Community Magazine July 2014

32 COMMUNITY MAGAZINE DR. JASON ESSES How Torah Judaism draws a delicate balance between the inherent sanctity of life and the concern to alleviate the suffering of terminally ill patients. O ver the last decade, first as a resident, and now as a practicing cardiologist, I have seen many cases where “end of life” decisions were a central part of the treatment discussion. From the patient suffering from end-stage congestive heart failure or emphysema with impaired breathing, to a post-cardiac arrest patient or stroke patient who suffered significant brain damage, to an elderly patient with end-stage dementia who is bed-bound, the issue of how to approach the illness requires precisely defining the goals of care. Time and time again, I have witnessed a distraught family who was either unaware of the issues, incapable of discussing them, or simply incapable of comprehending the gravity of the situation. It is the duty of the physician to sit down with the family and have a serious discussion about a particular prognosis, but it is also the job of the caretakers to seek spiritual advice in addition to the medical advice given by the physician. I have also witnessed how the secular world’s view on the value of life often clashes with that of our Orthodox Jewish tradition. The secular world places tremendous weight on the concepts of “patient autonomy,” “quality of life” and “patient suffering,” an emphasis which is generally consonant with the Jewish viewpoint. However, there are situations where the views diverge, especially in the area of “end of life.” Many in the secular world believe that if there is no quality of life, then we should not prolong one’s life, as it leads to unnecessary suffering. Generally speaking, Orthodox Judaism does not subscribe to the notion of quantifying “quality of life” such that life can at times be no longer worth prolonging. This essay seeks to clarify the basic guidelines governing end of life questions as outlined by our leading halachic authorities, to demonstrate the difference between the Torah’s viewpoint and that of general society. To provide a typical example of this common issue, I asked Carol Mezrachi, a daughter of a patient of mine, and her caretaker, to write about her experiences, and she graciously agreed. This is what she had to say: The transition from elderly care to end of life care can be thrust upon us so suddenly, only to find ourselves facing a medical establishment hardly appreciative of our Jewish perspective on life. Unfortunately, I had to learn the hashkafot (outlook) and general halachot regarding “end of life” care under extreme pressure and duress. My mother, Rose Tawil, was taken to the hospital with labored breathing at the age of 92. In the emergency room it is routine to be asked questions regarding intubation (placement of the patient on the ventilator) and cardiac resuscitation (CPR). If we are hesitant because we lack the knowledge or understanding of the implications of these terms, the medical staff is more than happy to prod us to comply with their belief that a woman of 92 with moderate dementia is probably better off left to die without intervention, and should have a DNR/DNI (do not resuscitate/do not intubate) order.