SHALOM 49 - Ethics and Judaism

When G.'s kidneys finally failed, he was ninety five years old, and had already suffered multiple strokes. At that stage he was already comatose, probably never to regain consciousness. The only way to counter the imminent threat to his life, posed by the renal failure, was to put him on blood dialysis. This treatment was not supposed to help him recover to any semblance of health, but was intended to prolong his life in his comatose state. The hospital put the question to the family, should the fight for G.'s life continue using all available means, ignoring possible adverse side effects, and the hopelessness of the situation.

In Maimonides' code the laws of saving the life a human being go hand in hand with the laws of murder. The portion of the code handling these laws is called "The Laws of a Murderer and the Preservation of Life". In the first chapter of this portion (par. 14) Maimonides rules "whoever is able to save a life and did not do so transgresses the Biblical Commandment 'You shall not stand by the blood of your fellow man' (Lev. XIX, 16)". He rules further (par. 16) "Even though the transgression of these commandments is not punishable by flogging, because these are passive commandments, these are indeed severe ones; because whoever destroys a single soul of Israel is as guilty as though he had destroyed the entire world, and whoever preserves a single soul of Israel is merited as though he had preserved the entire world."

This last ruling indicates that abstaining from saving life is tantamount to passive murder, which is as severe – in principle if not in actual punishment – to active murder. Murder is an absolute criminal offence, and has no justification. It is forbidden even in order to save life: "One came before Raba and said to him ‘The governor of my town has ordered me, "Go and kill so and so; if not, I will put you to death"’. He answered him, ‘Let him rather put you to death than that you should commit murder; who knows that your blood is redder? Perhaps his blood is redder.’" (Sanhedrin 74, a). The only exception to this rule is the permission to kill a person who is about to murder someone else. It should follow that, similarly, the obligation to save life is also absolute, and there is no justification to abstaining from doing so. Also, Maimonides rules (Laws of Shabbat II, 18) that the laws of Shabbat should be violated even in order to prolong life, when saving this life is not possible. Hence, prolonging life, which is equivalent to saving life, is an absolute obligation and should be attempted in all circumstances.

An indication to the severity of murder is the Commandment to perform a ceremony in which a heifer's neck is being stricken off, when a corpse of a murder victim is found, and the perpetrator is unknown: "…the city which is nearest to the slain man, the elders of that city shall take a heifer, which has not been worked with, and which has not pulled in the yoke; And the elders of that city shall bring down the heifer to a rough ravine, which is neither plowed nor sown, and shall strike off the heifer’s neck there in the ravine" (Deut. XXI, 3-4). The Sages interpret this commandment "why does the Torah mention that he should bring a heifer into a ravine? … Let something which did not produce fruit have its neck broken in a place which is not fertile and atone for one who was not allowed to produce fruit" (Sota 46, a). Each human being has a unique mission to perform in G-d's service in his lifetime, and murder is a terrible deprivation of the victim's ability to complete his task. Job is quoted saying: "Has not a man a service upon earth? Are not his days like the days of a hireling?" (VII, 1) thus each and every moment of Man's life is invaluable.

This attitude is brought forth in a famous story of the martyrdom of Rabbi Hanina ben Tradion (Avoda Zara 18, a): "R. Hanina b. Teradion was found sitting and occupying himself with the Torah, publicly gathering assemblies, and keeping a scroll of the Torah in his bosom. Straightaway they took hold of him, wrapt him in the Scroll of the Torah, placed bundles of branches round him and set them on fire. They then brought tufts of wool, which they had soaked in water, and placed them over his heart, so that he should not expire quickly. His disciples called out, ‘Rabbi, what seest thou?’ He answered them, ‘The parchments are being burnt but the letters are soaring on high.’ ‘Open then thy mouth’ [said they] ‘so that the fire enter into thee.’ He replied, ‘Let Him who gave me [my soul] take it away, but no one should injure oneself.’"

