One of the hallmarks of an Israeli law concerning the treatment of dying patients is that it requires that such patients be given treatments to reduce their pain.
While palliative care, as it’s called, is a growing field of medicine throughout the world, Israel is the first to enshrine its importance in law, according to Dr. Avraham Steinberg, the director of The Center for Medical Ethics, Hebrew University-Hadassah Medical School in Jerusalem.
“We are obligated to ameliorate pain as best we can,” he said Sunday evening.
Steinberg, who is also a pediatric neurologist for Shaare Zedek Medical Center, was in town for Pittsburgh’s first annual Conference on Jewish Medical Ethics.
The conference, held at the Sheraton Station Square, was jointly sponsored by the Kollel Jewish Learning Cetner, the Pittsburgh Society for Jewish Medical Ethics and the Maimonides Society of the United Jewish Federation.
Steinberg spent much of his talk describing a law adopted in 2005 by the Knesset that attempts to integrate halachic parameters with medical
The law is rooted in the belief that decisions about how to treat dying patients are not merely matters of medicine.
“The dilemma is not primarily a medical or scientific one,” said Steinberg. “It is social, religious, cultural.”
For the Israeli medical system, and for Jews in the Diaspora, that means that Jewish law is an integral part of the process.
For example, while U.S. law does not make a distinction between withholding and withdrawing life-sustaining treatments, said Steinberg, in halacha there is a difference.
In Jewish law, he said, there are times that it is permissible to decide not to begin a course of treatment.
“If a patient is dying and suffering,” said Steinberg, “we should not prolong their suffering in vain, knowing we won’t cure them.”
However, once a treatment has been administered, the law is different.
“Acting in a way that will hasten death is always forbidden,” he said.
The difference in halacha is in whether the deed is passive or active. Jewish law permits passively allowing events to unfold, but prohibits taking harmful action.
Even when it comes to withholding treatments, the attitude of Jewish law is stricter than procedures in place in many western countries.
“An order of DNR (do not resuscitate) used to mean ‘treat with all treatments, but don’t resuscitate when he dies,’” said Steinberg. “Now when many physicians order DNR, they really mean ‘do not treat.’”
In the United States that may mean that terminal patients are denied feeding tubes and intravenous fluids. According to Steinberg, it is unacceptable to withhold nutrition, even from someone who is near death.
“If someone has cancer and is dying, it is OK not to give him chemotherapy,” said Steinberg, “but killing him of hunger has nothing to do with the dying process.”
The Israeli law also touches on a matter of Jewish law that is the source of much debate: whether a person who is brain dead, but whose heart is still beating, is dead or alive.
The conclusion of the law passed by Knesset is that brain death is indeed death. However, the Israeli law stipulates that families that wish to keep a brain dead relative on life support should not be prevented from doing so.
“If the family doesn’t accept [brain death], he should be kept on a respirator until cardiac arrest,” said Steinberg.
Although the brain death debate is a serious, and often contentious, one, Steinberg found some humor in the matter.
“A person can die only once,” he said. “It’s usually the first time that counts.”
(Susan Jacobs Jablow can be reached at firstname.lastname@example.org.)