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Reform conference in S.F. probes Jewish view on end-of-life issues

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Message: If you are having trouble reading this email, you may view this article online at: http://www.jweekly.com/11807/full/11807/reform-conference-in-s-f-probes-jewish-view-on-end-of-life-issues/ Reform conference in S.F. probes Jewish view on end-of-life issues Friday, October 15, 1999 | by RONNIE CAPLANE A woman is brought to a hospital. She is brain dead and put on life support. Her family asks that life support be removed and she be allowed to die. What should the doctor do? An easy question, right? But what if she doesn't die, living in a vegetative state for years and the family asks the doctor to help accelerate her death? What should the doctor do? What if that woman is pregnant and the baby would very likely be born healthy if the woman is maintained on life support for a month? What should the doctor do? Does it make a difference if the pregnancy was unwanted and there is no one in the immediate family who wants the baby? These end-of-life questions were some of the issues discussed at a four-day conference titled "Bio-Ethics & Sacred Decisions: Medical Technology, Liberal Judaism & Our Lives." The conference took place at the Crowne Plaza Hotel in San Francisco from last Friday through Monday. The Reform movement's Union of American Hebrew Congregations sponsored the event. Drawing a couple of hundred doctors, medical ethicists, rabbis and lawyers from across the United States and Canada, the conference looked at a Jewish approach to medical ethics. The Hebrew Academy's Institute on Medical Ethics, which is based in San Francisco and represents the Orthodox, has sponsored an annual medical ethics conference for years. But this was a first for the Reform movement. On Sunday, Rabbi Peter Knobel of Evanston, Ill., opened a panel titled "Decisions at the End of Life" with a distinction between a person who is gosas and tefa. He said gosas refers to a person who is expected to die within 72 hours. "The person is a flickering candle. You have to be careful not to snuff it out, but Jewish law allows the removal of impediments to the person dying," Knobel said. "Tefa is a person who has been diagnosed with a terminal illness." Jonathan Moreno, chair of the bio-ethics department at the University of Virginia, compared the attitude of the Christian right and Orthodox Judaism on a patient's right of self-determination. Although temperamentally and philosophically different, these viewpoints come to the same conclusion. "Orthodox Jews have a vitalist philosophy—life must be sustained," Moreno said. "The Christian right believes there is always hope, therefore medicine should not cut off any possibilities." Neither tolerates anything, passive or active, that accelerates death. Orthodoxy comes to this through halachah, or Jewish law. For the Reform Jew, halachah is not binding. Other sources, such as Jewish texts and the biography of the patient, need to be taken into consideration, Knobel said. Using this model, Knobel and Moreno talked about how the question of keeping a woman alive to sustain the life of her unborn fetus might be resolved. Moreno, who defines himself as an ethicist who is a Jew, said the question is complicated by the inability to medically define when death occurs. When the brain waves are flat? When the heart stops beating? When the person ceases to be who they were? In the example above, he said the hospital's duty is to act in the best interest of the baby. Knobel however, said that he would look at the mother's biography. What is her family situation? Did she want this baby? Does she have a husband who wants this child? The answers to these questions would affect whether the mother should be maintained until the child is born. The more advanced medicine becomes, the more complicated the ethical issues. For instance, what about forced paternity? Should a doctor harvest sperm from a man who is brain dead if his wife requests it? How do views on this square with the harvesting of a kidney or other organs from someone who isn't a registered organ donor? On the flip side of questions about sustaining life are questions about ending it—whether actively or passively. Many patients prepare an advance directive, appointing a representative to make sure they are not kept alive under designated circumstances. But a patient might be in a hospital with a religious affiliation that does not allow life-sustaining assistance to be withdrawn. In that case, his or her desires might not be honored. As Moreno urged people to push their states to adopt death-with-dignity statutes, another discussion group was exploring pain management and hospice care. "When patients are cared for and not in pain, there is less of a desire to die," said Dr. Ilena Blicker of Glendale. The biggest concerns of terminally ill patients are being alone, in pain and a burden to family, she added. They can relax only when convinced that these things will not happen. According to Dr. Michael Levy, a specialist in pain management of the terminally ill, with good pain medication and hospice care, people live longer. And contrary to some beliefs, pain medication does not hasten a patient's death, even when sedation is necessary, the Cherry Hill, N.J., doctor said. "I will not do anything to hasten your death," Levy says he tells his patients when asked. "But I will make sure you have as little pain as possible." Ultimately, said one rabbi, it comes down to an individual being able to find comfort and prepare for what's ahead. "If people master the textual tradition, it gives them a greater ability to face crises," said Rabbi Alan Berg of Peninsula Temple Beth El in San Mateo. This lifelong pursuit can help people connect to God when they face death. "The act of death is an atonement."

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