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Death with Dignity?

Death with Dignity?

As a doctor and as a Jew, I am against physician-assisted suicide.

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On October 6th 2015, Governor Jerry Brown signed a controversial “Death-With-Dignity” law into effect effectively marking one of the worst decisions by the state of California since outlawing Frisbee tossing at the beach without explicit lifeguard permission. This legislation was based on a similar law passed over 20 years ago in Oregon allowing for physicians to prescribe lethal medications to terminally ill patients, one which the Federal Government has taken issue with and one that as a religious Jew and a physician I am forced to take issue with myself.

All of my colleagues went to medical school with different aspirations. But whether it was to ambitiously cure cancer or serve as a humble small town doc, not a single person I know went through the trials and tribulations of medical training to participate in physician-assisted suicide. The ancient and original code of physician-hood attributed to Hippocrates over two thousand years ago states, “Nor shall any man’s entreaty prevail upon me to administer poison to anyone.” For folks that aren’t history buffs, an updated version – The AMA’s Code of Medical Ethics – reads, “Physician assisted suicide is fundamentally incompatible with the physician’s role as healer.”

Alleviating pain is providing care; physician-assisted suicide is actively promoting death.

Being compassionate is incumbent upon all human beings and this necessarily includes physicians. Providing patients with alternatives between aggressive models of care and more palliative choices is also the responsibility of the medical field. This is why hospitals and health care systems have dedicated palliative care teams, hospice consultation services, and offer end-of-life counseling. Addressing a patient’s wishes regarding declining aggressive care – involving intubation and resuscitation – is different than prescribing a lethal pill with the intent of hastening a patient’s demise. Alleviating pain and suffering and physician-assisted suicide are light years apart. One is providing care and the other is actively promoting death.

As a psychiatrist, I am particularly concerned with the language of such laws requiring that a patient be deemed “mentally competent” to ask a physician to prescribe lethal medications. Would such competence be determined by a forensic psychiatrist? A court of law? Or a physician the patient had just met who happened to feel exempt from their profession’s official ethical code? In the past week, I have already been approached regarding a paranoid and psychotic woman who is “traveling to California to get euthanized because there isn’t any reason to live.” I can tell you she isn’t competent but who’s to say what would happen in California? “Mentally competent” is too subjective a term which is tremendously dangerous when life is on the line.

From a Jewish perspective, physician-assisted suicide is a tragedy because life is a precious gift. The Torah teaches us, “I have set before you life and death, the blessing and the curse, you shall choose life so that you and your descendants will live” (Deuteronomy 30:19). Our Creator wants us to do the best we can with what we’ve been given. Chronic pain and illness are not an easy thing to live through; nor are they an indication that one should throw away the life they’ve been given.

Consider the case of Dr. Rachamim Melamed-Cohen who was diagnosed with ALS – a condition also known as Lou Gehrig’s Disease for which other similarly affected individuals have pursued physician-assisted suicide – and became paralyzed with the lone exception of his eye movements. Not only has Dr. Melamed-Cohen survived for over a decade, he has authored multiple books, prays three times daily, and spends quality time with his 26 grandchildren. Such a case is proof that illness and disability are not the measures of quality in one’s life.

 

While the “Death-With-Dignity” legislation generally applies to “terminally ill patients” who will die within six months, such predictions are often premature with the limited tools available to modern physicians. I’ve witnessed miraculous recoveries myself in the hallowed halls of Harvard Med School and the Talmud is clear that giving up hope is not an option, teaching us the story of King Hezekiah’s own battle with “terminal illness” and stating, “even if a sharp sword is resting on your neck, you shouldn’t give up on divine mercy,” (Talmud Berachot 10A).

Not that we need a reminder, but Maimonides is clear that both killing and suicide are absolutely forbidden, “Whoever causes the loss of a soul is considered as if he destroyed the entire world,” (The Laws of Murder and Protecting Life 1:16). As Rabbi Yitzchok Breitowitz – a Harvard-trained lawyer and an expert in the field of Jewish Ethics – once wrote, “Because all human beings are formed in the image of the Divine, all life is regarded as being of infinite value regardless of its duration or quality. As all mathematicians realize, infinity cannot be halved. If and when some human life is deemed to be less valuable than others, then life as a whole has gone from being infinite to being relative and the lives of us have become cheapened and debased.”

