Against Assisted Suicide

There are at least two ways to reason toward a Jewish position against assisted suicide.  One is indirect, the other more direct.  The roundabout way considers the arguments put forward by those supporting, endorsing or otherwise permitting assisted suicide.  This tack takes on their assumptions, how they read their chosen sources, and their overall arguments.  The second approach is more direct.  Here, positive arguments assert that Judaism does not and cannot endorse assisted suicide.  This brief essay combines such deconstructive and constructive approaches to claim neither suicide nor assisted suicide receive Judaic endorsement.[fn]This essay is meant to be demonstrative and pedagogical, and may not necessarily reflect the normative position of the author.[/fn]

Indirect Arguments

The essays in this collection that endorse suicide and assisted suicide use several strategies to make their case.  One strategy is to invoke principles.  For example, Teutsch and Klein argue that the principle of kavod (honor/respect) supersedes other principles, especially piku’ach nefesh (the duty to save or preserve life) when it comes to caring for someone whose physical and mental wellbeing is in dramatic decline.  Teutsch claims, “for those of us who consider ourselves post-halakhic,…an individual ought to have the right to decide that the value of kavod, dignity, can under some circumstances take precedence over piku’akh nefesh.”  The use of the word “right” is confusing: it does not mean a human right per se or rights generally but permission.  That is, post-halakhists think one ought to be permitted to commit (assisted) suicide because, and primarily only because, they prioritize honor over the principle of saving a life.  This reprioritization emerges from their commitment to autonomy.  Why they privilege the very recent and slippery concept of autonomy over well-developed older Jewish values remains unclear.  Both Teutsch and Klein support this permission by pointing to a Talmudic discussion of activities one should rather be killed before being forced to do: idolatry, sexual licentiousness, and murder.[fn]BT Sanhedrin 74a-b.[/fn]  I agree that that Talmudic discussion situates piku’akh nefesh below other values.  I disagree, however, that it grants permission to subsume it to kavod or that it could even apply to suicide and assisted suicide.  The activities the Talmud says one ought not commit even under duress are crimes.  Declining physical and mental wellbeing is no crime, and one certainly should not commit (assisted) suicide in a situation of duress.  So forcibly analogizing this Talmudic source to (assisted) suicide strains logic.

Another way supporters of suicide and assisted suicide make their case is by turning to look at what Jews actually do and say.  Teutsch asserts that “the beliefs and practices of ordinary Jews ought to be taken into consideration by poskim (halakhic decisors) and Jewish bioethicists in formulating positions on suicide and assisted suicide.”  It is unclear why this should be the case, or where the boundaries of this influence should lay.  Popular beliefs and practices could very well be contrary to Jewish commitments and teachings; for example, contrary to profound theological commitments like betzelem Elohim, that all humans are of equal worth, Jews for centuries thought women should not be communal, liturgical or legal leaders.  Just because many Jews think or do something does not make it good or right or reflective of Judaism’s best thinking on a matter.  Similarly, the current trend to give full funereal and burial rites to those who complete a suicide are b’diyavad issues; they are after the fact.  They pertain to what to do with a body of someone who died by (assisted) suicide.  Such practices say nothing about the permissibility of the (assisted) suicide lehatkhilah, in the first place.  

Another example of this turn to the populace is Crean’s statement, “as liberal Jews, we have the option of cherry-picking the part of the tradition that fits us, that supports what our minds and hearts also tell us is good, right and true.”  For Crean, we “liberal Jews” are the judges of Judaism’s significance to our contemporary circumstance.  We are the arbiters of what and how Judaism speaks to us today, if it does at all.  Judaism is thus to reflect our current values and practices, not inform them.  Why ask, then, what Judaism has to say about suicide and assisted suicide if it will only reflect back to us our preconceived conclusions?

Crean’s comment leads us to a third strategy common among bioethicists of all stripes: the tendency to cherry pick.  This is evident not only in the sources that scholars choose to include in their essays, but also by how they read those sources.  One illustration will suffice here.  Many point to the story of Ḥananya ben Teradyon being burned alive at the stake by the Romans in the Second Century.[fn]BT Avodah Zarah 18a.[/fn] It is a complicated, multitiered, ambivalent and ambiguous story.[fn]See Jonathan K. Crane.  Narratives and Jewish Bioethics.  New York: Palgrave Macmillan.  2013.[/fn]  Yet supporters of (assisted) suicide flatten the story to heighten just those portions of the story that buttress their position (e.g., Ḥananya assuring the executioner a place in the olam habah for hastening his fiery demise).  This truncated reading all but erases the story’s richness.  It also opens up a perverse analogy between someone tragically dying or yearning to die and the so-called “heroic” executioner who was killing a Jew for practicing his religion.[fn]Reisner similarly cherry picks this source, highlighting only that tiny bit of the story that supports his conclusion that neither suicide nor assisted suicide is sanctioned.[/fn] Cherry picking sources to endorse one’s conclusion and insisting complex sources fully endorse one’s conclusion at the expense of acknowledging valid alternative readings, do a disservice to the textual tradition as well as the contemporary audience by not enabling them to consider a source’s multifaceted concerns or an issue’s multidimensionality.

