Jewish Institute of Bioethics launches new book
TEANECK About 10 years ago, Rabbi Dr. David Feldman was being interviewed on radio about end-of-life issues. The interviewer’s take on the discussion was: "You mean, ‘Where there’s life, there’s hope.’"
But, Feldman replied, "I wouldn’t be so unoriginal. What we need to guide our lives by is, ‘Where there’s life, there’s life,’ even if it’s futile and the quality of life has descended."
Now, he told The Jewish Standard, he’s written a book called just that, "with the idea of explaining how life is precious and Jewish law tells us so."
Rabbi Dr. David Feldman and Dr. Michael Harris aim to help people deal with end-of-life issues
"Where There’s Life, There’s Life" (Yashar Books) which addresses end-of-life issues from the perspective of halacha (Jewish law) was unveiled earlier this month at an event sponsored by the Jewish Institute of Bioethics. The program, held at the Jewish Center of Teaneck, featured Feldman, who is rabbi emeritus of that synagogue, and Dr. Michael Harris, professor of pediatrics at the University of Medicine and Dentistry of New Jersey and director of the Tomorrows Children Institute at Hackensack University Medical Center.
Feldman emphasizes the sanctity of life and tackles complex issues related to life and death in his chapters on pikuach nefesh (the Jewish obligation to preserve life), reproductive technology, abortion and stem-cell research, and organ transplantation.
"I’m very bothered when I hear some people say, ‘I don’t want to be a burden so I don’t want the doctor to do certain things,’" said Feldman. "You hear it from people who’ve given everything to their children." He recalled how the first patient of so-called suicide doctor Dr. Jack Kevorkian justified her request for assisted suicide by her concern that she would become a burden on her family. "Dr. Kevorkian didn’t do anything right," said Feldman. "He didn’t say, ‘Let’s wait until you become a burden.’ He just helped her take her life. None of his patients referred to pain, just to becoming a burden. There’s something terrible about this. With regard to physician-assisted suicide or elected suicide, we’re not doing anyone a favor."
He argued that if assisted suicide were legal, then people who are aged or infirm could be pressured to perform it so as not to be a burden to family. "If assisted suicide is legally permitted then [elderly persons] have no protection against having to give up their lives because they have the legal permission to do so." On the other hand, if it is against the law, then the elderly and infirm are protected. They could say, "Don’t pressure me and don’t expect me to elect it, because it’s not permissible," said Feldman.
Preservation of life
At the book launch, Feldman said that pikuach nefesh, the preservation of life, is such an important principle that if an illness occurs on the Sabbath, or even on Yom Kippur, it is imperative to seek medical attention without delay, even if that means violating a holy day. He further explained that it is improper to seek out a non-Jewish person or a child who is not yet bar mitzvah age to take care of the patient in order to avoid violating the Sabbath. That would give people "the wrong idea, that [violating Shabbat to save a life] is forbidden. This is your commandment: set aside Shabbos, even Yom Kippur, to save a life."
When a Jewish doctor is called to help a patient on the Sabbath, Feldman said, according to Jewish law he is to minister to the patient and then is permitted to return home, even if it means violating the Sabbath to do so. According to the halachic authority Rabbi Moshe Feinstein, Feldman said, "The law is, he takes care of the person and comes home. Because if he’s not allowed to come home, then the next time he’ll rationalize and hesitate [to help the patient] . Shabbos and Yom Kippur are not as important as the possibility of saving a life."
With regard to transplantation, initially there was rabbinic uncertainty regarding the harvesting of organs, as it might mean hastening the death of the donor. However, said Feldman, modern medical technology can identify when a patient is brain dead, so "maybe the life of the donor is not life anymore."
Another issue that has made organ donation controversial has to do with the Jewish proscription against desecration of the body of the deceased. Because of this, unless there is a compelling reason, autopsies of the remains of Jewish people are generally prohibited and organ donation has traditionally been taboo in the Jewish community.
But, Feldman noted, in years past there was little success with heart transplantation; it was felt that desecration of the body couldn’t be justified since there was little hope that the donated organ would save a life. In recent years the rate of success of transplantation has improved dramatically. "Now we have cyclosporine to fight [organ] rejection," said Feldman. "And Blue Cross pays for it. Before they said it was experimental." Since there is a real expectation that organ transplantation will save a life, the removal of an organ from a deceased donor can be justified.
Dr. Michael Harris told of a youngster he treated more than 10 years ago, a 14-year-old girl with advanced cancer whose feelings about life and death touched him deeply. "When a child is very ill," he asked, "how can we handle it? I’ve been very fortunate to meet many children and families who are very perceptive [with regard to this issue]." Referring to Feldman’s book, he said that seriously ill children have taught him that "when there is life, there is life . Live life to its fullest."
