Hastening Death vs. Letting Death Come
When it's acceptable to use a "living will" to end treatment of terminally ill patients
When the Harvard criteria of death have been satisfied, life support machinery may be removed. This state of "brain dead" has been defined by an ad hoc committee of the Harvard Medical School in 1968 (Journal of the American Medical Association Vol 205, pp 337 ff). It recommended three tests: (1) Lack of response to external stimuli or to internal reed; (2) absence of movement and breathing as observed by physicians over a period of at least one hour; (3) absence of elicitable reflexes; and a fourth criterion to confirm the other three; (4) a flat or isoelectric electroencephalogram.
The group also suggested that this examination be repeated after an interval of 24 hours. Several Orthodox authorities have accepted these criteria while others have rejected them.
Moses Feinstein felt that they could be accepted along with shutting off the respirator briefly in order to see whether independent breathing was continuing (Igrot Mosheh Yoreh Deah #174).
Moses Tendler has gone somewhat further and has accepted the Harvard criteria. David Bleich and Jacob Levy have vigorously rejected these criteria as they feel that life must have ceased entirely with the heart no longer functioning, a condition belatedly established by the Hatam Sofer in the 18th century (Responsa Hatam Sofer Yoreh Deah #338).
We can see that although the question has not been resolved by our Orthodox colleagues, some of them have certainly accepted the recommendations of the Harvard Medical School committee. We are satisfied that these criteria comply with our concern that life has ended. Therefore, when circulation and respiration only continue through mechanical means, as established by the above mentioned tests, then the suffering of the patient and his/her family may be permitted to cease, as no "natural independent life" functions have been sustained. We would permit a physician in good conscience to cease treatment and to remove life giving support systems.
The Persistent Vegetative State
The "persistent vegetative state" is more difficult as "brain death" has not yet been reached. Such an individual would be considered a goses, who is considered to be a living human being in all respects. One may desecrate the Sabbath to help him according to Jacob Reischer (Shevut Yaakov 1:13), though others (Kenesset Hagadol) disagreed.
The long discussions about a goses indicate that no positive actions to hasten death may be taken, so he/she is not to be moved or his/her eyes closed, etc. As stated above, there is no prohibition against diminishing pain or increasing the person's comfort or initiating new treatment which will not change the condition of the patient.
Under these circumstances a "Living Will" may be helpful although we realize that we know little of the "inner life" of people in this state; we do not wish to terminate what may still be significant to them.
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