Who shall live and who shall die? Who in their time and who before their time? The haunting words of the Unetaneh Tokef prayer, the haunting reality of our lives. On Feb. 21-22, The Judaism, Science and Medicine Group – sponsored by Arizona State University Center for Jewish Studies, the Harold and Jean Grossman Chair in Jewish Studies at ASU, the Irving and Miriam Lowe Professor of Modern Judaism at ASU, with support from the Dr. Michael Anbar Lecture in Judaism, Sciences and Medicine Endowment and Valley Beit Midrash – hosted an international gathering of 125 participants to examine “Health, Mortality and Morality: Jewish Perspectives.” The conference focused on how Jewish tradition and values can and should inform decision-making in the challenging and often heartbreaking environment at the end of life.

The Judaism, Science and Medicine Group was established in 2008, according to Dr. Hava Tirosh-Samuelson, “to bridge the gap not only between religious and scientific discourses, but also between the natural sciences, the social sciences, and the humanities.” In her opening comments, she noted, “All humans are mortal and all humans die, be it abruptly, unexpectedly, slowly, painfully, violently or peacefully. There are infinite ways to reach the end of life, but we, as a society, generally avoid thinking about or reflecting about the reality of our mortality, even though human awareness of mortality gives rise to religiosity, the pursuit of wisdom and fantasies about immortal life.”

Participants focused on core texts within the Jewish tradition, defining the values that underlie a Jewish approach to medical decision-making in the face of terminal illness. What emerged is a mandate for Jewish authorities to address the disconnect between a world in which life expectancy was minimal and the contemporary reality of individuals outliving any sense of quality of life.

Speakers recognized that there is a broad diversity of opinions as to what is medically permissible and a lack of clarity regarding basic terminology as it relates to end of life. Judaism emphasizes an extreme focus on saving life at all costs. Yet, what does that mean to a patient who is utterly dependent on a respirator or someone whose Alzheimer’s disease has robbed them of all dignity and any connection to their own sense of dignity? Is living as long as possible a reasonable goal without any context of meaning and purpose in that life?

Rabbi Jason Weiner, senior rabbi and manager of the Spiritual Care Department at Cedars-Sinai Medical Center, addressed the practical considerations regarding withdrawing versus withholding treatment. Rabbi Saul Berman of Yeshiva University observed that every question in the contemporary environment has one answer: “It’s controversial.” Rabbi Richard Address, representing the Reform movement’s “Jewish Sacred Aging” project, shared a number of beautiful contemporary rituals developed to address situations unimaginable to our ancestors – moving into an assisted living facility, receiving a devastating diagnosis, disposing of fertilized embryos (jewishsacredaging.com).

On the second day of the conference, it was Rabbi David Teutsch who challenged the relatively dispassionate tone of the conversation with a heartfelt and heart-wrenching description of this mother’s suffering through the diminution of her capacities into her 90s. He noted that she “experiences her growing incompetence as an intolerable burden.” Rabbi Teutsch argued for the acceptance of some form of assisted suicide as morally appropriate within the context of appropriate legislation.

A panel of practicing physicians cautioned about when the right to die might become pressure to die, especially within certain demographics such as the poor, the elderly and the psychologically vulnerable. Physicians spoke passionately about the critical role of religion in alleviating isolation and the vital role of spirituality in psychological well-being. “Loneliness,” noted Dr. Judith Engelman, “is toxic.”

Fundamentally, the Judaism, Science, and Medicine Group challenges us to think about: What does our tradition say? What does that mean? What does it mean today? What values underlie this teaching? How can these values inform our decision-making? The keynote speaker, Rabbi Elliot Dorff, noted the critical role of rabbis in lending moral support to those making hard decisions at the end of life. The message to Jewish leaders is that if Judaism is to continue to be relevant in the lives of Jews, then we must be able to say something profound, meaningful and helpful, ideally as part of an ongoing conversation and not in the emotional environment of a hospital room at the end of life.

How fortunate we are to have this resource at ASU to encourage depth of thinking about an issue that becomes more critical every day.

Rabbi Bonnie Koppell is a spiritual leader at Temple Chai, and a U.S. Army Reserve chaplain.