In January of 2017, some people came to speak to me about a bill that they were hoping to bring to the legislature in the future. The bill would follow a similar law in Oregon that would help people suffering from a terminal illness to die on their own terms. It was not an assisted dying bill, it was a bill that said that the terminally ill individual could go to their primary care physician to talk of their desire to die, they would refer the individual to mental health support services if they wished, but ultimately if not then that physician would be able to write a prescription for a medical cocktail that the individual had to pick up from the pharmacy themselves, then could take home, consume, and it would painlessly lead to their death. The key thing of the bill was that the cause of death on the death certificate would not be suicide but the terminal illness that the person was suffering from. I was very sympathetic but to me there was a core problem with the bill – that I thought it was dishonest because the cause of death was, as far as I was concerned at the time, suicide. I wanted to help but emotionally could not do so.
Two years ago, my thinking on this started to shift. I gave a sermon in which I shared a narrative from Talmud (Ketubot 104a) in which Rabbi Judah HaNasi is dying and the other Rabbis and his students decree a fast and pray to keep him alive. His maidservant went up to the roof and prays that the lower realms might win out over the upper realms, in other words, that he be kept alive and not taken to heaven. However, when she sees how often he has to go to the bathroom, and how uncomfortable he is taking off and putting on his tefillin, and how much discomfort he is in, she changes her mind. However, the sages are still praying for him to remain alive, so she takes a jug and throws it to the ground. The sages are shocked by the sound, stop praying for a moment, and as a result Judah HaNasi dies. Did she kill him? No, she clearly didn’t. She just saw that keeping someone alive just so that they might suffer is not a just cause, so she intervenes and he then dies as a result of what was killing him in the first place. It’s not an identical situation to this bill but it is very similar and it does highlight a particular ethic, which is codified in the 16th century text the Shulchan Arukh that says that “it is forbidden, according to the law of the Torah, to inflict pain upon any living creature. On the contrary, it is our duty to relieve the pain of any creature…”
But, for the most perverse reason, many people are extending their suffering instead of ending it, and that reason is life insurance policies, which are usually invalidated if someone takes their own life. The fact that people endure continued extreme suffering in order to financially protect their surviving loved ones is clearly immoral. So, putting the cause of death as the terminal illness means that such a thing no longer happens. And, indeed, had it not been for the pre-existing terminal illness, the person involved would not even be taking this concoction, so actually one can say that the terminal illness was the overlying cause, just as the maidservant didn’t cause Rabbi Judah haNasi’s death even if she hastened it.
It is fascinating that once this law was enacted in Oregon, the number of people who died from suicide decreased dramatically because people were more openly talking about their issues with a primary care physician who was then able to refer them to professional support if they needed. Indeed, a third of the people who started the process with their physician never even completed the process but did end up with professional support or, importantly, the essential human ability to make a choice as their decreasing mobility robbed them of basic choices.
My sermon two years ago also included reference to the death of Saul in 1 Samuel 31. Saul is seriously wounded and he turns to his armor bearer and asks to be run through so that the Philistines do not torture him. The armor bearer is afraid to do so, so Saul takes his own life instead (I Sam. 31:2-4). Many commentators say that Saul behaved improperly, as with much else in his life, but one minority opinion from the 14th century Besamim Rosh says that if a person is dying and in intolerable pain, it is permitted for them to take their own life. Minority opinion though it may be, it is still an opinion in our tradition that rather accords with the narrative of the maidservant in Tractate Ketubot.
Four years after I was first consulted, the bill is now being voted on in the Legislature and, after much reflection and difficult soul searching, I have now openly spoken in support of the bill. In my 16-year Rabbinic career, I have had too many people who are slowly and painfully dying ask me if there is anything I could do to end it all. I have always told them the same – that there is nothing I can do. Now, by supporting this bill, I feel that I can. I can give them a real choice, through supporting this bill I can help them get support or a little dignity as their decaying body tries to rob them of it. And to be clear, this is not encouraging terminally ill people to end their lives, it’s just allowing them to do it painlessly and with dignity.
At a funeral service, I always recite the line Adonai natan vAdonai lakach y’hi shem Adonai m’vorach – God has given, God has taken away, may God’s Name be blessed. Could I recite that line if someone with a terminal illness got a prescription that deliberately ended their life early? Yes, I absolutely could… because God “took away” the moment they got a terminal illness.
