Health Care Proxies: The Judaic Limits

February 2000

By: Michelle L. Feinberg, Esq.
(Originally published Jewish Reporter)

A Health Care Proxy is one ingredient to a comprehensive estate plan. It is in this document that a person appoints another as his health care agent to make medical decisions for him in the event that he is incapable of speaking for himself. He gives guidance within the instrument to his health care agent by expressing his wishes pertaining to medical treatment if he were faced with a terminal illness. As an estate planning attorney, I have been asked by many clients what choices regarding medical treatments are consistent with Judaic precepts. In response, this article briefly outlines what options Judaism permits to a dying patient.

In most circumstances, Jewish medical law differs among the orthodox, conservative and reform sects. Orthodox Judaism mandates that even if the patient will live only a short time, one is required to do everything possible to save his life, even if he is in great pain. Although there is a split of authority in the Conservative movement, all agree that life is a gift from God, and its value is not measured by its usefulness or quality. Giving greater flexibility to the terminally ill patient, Reform Judaism states that the dying patient is entitled to choose to die, and differentiates hastening death from the cessation of efforts to delay it.

According to the American Reform Responsa of the Central Conference of American Rabbis (\"Reform Responsa\"), while one \"may not do any overt act to hasten death\", one may either refrain from doing that which prevents death, or remove the causes that delay death, such as intravenous feeding or hydrating tubes, so long as it is \"gentle enough so as not to disturb the patient.\" One may direct the physician not to refill the nutriment after the current dosage runs out.

As indicated by the Committee on Jewish Law and Standards Rabbinical Assembly in its publication of Jewish Medical Directives for Health Care, two differing positions emerge from the Conservative movement regarding a patient\'s right to refuse life-sustaining feeding tubes. The more liberal belief takes the position that since treatment that extends life without hope for cure does not benefit the patient, he may reject such treatment. An opposing view interprets the law to command that all hydration, nutrition and medication be provided if it will sustain life. Still, those medical interventions which only prolong the act of dying are not required, even by this stricter standard.

Although Orthodox Judaism does not permit the rejection of feeding tubes if they can save the life of the patient, it also forbids the use of artificial mechanical means to draw out the dying process. According to Rabbi Eliezer Yehuda Waldenberg\'s responsa texts entitled Tzitz Eliezer, (as compiled and edited by Avraham Steinberg, M.D., in Jewish Medical Law) if a patient is resuscitated and placed on a respirator, Jewish medical law allows the disconnection of the respirator if pulse and breathing, without the respirator, have ceased.

Both the Reform and Conservative movements agree that once respiration and circulation continue only through mechanical life support, the patient may forgo these measures. As interpreted by the Reform Responsa, once it is determined that \"natural independent life\" has ended, the patient should not have to suffer anymore. Conservative Rabbi Elliot N. Dorff explains in Matters Of Life And Death, A Jewish Approach To Modern Medical Ethics, once it is determined that the patient is dying, it is permitted to remove the impediments to death and refrain from all medical efforts to save the patient, but not those efforts to ease pain.

Throughout the dying process, medications can be administered to alleviate pain. There is agreement among all three sects that dosages of pain medication strong enough to shorten life may be given to a dying patient so long as pain relief, and not hastening death is the primary purpose of the dosages. In the Reform Responsa it is reasoned that even though the pain medication may weaken the patient\'s heart, so too would the pain itself.

It is possible to state within your health care proxy that you direct your health care agent to make medical decisions for you that are consistent with your religious beliefs. You will want to be sure that your health care agent has an understanding of what those beliefs are and what these decisions may entail, which may require you to describe in detail the specific application of your beliefs to the range of medical decisions that may have to be made. A consultation with your rabbi before you meet with your lawyer could be useful in enabling you to articulate your wishes.