January 1999 The Ethics Of Dying By Rabbi Alvin Kass The "ethics of dying" is one of the hottest subjects on the current agenda of physicians, ethicists, and clergymen. That is so because recent advances in medical technology have left so many of us more afraid of dying than of death. People on all sides of the issue have predicted that the question of whether it is morally proper to take your own life or to help others die will shortly become as protracted, emotional, and unyielding as the battle over abortion. The nub of the question is whether life should be prolonged through medical know-how and technilogical expertise when that life is no longer deemed qualitatively meaningful. Quite frankly, I find the concept of "quality of life" difficult to handle, because of the problems of defining quality. What is a senseless or useless existence to one person may be eminently sensible and useful to another. Furthermore, once we sanction the removal from this world of extremely sick patients, with or without their consent, there will be no end to killing. Standards are likely to shift to ever greater intolerance of those whom we adjudge to be "abnormal" or socially unfit. Pressures will grow to eliminate the suffering of those who are considered a nuisance to themselves as well as their caretakers; and who are likewise thought of as a burden to society. Proponents of legally assisted suicide and mercy killing, usually referred to as euthanasia, a Greek word, meaning an easy or pleasant death, act on the assumption that people have the right to choose for themselves when and how to die. That idea, however, is patently un-Jewish. Our tradition would contend that autonomy does not extend to one's own life. Our body and existence are the property of God. Life is a priceless gift bestowed upon us by the Almighty regarding which we possess only temporary stewardship. God retains the exclusive right to determine when our earthly pilgrimage should end. As the Talmud put it, "Without our will we come into the world; without our will life is taken away." The classic case is that of Hananyah ben Teradiyon who was burned at the stake for violating the Roman decree against teaching the Torah. He declined to inhale the flames in order to accelerate his demise, declaring "Better that God who gave life should take it; one should not injure oneself." Is there nothing, then, that can be done to ameliorate the plight of the suffering but wait for the inevitable? Not at all! First of all, Judaism distinguishes between the withholding or withdrawing of treatment and direct killing. Although recent court cases have attempted to erase that difference, patients legally and morally have the right to refuse unwanted medical intervention. That should not be viewed as part of the right to kill yourself, but rather as part of the right to decide how we are going to live, even while we are dying. In this regard, Judaism claims that there is a world of difference between "active euthanasia" which is tantamount to murder and "passive euthanasia" which involves the removal of artificial obstacles to death. There also need to be improvements in the management of pain. Most experts believe that where palliative medicine is practiced in the appropriate way, such as the hospice setting, requests for assisted suicide would decline to negligible proportions. Finally, and most importantly, the dying need the contact, care, attention and affection of those whom they love. The impulse to commit suicide comes mostly from people who feel alone and abandoned. If we can discard the hedonistic concept of life, which permeates contemporary society, the final weeks and months of life, though filled with pain and suffering, can be profoundly meaningful, provided we are surrounded by love and caring.