During a trip to the nursing home to visit her 93-year-old mother, Shoshana Silberman of Lawrenceville was told by the head nurse that her mother, who could not swallow, was near death.
The nurse said, according to Silberman, “perhaps it was time for morphine—it would prevent her from choking to death.”
Silberman had been particularly fearful of that possibility, so to relieve her mother’s suffering, she okayed the morphine. A few hours later, her mother died peacefully.
Perhaps, Silberman suggested, there should be tighter guidelines for these complicated circumstances, but, ultimately, it comes down to an emotional decision.
“Maybe our human gut tells us we have to do something to alleviate a terrible situation,” she said.
In the first event in a new Judaism and Science series held at The Jewish Center on Nov. 28, Rabbi Julie Roth, executive director of the Center for Jewish Life at Princeton University, and Harold Shapiro, president emeritus of Princeton University and professor of economics and public affairs at the Woodrow Wilson School, discussed “Bioethics: Physician-Assisted Suicide and End of Life.”
Silberman was one of several attendees who participated in the discussion of a weighty, and often emotional, subject.
First Roth reviewed Jewish texts that rabbis across denominations have interpreted to mean that physician-assisted suicide is prohibited under Jewish law. Basing several of her explanations on Elliot Dorff’s book “Matters of Life and Death” (The Jewish Publication Society, 2003), she said that because Jewish law considers that “the body belongs to God” and that “human worth stems from being created in God’s image,” suicide is prohibited for a person of sound mind, except in cases of martyrdom. She added that Jewish law shows consideration for a person suffering from mental illness.
Assisted suicide would be prohibited, she said, because it’s as if one is actively placing “a stumbling block before the blind” — for example, a doctor setting up an IV so that a patient can administer a fatal dose of a drug.
Still, Roth agreed with Silberman that “in the moment we are more governed by feelings rather than principles or rules,” and noted that the Conservative movement would not have objected to her decision for her mother.
“It is permissible to administer morphine when people are actively dying even if it will hasten their death, as long as the reason is to alleviate their suffering,” Roth said.
She noted that the Conservative movement supports a variety of stances on end-of-life issues. Some rabbis support the notion that every moment of life should be preserved, whereas others allow a doctor to remove an impediment that is preventing a person from dying, as exemplified in a Talmudic text.
As Rabbi Hananiah ben Teradion, a Mishnaic-era scholar, was being burned alive by the Romans, his tormentors wrapped wet wool around his heart to prolong his suffering. The rabbis ultimately decided that removing the wool, as one of the guards eventually did to hasten the rabbi’s death, was permissible in that case. Roth said she found one Reform rabbi who concluded from the story that it is meritorious to end an individual’s suffering, even if doing so would result in an earlier demise.
Speaking from a secular perspective, Shapiro focused largely on the Canadian Supreme Court’s decision last year that not only allowed physician-assisted suicide, but established it as a patient right in all Canadian provinces, provided the person is part of the Canadian national health system.
“It is not simply a matter of something you could do and you won’t be prosecuted, but it is a right — as a patient or a citizen you have a right to demand this from local hospitals and the local hospitals have to provide it,” Shapiro said. In the United States, physician-assisted suicide is allowed in six states — California, Colorado, Oregon, Montana, Vermont, Washington — and the District of Columbia.
Recalling articles he had written for medical journals in the late 1980s and early 1990s, Shapiro said that doctors had been administering morphine in cases like Silberman’s mother for years.
“Doctors have been doing what they thought was the most humane thing to do, but for society as a whole you have to decide what the rules are,” he said. Given the spectacular medical advances of recent years, Shapiro said, “we are living longer, better lives, but more often we are kept alive in circumstances that are not very redeeming,” and questions about the legitimate or appropriate use of physician-assisted suicide have become commonplace.
Robert Karp, a retired pediatrician who lives in Princeton, talked about the complexities of being a doctor tasked with saving lives but whose profession also witnesses suffering. At a hospital with a sickle cell anemia clinic, he said, the parents of a doomed teenager “were holding onto life for their dying child.”
“I see a difference between stopping when you realize there is nothing more that can be done and doing too much,” Karp said.
Hazel Stix of Princeton, who has attended hearings on the Aid in Dying for the Terminally Ill Act — it already passed in the NJ Assembly and could come to a vote in the state Senate soon — in the New Jersey legislature, said that ending a life is a private decision. “Neither side has a right to impose its conception of morality on the personal decision of an individual,” she said. “The decision to end one’s life should be strictly a matter of personal choice.”
Shapiro admitted he was not comfortable with the distinction between the morality of letting a person die versus actively killing someone.
“I can’t work out the moral difference here; I’ve never been able to resolve that,” he said. He also wondered why the U.S. Supreme Court would use this distinction rather than focusing on privacy, as it did in Roe v. Wade with respect to abortion.
“What could be more personal than a decision like this?” he asked.
For Jeremy Kasden, cochair of The Jewish Center’s adult education committee, the issue of assisted suicide came to mind when discussing with his astronomical science students the ethics of a possible mission to Mars. Although scientists think they could safely deliver humans to Mars, they most likely would not be able to bring them back; yet, thousands of people volunteered for such a voyage.
“Those people are choosing to commit long-term suicide,” Kasden said. “My feeling was that, as an engineer, I am assisting suicide, and am I ethically bound not to do that?”