Abstract
This article first examines six fundamental Jewish convictions that affect end-of-life care. It then discusses Advance Directives. This is followed by an extensive section on the details of end-of-life care as from the perspective of Jewish law, tradition, and theology. This includes defining death, foregoing life-sustaining treatment, artificial nutrition and hydration, curing the patient and not the disease, pain control and palliative care, medical experimentation and research, and social support of the sick. The last section discusses care of the deceased, including Jewish norms about burial, cremation, autopsies, organ and tissue donation, and donating one’s body to science.
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Notes
- 1.
In Dorff (1998, pp. 14–34), I describe seven foundational principles for Jewish medical ethics, but these three will suffice for the purposes of this topic.
- 2.
See, for example, Deuteronomy 10:14; Psalms 24:1. See also Genesis 14:19, 22 (where the Hebrew word for “Creator” [koneh] also means “Possessor,” and where “heaven and earth” is a merism for those and everything in between); Exodus 20:11; Leviticus 25:23, 42, 55; Deuteronomy 4:35, 39; 32:6.
- 3.
In this and all of the following citations, these are the abbreviations that refer to rabbinic materials:
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M. = Mishnah, edited by Rabbi Judah Ha-Nasi, c. 200 C.E.
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J. = Jerusalem Talmud, edited c. 400 C.E.
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B. = Babylonian Talmud, edited c. 500 C.E.
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M.T. = Maimonides’ Mishneh Torah, completed in 1177 C.E.
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S.A. = Joseph Karo’s Shulḥan Arukh, completed in 1563, with glosses later inserted by Moses Isserles to indicate where the practices of Ashkenazic Jewry in northern and eastern Europe differed from the practices of Sephardic Jewry in the Mediterranean basin, which Karo had recorded.
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- 4.
Genesis Rabbah 34:19 states that the ban against suicide includes not only cases where blood was shed, but also self-inflicted death through strangulation and the like; M.T. Laws of Murder 2:3; M.T. Laws of Injury and Damage 5:1; S.A. Yoreh De’ah 345:1–3. See Bleich (1981), chap. 26, cf. Dorff (1998, pp. 176–198 and pp. 375–376), where the official statement on assisted suicide of the Conservative Movement’s Committee on Jewish Law and Standards is reprinted (also in Mackler 2000, pp. 405–434) and at https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19912000/assistedsuicide.pdf.
- 5.
Naḥmanides (1963, p. 43); this passage comes from Naḥmanides’ Torat Ha’adam (The Instruction of Man), Sh’ar Sakkanah (Section on Danger) on B. Bava Kamma, chapter 8, and is cited by Joseph Karo in his commentary to the Tur, Bet Yosef, Yoreh De’ah 336. Naḥmanides bases himself on similar reasoning in B. Sanhedrin 84b.
- 6.
Cf. B. Avodah Zarah 40b, a story in which Rabbi expresses appreciation for foods that can cure. Although circumcision is not justified in the Jewish tradition in medical terms, it is instructive that the Rabbis maintained that Jewish boys were not born circumcised specifically because God created the world such that it would need human fixing, a similar idea to the one articulated here on behalf of physicians’ activity despite God’s rule; see Genesis Rabbah 11:6; Pesikta Rabbati 22:4.
- 7.
In the first of those passages, it is the judge who judges justly who is called God’s partner; in the second, it is anyone who recites Genesis 2:1–3 (about God resting on the seventh day) on Friday night who thereby participates in God’s ongoing act of creation. The Talmud in B. Sanhedrin 38a specifically objected to the Sadducees saying that angels or any being other than humans participate with God in creation.
- 8.
On this subject generally, see Reisner (1991a, pp. 60–62) (in Mackler 2000, pp. 250–253) and at https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19861990/reisner_care.pdf, pp. 10–13.
- 9.
See Dorff and Rosett (1988) for more on the sources, methods, and guiding beliefs of Jewish law.
- 10.
- 11.
For a more thorough treatment of these sources of Jewish morality, see Dorff (2003, pp. 311–344).
- 12.
In context, that passage, like Exodus 20:13 in the Ten Commandments, may be talking specifically about the legal setting, warning that one not allege a false charge, but the later Jewish tradition understood it more broadly to forbid all falsehood. See, for example, B. Ketubbot 17a; B. Shevuot 30b, 31a; B. Bava Mezia 49a; M.T. Laws of Ethics (De’ot) 2:6; cf. 5:13. Moreover, other verses in the Bible itself, such as Psalms 101:7, Psalms 119:163, and Proverbs 13:5, condemn falsehood in general.
