Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Of Life and Death: A Jewish Response to Doctor Assisted Suicide

The Institute for Jewish Medical Ethics of the Hebrew Academy of San Francisco
Reproduced with permission

Rabbi Asher Lipner *

According to the cover story of the July 21st New York Times Magazine, the stage is now set for a Supreme Court decision on the legality of doctor assisted suicide. Two recent decisions of lower Federal Courts have found it unconstitutional for states to ban this practice, because such a ban would impinge on various rights provided by the fourteenth amendment. In the article, entitled "The New Pro Lifers", Paul Wilkes writes that the decision of the Supreme Court will "have a societal impact that rivals or surpasses that of Roe vs. Wade, the 1973 decision legalizing abortion." The impact on society is then discussed in the article by a psychiatrist, a lawyer, a secular ethicist, a neurologist and a spokesman for the Catholic church. There is mention made of the opinion of Orthodox Jewry which is said to be in strong opposition to assisted suicide out of "deep religious belief and with a still fresh memory of the euthanasia of the Holocaust."

While this statement correctly expresses the traditional Jewish conclusion, it sheds no light on the philosophical and moral underpinnings at its core. At a time when a subject with such great moral implications is being hotly debated in our society, it is important for Jews to understand our own tradition in order for us to keep our sense of identity within a culture that is tolerant to so many diverse and, often, antagonistic points of view. In addition, the moral and ethical ideals imparted to us by the Torah, through its Mitzvot, have relevance not only to Jews, but also to the entire world. The Noachide Laws are meant to give the Gentile world a morality that measures up to Divine standards, just as Jews have the 613 commandments of the Torah. As such, these laws are to be understood through the Torah's values, as they are reflected by its attitudes on issues like the value and sanctity of human life.

It should therefore be no wonder that Jewish medical ethics has become a specialized area of research that is being pursued by both Rabbis and laymen, both Doctors and patients, and yes, both Jews and Gentiles. After all, the values of the Torah are eternal, as relevant in today's modern world as the day they were given to Moses at Sinai.

The question of doctor assisted suicide, from a Halachic perspective, can be divided into three separate issues. The first involves the sin of suicide. In the beginning of B'reishit, G-d says "Only the blood from your own lives shall I demand." The Talmud explains that this refers to the act of taking one's own life. Taking a human life is forbidden regardless regardless whether it is ours or someone else's. The Torah has made it clear that we do not own our own bodies any more than we own another's. Rather, our lives were given to us by G-d for the purpose of sanctification of His Name.

In fact, as Rabbi J.D. Bleich points out in "Jewish Bioethics", the Torah considers suicide a more tragic misdeed than homicide, in several regards. Because of the finality of taking one's own life, there is no opportunity left to atone for the act. Neither repentance nor the redemptive nature of the sinner's own death can make amends for the act of suicide. Furthermore, the finality of Dosing to end a life through a sin implies a complete disavowing of faith in an afterlife, an important tenet of Judaism. Whereas the murderer may rationalize his evil by temporarily denying his own mortality and delaying his conscience's call for justice, the suicide stares death in the face, neglects his conscience permanently, and consciously rejects any notion of accountability after death.

While everyone understands the general moral problem of commiting suicide, the individual cases that are being argued before the courts are of unique and extenuating circumstances; in which the Torah perspective is not as readily perceived. Some find it emotionally difficult, for example, to accept that it is wrong for an individual, who is suffering greatly from an incurable disease, to choose to end their pain through opting out of life. However, it is specifically to these individuals that the Torah is speaking. Human nature is endowed with a powerful survival instinct, and it is therefore obvious that for someone to choose to die, they must be suffering greatly. The Halacha reflects this reality by suspending the posthumous punishment for Jewish suicides, allowing them to be granted burial in a Jewish cemetery. The reasoning is that a present day suicide is almost always the act of an individual who, because of pain, suffering and depression, is unable to think clearly and act rationally.

Those in our society who argue for the legalization of assisted suicide maintain, on the contrary, that there are times when suicide is the sane and appropriate course for an individual to choose. They claim that there are some people who have so little quality of life that they are very rational in their choosing to end it all. The concept of euthanasia, mercy killing, for example, assumes that there are those people for whom assistance with the act of dying would be a favor.

While the Torah is the ultimate source of human compassion and mercy, it wisely forbids human beings to define what is merciful when it comes to the ending of human life. There are some decisions, according to the Torah, that can only be made by the merciful G-d who has given us life to begin with. The Talmud's existential attitude that, "Against your will you were born, and against your will you will die," clearly points out the need to ultimately relinquish control over our own life and death to our Creator. The wisdom in leaving this matter up to G-d and not in the hands of human beings, whether a doctor, the family or even the suffering individual, can be seen by examining a society that takes a different approach.

