to hasten death, regardless of the humane motives of the physician or the family, this transcends the role of the physician and enters the realm that only God inhabits – the gift of life and death.

Judaism’s stance on physician-assisted suicide is clear. If a physician may not do anything that will hasten the death of a moribund patient, one is obviously prohibited from prescribing a lethal dose of medication to allow a terminally ill patient, who may still live for months, to commit suicide.

The changing values of our society, which are increasingly accepting of physician-assisted suicide, are clearly contrary to the teachings of traditional Judaism.

As is often the case in our sound-bite society, the factors to be considered with every patient are much more nuanced than the media will have us believe.

The choice is not between the false specter of so-called “death panels” eager to pull the plug on a patient and those who would use technology to prolong the suffering of dying patients. There is a way to respect the sanctity of life of those with a terminal diagnosis while withholding or removing impediments to a peaceful death.

But this requires physicians with wisdom, expert clinical judgment, skills of communication, and sensitivity to the value of life and the concerns of families. It also requires sensitive guidance from spiritual leaders, who sometimes view death as an enemy rather than inevitable, and who should heed the wisdom of Ecclesiastes 3:1 that, “There is a time for everything and a season for every activity under heaven…a time to be born and a time to die.”

None of this is assisted by the availability in law of an unacceptable option of assisted suicide.

The writer is a rabbi and physician who lives in Ramat Poleg, Netanya, and is a co-founder of Techelet-Inspiring Judaism.