Death and dignity in New Jersey

Death and dignity in New Jersey

The New Jersey State Senate is due to consider a bill legalizing and regulating physician-assisted suicide – the “New Jersey Death with Dignity Act” – already approved by the State Assembly.

The law would permit “qualified” competent adults, whom physicians predict will die of a terminal disease within six months, to obtain lethal drugs in order to end their own lives. As the New Jersey Senate (before which, in 1861, Abraham Lincoln called Americans the “almost Chosen People”) prepares for this debate, the citizenry of the state and its legislators can benefit profoundly from the wisdom of Jewish tradition.

Suicide is not a sin in Judaism. Suicide is (as Catholic theologian G. K. Chesterton said) “THE sin.”

That principled, absolute opposition to suicide was also the position of, among others, Rabbi Seymour Siegel: “One can say that the revulsion of the suicide is the hinge upon which the whole ethical system of Judaism turns. By disdaining the suicide, Judaism affirms its high valuation of life and its belief in the sovereignty of the Creator.”

Chesterton elaborated on the principle Rabbi Siegel would come to share: “It is the ultimate and absolute evil… The man who kills a man, kills a man. The man who kills himself, kills all men; as far as he is concerned he wipes out the world… There is not a tiny creature in the cosmos at whom his death is not a sneer.”

The fact that Jewish ethics (or Roman Catholic doctrine) soundly condemns suicide is itself, of course, insufficient cause to ban its practice in a secular democracy with a religiously and culturally diverse population. Such an argument, based exclusively on religious principle, would be theocratic in nature – religious coercion inconsistent with our constitutional system. However, it would be the height of folly to abandon good public policy simply because its wisdom is acknowledged and anticipated by life-affirming religious traditions. I offer my fellow New Jersey citizens insights from Jewish law and tradition not because they all should necessarily be bound by that discipline. I do so because I firmly believe that in this troubling ethical debate, Judaism long since has articulated eternal truths and identified moral absolutes that transcend faith and culture and individual autonomy. I do so because Judaism’s mission to teach the absolute sanctity of all human life has never been more urgent – or more embattled. I am grateful, too, for the shared moral perspective taught by our sister faith.

I find the proposed “Death with Dignity” act to be profoundly dishonest. While asserting a person’s right to end his or her own life, it provides that the death certificate “shall list the underlying terminal disease as the cause of death.” That is to say, the law requires that the lethal actions for which it provides moral and legal sanction be obfuscated. The consequences of the law must be hidden from view and expunged from the record.

Also less than forthright is the law’s assurance that a health care facility (as, for example, a hospital administered by a religious body opposed to suicide) may bar its employees from facilitating patient suicides under the proposed act. Such religious institutions’ authority to prohibit physicians’ participation in assisted suicide does not extend to actions taken in “the private medical office of a physician or other provider.” Similarly, a physician would enjoy immunity from employer bans and punitive action when “acting outside the course and scope of that individual’s capacity as an employee.” That is, an oncologist prohibited by Saint Mary’s Hospital from prescribing a lethal dose of narcotics to a terminal patient could circumvent his employer’s directives by doing so strategically, in the privacy of his own office, or by doing so ostensibly not as an employee, but as a trusted friend of the family, “off the clock.”

The very use of “medication” to effect patient suicide is profoundly deceitful. Suicide by a self-administered overdose of physician-prescribed drugs is no more morally defensible or refined than suicide by firearm or hanging, exposure to the elements, or poison. The “big lie” of involving healers and “curative” substances in state-regulated suicide was addressed decades ago by Daniel Callahan, co-founder and president of the Hastings Center, a research organization in Westchester County:

“As people have turned away from religion and elevated medicine as the supreme arbiter of our lives, we ask for medicine’s sanction. It might be argued that if a person wants to commit suicide, they can most often do it themselves – why bring in the medical community to legitimate it? Why? Because we need somebody in authority to say it is okay for us to do something that we know is reprehensible.”

The true role of medical professionals and “medication” in the proposed law is not to avoid but to mask the moral offense in self-destruction, and in so doing, to delude patients and their families by manipulating the trust and esteem customarily vested in the physician.

The safeguards built into the law are themselves illusory: “A person who substantially complies in good faith with the provisions of this act shall be deemed to be in compliance with this act” – desultory departure from exacting legal or medical protocols notwithstanding.

The most insidious deception inherent in the proposed law, however, is codified in its very name: the “Death with Dignity Act.” What greater assault on human dignity could be perpetrated than the official determination that a person’s life no longer merits society’s unqualified protection and esteem as sacrosanct. There is no dignity, to borrow a telling term from the medical horrors of the Nazi era, in being ruled lebensunwertig – “not worthy of life” – nor of the unconditional moral immunities human life commands.

