Brazen New World
Asked by The New York Times in 2005 what today-taken-for-granted idea or value he thinks may disappear in the next 35 years, Professor Peter Singer, the Professor of Bioethics at Princeton University’s Center for Human Values, responded: “the traditional view of the sanctity of human life.” It will, he explained, “collapse under pressure from scientific, technological and demographic developments.”
This past January 30, the College of Physicians and Surgeons of Manitoba, Canada issued a policy statement that may come to permit the professor to add “prophet” to his curriculum vitae.
In that document, the governing body of the Canadian province’s medical profession directs that doctors have the final say with regard to ending life-sustaining treatment of patients – regardless of the wishes or religious beliefs of the patients or their families. It also establishes a baseline for justifying life-sustaining treatment – including a patient’s ability to “experience his/her own existence” – below which a doctor is directed to end life-sustaining treatment, regardless of the wishes of the patient’s family. The new policy paper has garnered much attention, and may well have ramifications throughout Canada and, conceivably, elsewhere.
Underlying the document – saturating it, actually – is the premise that ending a human life is a medical decision, not a moral one. Or, alternately, that medical training somehow confers the ultimate moral authority to pass judgments on the worthiness of human lives.
Either contention is offensive. A foundation of what has come to be called civilization is that people are not mere things or even animals, that human life has a special, sacred, nature. Historically, the right to take steps to end a life has been regarded first and foremost as an ethical issue, not a medical one. And doctors, for all their training, are no more inherently qualified to address ethical issues than CEOs or plumbers.
As it happens, the Manitoba policy goes beyond the ethical dumbing down of life and death decision-making. It actually betrays a preference for ending patients’ lives. For while it gives physicians the final say (even against the family’s wishes) for terminating life support, it puts the final decision (literally) in the family’s hand when the family feels the patient should die and it is the doctor who feels otherwise. In Manitoba medicine, it seems, death is the desideratum.
That contention is further evident in the Manitoba policy statement’s self-awareness baseline, which exemplifies the pitfalls of what might be called iatro-arrogance – or, put more prosaically, medical chutzpah.
Last year, the prestigious journal Science published a report on a young woman who was declared vegetative. For five months, she showed no signs of awareness whatsoever. Scientists, though, decided to put her in a Functional Magnetic Resonance Imaging scanner, a machine that tracks blood flow to different parts of the brain and that was only developed a few years ago. When they asked her to imagine things like playing tennis and walking through her home, the scan lit up with telltale patterns of language, movement and navigation indistinguishable from those produced by the brains of healthy, conscious people. The report’s authors, while stressing that the patient may still be classified as “unconscious,” conclude nonetheless that she has a “rich mental life.”
That young woman seemed entirely unaware of her environment. Only the development of a new diagnostic technology revealed active brain function. Is it unreasonable to wonder what future technologies might yet be developed that will detect other layers of human consciousness? Or what layers might forever elude scientific instrumentation?
And then there is the misguided assumption of medical infallibility. In Calgary last year, doctors were ready to pull the plug on Zongwu Jin, who had suffered a brain injury. After his family obtained a court order to maintain life support, Mr. Jin’s condition improved markedly and he is now doing exercises aimed at helping him walk again.
More recently, doctors at Manitoba’s own Grace Memorial Hospital sought to disconnect Samuel Golubchuk from the ventilator that was helping him breathe, claiming that he was unconscious and unresponsive – presumably never to recover. Mr. Golubchuk’s children, Orthodox Jews whose religious convictions opposed terminating their father’s life, promptly sought and obtained a court injunction. The judge in that case recently announced that there were sufficient grounds to doubt the hospital’s analysis of the patient’s condition, and Mr. Golubchuk’s children report that he is now alert and making purposeful movements.
Neither those cases, nor scores of similar ones, seem to have given the Manitoba College of Physicians pause before arrogating to doctors the final say in matters of life and death. One thing is certain: In the wake of Manitoba medicine’s new rules, physicians in that province will in the future be spared such embarrassing outcomes. Dead patients tell no tales.
Elephants sometimes do, though, albeit silently. Like the imposing one that lurked in the room where the Manitoba medical group crafted their new policy statement. It was the pachyderm that answers to the name of Professor Singer’s polite phrase: “demographic developments.”
We live in times when the elderly and diseased are rapidly increasing in number, and where the medical profession has made great strides, increasing longevity and providing cures for many once-fatal illnesses. Add skyrocketing insurance costs and the resultant fiscal crisis in health care, and life runs the risk of becoming less a holy, invaluable divine gift than… a commodity.
And every businessman knows how important it is to efficiently turn over one’s stock, clearing out the old to make way for the new. Apparently, doctors can learn that lesson too.
Making things worse still is the great and increasing demand for transplantable organs. A doctor in California currently stands charged with injecting an incapacitated patient with inappropriate medications in order to harvest his organs more quickly. No one knows how often similar things happen – or will happen if society becomes accustomed to allowing doctors to decide when a life is no longer worth living.
What does Judaism have to say about all this? Far more than can be summarized in a paragraph or two, to be sure, but certain guiding principles can be briefly stated: Jewish religious law, or halacha, does not always insist that life be maintained; in some cases of seriously ill patients, Judaism forbids intercessions that will prolong suffering. But the active removal of connected life-support systems or withholding of nourishment are another matter entirely. Halacha requires that death be clearly established, and does not permit any action that might hasten the demise of a person in extremis.
Put succinctly: Judaism considers life precious, indeed holy, even when its “quality” is severely diminished.
Quite a different approach from that of the Manitoba College of Physicians and Surgeons. Or from Professor Singer, who has supported the termination of what he calls “miserable beings” – people whose lives he deems devoid of pleasure.
