A geriatric chaplain reflects on how best to accompany loved ones with loving compassion.
Patient-assisted suicide is not an easy topic of discussion. The word “suicide” is enough to raise anxiety and increase suspicion among interlocutors. Where one is located (coming from) becomes an important piece of information in the discussion. Therefore, I want to identify where I stand at the start of this essay.
In addition to being a Reconstructionist rabbi, I am a certified geriatric chaplain whose professional service has been in senior long-term care. As such, I minister to people at the end of their long lives. In my entire career, I have never buried a child, a young adult or someone in the prime of life. Hence, I feel the need to limit my remarks to patients facing this decision at the end of a long life. Questions of patient-assisted suicide regarding younger adults who are dealing with terminal illness are beyond the scope of my experience.
The question before us is two-fold. First, “Should patient assisted suicide be a legal medical option?” Second, “If legal, what guidance does Judaism have for those faced with such a decision?
With respect to legalization, patient-assisted suicide could be compared to the issue of legal abortion. The most relevant ways in which these two issues overlap, and about which there is likely to be general agreement are:
- No one makes such a decision lightly.
- It is a private decision involving the patient and their doctor (and often other family members).
- There exist differing religious views about the morality of the option, but one group’s norms and values should not be imposed on or limit the freedom of choice of another.
In places where assisted suicide does become legal, as a chaplain, my concern then is how to companion those who will be faced with the option. In chaplaincy, the middah (soul quality) of compassion is paramount; and as a Reconstructionist rabbi, I look to Judaism for guidance, but am not strictly bound by any particular halakhic (legal) decision.
As a chaplain, I am well-acquainted with death and end-of-life decisions. The preparations and decisions patients and their loved ones make are part of the natural process of living and dying, of exercising autonomy and maintaining dignity. I remember a time when living wills were not the norm and were often disregarded by health-care providers insistent on doing everything possible to prolong life. And now, a generation later, here we are, in a similar discussion about when and how to let go.
Today, honoring a person’s living will is standard practice. During the years in between, it was often the chaplain who helped navigate the frequently turbulent waters of the decision process and its consequences. As a chaplain, I supported the patient’s right to autonomy—to decide what medications, procedures, therapy or even nutrition to accept or reject. I worked with families to help them understand their loved one’s wishes and to help them accept that life does come to an end—that the human body, mind and spirit somehow know when the time is right to turn towards the inevitable.
I chose to use the words “turning towards” because I have seen this turning again and again in my bedside practice. Family members often experience this turning as their loved one “giving up.” Reframing it as “turning” changes the experience and reality of their companionship. Ideally, it helps them be more present.
Most of us have lost the deep listening skill that can inform us of this turning. It is like some commentators who say that the true miracle of the burning bush was that Moshe paid attention long enough to notice that the bush was burning but not being consumed. Sitting with the dying is staying long enough to see where they are on their journey.
Accompanying someone along the path of dying is, for most, a new experience. They don’t know how to read the road signs or know which fork in the road is best taken. Every bump or pothole can seem like a disaster. And, most crucially, the whole purpose of their companionship can be sabotaged by their resisting the destination of the journey.
For much of my career, I have been modeling for family members how to be fully present with their loved one on their final journey, or in the absence of family, being present myself to the patient. Mostly, this is a peaceful and holy time of deep connection. It is a time, in Jewish tradition, when the soul can return to its original purity. The final vidui recited by the dying or on their behalf by the chaplain or a loved one is an acknowledgement of a life well-lived as a fallible human being.
God knows that we make mistakes, and cause suffering to ourselves and others. God knows that we try to make amends, try harder to be good. God waits patiently for our return to our better natures. Jewish tradition teaches that there are three ways to atone for wrongs committed and suffering caused. One is by making teshuvah (repenting and making amends) together with the rituals of the Yamim Noraim (the days from Rosh Hashanah through Yom Kippur). Another means, according to a talmudic discussion, is through yissurin, suffering, and a third is through death.
Curiously, the talmudic passage (BT Berakhot 5b) that asserts suffering is a means to atonement ends with three examples of rabbis refusing their suffering, the theoretical discussion of the law notwithstanding. In one of these stories R. Hiyya b. Abba fell ill, and R. Johanan went in to visit him. R. Johanan said to him: Are your sufferings welcome to you? He replied: Neither they nor their reward. R. Johanan said to him: Give me your hand. He gave him his hand, and he raised him.
We can learn from this story that it is permitted to refuse to suffer.
In the story, R. Johanan was able to perform some sort of miracle. Unlike R. Johanan, we are not able to perform such a miracle. If a patient reaches the point where they can no longer bear their suffering, the means open to us of “lifting” them out of their unwanted suffering is assisted suicide.
A second idea from Jewish tradition that bears on this issue is that just as God is a rofeh, a healer, so we, too, must be healers. Humanity is given the knowledge to heal and relieve suffering, and we have the obligation to use such knowledge for this purpose. Today, we now have the ability to “lift” another out of their suffering through assisted suicide. Our knowledge also includes the understanding that there can be healing in death just as there is healing in life. Thus, to heal by means of assisted suicide may in certain instances be considered an obligation.
There is also a mystical teaching that everything we do is permeated by the Divine will. When I am faced with supporting someone in a difficult end-of-life decision, I share with them what I know of the Jewish view, but I also suggest to them that they follow their heart and let God work the Divine will through them.
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. I view this as a strength of our living tradition in its confrontation with ever-changing conditions of life.
So, if I were the chaplain to someone facing the decision of asking for assistance to die, I would, like R. Johanan, ask, “Are your sufferings really too much for you?” I would also ask the patient if they are able to forgive the potential assistant for hastening their death. I see this forgiveness as a necessary component of the patient’s true wishes and ability to own their decision. If the assistance is expected of a loved one rather than a professional, I would help the patient understand the burden they are placing upon their loved one’s soul and psyche. I would speak to the loved one, called upon to share in this life-altering decision and ask if they are prepared to administer this final act of compassion to relieve their loved one’s suffering. It must be freely given as a courageous act of love. I would help them feel God’s loving presence as the source of their strength to perform the task.
Above all, if asked to take part in such a decision process, I would hope to facilitate the patient and their loved one in a mutual vidui where forgiveness is given and received by both parties, and their bond of love is reaffirmed in the presence of the Holy One of Blessing, who makes such decisions possible.