Choosing between life and death

As Jews, we value life above everything else. We are commanded to choose and value life. We are commanded to save lives first, even if that means breaking the traditions connected with Shabbat.

In the Talmud, Yoma 85b, Rabbi Shimon Ben Mansiah declares that we are commanded to sin on Shabbat to save lives so that the people who live as a result of those sins can go on and observe Shabbat later. Saving lives comes first. On the same page, Rabbi Yochanan ben Yosef asserts that the holiness of Shabbat is given into your hands, you are not given into it (to die observing Shabbat.) In other words, laws are given for us to live by them, not to die because of them.

Saving life is more important than anything else.

Yet, medical science has changed the way we think about preserving life. As the chaplain at Banner Thunderbird Hospital in Glendale, I work very closely with families of people who are in the hospital's intensive care unit. Their loved one is hooked up to all kinds of pumps and machines, the most significant being the respirator. This machine forces air into the lungs, essentially breathing for the person in the bed. Because they have enough air, their hearts keep beating. Their blood pressure is controlled by medication, hydration and nutrition is pumped into their bodies, and they continue to live. This is called "life support."

Sometimes life support is the absolutely appropriate mode of intervention, when someone has an illness that can be cured, or when their systems are generally well enough to enable them to get better once they are weaned off the machines. But sometimes, people become imprisoned by their loved ones' hope that they will get better, despite the overwhelming evidence indicating that they can't get better, or serious underlying illnesses which they will continue to suffer with. Instead of their lives being prolonged, their death is prolonged. They remain on the machines for days, weeks, months, even years. This is not living.

I worked with a man whose father was brought into the hospital with a necrotic foot. He had been in a nursing home, on a ventilator for almost a year. He had never regained consciousness. His foot had gangrene, and the infection would kill him if it were not amputated. The doctors and nurses at the hospital were very upset that the son wanted his father's leg amputated, and for him to continue to "live" on the ventilator indefinitely. The father had no quality of life, had no hope for recovery, and now was having parts of his body cut off. This was not life - it was an unnatural prolongation of dying.

All of us die. I hope that's not news to anyone. None of us has much choice about when we will die, or even, most of the time, how. But acceptance of the inevitable certainly has to be part of our approach. None of us wants to see a loved one die, and none of us wants to believe at the time of the insertion of the ventilator tube that the life of a loved one is near its end. We are entitled to hope for more time with our loved ones. But we also have to be realistic.

There seems to be a conflict between "life support" and "natural death." I have been encouraging a change of language in the ICU, from "withdrawal of life support" to "allow a natural death." In many cases, it's not "life support" anyway, but prolonging an unnatural experience of almost death - life beyond the natural.

We need to be cautious, to value and cling to life, at the same time as we recognize that just because we can keep a heart pumping, and lungs expanding, doesn't mean we should do so. To prolong death is just as wrong as not preserving life. The key is often looking at what the benefit will be to the patient, if and when breathing can be restored.

If the patient will suffer increased pain, decreased awareness or appreciation of life, or a return to an underlying serious illness, prolonging their death seems to be the best we can do, and therefore is not an acceptable approach.

Rabbi Rafael Goldstein is the chaplain at Banner Thunderbird Hospital in Glendale, and maintains a private practice in spiritual counseling. Ordained by the Academy for Jewish Religion, he is a board-certified chaplain. He can be reached at ravrafael@earthlink.net.

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