Adena Kleiner asks: I hate to compare medical TV shows to real life, let alone Halacha, however plenty of times on TV I see instances of patients begging for a "mercy killing." What is the Halachik approach to this situation? Based off of the fact that a Jew is not allowed to commit suicide, I would assume that the answer would be that a Jew is forbidden to do this, however I think this issue brings up a bigger question. What is the Halachik approach to the question of sanctity of life vs. quality of life?
Hi Adena, great question! So in general, Halakha believes very strongly in the sanctity of life. Everyone is created b'tzelem Elokim and one who saves one life is considered by the Gemara to have saved an entire world. It is for these reasons that we always do whatever possible to save someone's life, with Pikuakh Nefesh overriding Shabbat, even if there is only a small chance of that person being alive.
However, although there is a mitzvah to save a life, there is also a mitzvah to alleviate pain and suffering. What happens when these two mitzvot contradict? For example (lo aleinu): does a terminally ill cancer patient have a halakhic obligation to endure chemo treatment or invasive surgery, if this will only grant them a few more months of life, but also cause extraordinary pain? It seems that the Halakha differentiates between prolonging life and prolonging death. On one hand, one is forbidden to actively do anything to end someone's life, since even someone very close to death (a goses), is considered Halakhically fully alive and one may not do anything to hasten their death (Shuchan Arukh, Y.D. 339:1). Actively assisting patient suicide would be considered murder, even if that person was in great pain.
However, although we do believe in the importance of חיי שעה- temporary life, it has to have a minimum of quality to it. Therefore, in certain circumstances, one may remove an impediment that is preventing someone from dying (The Sefer Hasidim, quoted l'halakha by the Rama: Y.D. 339:1), as now one is passively allowing the natural process of death to continue, instead of actively ending a life. Practically speaking, this would allow physicians to withhold certain treatments but would not allow for active Euthanasia. This perspective is seen in a number of Gemarot. In Ketubot 104a, R' Yehuda HaNasi was sick and in great pain but his students were praying for him to stay alive. His maidservant came in, threw an object at the students (!!) to disrupt their tefilot, consequently allowing him to die. The Gemara seems to conclude that his maidservant acted correctly. Also, in Avoda Zara 18a, when R' Chananya ben Tardyon was being burned alive by the Romans, he refused to open his mouth to the flames to actively hasten his death, but he did allow the executioner to remove the water soaked cloths around his heart - passively removing an impediment preventing his death.
Therefore, R' Moshe Feinstein (Igrot Moshe, C.M. 2:73:1 and Y.D. 2:174:3) permitted withholding medical treatment as long as the following conditions had been met: (1) The patient's condition must be terminal, and s/he will not recover, even with treatment. (2) The patient is enduring unbearable pain and suffering. (3) The patient indicated that they do not want to be treated. (4) The patient can decline painful treatment - chemo, surgery, but NOT food, water or oxygen (a feeding tube and antibiotics would potentially fall into this category). Unfortunately, this is a difficult question that many families face, but it seems that Hazal and the Halakhic system try to balance the sanctity of life with preventing unnecessary suffering. For further reading, check out the Encyclopedia of Jewish Medical Ethics by Dr. Fred Rosner, which I think we have in the Ma'ayanot Bet Midrash.
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