Hence, even though his fate was sealed and he was suffering terrible pain, he refused to hasten his death. The decision to end life, even to shorten it by few moments is G=-d' alone, as He gives life and is aware of the real mission of Man, and whether it was completed.

However, the story does not end here: "The Executioner then said to him, ‘Rabbi, if I raise the flame and take away the tufts of wool from over thy heart, will thou cause me to enter into the life to come?’ ‘Yes,’ he replied. ‘Then swear unto me’ [he urged]. He swore unto him. He thereupon raised the flame and removed the tufts of wool from over his heart, and his soul departed speedily. The Executioner then jumped and threw himself into the fire. A voice from Heaven exclaimed: R. Hanina b. Teradion and the Executioner have been assigned to the world to come."

What caused the change in Rabbi Hanina's attitude to allow the executioner to actively hasten his demise? It seems that he interpreted the revelation he had of Torah scroll whose parchment is being burnt and the letters soar back to Heaven, as relating to himself – he was that Torah scroll, and his mission was complete. However, he refused to act upon this revelation until it was coupled by the executioner's offer. This offer convinced Rabbi Hanina that indeed he had no further duty to perform in this world, thus hastening his departure is not really murder.

Of course, such a decision requires a revelation from Heaven, which was unique to Rabbi Hanina and cannot be duplicated in real life situations. However, an actual deduction can be made from the moral of the story, regarding not an issue of an active act of hastening one's death, but the abstaining from taking extraordinary measures to prolong life of misery, that seem to have reached its end.

It seems that since prolonging such life is an active step, rather than allowing matters to take their own course, the people who are responsible for deciding on taking these measures are required to consider whether the patient's life had not really reached its end, because of his condition, and prolonging this life is no longer an absolute obligation. Once it is deduced that there is no absolute obligation to prolong such a patient's life, the extraordinary measures to do so should be taken only if they benefit the patient by reducing his pain. Otherwise Man's interference is not called for.

Hence, it seems that there is no obligation, and therefore no reason, to start blood dialysis on G. Treatment should be limited to alleviating discomfort in the last moments of his life.

