Our tradition teaches that the first time a particular turn
of phrase is used in Tanakh is significant. This week, in Parashat
Vayechi, there are two such turns of phrase: “death draws near”, and later
on, “has taken ill.” Midrash
teaches us that Ya’akov Avinu was the first individual who was sick
before he died. Prior to that, people were hale and hearty up until the moment
of death, and died suddenly and unexpectedly.
Ya’akov prayed to God to give him some warning of his impending
demise, in order to put his affairs in order and have an opportunity to have
important final conversations with his children and to say goodbye.
In the eighth chapter of Masekhet Yoma, our sages
assert that one may violate the laws of Shabbat or Yom Kippur in
a case of pikuach nefesh – saving a life. Pikuach nefesh is
obviously a Torah value, as our sages cite numerous proof texts within Tanakh
that reinforce the notion that it takes precedence. Some examples include Vayikra 18:5 (“These
are the commandments that an individual must observe to live by them” – one must
live by them and not die as a result of them) and Shemot 31:13 (“You
must still keep My Sabbaths” – the phrase “you must still” implies that there
are circumstances where one must not keep the Sabbath.) Another proof text, Shemot 31:16, is
used as a statistical argument to assert that one must violate Shabbat to
save a person’s life so that he or she may observe many more in the future. Ultimately, pikuach nefesh is such an
important concern that one may violate Shabbat even when it is certain
that life will only be extended a few more minutes (even though they will not
live until the following week.)
The unfortunate fact is that we all are mortal. The question
is not a matter of “if” but of “how” we will die. Those of us who live a full life, sound of
mind and body, are truly fortunate. Over the past several generations, life
expectancies have increased dramatically. When people live longer, there is
more opportunity for things to go wrong and health to decline because of the
vagaries of old age. Thus, many of us will likely face daunting health challenges
and possibly protracted terminal illness.
To ignore this is to deny reality.
In an age where we read almost daily about new and
miraculous life-saving treatments for terminal illness, it is easy to be lulled
into a false sense of security that no health challenge is insurmountable and
that health providers always know what is in our best interest when advising on
a course of treatment to battle illness.
Because of our belief in the primacy of pikuach nefesh, we seek every
available life-saving measure, even when there is little chance of success and
tremendous potential for debilitating side effects.
Dr. Atul Gawande, in his book “Being Mortal,” documents that
people who adopt this approach without considering what alternatives might
exist often don’t realize that the end is near until it is too late to gather
friends and family to say one’s farewells. Even when there is time, loved ones’
final memory of the deceased may be of an individual who is a shadow of what
they once were, hooked up via tubes and electrodes to all manner of
life-sustaining equipment and unable to communicate or debilitated by pain. This scenario stands in stark contrast to Ya’akov
Avinu’s dignified end of life, and demands that we seek a more nuanced
understanding of pikuach nefesh and extending life.
Dr. Gawande discusses end-of-life planning, such as a
program introduced by the Gunderson Health System in LaCrosse Wisconsin and
subsequently offered to other healthcare systems and hospitals under their “Respecting
Choices” program. Taken in an aggregate, and measured statistically, individuals
and their families who have hard conversations and take time to carefully think
through what their end-of-life might be like have better outcomes – both in
quality of life during the end stages of their terminal illness, as well as longer
life expectancies. I am comfortable with a statistical understanding of “extending
life” in the context of a discussion about end of life – after all, the Talmud
also used a statistical approach to justify violating Shabbat in a case
of pikuach nefesh.
Having conversations with family about end of life and
taking the time to think through various scenarios and communicate what one
might want is a hard and emotionally fraught process. It is also a critically
important and worthwhile one, and is a harmonization of both the value of pikuach
nefesh and also the value of having a dignified end-of-life as desired and modeled
by Ya’akov Avinu.
Each conversation and the decisions stemming from it are
very personal and individual, there are no “right” or “wrong” answers, and
families must commit to honoring the wishes of their loved one when the time
comes. I encourage all of you – no matter what age you are – to consider having
these conversations and to complete an advance directive and living will that
communicates your decisions clearly and explicitly. There is ample halakhic material and
an increasing number of facilitators nationally to help individuals and their
families have these discussions.
In an effort to increase community awareness of this issue,
Jewish Federation of Greater Metrowest is screening the Frontline documentary “Being
Mortal,” based on Dr. Gawande’s book, on Monday, January 30, 2017, at 7 pm, at
JKHA/RKYHS, 110 South Orange Avenue, Livingston. The documentary will be followed by a conversation
facilitated by Joshua Schor, MD, the Medical Director of Daughters of
Israel. The event is free and open to
the public, but you must RSVP to Mara Gellman, mgellman@jfedgmw.org, by Monday,
January 23. I encourage as many of you
who can to attend and hope to see you there.
May God protect and preserve each of us, and grant us long
life with sound mind and body. May God give us the emotional strength to have
these difficult conversations with our families, and peace and comfort as a
result the decisions that stem from those conversations.
Halakha,
halakhic Jewish
law, having to do with Jewish law
Masekhet
Yoma A
tractate in the Babylonian Talmud dealing primarily with the laws of Yom
Kippur.
Midrash An
ancient commentary on scripture, redacted circa 2nd century CE
Parashat Vayechi The
final weekly Torah portion in the Book of Genesis
Shemot The
Book of Exodus
Tanakh Scripture
(the Hebrew Bible)
Vayikra The
Book of Leviticus
Ya’akov Avinu Our
patriarch Jacob