Of course, those suffering with terminal illness (indeed, any who suffer) require our compassion. By divorcing compassion from reason and a sense of normative moral duty, however, by acceding even to a patient’s own desperate urging to kill in the name of kindness, we distort the moral virtue of compassion beyond all recognition. Permitting or facilitating suicide in the name of compassion is the wrong application of the right principle.

The argument from compassion for legalizing suicide is simultaneously seductive and perilous. How quickly the right to suicide will be perceived – especially by the physically depleted and emotionally vulnerable – as a duty of self-destruction. Do not loved ones who share the anxiety of illness (as, too, the emotional trials, financial burdens, and often onerous demands on personal time and energy occasioned by caring for the terminally ill) also deserve compassion? Will not the absolutized principle of “compassion” invoked to justify physician-assisted suicide also demand selfless compassion from the terminally ill, to alleviate the “suffering” of those around them? Notwithstanding its procedural safeguards, the proposed law will place unjust pressure on the terminally ill to end if not their own, then the collateral suffering of loved ones.

Rabbi Emanuel Rackman discussed the far-reaching consequences of the type of law now pending in New Jersey:

“The misery of the few who might take advantage of the legislation proposed is naught by comparison with the misery of the multitudes whom the Leviathan will destroy when and if we raze the ramparts which religion has raised for millennia around the sanctity of life.”

Historically, Jewish law has responded to the moral offense of suicide with two complementary and carefully balanced policies. First, the suicide is theoretically “punishable” with posthumous sanctions: certain funerary prayers and rites are withheld, burial is at a distance from other graves, and mourners continue daily recitation of Kaddish longer than usual – as its fullest expiatory power is deemed necessary following so sinful a demise.

The second historic trend in Jewish law has been to consider only the narrowest conceivable category of suicide as culpable: only those people who, in a calm state and with sound mind and judgment, clearly state before witnesses their intention to take their own lives, and then proceed immediately to carry out their threatened course of self-destruction. In other words, rabbinic tradition has, gratefully, all but legislated “true” suicide (and any punitive measures imposed in its wake) out of existence – an expression of incredulous disdain for suicide as well as a gesture of genuine compassion for both the deceased and the bereaved.

The “safeguard” in the proposed physician-assisted suicide legislation require precisely those elements that render suicide halachically culpable: establishment of psychological competence, unambiguous declaration of suicidal intent before witnesses, and self-administered lethal action in accordance with those pronouncements. The proposed New Jersey law, that is to say, would remove any claim to extending or exculpatory circumstances, and restore the tragic category of culpable suicide, thus undoing millennia of indulgent sensitivity and compassion toward those driven to such desperate acts.

Jews traditionally are self-described as “rachmanim, b’nei rachmanim” – compassionate people, born and bred (literally, “compassionate people, children of the compassionate”). The call for compassion in the current debate is alluring – perhaps especially to us as Jews. Suicide, however, simply cannot be reconciled with our ancestral tradition, our historic mission, our life-affirming code. “Let God Who gave life take it away; let no mortal commit self-injury.” These succinct and stirring words were spoken by the martyred Rabbi Hanina ben Teradyon as he was tortured and burned alive, wrapped in a Torah scroll by his Roman tormenters. He was responding to the despairing pleas of heartbroken disciples, witnessing his agony, who urged him to “inhale” the flames, so as to expedite his death and end his own suffering. Hanina’s death is recalled each year in the Yom Kippur liturgy – a dramatic ritual reminder of one of our most sacred principles, on the holiest day of the year.

As I am moved each year by Yom Kippur’s martyrology, I am reminded by Rabbi Hanina’s dictum of the last words I ever heard spoken between my parents, of blessed memory. My mother, who would die just 24 hours before Kol Nidrei, was in her last, painful days, lying in the same hospital where, 30 years earlier almost to the day, she had given birth to me. My father attended her throughout her final illness with heroic devotion. With only hours or days to live, she certainly would, alas, have qualified as a candidate for New Jersey’s physician-assisted suicide law. She awoke in her bed, surprised to have been granted another day. Though by no means generally given to theological speculation, she turned to my father, and with inspiring moral clarity, said, “I guess God doesn’t want me to die yet.” Taking her by the hand, my father tenderly and insistently assured her, “Of course not.”

Hanina ben Teradyon could not have said it better himself.

Rachmanim b’nei rachmanim.

May our elected officials – and the “almost Chosen People” of our state – awake to similar wisdom and compassion.