Time to Desist
By Rabbi Shabtai A. Rappoport
When G.'s kidneys finally failed, he was ninety five years old, and had already suffered multiple strokes. At that stage he was already comatose, probably never to regain consciousness. The only way to counter the imminent threat to his life, posed by the renal failure, was to put him on blood dialysis. This treatment was not supposed to help him recover to any semblance of health, but was intended to prolong his life in his comatose state. The hospital put the question to the family, should the fight for G.'s life continue using all available means, ignoring possible adverse side effects, and the hopelessness of the situation. In Maimonides' code the laws of saving the life a human being go hand in hand with the laws of murder. The portion of the code handling these laws is called "The Laws of a Murderer and the Preservation of Life". In the first chapter of this portion (par. 14) Maimonides rules "whoever is able to save a life and did not do so transgresses the Biblical Commandment 'You shall not stand by the blood of your fellow man' (Lev. XIX, 16)". He rules further (par. 16) "Even though the transgression of these commandments is not punishable by flogging, because these are passive commandments, these are indeed severe ones; because whoever destroys a single soul of Israel is as guilty as though he had destroyed the entire world, and whoever preserves a single soul of Israel is merited as though he had preserved the entire world." This last ruling indicates that abstaining from saving life is tantamount to passive murder, which is as severe – in principle if not in actual punishment – to active murder. Murder is an absolute criminal offence, and has no justification. It is forbidden even in order to save life: "One came before Raba and said to him ‘The governor of my town has ordered me, "Go and kill so and so; if not, I will put you to death"’. He answered him, ‘Let him rather put you to death than that you should commit murder; who knows that your blood is redder? Perhaps his blood is redder.’" (Sanhedrin 74, a). The only exception to this rule is the permission to kill a person who is about to murder someone else. It should follow that, similarly, the obligation to save life is also absolute, and there is no justification to abstaining from doing so. Also, Maimonides rules (Laws of Shabbat II, 18) that the laws of Shabbat should be violated even in order to prolong life, when saving this life is not possible. Hence, prolonging life, which is equivalent to saving life, is an absolute obligation and should be attempted in all circumstances. An indication to the severity of murder is the Commandment to perform a ceremony in which a heifer's neck is being stricken off, when a corpse of a murder victim is found, and the perpetrator is unknown: "…the city which is nearest to the slain man, the elders of that city shall take a heifer, which has not been worked with, and which has not pulled in the yoke; And the elders of that city shall bring down the heifer to a rough ravine, which is neither plowed nor sown, and shall strike off the heifer’s neck there in the ravine" (Deut. XXI, 3-4). The Sages interpret this commandment "why does the Torah mention that he should bring a heifer into a ravine? … Let something which did not produce fruit have its neck broken in a place which is not fertile and atone for one who was not allowed to produce fruit" (Sota 46, a). Each human being has a unique mission to perform in G-d's service in his lifetime, and murder is a terrible deprivation of the victim's ability to complete his task. Job is quoted saying: "Has not a man a service upon earth? Are not his days like the days of a hireling?" (VII, 1) thus each and every moment of Man's life is invaluable. This attitude is brought forth in a famous story of the martyrdom of Rabbi Hanina ben Tradion (Avoda Zara 18, a): "R. Hanina b. Teradion was found sitting and occupying himself with the Torah, publicly gathering assemblies, and keeping a scroll of the Torah in his bosom. Straightaway they took hold of him, wrapt him in the Scroll of the Torah, placed bundles of branches round him and set them on fire. They then brought tufts of wool, which they had soaked in water, and placed them over his heart, so that he should not expire quickly. His disciples called out, ‘Rabbi, what seest thou?’ He answered them, ‘The parchments are being burnt but the letters are soaring on high.’ ‘Open then thy mouth’ [said they] ‘so that the fire enter into thee.’ He replied, ‘Let Him who gave me [my soul] take it away, but no one should injure oneself.’" Hence, even though his fate was sealed and he was suffering terrible pain, he refused to hasten his death. The decision to end life, even to shorten it by few moments is G=-d' alone, as He gives life and is aware of the real mission of Man, and whether it was completed. However, the story does not end here: "The Executioner then said to him, ‘Rabbi, if I raise the flame and take away the tufts of wool from over thy heart, will thou cause me to enter into the life to come?’ ‘Yes,’ he replied. ‘Then swear unto me’ [he urged]. He swore unto him. He thereupon raised the flame and removed the tufts of wool from over his heart, and his soul departed speedily. The Executioner then jumped and threw himself into the fire. A voice from Heaven exclaimed: R. Hanina b. Teradion and the Executioner have been assigned to the world to come." What caused the change in Rabbi Hanina's attitude to allow the executioner to actively hasten his demise? It seems that he interpreted the revelation he had of Torah scroll whose parchment is being burnt and the letters soar back to Heaven, as relating to himself – he was that Torah scroll, and his mission was complete. However, he refused to act upon this revelation until it was coupled by the executioner's offer. This offer convinced Rabbi Hanina that indeed he had no further duty to perform in this world, thus hastening his departure is not really murder. Of course, such a decision requires a revelation from Heaven, which was unique to Rabbi Hanina and cannot be duplicated in real life situations. However, an actual deduction can be made from the moral of the story, regarding not an issue of an active act of hastening one's death, but the abstaining from taking extraordinary measures to prolong life of misery, that seem to have reached its end. It seems that since prolonging such life is an active step, rather than allowing matters to take their own course, the people who are responsible for deciding on taking these measures are required to consider whether the patient's life had not really reached its end, because of his condition, and prolonging this life is no longer an absolute obligation. Once it is deduced that there is no absolute obligation to prolong such a patient's life, the extraordinary measures to do so should be taken only if they benefit the patient by reducing his pain. Otherwise Man's interference is not called for. Hence, it seems that there is no obligation, and therefore no reason, to start blood dialysis on G. Treatment should be limited to alleviating discomfort in the last moments of his life.