Who shall live and who shall die?

During Rosh HaShanah services we recited the following words as part of Unetaneh Tokef: “B’rosh hashanah yikatevun, uv yom tzom kippur yechatemun – On Rosh HaShanah it is inscribed, and on Yom Kippur it is sealed.” We then affirmed our ability to influence what is written through the vehicles of prayer, repentance, and tzedakah.

Outside of shul, we are frequently given other prescriptions for increasing the length and quality of our days, whether through eating well, getting enough exercise, or taking other steps to maintain a healthy lifestyle.

The common denominator – whether or not one believes the liturgy or the fitness tips – is the idea that we have some control over our own bodies and our own lives. And, to take this assumption one step further, we have control not only over our lives but of our deaths as well, through vehicles such as living wills and health care proxies.

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A recent incident in New Jersey, now the subject of a lawsuit, has called this assumption into question, throwing into doubt whether there is a universal right to patient autonomy.

In March, 73-year-old Elizabeth resident Ruben Betancourt suffered oxygen deprivation during surgery and was declared to be in a persistent vegetative state. According to Agudath Israel of America – which has filed a lawsuit together with the Rabbinical Council of America – his daughter wanted to keep her father on life support. Doctors at his hospital, however, claimed that the decision was theirs. While the New Jersey Superior Court agreed with the daughter and barred the hospital from removing the life support, Mr. Betancourt died. Nevertheless, the hospital has appealed the court’s decision.

Agudath Israel and the RCA raise an interesting point. Since the New Jersey courts have held on numerous occasions that patients and their families have the right to refuse life-sustaining medical care despite objections from the patient’s health care providers, the two Jewish groups argue that patients should similarly have the right to choose to live.

According to the groups’ attorney, the underlying assumption behind appellant’s argument is that the decision to terminate medical care is fundamentally a medical decision. The two Orthodox groups, however, take issue with that assumption, holding instead that this is an ethical decision.

The issues are complicated, and there are competing needs and values. The case will bear close watching.

L.G.