- 13.
- 14.
The prohibition of murder, as in the sixth of the Ten Commandments, does not interdict all killing of humans. On the contrary, Judaism requires self-defense, even to the extent of killing one’s attacker, for both individuals (Exodus 22:1; B. Berakhot 58a; B. Yoma 85b; B. Sanhedrin 72a) and communities (as in war) (Deuteronomy 20–21; M. Sotah 8:7 [44b]). See Dorff (2002, chap. 7).
- 15.
This includes even inanimate property that belongs to us among human beings, for God is the ultimate owner. Cf. Deuteronomy 20:19; B. Bava Kamma 8:6, 7; B. Bava Kamma 92a, 93a; S.A. Hoshen Mishpat 420:1, 31.
- 16.
Cf. RaN, B. Nedarim 40a. The Talmud records such prayers: B. Ketubbot 104a, B. Bava Mezia 84a, and B. Ta’anit 23a. Note that this is not a form of passive euthanasia, for there people refrain from acting, but here God is asked to act.
- 17.
- 18.
For a summary of some of the varying Orthodox opinions up to 1978 in America, England, and Israel on defining the moment of death, see Goldman (1978, pp. 223–229). See also Rosner and Bleich (1979, pp. 367–371) and Bleich (1981, pp. 146–157). For the Israeli Chief Rabbinate’s ruling, see Jakobovits (1989). For Conservative positions, see the opinion of Jack Segal, cited in Goldman (1978, pp. 229–230 n.42), Siegel (1975, 1976), and Goldfarb (1976). The first official endorsement of the new criteria for the Conservative Movement came in the approval of the Conservative Movement’s Committee on Jewish Law and Standards in December, 1990 of the responsa by Rabbis Elliot N. Dorff and Avram Reisner (see Dorff 1991; Reisner 1991a), both of which assume and explicitly invoke the new medical definition.
- 19.
Life itself, of course, is terminal, and so the restriction of this criterion to those states recognized as illnesses—and the very definition of illness or malady—becomes critical. A very good analysis of this has been suggested by Bernard Gert, Dan Clouser, and Charles M. Culver and discussed with clarity and applications by Ronald M. Green in Dorff and Zoloth (2015, pp. 257–273).
- 20.
Thus the Talmud specifically says, “We do not worry about mere hours of life” (B. Avodah Zarah 27b). The Talmud also says, however, that we may desecrate the Sabbath even if the chances are that it will only save mere hours of life (B. Yoma 85a). The latter source has led some Orthodox rabbis to insist in medical situations that every moment of life is holy and that therefore every medical therapy must be used to save even moments of life; see, for example, Bleich (1981, pp. 118–119, 134–145). The only exception is when a person is a goses, which Rabbi Bleich defines as within 72 h of death, at which time passive, but not active, euthanasia may be practiced. He then uses the source in Avodah Zarah to permit removing only hazardous therapies that may hasten death if they do not succeed in lengthening life. Rabbi Bleich’s position is not, however, necessitated by the sources. On the contrary, they specifically allow us (or, on some readings, command us) not to inhibit the process of dying when we can no longer cure, even long before 72 h before death (however that is predicted).
- 21.
Tosafot, B. Avodah Zarah 27b, s.v., lehayyei sha’ah lo hyyshenan. See Dorff (1991, pp. 15–17, 43, n.22) (in Mackler 2000, pp. 311–114; online, pp. 79–82), (1998, pp. 202–208). For a contrasting interpretation of this source, see Reisner (1991a, pp. 56–57, 72, n.21) (in Mackler 2000, pp. 245–247, 255–257, n.22; online, pp. 18–19, pp. 26–38 n.22).
- 22.
In other words, Rabbi Reisner does not accept the “double effect” argument, while I do. See Reisner (1991a, pp. 66, 83–85, ns.50–52) (in Mackler 2000, pp. 269–270, pp. 283–286, ns.12–14; online, pp. 29, 55–57 ns.50–52) and see, in contrast, Dorff (1991, pp. 17–19, 43–45, ns.24–27) (in Mackler 2000, pp. 314–316, 328–330, ns.7–10; online pp. 82–83, 113–115 ns.24–27), (1998, pp. 185–186, 218–219, 379 n.76). See also Rabbi Reisner’s summary of the differences between the Dorff and Reisner positions, Reisner (1991b).
- 23.
- 24.
