A 60-year-old Orthodox Jewish male became ill with pneumonia, requiring mechanical ventilation and cardiopulmonary resuscitation. As a result, he became severely brain damaged and remains in a vegetative state months later. The hospital concluded that further resuscitation attempts (if called for) would be futile and asked the family to sign a "do not resuscitate" order. The family refuses due to their feeling of obligation to preserve life regardless of outcome. Since there is no hope for recovery for this gentleman, is there any way that a choice not to resuscitate this gentleman could still respect his and his family's religious beliefs? What does Judaism say about such a situation?

It probably is not surprising that rabbis differ about what appropriate treatment of people in a vegetative state from a Jewish point ov view.  Not only is it commonly the case that rabbis differ, but in this kind of case we are now able to keep bodily functions going in ways that our parents could not even have imagined, let alone our ancestors, long after the person would have died without modern medical interventions.  This is one example of the Kantian problem that we face often in modern medical practice.  As Kant pointed out, when one cannot do something, one does not need to ask if one should; once one can do something, though, one does need to ask whether one should, for there are all kinds of things that people can do that they should not do (e.g., smoke, eat a half-gallon of ice cream every day, etc.).  The machines and tubes that keep a vegetative patient alive were not invented for that purpose; they were invented to keep a person alive for a few hours or possibly a day or two so that the person could successfully undergo surgery.  These interventions were not intended for long-term support, but now that we have them, we must ask when we should use them -- and when not.

 

Given that our ancestors could never have even contemplated a situation like this, let alone deal with it, any rabbi trying to apply the tradition will not find a case or precedent directly on point.  He must rather apply some of the principles of the tradition to this new case.  Yes, the tradition asks us to preserve life whenever we can, but it did not even imagine that we could do so for patients in a vegetative state, and one passage in the Talmud asserts that "we do not worry about the life of an hour" (l'hayyei sha'ah lo hashinan) -- that is, we do not seek to preserve life when it is clearly and irreversably ending.  Furthermore, Tosafot on Avodah Zarah 27b states that the underlying principle that we should use in judging these cases is the welfare of the patient.  Tosafot assumed, of course, that the patient's welfare was always in sustaining life as much as possible, but even if that was true in the 12th century, it probably is not true in ours.  So based on the principles that the Talmud and Tosafot announce, I have ruled that we may remove life support from a patient in a vegetative state after due examination to make sure that he or she is actually in such a state.  See Elliot N. Dorff, Matters of Life and Death: A Jewish Approach to Modern Medical Ethics (Philadelphia: Jewish Publication Society, 1998), pp. 213-217. 

 

Rabbi Elliot N. Dorff, Ph.D., Rector and Distinguished Professor of Philosophy, American Jewish University, and Chair, Committee on Jewish Law and Standards of the Rabbinical Assembly.

 There would be no reason in jewish law to oppose a DNR in this case

We are not required to call people back from heaven (as it were) particularly when they are this compromised

however if someone (and hopefully the family is reflecting this person's expressed desire) wants to continue to live even a very compromised life

no one has the right to take that life from them and no DNR order is appropriate

“Just as a man has a right to live, so there comes a time when he has a right to die.”

 

This is how Rabbi Solomon B. Freehof, then chairman of the Responsa Committee of the Central Conference of American Rabbis, interpreted the words of Sefer Chasidim, reflecting on the words of Kohelet, “there is a time to live and a time to die”: “If a man is dying, we do not pray too hard that his soul return and that he revive from the coma; he can at best live only a few days and in those days will endure great suffering; so ‘there is a time to die.’” Rabbi Freehof goes on to show that the Talmudic and post-Talmudic record permits us to remove that which hinders death, providing that in doing so we do not disturb the patient in a manner that may hasten death (e.g., B. Ketubot 104a, where the servant-woman of Rabbi Judah the Prince smashes a earthen jar as he lay dying in order to disturb the incessant prayers of his students, that his soul might peacefully depart; Shulchan Aruch, Yoreh De-a 339, which states that one may not remove a pillow from beneath the head of the dying patient but may stop someone from chopping wood outside when the rhythmic sound of wood-chopping “focuses the mind of the dying patient and prevents his soul from departing”).[1] 

 

In other words, “preventing that which delays the death” of one whose death is imminent is permitted.  Jewish law does not require us to preserve life regardless of outcome.[2]

 

My teacher Rabbi Mark Washofsky, current chair of our Responsa Committee, comments further on this issue. Treatments that no longer offer any hope of healing, he writes, treatments that might delay death but “can neither reverse nor halt the decline” of a patient, “are no longer considered medicine; the patient may refuse them.”[3]

 

While we have no absolute test for when a patient is terminal, for when death is imminent enough; or for when a treatment ceases to have any therapeutic effect; Jewish law clearly allows us to engage in these moral choices, uncertain as they may be.  As Rabbi Washofsky concludes in his discussion of Refusing Medical Treatment:

 

We do not make this choice arbitrarily; we do not think that all the alternatives are equally good or equally bad. We decide as carefully and as thoroughly as we can, weighing the information at our disposal and the circumstances of the case against the teachings of Jewish tradition as we understand them.  What emerges from this process, from the moral discussion or argument we conduct within our communities and within ourselves, is a decision that we can never be sure is absolutely “correct.” It is, however, the best we can do.  It is all we are expected to do. And it is most assuredly what we must do if we are to fulfill what is expected of us as religious Jews and moral beings.[4]

 

Submitted with prayers for the patient and his family, that they may all find strength and comfort in God’s healing embrace.