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.
(24) Rosemary Rigopoulos, October 18, 2019 12:36 PM
Your articles have deepened my respect for Judaism
Please write about abortion.
(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.
Anonymous, December 27, 2018 5:33 PM
Did you take her to the library?
If not, why not?
(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
(18) goldy rosenberg, October 29, 2015 10:21 PM
disturbing research by NIH this week, too
Important article. After a hospital tried killing my father "with dignity" I began to see the disturbing trend we are headed in within our nation. Much of life, even pain, is about how it’s framed. Fifty Shades of Grey depicts pain, and everyone cheers. A workout schedule, only if it hurts is it working. The climber who bleeds or whose toes fall off from frostbite we think heroic. But a senior who opts for pain while holding on to life is disparaged. Suddenly pain is anathema to quality of life. WHY?
Even more disturbing is that the NIH and Mt. Sinai hospital just did research into how much end of life costs for those with dementia. I know all liberals said we would not go down this slippery slope...but pray tell why we need to know the costs of keeping someone with dementia alive and how you are going to be sure they want to "die with dignity" if they have dementia?!
Nancy, November 15, 2017 6:56 PM
To commenter #18 Goldy Rosenberg
You have just brought up 2 big issues in this debate: money and age. Re: Dementia. My father a'h had Alzheimer's Disease. I can only HOPE that medical professionals showed some respect to my parents when I was not around.
(17) Anonymous, October 26, 2015 11:41 AM
Does "dying with dignity" reduce pain or medical costs
Another question is whether the purpose of the campaign to urge patients to chose to “die with dignity” is to spare patient for enduring pain or to spare the medical institutions from paying for treatment?
I remember when my elderly mother required a medical procedure that would mean an expensive rehabilitation of several months. (The procedure would have to be covered by her medical insurance, which she’d paid into for many years.) The medical personnel involved in her treatment had a meeting with the family at her bedside to try to persuade her not to choose that treatment, since it would prolong her life but not cure her. I’ll never forget how the doctor kept asking her “Don’t you want to die with dignity?” or how my mother finally had enough and got him to back off by looking him right in the eye and telling him firmly, “I want you to do everything you can to keep me alive.”
(16) Greg snider, October 26, 2015 6:28 AM
DWD not reuired
I don't understand the concern re: a 6 month diagnosis. At no point is a person who has acquired the meds required to take them. If someone recovers, great - if not, the DWD option is still available to them. Look to Oregon for how well this compassionate law has worked for the past 18!years.
(15) Suzette Vallieres, October 26, 2015 3:29 AM
story against euthanasia...true story.
I had been caring for a man who was a quad. his paralysis led me to thinking about all the suffering I have witnessed. I knew I was against abortion but people suffering I did not understand why a G-d of love would want this.
A women that I did not know was waiting for me one day when I got home from work I invited her into my home. She had shown up to invite me to be involved with a group.
She began to tell me a little about herself. As we sat sipping tea she told me her mother had a terrible stroke when she was in her sixties. She said she was to sick to put in a nursing home. Her husband and she cared for the mother who lived around the corner, they were sure she would die with in the year. She did not pass....They rented a hospital bed and sold her home and moved her in with them. They cared for her day in and out year after year. After a couple years they could strap her into a chair and push her up to the table and she could shovel food into her mouth. She was gone face all droopy. The mother took her on a plane when her grandbabies were born in Florida and helped her daughter. After 17 yrs. she took the mother to a doctor who told her she now has cancer and she will go fast. She was in the hospital and she was sitting with her mother....She was petting her hand and told her mom...it wont be long now and you will go to heaven. Her mothers face changed right in front of her eye's...She looked normal and she looked her daughter in the eye for the first time in all those years....She sat up in bed ...by herself and she told her daughter yes! I am going to heaven. Then she laid back down and her face went back into paralysis and three days later she was gone. The hair stood up on my arms but I knew that I knew this women ...this women was telling the truth...there is more to the story. But there is a reason for all of our suffering it is not in vain...only G-d knows why but he knows and that is enough.
Mike, October 31, 2015 7:46 PM
very interesting story
thank you for sharing this story. I think that I proves that people who -we- think are 'gone', who have dementia may well understand things, even if we are not aware of it, and even if we assume that they don't.
The women who said 'yes! I am going to heaven' - perhaps she did not mind dying, but I don't think that we should make that assumption about everyone. Many old people do want to continue living.
So one of things I personally take out of the story that you have related is that one is not allowed to end someone else's life, even if it appears to -us- to be meaningless, because it may have very great meaning in general and for the person who is ill.
(14) Beverly Margolis, October 26, 2015 1:56 AM
Incurable pain
Although I agree 100%, I wonder of what use it is to keep someone in intractable pain when even the strongest drugs don't touch the pain.
I've got osteoarthritis in my spine and neck. I still want to live a longer life, suicide is NEVER even a thought. But when someone is just the shell of a human being, why can't they choose to end their agony?
It's easy to dismiss their agony, but to the individual who has nothing to live for, why not let them choose to end their lives?
(13) Bracha Goetz, October 26, 2015 12:54 AM
So well expressed!
(12) Tovah, October 26, 2015 12:43 AM
Shkoyach!! A resounding agreement on all counts. PAS is a big problem. How about a script for medical marijuana instead?
(11) Thom McCann, October 26, 2015 12:38 AM
"Dr. Death" helped kill patients in theU.S.
The doctor was insane.
You have seen his kind in bloody, horror movies.
He was Dr. Jack Kervorkian, known as “Dr. Death” or “The Ghoul” who escorted terminal patients through the doors of death.