And even as grise an eminence as The New York Times has euphemistically advocated “more humane policies for easing the last days of the terminally ill” – leaving the rubbery phrases “humane policies,” “last days” and even “terminally ill” for future clarification.
That may well be, as Professor Singer suggests, the wave of the future. But Judaism was born out of resistance against wrong. Abraham’s rejection of paganism was what merited his becoming the forefather of the Jewish people; he was willing, in the words of the Midrash, “to be on one side of the river, while the rest of the world was on the other.”
And so, Judaism today finds itself similarly standing opposite a world going mad. Amid the shouts of “Progress!”, “Science!” and “Fiscal Responsibility!”, Jews who care about their religious tradition must quietly, resolutely, stand the Jewish ground, and say: “No. Even a moment of human life is invaluable.”
© 2008 AM ECHAD RESOURCES
[Rabbi Shafran is director of public affairs for Agudath Israel of America.]
The problem is that the modern training of medicine in the university setting is, like all other parts of the current liberal arts university setting, either coldly scientific (the clinical subjects like physiology, cardiology, etc.) or completely secular humanistic (the subjects like medical ethics, end-of-life, etc).
As a resident, I participated in a seminar on palliative care and the subject of passive euthanasia – not treating a patient who is terminally ill but just letting him pass away – came up. The instructor asked some others what their opinions were and the usual lines like “Well, if he’s suffering so much, what is his life worth?” or “I wouldn’t feel right prolonging his pain.” When she got to me, I answered simply: “Every moment of life has infinite value. If I, through omission or comission, shorten a person’s life, how is that different from murder?”
Naturally, I was immediately labelled “extreme”.
It’s interesting that Rav Shafran would choose Peter Singer as his “prophet”. Prof Singer is well known in the medical community for his lack of appreciation for the sanctity of life and his strong utilitarian views. What is less well understood is that the average medical student that does not come from a defined ethical background (be it Jewish or otherwise) receives much guidance in the secular humanistic viewpoint that suffering is unacceptable and trumps the right to live. Euthanasia, passive or active, abortion, are all judged by their convenience to the person. The thought of answering to a Higher Power, that our bodies and lives might not just be ours to do with as we please is not one that is taught to them. Infringed on autonomy, you see.
I wonder if the good Rabbi can bring us up to date on the current medical conditions of the unnamed seemingly comatose woman, Zongwu Jin and Mr. Golubchuk. (“Alert” and “making purposeful movements” are pretty vague. Has communication been established? Has any impartial observer seen the purposeful movements? Family members have been known to see what they wish to see. Not that it happened here of course.)
Sometimes the threat to the sanctity of life can come from from within religion, as we are seeing in the middle east.
Even within Judaism, the overemphasis and overapplication and overteaching of the concept of “be killed and not violate certain prohibitions” (ye’hareg v’al ya’avor) can lead to the cheapening of human life. While we do have this concept, situations where it is applicable are very rare. Furthermore we are obligated to anticipate such threats, and if necessary move away from locations that will lead to ye’hareg v’al ya’avor situations. When teaching about the prohibitions relating to sexual immorality, the harm that can be caused to others should be emphasized first and formost and only afterwards the ye’hareg v’al ya’avor aspect. Judaism teches that any sexual exploitation is a form of murder.
The other way life can be cheapened is thru “leader worship” which can negate the value of the life of non-leaders in the pusuit of creating new leaders. A famous quote from the Michtav (letters from) Eliyahu (by Rabbi EE Dessler) when taken out of context can lead to such thinking. Perhaps not every private letter written by our Torah leaders of previous generations should be published in books for wide distribution.
But the active removal of connected life-support systems or withholding of nourishment are another matter entirely. Halacha requires that death be clearly established, and does not permit any action that might hasten the demise of a person in extremis.
Does this change when there is a shortage of life-support systems and the doctors have to choose between saving patient A who has been connected to life support for ten months and patient B who just arrived in the ER and seems to have a higher chance of recovery?
If the College of Physicians and Surgeons of Manitoba was honest, they would clearly state that Canadian society can choose between higher taxes and a lower level of medical services. But that would put the current system of socialized compulsory healthcare into question. Canadians might start lobbying for the law to change to allow medical services to be sold in a market again instead of requiring everything to go through the government system.
I think articles like this present an overly-cynical view of secular ethics and of the medical profession. Clearly, the secular view is very different than the Torah view, but most doctors and family members are not trying to murder patients to save the government (or themselves) money. The real point of the issue is whether life in a vegetative or severely demented state is worth prolonging (both worth it to the patient and worth the cost to society). The Torah says it is, but the secular world (in general) thinks it isn’t.
As end of life medical treatments become even more sophisticated, more invasive, and possibly more painful, the Poskim will have to continue to assess the issue of prolonging life in the face of terminal and incurable illness when these treatments increase the pain and suffering of the patient.
Avi Shafran wrote:
“Making things worse still is the great and increasing demand for transplantable organs. A doctor in California currently stands charged with injecting an incapacitated patient with inappropriate medications in order to harvest his organs more quickly. No one knows how often similar things happen – or will happen if society becomes accustomed to allowing doctors to decide when a life is no longer worth living.”
This is a red herring. In the vast majority of cases, patients who have been on life support for extended amounts of time or who are seriously ill for any reason are not eligible to be organ donors.
“Jewish religious law, or halacha, does not always insist that life be maintained; in some cases of seriously ill patients, Judaism forbids intercessions that will prolong suffering. But the active removal of connected life-support systems or withholding of nourishment are another matter entirely.”
That’s true, hence the need for more public education about the halachic acceptability of DNR orders and the like.