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    Respect for the dying patient – Ask the Rabbi

    Q. When hospital resources are so stretched because of budgetary constraints, why let dying patients linger and occupy beds?

    A. Whether to be positive or negative in one’s thinking is a major question in life, whatever the context or problem. It is especially important at the beginning and the end of life. Do we say, “I don’t want a child?” (negative) or “Every child brings its own blessing” (positive)? Do we say, “The patient’s life has no point!” (negative) or “The patient is still alive!” (positive)?

    In regard to the second issue, Judaism votes for the positive. It views life as the supreme sanctity. Life is given by God, and preserving it is a Divine command. Every human life is in the image of God. To write off a life is to diminish God. “Even if a person is moribund for a long time and this causes great suffering to him and his family,” says the halachah, “it is forbidden to hasten his death”.

    This applies regardless of the age, ethnic background, profession or social status of the patient. Ancient Greek and Roman thinking thought otherwise and dismissed the old and seriously ill as useless. Jewish teaching spoke of the dignity of man – not rich man, white man, eminent man, healthy man, intellectual man or any other adjectival man, but every man without distinction. Hence, whoever the patient is, they are entitled to all available means of treatment. To say that a patient is costing the system too much is to apply the wrong criterion. “A dying person is alive in every respect,” Jewish law affirms. (It is even forbidden to prepare a eulogy in advance or to set funeral arrangements in place before the person has died.)

    One must not give up on a patient or shorten their life. But what about shortening their dying? Can we distinguish between prolonging life and prolonging death? If, says Rabbi Moshe Isserles, something artificial such as the noise of chopping wood is preventing the soul from departing, one may stop the noise to allow the person to die (R’ma on Shulchan Aruch, Yoreh De’ah 339:1). This clearly accepts that a person has a right to die.

    But how do we define dying? A traditional approach is to say that a gosses – a dying person – is someone within three days of death. Today’s medical science makes this definition too simple. Much work is being done on the question of when a patient has moved from the “Let the person live” to “Let the person die” category.

    Readers seeking material in English should consult “Responsa of Rav Moshe Feinstein: volume 1, ‘Care of the Critically Ill'”, edited by Rabbi MD Tendler, 1996 edition. Summarising Rabbi Feinstein’s detailed responsa, Rabbi Tendler writes, “With reference to comatose patients, the terminally ill, and those suffering from intractable pain, he rules that no effort should be made to prolong their lives by pharmacological or technical means; however, hydration and nutrition must be provided” (page 139).

    It may sound paradoxical, but there are two principles that thus arise: every human being must be allowed to live, and also be allowed to die.

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