Finally, supporters of suicide and assisted suicide frequently have in mind some generic (or specific) old person in the throes of intractable pain or profound dissatisfaction with life.  They leave undefined, however, where the boundary between old and not old is, what constitutes sufficient pain to qualify as intractable, or where the dimensions of profound dissatisfaction lie.  Without observable biomarkers, these are social if not idiosyncratic constructs malleable to cultural meddling.  Reliance upon ambiguous terms, ideas and experiences, and upon arbitrary boundaries to promote (assisted) suicide is philosophically, theologically and normatively dangerous.

Direct Arguments

A strategy to argue against endorsing suicide and assisted suicide could go as follows.  Jurisprudentially, Jewish law distinguishes acts of omission from acts of commission.  According to Isserles,

It is forbidden to do anything that brings about the acceleration of death, even for one whose dying is taking a long time and does not have the capacity to withdraw…. However, if there is some factor which is preventing the exit of the soul such as a nearby woodchopper or salt placed under his tongue—and these things impede his death—it is permissible to remove them, because in doing so one actively does nothing but remove an obstacle preventing his natural death.[fn]Isserles on SA Yoreh De’ah 339.1; Sefer Ḥasidim, attributed to Rabbi Judah the Pious, #723; see also #234.[/fn]

Isserles hereby defines as an act of omission those interventions that remove impediments to someone’s otherwise natural, if tragic, demise.  Today we might call such actions the withdrawing or withholding of certain medical interventions that keep someone animated.  Let me be clear: removal of an intervention is not assisted suicide.  Assisted suicide, like suicide itself, is an act of commission because it involves the deliberate, active termination of a life.

The closest we could come to deliberately or actively bringing about someone’s or one’s own death is prayer.  We may pray for someone to die.  Indeed, we may even be obligated to pray for someone to die.  But we are not granted permission to actively bring about someone else’s death.[fn]See Jonathan K. Crane.  “Praying to Die: Medicine and Liturgy.”  Journal of Religious Ethics.  43:1(2015):1-27.[/fn]

Intercessory prayer logically leads our argument to theology.  Jewish theologies of human provenance do not support acting to end one’s own or another’s life.  According to the theory of human creation promoted in the first creation story (Genesis 1:1-2:4a), humans are betzelem Elohim (made in God’s image) and blessed to procreate.  That theory says nothing about a divine sanction to end one’s life; indeed, mortality is not indicated anywhere in that story at all.  If one turns to the second creation story (Genesis 2:4b-3:25), humans are concoctions of organic material and divine pneuma, tasked to steward terrestrial existence and commanded to eat carefully lest they incur death.  Here, mortality is not something God desires humans to hasten, whether for oneself or another.  In short, neither theological ontology or theory of human provenance hints that foreshortening human life is divinely sanctioned.

But is it necessary to turn to theology at all?  Must we assume a theological stance like Reisner’s (those who believe in God will not contemplate or act to “usurp God’s domain”) to be against (assisted) suicide?  While relying upon theology may be helpful, it may not be necessary.  What’s at stake here is not theology but the line between life worthy of maintenance and life unworthy of maintenance.  If any human life is deemed unworthy of maintenance by whatever anthropocentric or ego-centric criteria, then all human lives must justify their merit to be maintained.  Because irrespective of faith, it is humanly wrought resources that maintain human lives.  

If egregious, intractable pain is considered sufficient justification to no longer maintain a particular life, then debate can and should rage about what constitutes egregious, intractable pain.  Some might say that in addition to pain, certain characteristics (e.g., coma, quadriplegia, no longer enjoying the taste of food and drink, or being just plain old tired of living) also qualify to be included in the “not to be maintained” category.  It is not that that category will forever expand; the slippery slope is not my concern.  It is the very act of thinking it reasonable to forge the category in the first place that is dangerous.  This is not to say that all human lives must be lengthened despite quality of lived experience.  On the contrary.  It requires acknowledging that human life is mortal, and that we should not get in the way of that very mortality.  Isserles rules in this fashion: get out of the way of death.  Mortality is an essential feature of human nature, of what it means to be human.  Getting out of the way of death is not the same as hastening someone’s or one’s own demise.  For those who are so inclined, we may pray for someone to die; we may not actively bring that death about.  Some might argue that capital punishment contradicts this assertion; that we as a society can and should bring about someone’s death.  That analogy fails for the simple reason that capital punishment is meant for those convicted of certain crimes; it has nothing to do with human ailment or boredom.  

Of course many will argue that the Jewish tradition requires us to heal, to be rofi’im. Healing or bringing someone from illness or injury to improved health, and perhaps even curing someone altogether, is amazing and should be pursued with gusto.  Yet medicine is only as good as it is today; plenty of cases transcend medicine’s capacity to ameliorate, improve or cure.  We cannot be rofi’im per se beyond our current rofeh technologies.  Though our capacity to heal and cure may be limited, our capacity to care can be boundless.  Irrespective of a patient’s wellbeing or prognosis, we can always care, even unto death.  Neither forestalling nor hastening death is our task.

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