Life Support Decisions

Turning Off Life Support: The Jewish Perspective

A large component of the CMC’s work with Jewish hospital patients is in helping to deal with the reality of end-of-life issues. These issues are often very difficult and complex, and family members are frequently quite unprepared to deal with them. They may suddenly face the responsibility of making complicated decisions regarding the commencement, continuation or termination of life support for a dying patient. Further adding to the confusion, medical opinion on the patient may be inconclusive. Worse yet, even if presented as conclusive it is certainly still fallible. What is the Jewish perspective and what are some practical guidelines for the appropriate course of action to take under these exceedingly trying circumstances?

It must be noted that because no two cases are alike, details and applications to specific situations require consultation with a competent rabbinic authority. Nevertheless, there are general principles of halachah (Jewish law) with regard to life support and end-of-life issues.

The foundational principle of halacha in this matter is the absolute and irrevocable sanctity and equal value of all human life. Nobody has the right to decide to proactively shorten his own or anyone else’s life, regardless of painful circumstances, loss of “normal” functionality or other factors. The fact that a person is alive means that G-d desires his presence in this world. To the question: “But for what purpose?” the answer is that G-d’s sense of purpose is far deeper than ours, and if we cannot see the crucial value of the unconscious or incognizant person, G-d can and does.

At the same time however, there is also an obligation to alleviate human suffering as far as possible. Sometimes this may hold true even if the alleviation of suffering is not the course that would be consistent with the greatest possible prolongation of life. How do we balance the principles of preserving life and alleviating suffering in situations where the two priorities point in opposite directions?

The guiding rule in these situations lies in the profound difference between intervention and non-intervention. If it is determined that putting a patient onto a life support machine would only prolong suffering and death, then halachic authorities may endorse non-intervention, and they may rule that there is no obligation to put the patient on the machine. On the other hand, active intervention may only be used to prolong life, but not to shorten it. This means that if a patient is already on life support machines, a person may not proactively turn off or detach those machines.

“For they are our life…”

It is axiomatic to Judaism that the halacha must be followed even if we are unable to immediately discern any profit thereby. Sometimes this can be extremely challenging, particularly when the weight of expert opinion points to a different course of action. Nevertheless, we are obligated to trust in G-d’s authority and follow Torah law, even if we don’t always merit to understand the reason for a particular halacha in a particular situation.

The rabbis of the CMC visit Jewish patients in a number of Chicagoland hospitals on a weekly basis. In addition, they are always on-call in cases of emergency. Such was one occasion one late Thursday evening several years ago. Rabbi Aron Wolf received a call from the chaplain’s office of a local hospital. “The family of a Jewish patient are asking for a rabbi to come and say some prayers,” he was told. “The patient had a stroke and the doctors are saying she doesn’t have much time left.”

Rabbi Wolf quickly made his way to the hospital and found the patient to be unresponsive, the last vestiges of her life apparently lingering by sole virtue of the unremitting work of a life support machine, with its persistent blinking, beeping and pumping. Her family, many of whom were not Jewish, looked on as she lay in her bed at death’s door, having gathered together to be with her during her last moments on earth. The atmosphere in the room was muted and somber; the family was resigned to the prospect of the patient’s inevitable passing.

After reciting some appropriate prayers, Rabbi Wolf spoke with the head of the family and heard the doctor’s prognosis. The doctor had said that the patient was in a vegetative state and without any hope of recovery whatsoever. In view of this opinion and of the doctor’s resultant recommendation, the family was now preparing to remove life support from the patient, allowing her to expire.

Rabbi Wolf sat at length with the family and discussed the situation from the perspective of Jewish law. They talked about the infinite value of the gift of human life, which derives from G-d as the ultimate source and only provider of this gift. Rabbi Wolf drew the family’s attention to the inherent fallibility of human knowledge and judgment. He encouraged the family not to intervene by removing the life support machine, but to at least give the patient a little more time. Have faith in G-d and leave the decision to Him, he advised. Although they were reluctant at first, the family agreed to leave the patient on her life support machine, and to reconsider the circumstances a few days later, on the following Monday.

The next day, Friday, saw Rabbi Wolf return to the same hospital to make his regular weekly visits to the Jewish patients. He passed by the room of the patient he had met the night before, hoping but not fully expecting to see a little improvement in her condition. Imagine his complete astonishment and joy upon beholding the surreal spectacle of the formerly unresponsive patient sitting up in her bed, casually enjoying her lunch!

Rabbi Wolf spoke with the patient, sharing her profound gratitude and relief. Together they expressed prayerful thanks to G-d for restoring to her the gift of life. And what was the response from the medical establishment to this miraculous turn of events? “Yes”, a nurse wryly conceded to Rabbi Wolf, “She had quite a turnaround last night, didn’t she?”

The miraculous turnaround that the patient experienced gave the family a new awareness and appreciation for G-d, the giver of life and the issuer of the mitzvos, Jewish law. It is a precious gift indeed to experience such a material example of the literal fulfillment of the daily refrain recited in our evening prayers: “For they (the Torah and mitzvos) are our life and the length of our days…”