My uncle is terminally ill & suffering greatly. Can I pray for him to die?
Shlomo Brody
The writer, on-line editor of Tradition, teaches at Yeshivat Hakotel and is pursuing a doctorate in Jewish philosophy at the Hebrew University.
April 30, 2009
Q My uncle is terminally ill from cancer and suffering greatly. Can I pray for him to die?- B.K., New York Rabbi Shlomo Brody: Those of us who have experienced an agonizing extended death of a loved one certainly share your pain. Modern medicine allows doctors to heal - or at least to keep alive - many patients who in previous decades would have died quickly. The blessing of greater life expectancy, however, does not always improve quality of life, and in certain circumstances keeps people alive in excruciating conditions. While controversies over euthanasia and withholding treatments dominate public debate, the independent question of our prayers deserves greater attention. Judaism attributes great importance to preserving life, with the Mishna going so far as to state, "Anyone who saves a life is as if he has saved an entire world" (Sanhedrin 37a). One does not even possess the autonomy to harm oneself, as Judaism prohibits suicide and all forms of self-mutilation. Nonetheless, even life gets trumped at times by other values. Jewish law allows for the death penalty, sends soldiers out to battle and demands one be killed rather than commit idol worship, illicit relations or murder. In our case, the question remains whether Judaism attributes enough value to the quality of life to allow one to pray for the suffering patient to die. (To reiterate: This question remains independent of the propriety of "mercy killing" and less drastic forms of active, physical intervention.) Classic sources attribute certain spiritual benefits to the experience of suffering. Pain is regularly understood not only as divine punishment, but also as atonement. "Suffering erases all of a person's sins," the sages declared (Brachot 5a). The process of repentance that anguish should spawn, moreover, brings humans closer to God, as the psalmist exclaims, "I found trouble and sorrow; then I called upon the name of the Lord" (Psalms 116). Consequently, other sources speak of suffering as a sign of God's love or purifying experiences to make one worthy of the world to come. However, these "benefits," so to speak, remain a silver lining, with affliction seen as an undesirable curse. When asked whether they welcomed a period of suffering, one group of sages hastily responded, "Not it nor its reward!" (Brachot 5b). Noting that we violate Shabbat to treat someone on his deathbed, even though death is imminent, Rabbi Eliezer Waldenburg (Israel, d. 2006) concluded that every breath remains valuable and that one should never pray for an ailing person to die (Tzitz Eliezer 9:47). He cited a remarkable talmudic statement deeming it meritorious for an otherwise righteous adulteress (sota) to have a protracted, painful death rather than to die quickly (Sota 20a), proving that life always remains precious, especially given the spiritual implications of suffering. God will decide the fate of all, but we must do everything we can, including prayer, to extend life. Several talmudic stories, however, seem to encourage beseeching God to end the anguish of the terminally ill by allowing them to die. The handmaiden of Rabbi Yehuda Hanassi prayed for her ill master to die, with her requests ultimately answered over the fervent entreaties of his students, who declared a special fast day for his recovery (Ketubot 104a). Rabbi Akiva, moreover, criticized his students for not visiting the sick enough, as it callously prevented them from "praying for their recovery or their death" (Nedarim 40a). As Rabbeinu Nissim (14th century, Spain) explained, the very least we can do for those who suffer with no chance of recovery is to pray for the end of their suffering through death. This position was adopted by modern decisors like Rabbi Yehiel M. Epstein (Aruch Hashulhan YD 335:3), Rabbi Moshe Feinstein (Igrot Moshe CM 2:74) and Rabbi Shlomo Goren. The fact that we violate Shabbat in all life-endangering situations highlights the extent we go to preserve life, but does not preclude us from desiring a merciful death from God. One suggested prayer reads, "Please God, with the power of Your great mercy, and with Your great benevolence, may it be Your will to take the soul of so-and-so out from its closed prison to relieve him from his suffering, and may his soul return to the God who gave it to Him" (Encyclopedia of Jewish Medical Ethics III:1062). A nuanced position was taken by Tel Aviv Chief Rabbis Haim Halevi and Yisrael Meir Lau, who contend that caretaking relatives may not pray for death as this might reflect a desire (conscious or otherwise) to relieve themselves of their burdensome filial responsibilities. Others feel most comfortable with beseeching God for mercy on the sick person by all means, not precluding death, but without explicitly praying for their demise (Be'er Moshe VIII 239:4). May God provide mercy and comfort to the terminally ill and their loved ones that care for them.
