Can I let my sick parent fade away?

July 30, 2009

Question: A relative of mine whose mother has dementia was advised by a doctor to let her fade away on a saline drip rather than receive medical treatment. Does respect for parents require us to seek help to keep them alive in these circumstances — or let them go?

Rabbi Naftali Brawer

Naftali Brawer is rabbi at Borehamwood and Elstree United Synagogue.

Judaism is emphatically opposed to euthanasia. The underlying logic is that life is a gift from God and that it is not for us to determine whether or not it is of value. Even if the dying patient explicitly asks for his life to be terminated, we are duty bound to ignore his request. Maimonides rules that terminating the life of a dying person is murder, and as such it is never permitted (Laws of Murder 2:7).

As for the dying patient, Judaism simply does not recognise the notion that we are the masters of our own bodies. As bizarre as this idea may seem in postmodern society, Judaism maintains that it is the Giver of life alone who may determine when life ends.

While Jewish law is unequivocal with regard to “active” euthanasia, there is some debate over the permissibility of “passive” euthanasia. Passive euthanasia would entail withholding temporary life-prolonging therapies in cases of great suffering. Some rabbinic authorities argue that it is important to preserve life at all costs (Tzitz Eliezer 5: Ramat Rachel 5) while others take a more lenient view in relation to withholding palliative therapies (Igrot Moshe Yoreh Deah II 174).

Yet even those who permit “passive” euthanasia make the important distinction between administering medicines and therapies and responding to natural human needs. While they are lenient regarding the former, they are insistent on the latter.

Natural human needs are such things as food, drink and oxygen and as long as it is possible to administer these to the patient, they must not be withheld. Starving the patient to death is not permitted. Nonetheless Rabbi Moshe Feinstein rules that if the patient himself were to refuse nourishment, one is not obliged to force-feed him (Igrot Moshe Choshen Mishpat II 74:3).

Drawing on all of the above, it seems to me that it would be forbidden for your relative to withhold from her mother all life-sustaining nourishment except for saline in order to hasten her death.
Furthermore, while dementia is a profoundly distressing condition for both the sufferer and her family, it is not in itself life-threatening and it is possible that left to her own devices, this woman might live for a relatively long time. Under such circumstances, starving her to death would be against Jewish law.

Rabbi Jonathan Romain

Jonathan Romain is rabbi at Maidenhead (Reform) Synagogue.

There are drugs that can halt the pace of dementia, but there is no cure for it, so presumably the medical treatment is for another condition from which your friend’s mother suffers.

If she had all her faculties intact, then no doubt the family would pursue medication, but it seems the doctor reckoned that she was “no longer herself” and so advised letting her go.

In the field of medical ethics, there is a well established principle that Judaism is against actively killing someone, but it does allow withholding certain treatment in terminal situations and thereby hastening death. However, that is a different issue from the question here: to what extent is a person with dementia worth saving? Much of the response below also applies to those with Alzheimer’s.

On one level, the person they once were has already died: they have lost most of their intellectual abilities, they do not recognise close family and they may no longer know who they are themselves. In short, they have no shared past, even with a partner of several decades who is now a total stranger.

On another level, they still do count. They have a present. They can enjoy the feel of the sun or the smell of flowers or the sight of children playing. They can also have momentary relationships — laughing together, holding hands and, very occasionally, saying something that is surprisingly meaningful.

The fact that they have changed means that we too have to change in order to keep up with them. We have to see them not in terms of how they compare to the past, but relate to them purely in terms of the immediate present. We may have lost “the old them”, but a different version is still with us.

It also means that, providing they are not suffering from a painful irrevocable condition, there is no reason why they should not live out their days. The family may decide not to authorise any operations or major transfusions, but there is no need to withhold non-invasive treatment such as antibiotics, and certainly not to deny them food or liquid.

This is not to minimise the strain that carers can face in looking after those with dementia and other ailments — it can be physically gruelling and emotionally exhausting — but it is to insist upon the continuing humanity of those for whom we care.

Last updated: 3:57pm, August 4 2009