See Jakobovits (1975, pp. 150, 278–283, and, more generally, pp. 132–152). The Chief Rabbinate’s ruling and the Israeli Anatomy and Pathology Act of 1953 are cited at p. 150, and Rabbi Jakobovits’ own opinion can be found on pp. 278–283.
- 25.
Although somewhat dated, a good summary of the positions of all three movements on organ transplantation, with relevant quotations from responsa and other official position statements, can be found in Goldman (1978, pp. 211–237). This includes quotations from two earlier responsa approved by the Conservative Movement’s Committee on Jewish Law and Standards. A similar stance can be found in the work of two other Conservative rabbis, namely, Klein (1975, chap. 5), and Feldman (1986, pp. 103–108).
For a summary of Orthodox positions, see Jakobovits (1975, pp. 278–291), Rosner and Bleich (1979, pp. 387–400), and more recently, Steinberg (2003, pp. 695–711).
For a Reform position on this, see Freehof (1956, 1968 [both reprinted in Jacob 1983, pp. 288–296], 1960, pp. 130–131, 1974, pp. 216–233). In a March, 1986 responsum, the Central Conference of American Rabbis as a body officially affirmed the practice of organ donation, and the synagogue arm of the Reform Movement, through its Committee on The Synagogue as a Caring Community and Bio-Medical Ethics, published a manual for preparing for death that specifically includes provision for donation of one’s entire body or of particular organs to a specified person, hospital, or organ bank for transplantation or for research, medical education, therapy of another person, or any purpose authorized by law. The manual is Address (1992).
- 26.
Permission of the donor or his family must be procured so that the transplant does not constitute a theft according to Chief Rabbi Unterman’s responsum in Goldman (1978, p. 226). Feldman and Rosner (1984, p. 68) say that the family’s permission is only advisable in Jewish law, but it is mandatory in American law; that, however, would make it religiously required of American Jews as well under the Jewish legal principle of “the law of the land is the law” (B. Nedarim 28a; B. Gittin 10b; B. Bava Kamma 113a; B. Bava Batra 54b-55a). This principle is described in Dorff and Rosett (1988, pp. 515–523). See also Klein (1975, pp. 40–41).
References
Address, Richard F., ed. 1992. A time to prepare: A practical guide for individuals and families in determining one’s wishes for extraordinary medical treatment and financial arrangements. Philadelphia: Union of American Hebrew Congregations Committee on Bio-Medical Ethics. Updated version, 2016: http://jewishsacredaging.com/wp-content/uploads/2016/05/Expanded-A-Time-To-Prepare-Jewish-Sacred-Aging.pdf.
Bleich, J. David. 1977. Smoking. Tradition 16/4 (Summer): 130–133. reprinted in Dorff and Rosett 1988, pp. 349–352.
———. 1981. Judaism and healing. New York: Ktav.
Calgary Cooperative Memorial Society. More on cremation and its impact on the environment. https://www.calgarymemorial.com/effect-of-cremation-on-environment.html.
Dorff, Elliot N. 1991. A Jewish approach to end-stage medical care. Conservative Judaism 43/3: 3–51. reprinted in Mackler 2000, pp. 292–358 and, in an updated form, in Dorff 1998, chaps. 7–9. Also available in its original form online at https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19861990/dorff_care.pdf.
———. 1998. Matters of life and death: A Jewish approach to modern medical ethics. Philadelphia: Jewish Publication Society.
———. 2002. To do the right and the good: A Jewish approach to modern social ethics. Philadelphia: Jewish Publication Society.
———. 2003. Love your neighbor and yourself: A Jewish approach to modern personal ethics. Philadelphia: Jewish Publication Society.
———. 2005. The way into tikkun olam (repairing the world). Woodstock: Jewish Lights.
———. 2007. For the love of God and people: A philosophy of Jewish law. Philadelphia: Jewish Publication Society.
———. 2010. Applying Jewish law to new circumstances. In Teferet Leyisrael: Jubilee volume in honor of Israel Francus, ed. Joel Roth, Menahem Schmelzer, and Yaacov Francus, 189–199. New York: Jewish Theological Seminary.
Dorff, Elliot N., and Marc Gary. 2014. Providing references for schools or jobs. https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/2011-2020/providingreferences.pdf.
Dorff, Elliot N., and Louis Newman. 1995. Contemporary Jewish ethics and morality: A reader. New York: Oxford.
Dorff, Elliot N., and Arthur Rosett. 1988. A living tree: The roots and growth of Jewish law. Albany: State University of New York Press.
Dorff, Elliot N., and Laurie Zoloth, eds. 2015. Jews and genes: The genetic future in contemporary Jewish thought. Philadelphia: Jewish Publication Society.
