By Janis Siegel, JTNews Correspondent
There are few times in life when decisions matter more than when you or a loved is seriously or terminally ill. In these situations, the view of halachah, or Jewish law, makes one thing very clear: willfully ending your life or using drugs to do it is strictly forbidden.
Rabbi Moshe Kletenik of Congregation Bikur Cholim-Machzikay Hadath in Seattle is also a well-known international lecturer in ethics, bioethics, and Jewish law, and has served on numerous boards and committees. He does not mince words.
“When it comes to suicide and assisted suicide, that’s absolutely forbidden in Jewish law,” Kletenik told JTNews from his office in Seward Park. “It cannot be sanctioned. It’s prohibited.”
Kletenik was the third lecturer at Congregation Ezra Bessaroth’s four-part summer symposium series, “A Matter of Life and Death.”
It is a timely message. Just two weeks ago, proponents of a Washington death-with-dignity law, known as Initiative 1000, gathered enough valid signatures to put it on the November ballot for voters to weigh in on. The proposition would allow patients to request and receive “aid-in-dying” medicine to end their lives. Several local Jewish organizations have thrown their weight behind the initiative.
“In Judaism, a person does not have proprietary ownership over their body,” said Kletenik, who spent nine years as a member of the Bioethics and Critical Care Committee at St. Francis Medical Center in Pittsburgh, Penn. “We are stewards over the body God has given us for the period of time that he grants us to live on earth. According to Jewish law, there is not total patient autonomy.”
That, however, is where the absolute rule ends. During critical life-and-death decisions, a sick person or his or her family can enter into heart-wrenching territory, where treatment may mean more suffering for a patient.
According to Kletenik, it becomes a matter of weighing the risks and the benefits.
“In general, it is a mitzvah for someone to try and preserve their life and their health,” he said. “There are situations when a person is obligated to undertake treatment and there are other situations where it is discretionary, depending upon the medical condition of the person and the options that are available.”
To explain further, the rabbi depends on Torah and Talmudic sources to help illustrate the nuances of treatment choices. One comes from Talmud Avodah Zarah 18, a 6th-century Talmudic source, which records the story of a Rabbi Teradion, a Torah scholar who provokes the local authorities during a time of Jewish persecution by drawing crowds in the public square with his teachings.
He is captured and burned at the stake; however, his enemies decide to put water-soaked pieces of wool over his heart to prolong his pain.
Witnessing his agony, his students beg him to inhale the smoke and end his suffering, but the rabbi instructs them that only God can take his life, not a person of his own will.
The executioner, seeing an opportunity for himself, offers to remove the wool from the rabbi’s heart, raise the flame, and quickly end his suffering if the rabbi will only promise him that it will gain him entry into the afterlife.
The rabbi assures him it will, and he dies soon thereafter.
Kletenik explains the subtle distinction between taking one’s own life and allowing one’s life to be taken.
“Even if someone is in extreme pain, you are not allowed to hasten his or her death,” he said. “But, there are times when you are not able to treat or help. You are then withholding certain treatments.”
One of the most publicized cases of its kind in recent history was that of Terry Schiavo. Schiavo was a 41-year-old, severely brain-damaged woman who had been on life support for 15 years. Her husband deprived her of hydration and nutrition while her parents appealed to several courts to stop him, including the Supreme Court, with no success.
“Certainly Judaism would not have allowed it,” said Kletenik. “Judaism recognizes a permanent vegetative state, but that’s not death. Judaism would not leave that decision up to the person. It’s not ‘How does the family feel about it?’”
“In terms of ventilation and a respirator, nutrition and hydration — generally these things are not withheld, according to Jewish law,” he added. “You are not allowed to allow a person to die of dehydration or starvation.”
There are exceptions when a person is not obligated to prolong his or her life, but it is something to be decided on a case-by-case basis. Generally, Kletenik said, a person is not obligated to undertake an experimental treatment if there is a significant chance that he may die earlier, or if the medical treatment will only prolong life but not lessen the pain.
In other cases, according to Kletenik, a medical condition is simply not treatable.
“Judaism recognizes medical futility,” he said. “If a person has a certain illness, they can make the decision to withhold treatment, but Judaism would require them to continue treatment in some cases. Certainly, the degree of risk and pain, either psychological or physical, are factors to be considered.”
Kletenik offers halachic advance health care directives for his congregation and other Jews who want to ensure that their end-of-life care is carried out in accordance with Jewish law. It covers most of the same issues that other health care directives do, but it stipulates that treatment decisions and burial decisions be done according to Jewish law.
Most rabbis have these available to them, Kletenik said, but just remember, he warns, it doesn’t allow you to override the basic laws.
“Under Jewish law, even if they have a living will — that would not change it,” he said. “Euthanasia is absolutely forbidden.”