There are many voices in Judaism….perhaps too many voices… that say that suffering is a gift from God, that it helps us atone, elevates us, and is even a demonstration of God’s love (e.g. Genesis Rabbah 9:8, Zohar, Gen., 180b, etc.). I understand why a people who have suffered for thousands of years would say that because it provides a positive view of something profoundly negative. But that is a theological position that can help people move through suffering. At the same time, though, just like the maidservant, I would never seek to extend someone else’s suffering because I thought it was good for them. As Lion Feuchtwanger wrote in the Paris Gazette in 1940, “it is only the strong who are strengthened by suffering; the weak are made weaker.” When someone has already been weakened by a terminal illness, when they have suffered beyond the point that they can handle it any more, more suffering is not a gift from God or, if it is, it’s not a gift that most people appreciate! Indeed, to say to someone else that their suffering should extend because of a particular theological belief of mine would not only be religious hubris in the extreme, but also disturbingly callous. If a person is suffering toward the end of their life and if they believe that suffering is a gift from God, then it is absolutely their right to ignore this bill and suffer until the very end. That is different to a person saying that they believe that suffering is a gift from God so others should suffer, too. Imposing one’s own religious beliefs to prolong another person’s suffering is unequivocally immoral. You can say, “But our tradition says….” and even if I agreed with you (which I likely wouldn’t because our tradition rarely speaks with only one voice on any issue), you still don’t have the right to extend another person’s suffering as a result of your theological belief, only your own. If you believe Judaism is against it, don’t do it yourself. It’s really that simple. And this is core and I believe deserves repeating again – if your religious view prolongs the agony of another person who does not share the same theology or practice as you, it does not speak well of your religion. As it is, I refuse to listen to anyone who says that suffering is a gift from God and it’s not our place to interfere in it but who takes painkillers if they have a headache. That kind of pious hypocrisy does not interest me. Similarly, I refuse to listen to anyone who says that it’s not for us to intervene in God’s plan for our bodies but who also uses a doctor. That kind of pious hypocrisy does not interest me. I get it – it’s an emotional topic. We instinctively don’t want to make it easier for people to die but the reality is that the people who will be affected by this bill are already actively dying. Their terminal illness cannot be stopped. This doesn’t make people die, this doesn’t convince them to end their own lives because if someone is utterly determined to end their life to avoid suffering, they’re going to do it anyway, it's just that they will likely choose a method that is extremely painful in the short term to avoid suffering long-term. This bill helps reduce human suffering.
The question I ask myself is “Could I, as a Rabbi, sit with someone as they took this medication, just as I already sit with someone who is actively dying?” The answer is yes. If I can be there for someone to help them die with dignity, instead of in pain, if I can make that moment sacred for them, then I will.
But, isn’t it my duty to save everyone’s life? Doesn’t Judaism abhor suicide as a rejection of the gift of life from God? It used to. Orthodox authorities used to even deny mourning rites to people who took their own life because it was said that they had essentially denied God in that act. Reform Judaism has always considered that to be callous and cruel in the extreme. Influenced by this, more and more contemporary Orthodox authorities create a loophole and say that only someone who was not fully in their own mind would ever reject God by ending their own life, so we assume that they were essentially not in their own mind at the time, and we afford them mourning rites accordingly. I would say, if it’s possible for that, so it must be possible for this. Only those who live with intolerable chronic pain, or those who hear the cries for any kind of end by some of those who die from terminal illness can understand that suffering can take a person out of themselves in the cruellest of ways. An exception must be made for terminally ill patients. Even if we don’t count Saul as an exception, we do count Masada as an exception. There, in the year 74 CE, Josephus says that as the Romans finally ended their successful siege, the Jewish rebels there took their own lives instead of suffering at the hands of their besiegers. For nearly 2000 years, that act has stood as heroic resistance. So, if those people defeated by the Romans, knowing that the rest of their lives would be filled with unimaginable suffering, are allowed to be an exception, so too today’s terminally ill patients must be allowed to be an exception if they so choose. In my mind, it must always be better for me to sit with someone, to say Sh’ma, and to have them thank God for the life they’ve led up to that point than to prolong their pain and to doubt or curse God for the extended suffering they now endure and for them to beg me in despair to help end their life. And if I’m wrong, if it is not better, let it be on me, not on them. Terminally ill patients have enough to deal with already without any person saying that they’re doing something wrong. I hold no terminally ill individual liable for anything they do. I believe that everything we do should be to support them and help them maintain their humanity which was, indeed, a gift from God. I believe that if they choose to end their life on their terms instead of on the terms of the terminal illness from which they suffer, that we should support them in that choice and only blame the illness that ultimately led them to that decision. Judaism is an evolving religious civilization, so let it evolve with compassion for the most vulnerable in our society, as it always has. Let it not be the cause of prolonged agony, but the gateway to a life – and death - of dignity in the presence of God. And let us say, Amen.