In the Netherlands, where euthanasia with consent of the patient is not a prosecutable offense, ethical norms have been rapidly sliding down the slippery slope, as the lines between the patients', the doctors', the family's and society's wishes become increasingly blurred. As Doctor Herbert Hendin, a psychiatrist quoted in the "Times" article, has learned through his study of that country's practices, "In many instances, it became a doctor's decision, not a patient's. And as for hospice and palliative care for those who want to die naturally, they are relatively low priorities in the Netherlands. After all, with assisted suicide available, who needs them? It was almost as if you are a poor sport for not choosing it."

The last point made by Dr. Hendin, highlights the danger of assuming that the individual's decision to kill themselves affects only them; adopting a stance of "live and let die", so to speak. A recent panel, commissioned by the State of New York to study the social ramifications of legalizing assisted suicide, found that the elderly and the poor, whose situations place burdens on society, will be the ones who would most often be given the "right" to die. Doctors would offer this option as advice in cases where they see fit, some families would encourage their loved one to heed the doctor's advice, and the vulnerable, suffering individual will have nowhere to turn for support if they choose not to exercise their "constitutional right." Not only will those who burden society with their lives be called poor sports, but in a sense, they could be attacked as positively un-American.

Another case made for the individual's right to choose how and when to die is the argument made for an understandable and humane wish for "death with dignity". The experience of Iying incapacitated in a hospital bed, stuck through with tubes and machines necessary for eating and breathing, being sick and incoherent, is considered by many people to be an undignified situation; not one a human being would choose to live with.

A few years ago, at the International Conference of the Institute for Jewish Medical Ethics, Rabbi Maurice Lamm pointed out that the very phrase "death with dignity", is an oxymoron from a Jewish point of view. The Jewish people have been taught by our Torah that human life is, in its very essence, dignified and that death can never be so. Death is a necessary element of the human life cycle and sometimes may actually be a blessing for an individual in chronic pain. However, to actively choose to die and not to experience every; moment of the dignity of humeri life is' ultimately, an undignified act.

I was reminded of Rabbi Lamm's comments while watching a particularly poignant scene in the movie, "Schindler's List", in which a little boy is searching for a hiding place while the Nazis round up Jews from the ghetto for transport to the death camps. The boy looks into a latrine, only to find another young boy standing up to his waist in human excrement, peering up at him from his "occupied" hiding place. The first boy continues to look elsewhere. The initial shocking feeling the scene evokes is of the horror of the little boys having to put themselves in such an undignified situation to survive. Upon reflection, however, one realizes that the children intuitively understood that the life of the survivor is always more dignified than death. It is meaningfully ironic that the inhuman Nazi forces that sought to dehumanize and "undignify" innocent human life, were the very same that introduced euthanasia as a concept to modern civilization.

Jews, of course, have always appreciated the great moral victory of surviving. As a people, we have survived the horrors of pogroms and crusades, inquisitions and holocausts. Those who chose to give up their Jewish life in order to escape this unimaginable pain and suffering, can not be judged harshly. But neither can we endorse and condone taking the easy way out if we are going to continue to state the case for the Jewish concept of human dignity.

In one of the countless tales of individual martyrdom in Jewish history, the Talmud tells the story of Reb Chanina ben Tradion's execution at the hands of the anti-semitic Romans. While being burned alive at the stake, wrapped in a Torah scroll, his students asked him what vision he was having. He described, that while the Torah parchment was being consumed by the flames, he saw its letters "floating in the air". His students, in empathetic agony, proceeded to beg their Rabbi to inhale the noxious fumes of the smoke, in order to hasten his death and end his suffering. He replied, "Let He who has given me (my soul) take it away, but no one should injure himself." This answer is ultimately the last word of the Torah on the subject of suicide. As for the vision of the Torah's letters 'floating in the air", it beautifully symbolizes that, while suffering and persecution can wreak havoc on our physical lives, our souls, our ideals and our capacity for love can never be destroyed.

Assisted Suicide

While the individual wishing to kill themselves can be forgiven by the Halacha for giving up hope in the meaning of his or her own life, due to their pain, suffering and depression, the people seeking to help them kill themselves have no such excuse. The Torah states that giving somebody bad advice, either practical or moral, or assisting them to carry out a bad decision, is the moral equivalent of "placing a stumbling block in front of the blind." No example comes to mind that demonstrates this concept better than "assisted suicide." For, in reality, helping someone commit a desperate act of hopelessness can in no way be described as real assistance.

As for relieving people's suffering, there are ways to help them cope and to minimize their pain without killing them. Did anyone receiving the love and care of committed family and friends, the medical care to treat their pain, and the care of society in providing counseling and emotional support ever ask to die? And how can we ever say that we've done enough? How do we know when a little more love, a little more financial, emotional and moral support would not ease the mind of the sufferer and allow them to once again find meaning and quality, in their lives? Dr. Kathleen Foley, a pain specialist at Memorial Sloan-kettering Cancer Center in New York, says, as quoted by the "Times", "It is a well documented fact that those asking for assisted suicide almost always change their mind once we have their pain under control. We undermedicate terribly in American medicine..."

