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Jewish Bioethics and End-Of-Life Issues sb_06_2009_3:Layout 1 17/05/2011 8.24 Pagina 22 Jewish Bioethics and articolo End-of-Life Issues David Heyd his paper is divided into three parts: morally entail. In the field of the end of life, first, some general philosophical the second half of the twentieth century Tcomments on the subject of death gave rise to the new definition of brain and dying in bioethics; secondly, a review of death, to the novel techniques of organ some of the main attitudes of the Jewish tra- transplantation, and to an unprecedented dition to euthanasia; and thirdly, a look at power of medicine to extend life for a very some recent cases in the formation of norms long time (sometimes in a way which looks regarding the end of life in the Israeli legal “artificial” or futile). system, particularly the struggle to find a Although abortion and euthanasia have al- Chaim Perelman Professor of Philosophy, middle ground in the conflict between the ways been ethical issues and subjected to The Hebrew University of principle of the sanctity of life and the prin- normative regulation (both ethical and legal), Jerusalem ciple of autonomy. the particular problem of the exact timing of the beginning and end of life has had only I. marginal import. There were indeed debates about the status of the fetus as there were de- The symmetry between the bioethical prin- bates about the status of the dying person. ciples regarding the beginning of life and But nowadays, crucial ethical issues surround those concerning the end of life is both of the subtleties of the manner in which the philosophical and theological meaning. Both moment of coming into existence and pass- fields in modern medical ethics have devel- ing away is fixed. Thus, for example, is the oped along each other at the same time, very early embryo, three days after concep- namely in the course of the 1950’s and tion, a person protected from intervention 1960’s. The fierce debate about the ethics of for research purposes or for selection in an abortion and the legitimacy of euthanasia IVF procedure. Similarly, in the end-of-life ran parallel, raising the same issue of the na- context, is a brain dead but still breathing ture of life and the role of human autonomy person dead or alive and hence eligible or in deciding its beginning and its end. But ineligible to donate organs. later on the debate expanded from the tra- So far for the general changes in philosoph- ditional questions of abortion and euthana- ical discussions of the symmetrical problems sia to completely new issues that were raised in the beginning and the end of life. But the by the tremendous development in medical underlying assumption common to both is technologies. In the field of the beginning of that life and death are a given in the sense that life, decisions had to be made regarding pre- we have no control over them. Theologically, mature babies born very early and hence this is captured well in the famous Jewish with dubious life prospects, IVF technology, saying from the Tractate Avot (first and sec- surrogate motherhood, genetic screening, ond centuries A.D.) that man is born and PGD tests, cloning and stem cell research. All dies by necessity. these gave rise to the philosophical question «……for you were created against your will, of when life begins and what does that and you were born against your will, you live Studia Bioethica - vol. 2 (2009) n. 3 , pp. 22-28 22 sb_06_2009_3:Layout 1 17/05/2011 8.24 Pagina 23 against your will, and you will die against kind than ordinary preferences one makes your will…»1. within one’s life. For how can we compare I understand this as claiming that human be- the value of a certain kind of life with the ings have control of much of their life and value of the condition for any kind of life? hence are accountable and responsible for This raises the most difficult issue of the the way their lives go. But the very fact of morality of suicide which although belong- their coming into existence and that of ceas- ing to the end of life will not be dealt here. ing to live is beyond their power and hence It becomes relevant only when we deal with not a matter of choice. From a religious so-called “voluntary eu- point of view this means, of course, that life thanasia”, which is a sub- is not “owned” by human beings, that it is a species of suicide. But it The underlying assum- divine gift (even if some Jewish commenta- should be noticed that sui- ption common to both is tors in that text argue that necessity means cide which is mentioned a that life and death are a that it is not really a gift and that man would few times in the Old Testa- prefer not being born than being born). This ment (King Saul being the given in the sense that we sets the deep philosophical debate about the most famous case) is not have no control over them end of life. For here, the symmetry between condemned or prohibited the beginning of life and its end terminates. by Scriptures. Nor is it, by the way, con- We have indeed no control over our birth, demned as such in Judas’ death in the New but we do have some control over its end. Testament. It is only in later development of Death is inevitable, but its timing is not. Al- Jewish thought, probably under Christian though we cannot have any say about com- (Augustinian) influence, that suicide be- ing into life, once we are alive we do have at comes a grave sin. least the power to put an end to it or decide on the way we want to die. II. This is the logical or metaphysical back- ground to the big methodological debate “The Lord gave and the Lord has taken about the ethics of euthanasia. From the away-blessed be the name of the Lord”. This theological point of view, life is not only a phrase, originally from the book of Job (1, gift of God but also a holy gift. This is the 21) and recited by Jews in the face of death, principle of the sanctity of life, life being represents the fundamental attitude to death viewed as a good beyond all goods, a condi- and its inevitability. It gives absolute sover- tion which should not be violated even in eignty to God in the decision and timing of the face of suffering or despair. To put it in the birth and death of human beings. The more philosophical terms, life is the under- tone of the phrase is resigning, even fatalis- lying condition of all value since without it tic, but as we shall see it does not mean hu- nothing valuable can be achieved. On the man passivity. Indeed, till medieval times, other hand, from the human point of view, medical intervention was regarded as a sus- life itself is a condition which even if it can- picious human intervention in natural (or not be created by will (of the subject living divinely determined) processes and at most this life), it can be terminated at will. The treated as permissible (primarily meaning challenge for that attitude, which views the that the doctor is immune from blame if his value of human life as a matter of will, is that treatment does not succeed). Nachmanides it is hard to articulate any rational standards (13th century) is a good example for an am- in the light of which a person can say that no bivalent attitude to medical treatment which life is better than a life with certain quality. is an attempt to interfere with divine prov- Even if autonomy is the governing principle, idence by employing natural causes. It is at that is to say, it is legitimate for people to find most a tolerated practice. But Maimonides death superior to ongoing life, the reasons (and all major Jewish attitude to medicine for such a preference must be of a different ever since) is decisive in the positive view of 23 sb_06_2009_3:Layout 1 17/05/2011 8.24 Pagina 24 healing and sees no contradiction between remove salt from the dying man’s tongue, science and providence, between human in- since salt is a hindrance in the natural process tervention in the world and divine design2. of dying. The logic of this permission or Medical effort to restore health and to ex- even obligation is according to a famous tend life has become a direct duty, both for 16th century thinker, Rabbi Moshe Isserles physicians and for their patients. Theologi- that in the same way as stopping the source cally, medical treatment should be applied of noise as well as the removal of salt are even when the illness itself is considered as both are just forms of letting the natural inflicted by God. Human beings must do process take its course. But of course, for- their utmost to further life as long as possi- mally speaking they are “actions” rather than ble, either by not risking their own lives or omissions. This is directly relevant to the by administering the best medical treatment current debate about the question whether possible to extend life’s duration. In more there is a moral difference between not con- philosophical terms, although life is a natu- necting a patient to a respiratory in the first ral, universal and inevitable process, human place (starting chopping wood in order to intervention to delay it is a moral imperative.
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