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Home » Questions of Ethics, Shmini

Shmini: End of Life Care

Submitted by on March 23, 2011 – 1:43 pmNo Comment | 3,529 views

This You Call a Dilemma?

Just the other night I found myself in discussion with a student who argued that weighing an argument from the perspective of Torah without giving equal credence to chemistry, science and nature is short sighted. I agreed with him, but insisted that considering science and chemistry without considering Torah is a far worse proposition.

Twenty-four hours later I received graphic confirmation of my position. A radio talk show host in Toronto presented the story of Mr. Desmond Watson, a patient, who spent fourteen months at Oakville Trafalgar Memorial Hospital suffering from dementia, pneumonia and bed sores among other ailments. Doctors asked the family for permission to move Mr. Watson to Palliative care, which is a nice way of suggesting that the patient be permitted to die albeit comfortably.

The family objected because of Mr. Watson’s deep religious beliefs and appealed to the Provincial Panel of Consent and Capacity, which instructed the doctors to stay the course of aggressive treatment. Many health professionals disagreed with the ruling. One doctor said he could not imagine someone wanting to live with irreversible non-communicative dementia. Another had the temerity to suggest that it takes a great deal of love to fight for a loved one’s life, but even more love to let him go.

I was aghast. This man had been taken off the ventilator and was breathing spontaneously. end of life care - innerstreamHis heart and brain are in perfect working condition. Why was he being put out to pasture on account of dementia? Have we now reached the point of refusing to care for mentally ill patients?

The radio host went so far as to categorize the choice of life selfish because it puts the family through the emotional roller coaster of watching him die slowly and painfully. I was shocked. Should a teenager addicted to drugs commit suicide since the odds are against his kicking the habit and his family will be subjected to an emotional wringer? How did we get so far down this road?

When someone pointed out that the man was breathing on his own and is alive, the host replied, how long can that possibly last? I couldn’t believe it. How long will my breathing last? Who really knows?

A Little Background

When medical technology evolved and the possibility of heart transplantation was discovered doctors faced a dilemma. A heart is only viable for transplant while it is beating; once it dies it cannot be rehabilitated. One cannot harvest a heart from a dead patient because a dead heart is not viable for transplantation, but harvesting a heart from a living patient is tantamount to murder.

It became necessary to create a criterion of death that begins before the cessation of cardiac activity. A Harvard ad hoc committee solved the problem by crafting the term brain death. This criterion stops short of calling the patient dead; it merely states that the brain stem has ceased to function. But it did not take long to take the leap to actual death. Because the brain is the nerve center and control box of the entire body it is not a stretch to view a brain dead patient as effectively dead.

It thus became legal to harvest a beating heart from a patient whose brain stem ceased to function. This met with stiff resistance from many quarters, but the standard medical criteria of brain death held.

In his extensive essays on this subject Rabbi J David Bleich often wrote that science is capable of measuring an observable physiological condition, but not of defining the precise nature of life. Science can tell us whether brain function, cardiac activity or respiration has ceased, but science cannot pin down, let alone define, the nature or even the precise moment of death. Life is an ethereal, nee spiritual, quality that can only be defined by moral or religious considerations. A believing Jew must turn to the Torah rather than science for a definition of life and therefore death. (1)

The brain death criteria is one of healthy and rigorous debate in contemporary Halachic writings, but irrespective of where one stands on this subject, one must be horrified by the position espoused above. There is a mountain of difference between a patient with irreversible brain stem cessation and a patient with dementia and bed sores. Yet it appears that once the door opened to rendering a breathing person dead, it became possible to consider even repugnant examples of living death.

The doctors quoted above are reasonable people, whose logic is perhaps macabre, but sound. When I listen to it I wonder why we were so horrified by the Nazi program to exterminate mentally retarded patients. Using the logic of these doctors, one could hear the Nazis argue that long term patients use up resources that can be allocated to patients with better prognoses. Besides, if we won’t kill them, they will have to live with bed sores and put their family through the horrors of a demented grandfather.

This is where science, logic and chemistry fail to satisfy. This is where we must turn to our convictions and belief systems. One who believes the Torah dictum that a moment of life is of infinite value can never be swayed by macabre argumentation that stops just short of advocating homicide for patients with irreversible medical conditions.

The Eighth

This is why the tabernacle was inaugurated in the desert after on the eighth day, after a seven day practice run. Jewish thinkers have suggested that the number eight is instructive: if the natural revolves around the seven day week, the number eight represents the supernatural. (2)

To welcome G-d, to cherish sanctity and be suffused with reverence for life one must learn to transcend the limitations of human logic and embrace a higher order. It entails an acceptance of iron clad values, not subject to negotiation. It requires that we reach beyond seven and grasp for the number eight.

My response to the student, who argued that Torah without science is incomplete, is that science without Torah is tragic. When we first deviate from proper practice the movement is slight and difficult to identify. The human mind winds its way through a labyrinth of ideas and arrives at conclusions that boggle the observer, but seem perfectly valid to the logician who made the journey.

The only way to protect against such wanderings is to hold fast to the values that anchor and guide us. When we hold fast to the eight, we can navigate the seven with confidence. If we hold fast to our beliefs, we can apply logic in the pursuit of scientific discovery without fear of wandering too far afield.


  1. See Contemporary Halachic Problems, J David Bleich, Ktav Publishing, 1995, p. 316.
  2. See commentary of Kli Yakar to Leviticus 9:1.

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