Once again, the question becomes one of whom we are really assisting by legalizing assisted suicide. Is it the vulnerable individual who is in need of our support, or ourselves, as a society, trying to "solve" the problem of limited resources, and the inconvenience posed by people who need tremendous amounts of care.

The horrifying scenario described above in reference to the findings of the New York State Commission might sound a bit imaginative to some. However, it is only necessary to look at the proposed "Oregon plan", in which health care would be denied to anyone above the age of 65 who is not contributing to society, or the recent scandal involving the MENSA group of "geniuses", who published an idea of euthanizing mentally retarded people who have "no quality of life", to see what can happen when human beings attempt to play G-d. Especially in our materialistic society where how much a person "is worth" is understood in terms of their financial status, the value of an individual human life needs to be left to G-d to decide.

Doctor Assisted Suicide

It is shocking from a Jewish point of view that there are some doctors who have championed the cause of legalizing assisted suicide, ignoring the position of most doctors as expressed through the American Medical Association. Being a doctor, according to the Torah, is one of the only professions in which you directly fulfill a Divine precept by carrying out your job correctly. Physicians are seen as agents of G-d in saving human life and relieving suffering. This is why the medical profession has historically been greatly valued by the Jewish people, and this tradition can be seen even in today's American Jewish culture.

However, there are times when the agent of G-d, having been given incredible responsibility,v, is tempted to overstep the bounds of his mission. In light of the lofty regard in which Judaism has always held the practitioners of medicine, the following passage from the Talmud is astounding. The Gomorrah in Kiddushin states, with no explanation, that "the good among the doctors are destined to Hell". While obviously expressed this way for the shock value, the Gomorrah's statement is in great need of clarification.

The Maharsha, one of the great commentaries on Aggadic Talmud, explains that this statement is warning of the doctors who become too proficient for their own good. As stated previously, being a doctor makes one a partner with G-d in protecting human life. This role has a humbling effect on many medical personalities, who realize their great responsibilities and their human limitations. Unfortunately, it has the opposite effect on others. The Maharsha offers the example of the expert physician who over-confidently relies on his own knowledge of medicine and fails to consult a second opinion, thereby putting his patient's health and well-being at unnecessary risk of a mistake. The Gemmorah is warning physicians of the grave danger in allowing the privilege and honor of being G-d's agent to go to their heads.

There seems to be an interesting parallel between the experience of the "suicide-doctors" and many of their patients. From a psychological perspective, suicide can often be seen as an attempt to control a life that is being experienced as completely out of one's control. That is, when an individual is condemned to pain and suffering, one of the most frustrating and scary aspects of this experience is the lack of control they have over their lives. That is why helping patients retain some little element of control over their physical lives, such as making day to day decisions, is often extremely important to their emotional life. Furthermore, Victor Frankel, in "Man's Search for Meaning", in which he describes the coping mechanisms of Holocaust survivors, explains that the ability to find meaning in a suffering existence can alleviate to a large extent the emotional need for a sense of control in life.

The problem remains that for those who cannot find meaning in their lives of suffering, the loss of control often engenders a powerful wish to actively do the one thing that can still be done to end the pain and to stop life from pushing them around - to quit life. Unfortunately, doctors in our society are sometimes treated like gods. Modern science and medicine have become religions in which people look to their practitioners as they once did to their spiritual leaders. Society thereby places enormous pressure on doctors to solve all of their problems. When doctors face their own limitations, they experience it as a loss of control. We need to realize that, with all of the wonderful benefits given the world by modern medicine, we will still never be able to overcome death and make human beings immortal. Rather than doctors or anyone else feeling hopelessly out of control and, therefore, tempted to do extreme acts to rail against the fates, we need to understand that there actually is one way for us to achieve immortality; by showing our allegiance to G-d, the "silent partner" in caring for humanity, through our commitment to life, to its infinite value and to the immortal experience of love.


History has repeatedly shown that the survival of a civilization depends on the strength of its moral fabric. Our modern civilization, with all of its advances in science, medicine and technology, has begun to show decline and decay in its moral and spiritual life. With the problems we face in the areas of violent crime, drug and alcohol abuse, hatred and intolerance of others and the breakdown of the nuclear family, there is little reason for individuals who live in pain and suffering to want to live. We live in perhaps the most prosperous and free society in the history of the world, yet thousands of people still sleep in the streets of our cities and hundreds of thousands more have no medical coverage. There is little that individuals who live in pain and suffering can count on from our society in their time of need. Even Yale Kamisar, a civil libertarian law professor at the University of Michigan Law School, warns (in the New York Times), "If assisted suicide went through, we'd be providing more safeguards for criminals picked up on the street than we would for the terminally ill."

The Torah teaches compassion, love for our fellow man, and the infinite value of human life. These ideals are at the core of G-d's purpose for human existence. They have been the source of the inspiration of our people that has allowed us to survive through thousands of years of persecution. The Torah and its ideals are also the source of inspiration that we must offer our society and its unfortunate individuals who are faced with suffering so great as to make them question the meaning and value of their very survival.