Rabbi Marc Gellman writes about religion for Newsday.
I recently read an article about a man in a hospital who was so incapacitated that his body was useless. Staff disconnected one of the machines that was preventing the man from speaking and asked him if he wanted to continue living like that. He said no and asked them to "pull the plug." The man's family gathered around him, and he died shortly afterward. This got me thinking: If your body is useless and you decide not to go on living, is that considered suicide in God's eyes? What would God think when it was your time for judgment?
-- M., via email
I study and work in the field of medical ethics. As a congregational rabbi, I also counsel people on end-of-life decisions. On a personal level, my own father died in a hospice after a severe head injury caused by a fall. Your deep and perplexing question reaches me on so many levels.
For centuries, death took its natural course after healing was no longer possible. This is no longer true. Now, we can delay death without promoting healing. We know that religious teachings affirm the sacredness of life, and this leads to full support in most religious traditions for medical treatment to extend life by curing disease or providing remission from diseases that can't be completely cured.
In religious law, a person is simply not permitted to refuse clinically proven lifesaving medical treatment. Secular ethics also affirms that it's not rational to throw away one's life when healing is possible.
Many people do consider refusing proven medical therapy based on quality-of-life issues. I once counseled a man facing amputation of a gangrenous leg. He loved folk dancing and initially told me he'd rather die from gangrene than face a life without dancing. He eventually changed his mind, but if he had decided to refuse the amputation, his act would, indeed, have been suicide. I'm glad he decided for himself that a broken but healthy life was preferable to an impulsive death.
My good friend Tommy (Father Tom Hartman) once took me to visit a young man made a quadriplegic by a motorcycle accident. Tommy told me the man had asked Tommy to kill him because he didn't want to live with his new physical limitations and could not kill himself. Tom counseled the man, who went on to create an organization to help older quadriplegics counsel new ones and give them hope to live another day.
Most of the impulsive things we do can be reversed later. Suicide is not one of them. Quality-of-life issues ought never to trump life itself.
However, refusing medical treatment that's not therapeutic and cannot heal is a different ethical and religious question altogether. If all that medical science can do is delay your impending death, it has no place or purpose, and one can decide to remove all external impediments to death. This is not suicide because you're not refusing healing; instead, you are accepting death. You're refusing to be poked and prodded and drugged at the end of your life.
It's unclear to me from your email the precise medical condition of the patient to whom you refer. I presume from the active participation of the medical staff that he was indeed dying and pulling the plug was therefore an act of mercy, not malevolence.
The troubling element in the case you cited was that apparently the patient had no durable health care proxy or advance directives in place that would have made his wishes clear to the family and the medical staff. They questioned him when he was, no doubt, exhausted and not in full command of his faculties.
We should all take time while we're still lucid to explain our desires about end-of-life issues. Hospice care is also a compassionate alternative to dying in a busy and distracting hospital setting.
There is a rabbinic story about a dying person being kept alive by the noise of a nearby woodchopper. The rabbinic ruling was that the woodchopper must be silenced so the person could die. I take the woodchopper to be a symbol of all external and artificial impediments to death. There's also an old rabbinic teaching that a dying person is like a flickering candle. We must not do anything to prematurely extinguish the flame, but we must also not do anything to prolong it when it's finally ready to give up its light. How strange and comforting. What is true of candles is also true of us.