The patient, Naomi, who was near the end of her short life, asked him, "Is there anything I can donate of my organs?" Since she had advanced cancer, none of the major organs would be appropriate, as they might be tainted with cancer cells. However, the cornea of the eye has no blood supply, therefore cancer cells have no way of infiltrating it. "She was an extremely artistic child," Harris recalled. Naomi told her doctor, "That gives me such a great deal of pleasure, because the world is such a beautiful world and it gives me pleasure to know [the recipient] will see the world through my eyes."
Harris himself recently went through the ordeal of organ transplantation. He had contracted hepatitis C 19 years ago when he accidentally stuck himself with a needle from a young patient with hemophilia. He knew that eventually his own liver would give out and he’d have to rely on a donor to save his life. He did get the liver and is fully recovered. Now he is a strong advocate for educating Jews about organ donation.
Harris reported that in the 1980s the Knesset decided to permit organ donation. While the Israeli rabbinate did not reach unanimity on the issue, it was supportive, and "many of the major Orthodox rabbis in Israel have signed organ donor cards.
"The good news is that the overwhelming majority of individuals involved in halachic decisions are coming to believe that organ transplantation is okay," he said. "Organs are taken from people whose brain stem is dead and there is nothing we can do to save these individuals. American law is quite clear. Jewish law has now come around to this way of thinking."
Harris said that Robert Berman, the founder of the Halachic Organ Donor Society, "has a mission to change the attitude of the Jewish public, not only the Orthodox, but the Conservative and Reform."
According to Harris, in Israel approximately only 4 percent of people waiting for an organ get one, and "from 100 to 150 people die each year in Israel for lack of an organ." He recalled that the parents of the young terror victim, Alisa Flatow, went to Israel to arrange donation of her organs. "Her organs saved nine lives," he said.
"We must change the Jewish public’s perception of what organ donation is," said Harris. "At Columbia [College of Physicians and Surgeons], where I had my transplant, a sign in the hospital reads, ‘Don’t take your organs to heaven. Heaven only knows we need them here.’"
Wishes of the critically ill patient
Feldman cited Prof. Yale Kamisar of the University of San Diego School of Law, a noted expert on euthanasia and physician-assisted suicide, in reference to the Terri Schiavo case. Schiavo had been in a persistent vegetative state for many years, while Schiavo’s husband and her parents fought over control of her fate. "Yale Kamisar said that the family is the last to ask because they’re always prejudiced," said Feldman. "Either they love the person so much that they say, ‘Doctor, do everything,’ or they are prejudiced in the other direction." Family members have to deal with problems about insurance coverage and issues regarding the last will and testament. "How can you ever be disinterested or impartial, and say let the person die?" asked Feldman.
According to Alan Musicant, manager of Gutterman-Musicant/Wien & Wien Memorial Chapels in Hackensack, it should not be a relative who makes end-of-life decisions, although most people tend to put their spouse or children in charge of the decisions. Regardless of who is chosen as health-care proxy, "the best thing you can do for your family, a gift to them, is to take the mystery out of what your wishes are," said Musicant.
Harris also noted that although members of the family should be the last people to choose, "people who choose a health proxy usually choose a family member. I chose my wife first and my daughter second . One has to trust family. It’s just as important for the hospital and physician so they will know who to turn to."
Harris emphasized that a living will and a health-care proxy are critical documents that every person should complete. A valuable publication called the "Five Wishes" document helps each person record specific wishes with regard to critical care and end-of-life decisions.
According to Gutterman-Musicant’s Website, "The Five Wishes ® booklet is a Living Will that lets people document how they want to be cared for if they become seriously ill and unable to make decisions on their own. It addresses medical wishes, while taking into consideration emotional and spiritual needs as well." Issues that are addressed include: who is to make care decisions for the patient, the kinds of medical treatment the patient may or may not want, how the patient wants to be treated, and other issues the patient would like his or her loved ones to know about.
"We do a lot of programming for advanced planning. There are so many questions that come up," said Musicant. He reported that Gutterman-Musicant/Wien & Wien Memorial Chapels are working together with local rabbis to develop a halachic caveat, or series of statements, to accompany the Five Wishes document, that would address issues of Jewish law. Rabbi Shammai Engelmayer of Temple Israel in Cliffside Park is working with Feldman on a draft of that addendum, which recommends that people consult with rabbinic authorities regarding specific end-of-life issues. The draft includes the statement, "If conforming to Jewish law is a concern of yours, we urge you to take this document and review it with your rabbi, so that together you can prepare an end-of-life directive that meets your needs."
For information on the Halachic Organ Donor Society, go to www.hods.org. For "Five Wishes," go to www.guttermanmusicantwien.com or call (800) 3”-0533. For Feldman’s "Where There’s Life, There’s Life," go to www.yasharbooks.com or call (800) 799-0815.
Dr. Miryam Z. Wahrman is professor of biology, director of general education, and co-director of the Center for Holocaust and Genocide Studies at William Paterson University of New Jersey in Wanye. Her book "Brave New Judaism," which explores cutting-edge topics in Jewish bioethics, has been published by Brandeis University Press.