Sermon given October 18, 1996, by Rabbi Barry H. Block
My wife has no desire to be a rabbi. Toni is a psychiatrist. She has never attempted to officiate at a wedding, deliver a sermon, or teach a Torah study class. I, on the other hand, have frequently attempted to practice all kinds of medicine. I often share my diagnoses with Toni, occasionally suggesting treatments and speculating at prognoses. Toni promptly reminds me that I am not a physician. Toni is a Board Certified psychiatrist. I, on the other hand, am a Board Certified pop-psychiatrist, not to mention the “pop” varieties of many other specialties.
I offer this credential as a disclaimer tonight, because I want to talk about assisted suicide in all of its aspects, medical as well as religious. We would rightly reject a medical perspective that fails to account for the moral dimension in matters of life and death. Similarly, we must be wary of any religious pronouncement that disregards the realities of modern medicine. So tonight, I come before you as both an expert and a dilettante, as a rabbi who has studied the teachings of our tradition, and as a lay person who has made a serious attempt to understand the realities of medicine.
We Jews seek guidance from the ancient books of our faith. The problem is, of course, that ancient medicine was very different from our own. Nevertheless, two stories may prove instructive.
The end of King Saul’s life is a sad tale. The first King of Israel has become estranged from his protégé David, and distant from his own son, Jonathan. He is besieged by enemies all around him. In his final battle, Saul faces certain defeat. In his despair, he makes an unsuccessful attempt to commit suicide by falling on his sword. Suffering in terrible agony, Saul asks a nearby soldier to slay him. The soldier finishes the job, assisting in Saul’s suicide, if you will. When King David learns what the soldier has done, David executes him for the murder of King Saul.
The Talmud tells us that the Romans were burning Hanina ben Teradion at the stake, wrapped in a Torah scroll. His crime: teaching the Torah to his fellow Jews. The executioner takes tufts of wool, soaked in water, and places them over Rabbi Hanina’s heart, so that he might suffer a painful and prolonged death. The rabbi’s disciples, standing nearby, urge their teacher to take deep breaths, hoping that the fire will enter his lungs and kill him more quickly. The rabbi refuses. To do this, he says, would be suicide. Matters of life and death must remain in the hands of God. At that moment, the executioner experiences a sudden conversion. He offers to remove the wet tufts of wool, whose function is only to prolong the rabbi’s death. Rabbi Hanina permits the executioner to do so, and he dies without further suffering.
The Shulhan Aruch, a code of Jewish law written in the sixteenth century, articulates an ordinance very much in keeping with these stories. No action may be taken for the purpose of hastening death. The soldier who slew King Saul, for example, was beyond the law. However, if there is some artificial impediment to death, one may remove it, and allow the person to die. In other words, Rabbi Hanina’s executioner was justified in removing the wet tufts of wool.
To be sure, these stories don’t seem to be much like our modern situations. Moreover, the law in the Shulhan Aruch assumes that there is a clear difference between actions which hasten death and others which merely remove an impediment to it. In today’s world, these distinctions are less clear.
Physician-assisted suicide, though, is not in the gray area, and the stories of our tradition are instructive. When a doctor prescribes a dramatically large dosage of painkillers for the purpose of suicide, she is like the soldier who slays King Saul. She is clearly taking an action which hastens death. When a physician sets up a machine to dispense lethal gases to a person who flips the correct switch, he is not at all like Rabbi Hanina’s executioner, who merely removes an impediment to death. Such acts might have been declared legal by the decisions of two different federal appeals courts. They may be permitted by the law of the land. They are not permitted by Judaism. They are against the law of God.
Let us examine the arguments on the other side. Some charge that modern medicine has created a monster. People are kept alive and forced to suffer, long past the day when they could realistically have hoped for a cure. Compassion, we are told, is the key. If we truly care about the person who is in pain, if our concern is for the one who is facing certain death, we will permit that person to decide the hour of his or her death, and we should allow that person’s own doctor to help.
