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In Support of Medical Aid in Dying

Updated: Nov 28, 2023

Let me tell you about Mary Cohen. A refined woman of Southern upbringing, she lived in a modest two-room apartment in an assisted living facility. At the age of 95, she woke up one morning, got dressed in a dress and stockings, enjoyed breakfast, sat in her easy chair and died. My reaction? Where do I sign? As a rabbi, one of the most humble privileges is to be at the bedside of folks at the end of life. To pray together with them and their families and comfort them with the thought that it is okay for them to let go, that the community will be there to support their loved ones and they are free to make their end-of-life journey. When a person dies peacefully, at the end of a long, good life, it is sad but not necessarily tragic. When someone dies too young, or with extreme suffering, that is truly tragic. There are deaths, I sometimes think to myself, that give death a bad name. I look through the Hebrew Bible and see records of many deaths. “Abraham,” we read, “breathed his last and died in his ripe old age, satisfied.” (Genesis 25:8). His son Isaac’s death is described in almost the same words. For the most part, the Torah doesn’t share many instances of painful death. And then there is Saul, the first king of Israel. Wounded on the battlefield, he witnesses the death of his three sons and begs his armor bearer to finish him off. Ultimately, he falls on his own sword, likely wanting to end his own pain and forestall the suffering he would surely endure if captured by the enemy (II Samuel 1:5-10). Surprisingly, there is no condemnation of what clearly seems to be an act of suicide. For most of Jewish history, preemptively ending someone’s life has been strictly prohibited. Halacha, Jewish law, describes a terminally ill person as having the same status in all respects as a person in the midst of life. There is no compassion for the compassionate act of putting someone out of their misery as is stated in the 1994 responsum, “On the Treatment of the Terminally Ill” on the Central Conference of American Rabbis (CCAR) website. That was also the position of the Reform movement when it addressed what was then known as euthanasia 30 years ago. And that was my personal position, too. Temple Chai member Dr. Ron Fischler has been working for many years in support of a proposed medical-aid-in-dying law for Arizona. When he first engaged me in conversation, I couldn’t let go of the “slippery slope” concerns. Would the so-called right to die become an obligation to die when society is burdened by end-of-life care? Dr. Fischler and I shared many conversations and slowly I have come to a deeper understanding of the need for death-with-dignity provisions. Medical technology has radically changed. In the ancient world, when our traditional sources were formulated, most people did not survive to a ripe old age. They were taken by famine and infection, by war and childhood illnesses. Today, our life expectancy is made possible by medical advances, which have the side effect of allowing us to live long enough to suffer from a myriad of diseases unimaginable in previous centuries — cancer, stroke and heart disease — to name a few. I’m old enough to remember when pneumonia was “the old man’s friend,” but now antibiotics have made pneumonia a minor illness. Our lives can and are extended way beyond what many of us would consider to be quality of life. Based on the Sefer Chassidim, Rabbi Moses Isserles (1510-1572), known as Rama in his commentary on the Shulchan Aruch states: “If there is anything which causes a hindrance to the departure of the soul such as the presence of a knocking noise such as wood chopping near the patient’s house or if there is salt on the patient’s tongue, and these hinder the soul’s departure, then it is permissible to remove them because there is no act involved in this at all but only the removal of the impediment.” The Talmud relates that it was the unnamed maid of Rabbi Yehudah haNasi who had the good sense to distract his students from their relentless prayers on his behalf, prayers which were keeping him anchored to this earth, and not allowing him to die peacefully. She threw a pitcher to the ground and in the moment of its shattering, they were distracted from their prayers and he was mercifully able to die (BT Ketubot 104a) And this shocking rabbinic story: “It happened that an extremely elderly woman came before R. Yose ben Chalafta and said to him, “Rabbi, I am too old, and my life is distasteful to me. I can taste neither food nor drink and I would like to depart from this world.” He said to her, “What accounts for your long life?” She said, I am accustomed, even if there is something very dear to me, to set it aside and go early to the synagogue each day.” He said, “Refrain from going to the synagogue for three consecutive days.” She did so, and on the third day she fell ill and died.” (Yalkut Shimoni II, #943) It seems that our tradition does recognize that there is something to be said for the ability to let go at the appropriate moment. Commenting on the verse regarding Isaac’s age, the midrash says that until the time of Abraham, there were no signs of aging and no warning of impending death. Abraham felt slighted that when he and his son entered a community, they appeared to be the same age, so no one knew that he was the elder and worthy of honor. So, God granted him the “gift,” in quotes, of signs of aging. We can thank his son, the midrash continues, for suffering at the end of life, forestalling punishment in the world to come. And it was Jacob who demanded illness, to allow time to get one’s affairs in order. As a physician, Maimonides concluded that one week between illness and death was ideal. (Torat HaAdam, section “The Gate of the End,” subsection “The Matter of Departure,” quoting BT Moed Katan 28a and Tractate S’machot, also known as Evel Rabati, 3:9-11). I reflect on this having just lost my beloved sister-in-law, Fran, may her memory be for blessing. Her death was a tortuous process as she wasted away. No food for more than three weeks, vital signs that multiple medical professionals assured the family were incompatible with life and yet . . . Fran lived in New Jersey, where Medical Aid in Dying (MAID) is legal. Her daughter, my niece Valerie, is confident that had Fran known of its availability, she surely would have availed herself of the opportunity to control the timing of her death, following beautiful expressions of love and farewell. Fran’s death has converted me into a rabid supporter of MAID. We in Arizona have the opportunity to support a proposed law that would require a patient to: 1. Be an adult (18 years or older). 2. Be a resident of Arizona. 3. Be mentally capable of making and communicating health care decisions. 4. Be diagnosed by both an attending and a consulting physician as having a terminal illness deemed to result in death within six months. 5. Be informed by the attending health care provider of the diagnosis, the prognosis, the nature of the medication to be prescribed and other alternatives, including comfort care, hospice care and pain control. 6. Make an oral request for a prescription for a medication that will hasten death in a humane and dignified manner (such request to be documented in the patient’s medical record). The request may be made via telemedicine. 7. Wait 15 days from the initial oral request and submit a request for the medication in writing, witnessed by two people, and in substantially the same form supplied in the statute. The waiting period can be waived if it is deemed that the patient is likely to die within 15 days. Nationally, 30% of those who request MAID never end their own lives. Yet what a comfort to know that we can control and decide when we have had enough and are ready to let go. I know this notion is controversial. I am not suggesting that we don’t also have the right to request any and every lifesaving means available. Life is a gift and a blessing, and the Torah tells us to “Choose Life.” Yet, the CCAR, in a recent responsum, supported MAID as a halachically acceptable option and I am proud of that difficult decision. JN For more information about MAID, visit Reprinted from Jewish News of Greater Phoenix- 14 July 2023

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