Continuing Life

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life support
by R. Gidon Rothstein

27 Shevat: Tzitz Eliezer on the Necessity of Continuing Life

Questions of whether to extend life  mostly arise in tragic situations, when there’s no real hope of cure or even (often) improvement.

On the 20th of Shevat, 5749 (1989), Dr Eli Schussheim [who is, I think, still currently working, a respected Israeli surgeon and chairman of Agudat Efrat, which provides pregnant Israeli women with needed support for them to choose not to have an abortion] asked Tzitz Eliezer about two such cases. R. Waldenberg answered one on the 26th of Shevat (volume 18, Responsum 31) and the other on the 27th (18;62).

The Flashpoint: A Dying Boy

Let’s take that second one first, because it’s connected to this date, and is how I found these responsa. The question was about a terribly sad case, the final illness of the grandson of R. Aaron Soloveichik, z”l. He had had a brain tumor for two years, was now unconscious, breathing on a ventilator, and was building fluid on the brain (the shunt had become blocked or infected).

The doctors wanted to operate to replace the shunt, and the father, R. Moshe Soloveichik, agreed. The mother objected that her son wasn’t going to survive anyway, making this operation, in her mind, an unnecessary extension of his suffering. She sued to be certified the boy’s health care proxy, won, refused the operation, and the boy, Yisrael Soloveichik, passed away two days later.

Since a case like this could easily set a precedent, Dr. Schussheim asked for Tzitz Eliezer’s view.

The Importance of Human Life

Tzitz Eliezer strongly agrees with the father, that the boy’s life should have been extended as long as possible. As support, he notes that Shulchan Aruch allows violating Shabbat even for someone found crushed, such that he cannot live much longer no matter what, and despite the fact that his continued life will involve suffering. We extend life, even at the cost of violating Shabbat, even for a brief time, even if the person will suffer.

Commonly, people remember that the Gemara speaks of violating one Shabbat so that the person can keep many more. Tzitz Eliezer notes that Biur Halachah to 329;4, the paragraph in Orach Chayyim that has this ruling, makes clear that it doesn’t depend on living long enough to keep Shabbatot, that any mitzvot are enough, that the possibility of repenting is enough, and closes by noting that the actual source allowing violating Shabbat is the verse of va-chai bahem, that we’re not (generally) required to die as part of our observance of mitzvot. So we would violate Shabbat even to save a minor [who isn’t yet obligated in mitzvot, and doesn’t need to repent], a person considered not mentally competent (a shoteh), or a deaf-mute, whom halachah also sees as not competent to be obligated in mitvzot on a Biblical level.

Tzitz Eliezer expresses this as an independent obligation to extend life, an end of its own, despite the suffering of the person involved. That leads him to dismiss the mother’s view as an excess of compassion, and the court’s view as a function of its lack of understanding of the Torah’s values. Obviously, he says, we should do all we can to minimize suffering with whatever medication necessary, but fundamentally we are supposed to keep Jews alive as long as we can.

A Slow Death Is Still Life

Not directly relevant to this case but illustrative, he says, is R. Ya’akov Emden’s view in Mor U-Ketziah, that when doctors have a well-established procedure, we would coerce a Jew to undergo it to save his/her life, even if it involves amputation. Other values systems might think people have the right to decide their medical course, but not halachah—our bodies are not ours to the extent that we can reject medical treatment because we find it distasteful.

If the patient him/herself does not have the right to refuse treatment, Tzitz Eliezer says, all the more so relatives, including parents. As Rambam had put it, people’s lives don’t belong to them, they belong to Hashem, Who commanded doctors to heal. Given this view, it’s obvious to him, also, that we cannot disconnect any life-saving apparatus to which the person is connected.

As one further proof, he notes that the Gemara in Sotah speaks of the merit of Torah study extending a woman’s life, even if she had in fact had committed the adultery her husband suspected. Instead of the water immediately killing her, she wastes away slowly. Despite her remaining life being one of illness, the Gemara refers to it as a benefit of the merit of her Torah study. That shows Tzitz Eliezer that extending even a painful life is a desideratum.

[It is not my way to question these responsa. In this case, it does seem worth pointing out that Tzitz Eliezer has neglected the possibility that consciousness is relevant. In the cases of people who were crushed, it’s not clear whether they are conscious, or have any hope of returning to consciousness. It seems at least arguable that where there is no longer a reasonable possibility that the patient will ever regain consciousness, the obligation to extend life changes.

Similarly, while people must bear some suffering for extended life, my understanding is that there are levels of unrelievable suffering that then allow a patient to refuse further treatment, even in Tzitz Eliezer’s view. As always, I do not claim to be covering this halachic topic in all its breadth and applications, just to present the view of one reputable decisor in one case].

Delivering a Baby Out of a Pregnant Woman

The second question from Dr. Schussheim dealt with a woman who became brain dead in the seventh month of her pregnancy. The doctors wanted to deliver the baby right then, since the mother could more fully die at any moment.

The father was worried that the baby might not live [whereas if it stayed in the womb, and the mother’s body kept functioning with the aid of the machines to which she was attached, it would have longer to develop], or might have been damaged either by the mother’s situation, or by being delivered so early. He sued and won, the judge agreeing that the doctor’s inability to assess the fetus’ likelihood of living and/or escaping developmental damage gave the father the right to refuse delivery.

The next day, the mother passed away [taking the fetus with her]. Here, once again, was a legal precedent for a claim whose halachic validity Dr. Schussheim wanted to check.

Saving Even Those Not Yet Alive

The first part of Tzitz Eliezer’s rejection of the judge’s view focuses on halachot that require violating Shabbat to save fetuses, including where we don’t know how the baby will do once delivered, and where there is similarly no chezkat chayyim, no existing status as alive [we might have thought that the ability to violate Shabbat to save a life applies only to pre-existing life, not to helping it gain existence]. If that’s true for Shabbat, it’s certainly true during the week.

Halachah also recognizes a case of a fetus that’s already alive, with a barrier preventing it from coming into the world (the deceased mother, who cannot deliver the baby); seven months is far enough along for this fetus to qualify.

The father’s arguments about quality of life don’t hold halachic water, he says, since all the cases we saw earlier—a person who had been crushed, or a minor, etc.—didn’t have a full quality of life but had to be saved, even at the cost of violating Shabbat. Besides, the fetus might have lived, grown, and developed normally.

[Here, another of Tzitz Eliezer’s views make clear that this wasn’t the whole story. Perhaps his most famous halachic position was that he allowed first-trimester abortions in the case of certain deformities in the fetus. That being so, he must have agreed that some levels of deformity, removed the obligation to save that fetus’ life, at least at some point in its development. Once again, our goal here isn’t to cover the topic fully, but to present this responsum of Tzitz Eliezer’s. What he established here is that a fetus at seven months, with no defined deformity, is alive enough to obligate taking action to help it come into this world.]

Sum total, Tzitz Eliezer disagrees with the judge’s decision, and thinks it’s vital to object to it, and to take steps to see that it will not become a legally obligatory precedent.

As of 5749, Tzitz Eliezer was emphatic about the value of life, independent of all the kinds of reasons we see it as valuable, but as a value of its own, obligating Jews to do what they can to extend it.

About Gidon Rothstein

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