Not long ago, a surgeon told me a joke that was circulating among physicians. The joke is about oncologists, physicians who treat people with cancer. On the surface, the joke seems to bolster the argument that patients are forced to suffer for too long. The joke, which really isn’t so much funny as poignant, is this: “Why are there nails in coffins? So that the oncologists can’t get in.” The implication is that oncologists never stop trying to cure cancer, even to the hour of death.
One of the realities of modern medicine is that people who suffer from various diseases, including a wide variety of cancers and even AIDS, are staying alive and reasonably healthy and productive for longer. Often, a physician can not know the prognosis of a patient with a certain illness who is receiving a specific treatment. The drug is experimental; the studies are not complete. Oncologists, in particular, tend to be on the cutting edge of such developments. That they keep trying to cure the patient is laudable. That they remain hopeful is praiseworthy. They are not medical monsters but giants of hope. The little joke about them reflects a reputation of which oncologists may rightly be proud.
Oncologists, though, have a very specific job. They seek to treat and hopefully cure cancer. Left unchecked, modern medical advances in oncology could indeed lead to greater suffering among patients who still have some hope for a cure, but who will more likely die. For that reason, we must applaud and encourage the development of palliative care, treatment which seeks not to cure, but to ease pain.
Palliative care is an area of medicine which has seen rapid advance in recent years. I am pleased to note that a fellowship training program in palliative care is now being established in the Family Practice Department at our University of Texas Health Science Center at San Antonio. Specialists in palliative medicine have repeatedly assured me of their advances: With proper care, dieing patients no longer must suffer physical pain.
I can attest to the truth of that statement. Time and again, I have seen patients experiencing terrible pain while their disease was being treated. And yet, those same patients were freed of pain as soon as they went into hospice care, where they received palliative treatment. Hospice care works. It is true that the medications used to alleviate pain may, in some instances, hasten death. However, the intent is clear. Physical comfort, not immediate death, is the goal. Palliative medicine is not euthanasia or physician-assisted suicide.
My prayer is that the near future will bring at least one more modern medical advance in this area. I hope that the physicians who seek to cure life-threatening diseases will develop a closer collaboration with palliative care physicians. I have often wondered why true pain relief has to wait for hospice, and whether palliative care couldn’t go hand-in-hand with potentially curative treatment. The answer I have received from some oncologists is that they simply don’t know much about palliative care. That isn’t their specialty. Bringing palliative concerns into the patient’s life sooner will, no doubt, reduce the demand for physician-assisted suicide.
Physical distress is not the only kind of pain associated with life-threatening illness and other debilitating conditions. Many patients understandably become depressed. In fact, experts believe that the overwhelming majority of those who seek physician-assisted suicide are, in fact, clinically depressed. One could view this suffering as another of the monsters allegedly created by modern medicine. Instead, we should look at depression as one more condition which physicians can combat with ever-increasing effectiveness. More often than not, the patient who seeks a physician’s assistance in committing suicide really needs a good psychiatrist. With the right combination of medication and therapy, the anguish of depression, like physical pain, can almost always be alleviated.
A final argument made by those who favor physician-assisted comes in the form of a rhetorical question: “Whose life is it anyway?” The presumed answer to that question is that each of us is the ultimate master of our own lives, and that we are therefore free to dispense with our lives as we see fit. The logical extension, apparently, is that we should be permitted to engage professional assistance to execute our will.
Judaism disagrees. We learn that God, the Source of our lives, is life’s ultimate owner. Life is our most precious gift. Judaism teaches that, when we die, the Shema should be the last words on our lips. Even at that moment, as we lose our hold on life, on all that we hold dear, we affirm our faith in God. We acknowledge that no human being is or ought to be ultimately in control of matters of life and death.
We are permitted to remove impediments to God’s final decree. We must seek to provide comfort for the dieing, and alleviate suffering, even if an unintended result is a slightly sooner death. But we are forbidden from taking God’s power into our own hands. Only God may decree the hour of our death, and our entrance to life everlasting.