Right to die as well as possible
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If someone you love is at the end of life, dying in great pain, wishes not to continue and instead wants take medication that will allow them to gently slip away, should that option be available?
At present, this is illegal in Britain – those who do so fall foul of the Suicide Act and anyone who assists them can be liable to prosecution. However, legislation to introduce assisted dying will be debated today (Friday, July 18) in the House of Lords.
How should Jews react? Suicide has always been regarded as wrong, but assisted dying is a different situation. It does not apply to people who, for instance, if they overcame their depression, could live happily for many years to come, but to people who are terminally ill. Their only choice is how and when they die.
Until now, Jewish medical ethics has recognised that there are instances where one can stop someone from being kept alive artificially, such as through a life support machine, but has opposed allowing patients to take life-ending medication.
We defy God's work in medical treatments
Rabbis tend to refer to "the sanctity of life" . Sanctity of life means valuing each individual life, but does it include insisting someone lives on, against their will, in pain?
Some see value in suffering, and it is certainly true that it can alter one's perspective, but what use is that in one's final days, especially if the person is semi-conscious with morphine, while it is a cruel God who uses human agony as a divine blackboard.
Others argue that "God gives and God takes" and we cannot usurp that prerogative. Yet we are constantly defying God's handiwork at both ends: helping women otherwise unable to conceive, or giving heart transplants to those who need them.
There are many who regard a painful death as a regrettable part of the natural cycle of life, to be mitigated through medical care if possible and to be endured if not. That is entirely their view and must be respected.
But should those who wish to avoid that pain and indignity have the right to do so? And do other people have the right to prevent them making that choice?
Ecclesiastes says: "There is a time to be born and a time to die". It is noticeable that it does not say who chooses that time. Maybe it can be our decision.
Of course, there are practical concerns that assisted dying may render some people vulnerable to pressure from unscrupulous relatives, but the Bill has numerous safeguards.
The process can only be initiated by the patient; it must be confirmed by two independent doctors that they are terminally ill and of sound mind; they must be counselled by a palliative care expert to ensure they have considered other options; there has to be a 14-day waiting period for reflection; and they can change their mind at any time.
The same process was legalised in Oregon in 1997. Several thousand dying patients per year enquired about the possibility, but only around 0.2 per cent (in 2012 this meant 75 people) actually chose it.
It indicates that many people wish to have the emotional safety net of knowing they can resort to an assisted death if their situation makes life intolerable, but the vast majority find they never reach that stage.
This is difficult territory, but it is religiously appropriate to try to navigate it. If there is a right to die well - or at least to die as well as possible - it means having the option of assisted dying, whether or not it is taken up.
Jonathan Romain is rabbi of Maidenhead Synagogue and editor of Assisted Dying – Rabbinic Responses (Movement for Reform Judaism)