By Louis E. Newman
MUCH HAS BEEN WRITTEN about end-of-life issues from a Jewish perspective. Typically such accounts offer a series of broad principles that, it is claimed, derive from Jewish sources and determine appropriate medical treatments when caring for terminally ill patients. Those principles include: that all human life is infinitely precious and sacred; that quality-of-life considerations do not count in decisions about end-of-life treatment; that our bodies belong to God and hence personal autonomy is not a Jewish value; and that, when death is imminent, we are permitted to refrain from taking extraordinary measures to prolong it. Those principles are so frequently reiterated (see “Halakhic Considerations in End-of-Life Decisions,” Julian Jakobovits, Sh’ma, January 2004) that one might assume they are simply unimpeachable. But such an assumption would be mistaken.
It is no doubt true that these and similar principles can be derived from classical sources dealing with medical care for the dying (as well as other frequently cited sources about praying for the dying, and the famous story of Hanina ben Tradyon’s martyrdom). But discriminating readers of these texts also know that none of these sources provide clear and unambiguous directives applicable to the complex medical environment in which we today make such decisions. Consider the following:
- Some classical sources can be interpreted to support the view that the preservation of life is not the highest value, since it is sometimes permissible to take one’s own life.
- The tradition offers few broad principles on such matters; indeed, most principles are extrapolations from a series of specific halakhic rulings and midrashic statements. Deriving general principles from specific cases is always a matter of interpretation and, therefore, subject to disagreement among scholars.
- The current state of medical technology makes available forms of treatment unimaginable to our ancestors. It is not self-evident that they would have approached end-of-life treatment as they did if they had had at their disposal respirators, artificial and transplanted organs, life-sustaining drugs, and other advanced medical treatments we now take for granted.
- The traditional sources derive from a time when personal autonomy was not valued as it is today. Just as the rights of women (and the rights of men to have more than one wife) changed over time in response to changing social circumstances and cultural practices, end-of-life decisions might also need to be altered in relation to our social-cultural milieu.
Taking these factors into account would not necessarily lead to specific conclusions, either “conservative” or “liberal.” The point is that “the Jewish view” should emerge from a critical and nuanced interpretation of the sources in historical context.
The guidance that our tradition offers us on end-of-life treatment (as on all moral questions) is neither as simple nor as straightforward as some would have us believe. The classical texts themselves are rarely univocal, and frequently the reasoning behind a particular ruling is either absent or ambiguous. Moreover, religious traditions evolve in response to scientific knowledge, technological advances, cultural trends, intellectual currents, and new interpretations of received texts. The task of contemporary Jewish ethicists, as I understand it, is not merely to report what classical texts say about an issue. Rather they must weigh, interpret, elucidate, and contextualize what the sources say. In short, they are creators, not merely conveyers, of the tradition.
Jewish ethics must grow out of an encounter with traditional texts. But that encounter must begin by acknowledging the ambiguity of the texts and the complexity of applying them to unprecedented situations.
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