Eisenstein, J.D., ed. 1915. Ozar Midrashim. Vol. II. New York: Eisenstein.
Feldman, David M. 1986. Health and medicine in the Jewish tradition. New York: Crossroad.
Feldman, David M., and Fred Rosner, eds. 1984. Compendium on medical ethics. New York: Federation of Jewish Philanthropies of New York.
Freehof, Solomon B. 1956. The use of the cornea of the dead. C.C.A.R. [Central Conference of American Rabbis] Yearbook 66: 104–107.
———. 1960. Reform response. Cincinnati: Hebrew Union College Press.
———. 1968. Surgical transplants. C.C.A.R. Yearbook 78: 118–121.
———. 1974. Contemporary reform responsa. Cincinnati: Hebrew Union College Press.
———. 1977. Reform responsa for our time. Cincinnati: Hebrew Union College Press.
Goldfarb, Daniel C. 1976. The definition of death. Conservative Judaism 30/2: 10–22.
Goldman, Alex J. 1978. Judaism confronts contemporary issues. New York: Shengold Publishers.
Jacob, Walter, ed. 1983. American reform responsa. New York: Central Conference of American Rabbis.
Jakobovits, Immanuel. 1975. Jewish medical ethics. New York: Bloch.
Jakobovits, Yoel. 1989. [Brain death and] heart transplants: The [Israeli] Chief Rabbinate’s directives. Tradition 24 (4): 1–14.
Kalmanofsky, Jeremy. 2017. Alternative Kevura methods. https://www.rabbinicalassembly.org/sites/default/files/public/halakhah/teshuvot/2011-2020/alternative-burial_kalmanofksy_newversion.pdf.
Klein, Isaac. 1975. Responsa and Halakhic studies. New York: KTAV.
Mackler, Aaron L. 1993. Jewish medical directives for health care. https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19861990/mackler_care.pdf.
Mackler, Aaron. 2000. Life and death responsibilities in Jewish biomedical ethics. New York: The Jewish Theological Seminary of America (Finkelstein Institute.
Nahmanides. 1963. Kitvei Haramban, ed. Charles Chavel Jerusalem: Mosad Harav Kook.
Proceedings of the [Conservative] Rabbinical Assembly. 1983. Vol. 44. New York: Rabbinical Assembly.
Proceedings of the [Conservative] Rabbinical Assembly. 1990. Vol. 52. New York: Rabbinical Assembly.
Prouser, Joseph H. 1995. Hesed or Hiyyuv? The obligation to preserve life and the question of post-mortem organ donation. https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19912000/prouser_chesed.pdf.
Rabbinical Council of America. n.d. Halachic health care proxy. http://www.rabbis.org/pdfs/hcp.pdf.
Reisner, Avram Israel. 1991a. A Halakhic ethic of care for the terminally ill. Conservative Judaism 43/3: 52–89. reprinted in Mackler 2000, pp. 239–291; and available online at https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19861990/reisner_care.pdf.
———. 1991b. Mai Beinaiyhu [What is the difference between them?]. Conservative Judaism 43/3: 90–91. reprinted in Mackler 2000, pp. 236–238; and available online at https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/19861990/maibeinaihu.pdf.
Rosner, Fred, and J. David Bleich, eds. 1979. Jewish bioethics. New York: Sanhedrin Press.
Rosner, Fred, and Harav Moshe Tendler. 1990. Practical medical halachah. 3rd ed. Hoboken: Ktav.
Sharzer, Leonard. 2010. Organ donation after cardiac death. https://www.rabbinicalassembly.org/sites/default/files/assets/public/halakhah/teshuvot/20052010/dcd_teshuvah_final%2002-10.pdf.
Siegel, Seymour. 1975. Fetal experimentation. Conservative Judaism 29/4: 39–48.
———. 1976. Updating the criteria of death. Conservative Judaism 30/2: 23–30.
Steinberg, Avraham. 2003. Encyclopedia of Jewish medical ethics. 3 vols. Trans. Fred Rosner. Jerusalem/New York: Feldheim.
Volokh, Eugene. 2009. Duty to rescue/report statutes. http://volokh.com/2009/11/03/duty-to-rescuereport-statutes/.
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Dorff, E.N. (2019). Jewish Perspectives on End-of-Life Decisions. In: Knepper, T.D., Bregman, L., Gottschalk, M. (eds) Death and Dying. Comparative Philosophy of Religion, vol 2. Springer, Cham. https://doi.org/10.1007/978-3-030-19300-3_10
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