Kervorkian said, “vast numbers of people are alive who would rather be dead, who have lives not worth living.” This is frightening because these exact words, “lives not worth living,” were the exact words the Nazi used to murder children and adults who were mentally deficient.
He can be compared to the Nazi concentration death camp “doctor” Josef Mengele who was not interested in questions of "care," and cared nothing for actually "counseling" those who came to him.
For Kevorkian, it all came down to the mechanics of death. He told interviewer Sanjay Gupta: "What difference does it make if someone is terminal? We are all terminal."
Take a look at the now deceased Dr. Jack Kevorkian's paintings of bloody heads and bodies to realize how insane this "Doctor" really was. http://www.pbs.org/wgbh/pages/frontline/kevorkian/aboutk/art/
The American Medical Association in 1995 said he was “a reckless instrument of death…poses a great threat to the public.” He was ultimately convicted on a charge of second-degree murder.
The Germans themselves became frightened when their soldier husbands and sons came back with bad injuries that left them in a state of "lives not worth living."
Who decides?
The Nazi doctors did.
They still do.
(10) Anonymous, October 26, 2015 12:29 AM
The Other Side of the Story
My son, of blessed memory, succumbed recently to brain cancer. He courageously elected not to end his life and we elected to have hospice in our home, so that he could die cloaked in the greatest possible love and care. It is impossible to convey the honor and privilege we had of escorting our son to the World to Come and I know many other caregivers who have had similar reactions. I have come away convinced that the process caregivers must go through with terminally ill individuals enhance their and therefore mankind's treasury of compassion and that suicide, like many short-cuts, causes us to lose a precious chance to stretch the hearts and souls of those who are involved. I am very proud of my son for not opting for suicide even though his end of treatment was pronounced right when a young woman, diagnosed with the same form of brain cancer, chose to end her life. My son left grieving, but proud and enriched parents, whereas she left family members who are, after the fact, wrestling with distress at her choice. We must, in making these enormous decisions, consider that we are part of a spiritual network - not just individuals - and that Heaven may very well intend that others in our interconnected network be spiritually benefited by our unique and individual life dramas. It is not just about us alone.
(9) M. Benzvi, October 25, 2015 11:09 PM
Quality of Life
Quality of Life is what counts, over any religious beliefs. Death by starvation as is done now when all feeding is stopped is cruel punishment at the moment when the client and family are at their weakest state. Being merciful is knowing when to say enough is enough and help a patient to go out with dignity.
(8) Anonymous, October 25, 2015 10:01 PM
A difficult topic for sure.
It's somewhat ironic that it can be considered inhumane to let (FORCE) an animal live when suffering with a mere broken leg (for example), and NOT inhumane to FORCE a human to suffer with an incurable soon terminal illness, accompanied by an unbelievable level of pain, (at a level that no known pain killer comes close to relieving), to a degree that they can have no thoughts other than that of how to end the pain. Sometimes the question isn't life or death. The question is a life of living in a state of perpetual 24/7 un-releiveable agony beyond your imagination, or not. I understand how a life like this may not really be considered a life to some. But yes, it's scary how easily the "poison" could be used to murder someone who may have preferred life. It's a hard choice to make, at best, and at worse, murderous. As is, many men have been known to use sedatives to date rape women. So, certainly there would be deranged individuals that could use this properly gotten medicine to improperly kill others. But then guns, etc. can do the same too. It's a terrible reality sometimes.
(7) David Levy, October 25, 2015 7:16 PM
I'm sorry, Bernie, but a person's life is not his alone. It was given him or her by God, and only He has the right to determine when a person's time is up. Murdering one's own self is perhaps the worst sin one can commit. The world is not hefker (ownerless). We can't just do anything we want. What if a person wants to kill himself and is prevented, and the next day he changes his mind?
(6) Dvirah, October 25, 2015 7:16 PM
Reply to Bernie Ampel (Facebook comment)
There's a difference between someone deciding to die and commiting suicide on one's own, and a third person or comittee deciding to kill that person because he/they don't see that person's life as worthwhile. The problem with physician-assisted suicide is that this is not necessarily a decision made by the person who dies.
(5) Dolly Hewett, October 25, 2015 6:35 PM
I agree completely with the good Doctor.
(4) Pamela Fender, October 25, 2015 6:06 PM
From One Who Knows
My twin was not terminally ill; he was very depressed and wanted to end his life. His doctor at Kaiser in Los Angeles gave him a lethal prescription of morphine to end his life. My mother and sociopathic brother were the only ones who offered to "help" my twin brother in his suicide by administering morphine every hour for 10 days until my twin died.
I've written all about it in my memoir: Beside Myself: Recovery From My Family Betrayal and Estrangement.
Next week I'll have my 7th birthday without my beloved twin. I don't celebrate anymore, because my twin is no longer here.
Basically, murder was committed and no one was arrested.
So, you know how I feel about it.
Thank you for your piece.
(3) Tony Korn, October 25, 2015 5:08 PM
How To Die in Oregon
I strongly suggest that you watch closely every minute of the film / movie 'How To Die in Oregon' - see https://en.wikipedia.org/wiki/How_to_Die_in_Oregon.
(2) Another doc, October 25, 2015 10:54 AM
Crazy california
Illegal frisbee and guvernators and now physician assisted suicide? This is crazy...but until people understand the value of life and what they're living for we are gonna have more crazy things like this
(1) Steve, October 25, 2015 10:51 AM
Good to be alive
Everyday gd bless glad to be alive...
So many people dying early or getting killed or whatever we don't need kevorkians helping people to off themselves