Faith at the End of Life

Our lives are a gift from God. It is not up to us to end a life, no matter how much we want to end suffering.

The long-established Jewish attitude has been that life is a gift of God, to be taken only by God and not taken at the hand of a human, be it by murder or suicide. This is most famously stated by Beruriah. In comforting her husband, Rabbi Meir, upon the tragic loss of their children, she tells him that the ultimate owner has reclaimed his own (Midrash Mishlei 31). It is the attitude displayed by Rabbi Haninah ben Tradyon when he was being burned at the stake by the Romans and refused to act to hasten his death, even though that would lessen his suffering. “It is best,” he says, “that the one who gave life should take it. One should not harm oneself” (BT Avodah Zarah 18a). We were given much authority in this world, but not hegemony over our own lives. At the very moment that God grants us the greatest free will, in Deuteronomy 30:19 (“I have put before you life and death, blessing and curse”), Scripture enjoins that we “choose life.” Thus upon death we affirm “The Lord has given, the Lord has taken away. Praised be the name of the Lord” (Job 1:21).

Yet with today’s focus on personal autonomy has come a growing conviction that one should be able to choose the time of one’s own death. Suffering at the end of life can be overwhelming. Why, we wonder, should we not exercise our ability to bring it to an end? Indeed, it is out of our desperation to offer relief to those at the end of life that we increasingly encounter attempts to find traditional sources that might support measures to aid in bringing their suffering to an end, if even by bringing about their death.

Some have wished to receive permission to give aid in dying from the suicide of Saul or the deaths at Masada, but in neither case were the actors representatives of Jewish law, and the justifications offered after the fact (bedi’avad) were just that, not models of behavior to be undertaken at the outset. Others have sought to learn from the behavior of the centurion who was attending Haninah ben Tradyon as he faced death at the stake. The centurion stoked the flames and drew away the barriers to the flames (with Chaninah ben T’radyon’s apparent blessing). But in the face of every other tradition and Haninah’s own declaration, this is best understood as what was called “exceptional case euthanasia” in a dramatic of a distraught father in a case some years ago (Chicago, 26 April 1989). But little about these precedents seems directed towards our considered behavior.

Many have attempted to extrapolate from Jewish sources about the community’s growing understanding of mental illness and distress, neutralizing the opprobrium associated with suicide to reach a new permissive attitude towards committing suicide. Classical sources rule that suicides should not be eulogized and should be buried at the margin of a cemetery, both practices little observed today. Today, we are more likely to focus on the dignity of the deceased and downplay the occasion of the suicide. The development is laudable. There is no reason to concretize disapproval of suicide after the fact. But these responses, too, are after the fact and do not reach to a justification of engaging in suicide.[fn]Truth be told, the very model of end of life care based on t’reifah, a compromised life, that argues that one is not obligated to extend the full urgency of life-saving to such a compromised patient shares this fallacy. The precedents of t’reifah are, for example, that the murderer of a t’reifah may not be found guilty of capital murder because the victim was compromised (BT Shevuot 34a). It is halakhah’s concern not to apply capital punishment too broadly that functions here. No classic source ever entertained that because the murder was not considered ripe for capital punishment, that it follows that it is permissible to cause the death of a t’reifah.[/fn]

Others have found a source in the talmudic tale of Rabbi Judah the Patriarch’s maid who, concluding that it was the sages’ prayers that were preserving the life of Rabbi Judah, who was suffering, caused a distraction that interrupted their prayers, thus allowing Rabbi Judah to slip away (BT Ketubbot 104a); or in the midrashic story of Rabbi Yosi bar Halafta, who advised an old woman who wished to die to leave off her pious daily prayers (Yalkut Shimoni, Ekev 871); or in that of Rabbi Yohanan’s losing his mind with grief upon the death of Resh Lakish, such that the sages prayed for mercy on his behalf, and he died (BT Bava Metzia 84a); or in the medieval ruling of Rabbi Nissim Gerondi in his comments to BT Nedarim 40a that “there are times when one should pray for compassion that a person might die.” All of these deal with the presumed power of compassionate prayer, wherein the ultimate decision that a patient should live or die is left in God’s hands, as it should be, as we have said. No source contemplates that which we now contemplate—granting halakhic permission for an individual to act to bring about death. In the words of Arukh haShulkhan, “Though we see that the patient is suffering greatly… and it would be better for him to pass away, nevertheless it is forbidden to do anything to bring about his death.”[fn]Yechiel Michel Epstein, Arukh haShulkhan, Yoreh Deah 339.1.[/fn]

Which brings us to the heart of the matter. Those who believe in God, who believe in God’s place in the cosmos and our worshipful subservience to that God—a belief that lies at the heart of Judaism and stands as the first commandment—would not contemplate acting in such a way as to usurp God’s domain. And if out of suffering they were to contemplate such an act, or, God forbid, were to act in that way, they would themselves insist when relieved of that pain that their action was ill-conceived, forced upon them by the urgency of the situation, not undertaken in right mind for their right mind would not permit such an act. And those of us who do not have that elemental faith should concede that Judaism does.

Thus, it seems to me that when we are approached to aid a patient in dying, we need to insist that our tradition does not accept that route. We should offer the very best of palliative care and be zealous in attending to their pain, even to the point of sedation. But if the patient is insistent that bringing about death is his or her chosen route, we must certainly be understanding and convey empathy, not judgment; yet if we are rabbis or Jewish leadership representing Judaism, we should eschew participation in a process that however personally justified cannot be approved by our theocentric faith, but leave it to others who are not so constrained.[fn]This is not unlike an approach to intermarriage that recognizes it but will not consecrate it, the approach of the Conservative Rabbinical Assembly to which I belong. [/fn]

Hillel said: “Do not judge your fellow until you find yourself in their place” (Mishnah Avot 2:4). Ours is not to judge in such a case. The ultimate conversation is between the patient’s soul and God. Who knows if one course of events or another will find favor before God? Ours is not to judge or interpose our will for that of the patient. But our role as teachers of Judaism is surely to teach even at the end of life.

Last word: Rabbi Ila’a says in the name of Rabbi Elazar ben Simon: “Just as one is commanded to instruct a person [in the correct path] where one’s words will be heard, so one is commanded not to instruct where one’s words will not be heard” (BT Yevamot 65b). Though the halakhah is clear, the pastoral path requires humility and judgment, and sometimes even silence.

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