Physician-assisted suicide is not an ethical or Jewish concept.

October 25, 2015

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The opinions expressed in the comment section are the personal views of the commenters. Comments are moderated, so please keep it civil.

Visitor Comments: 25

(23) Anonymous, December 11, 2016 4:58 AM

Change the circumstances and save lives

There is, sadly, often a huge difference between end of life care from one person to another because of monetary concerns and the presence, or lack of, family support. Based on what I have seen, the desire for suicide often originates out of feelings of loneliness and the despair that comes from not being able to afford having the most basic needs met.I have seen people who were without the simplest, most basic necessities and it was these people who spoke of suicide ( I'm a ex Counselor).Those with a support system and money to "throw at the problem" were the ones who were willing to hang on to the end.Those left on their own with few resources were the ones who gave up.Anyone can volunteer to help these lonley, desperate people to have a little quality of life as they near the end if they accept a person as they are, not as an opportunity to push an agenda..I truly believe, based on 30 years of simple observation, that the desire to end life early comes from a feeling that *no one cares* and seeing this manefest.I remember one poor woman suffering from terminal cancer who told me that she would hang on if she could just go to the library and get something to read to distract herself from the fear and pain.No one could be bothered and this seemed to be the straw that broke the camels back.She was literally too poor to afford a taxi and the only people willing to help aggressively pushed thier religion on her.She ended her life after months of begging someone to help without taking advantage of her vulnerability.

(22) Toby Weitzman, November 4, 2015 1:51 AM

Dr.Freedman should be aware....

Imagine being in a nightmare 24/7 where people are chasing you, screaming to do awful things, giving you physical pain,
torturing you. And you could not wake up. Even for a minute.
This was my son's life , who had the brain disease schizophrenia and suffered more than 15 years with this. The best hospitals in the country, the best doctors, psychiatrists, neurologists, psychopharmacologists. He could not be pain free despite the heavy medications he took daily, in every combination, shots, etc. Jake was highly educated, Bar Mitzvah, Confirmation, trips to Israel., voracious reader, tried to finish college.but the voices would not cooperate. Jake was the bravest young man you would ever meet, suffering in silence every single day and night.
I am well aware of the Jewish laws that forbid us to take our own lives. But I also know this. G-d was with Jake when he chose to do this, and stayed with him until he was in G-ds arms, finally safe, finally at peace. And this is the G-d I know, this is the G-d Jake knows and no one , no one, should EVER pass judgement, until you have walked in Jake's shoes. He was my hero, my son, and G-d loves him and forgives him.

(21) Nancy, November 2, 2015 9:25 PM

Extreme pain vs. terminal illness.

I once saw a report on 60 minutes that said many health care professionals were not well versed in pain management. If someone's pain can be managed properly, it seems like that would make a big difference in his/her desire to live. On the other hand, I have a question: If someone has a diagnosis of ALS and chokes for some reason, is this REALLY what any physician would want for that patient?

(20) Anonymous, October 31, 2015 7:50 PM

there are mad doctors as well

A nonjewish acquaintance of ours related to us that she took her son to a pediatrician who she described as a "Nazi doctor" (he was indeed German and had lived during the Nazi era)

This doctor said about her son "It is better to be dead than to be so sick."

and the child wasn't even that sick...

(19) Mike, October 31, 2015 7:36 PM

regarding the issue of mental competence

A close relative of mine is a psychiatrist and he related how someone with a mental condition pleaded with him to give her "an injection of death".
So I can definitely understand how there are people who are mentally ill and who ask to be euthanized.

I totally agree with the author- it's totally unclear who would determine if the patient is not mentally ill.

I also agree with the other points. It's very wrong to assist anyone in suicide (and it also sends the wrong message)

Every human life is precious

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