The writer, on-line editor of Tradition, teaches at Yeshivat Hakotel and is pursuing a doctorate in Jewish philosophy at the Hebrew University.
New York Times, May 15, 2020
How a Nurse Who Gives Last Rites Spends His Sundays
Yaakov Shereshevsky has been saying the Viduy, a Jewish prayer, for terminal Covid patients.
Because rabbis can’t go into the patients’ rooms, the only people able to give last rites is us. I’m not trained to do this for the Jewish community, but for the past five or six weeks, I’ve been saying the Viduy in Hebrew, then in English. It’s the realization and acceptance that the end is here; it is time to say goodbye and ask forgiveness from our creator. They have family who need to know this is done, and the patients can’t say it for themselves. I’m not an emotional person, but it’s a rough thing to get through. It hurts. If their death is imminent, I wait with them. Then I pull it together in the elevator and return to my patients.
(א) וידוי החולה וכיצד אומרים לו. ובו ב"ס:
נטה למות אומרים לו התודה ואומרים לו הרבה התודו ולא מתו והרבה שלא התודו ומתו ובשכר שאתה מתודה אתה חי וכל המתודה יש לו חלק לעולם הבא ואם אינו יכול להתודות בפיו יתודה בלבו (ואם אינו יודע להתודות אומרים לו אמור מיתתי תהא כפרה על כל עונותי) (טור) וכל אלו הדברים אין אומרין לו בפני ע"ה ולא בפני נשים ולא בפני קטנים שמא יבכו וישברו לבו:
(ב) סדר וידוי שכיב מרע מודה אני לפניך ה' אלהי ואלהי אבותי שרפואתי ומיתתי בידך יהי רצון מלפניך שתרפאני רפואה שלימה ואם אמות תהא מיתתי כפרה על כל חטאים ועונות ופשעים שחטאתי ושעויתי ושפשעתי לפניך ותן חלקי בגן עדן וזכני לעוה"ב הצפון לצדיקים. (ואם רוצה להאריך כוידוי יו"כ הרשות בידו) (כל בו):
(1) If one feels death approaching, he is instructed, 'Confess [your sins]!'1Shab. 32a and Tur a.l. This applies only when he feels death approaching. Otherwise, he will think that he is dangerously ill and his heart will be broken — BaḤ and ShaK contra Perisha. Sifre, Num. V, 6: ‘R. Nathan says, “and that soul be guilty; then they shall confess their sin which they have done.” this (verse) forms the rule for all dead that they require confession of sin (prior to death).’ And they say to him, 'Many confessed [their sins] and died not, and many who have not confessed, died; and as a reward, should you confess, you will live;2T.H., derived from Sem. de R. Ḥiyya(H) I, 2. Cf. supra § 337, n. 2. and he who confesses [his sins] has a portion in the world to come.'3As we find written in the case of Achan, ‘Joshua said unto him, my son, give, I pray thee, glory to the Lord, the God of Israel, and make confession unto Him’ (Josh. VII, 19). ‘And Achan answered Joshua and said, of a truth I have sinned against the Lord, God of Israel, and thus and thus have I done’ (ibid. 20). The confession of Achan made atonement for him, as is written (ibid. 25), ‘The Lord shall trouble thee THIS DAY,’ i.e., only this day, but not in the world to come — Mishna, San. 43b. And if he is unable to make confession with his mouth, he should confess in his heart.2T.H., derived from Sem. de R. Ḥiyya(H) I, 2. Cf. supra § 337, n. 2. If he knows not what to confess, they instruct him, say, 'My death should be an expiation for all my sins.'4Tur — G. Mishna, San. ibid. All these instructions are given to him, not in the presence of illiterate people, nor women, nor minors, lest they cry and break his heart.2T.H., derived from Sem. de R. Ḥiyya(H) I, 2. Cf. supra § 337, n. 2.
(2) The order of confession5Cf. Sifra, Lev. V, 5 and Torah Temimah a.l. n. 56. for a dangerously ill person, is, 'I confess before Thee O Lord, my God and the God of my fathers, that my healing and my death are in your hand. May it be Thy will, to heal me completely, and if I die, my death should be an expiation for all sins, wrongs and rebellious acts,6Yoma 36a. O.Ḥ. § 621, 6. חטא refers to a sin committed unwittingly; עון to one committed wittingly and פשע to a rebellious act. The order here is from the lenient to the grave. Thus M.Abr. ibid. n. 5. which I have committed sinfully, wrongfully and rebelliously before Thee, and grant me a share in Paradise, and favour me with the world to come which is stored away for the Righteous.' And if he desires to prolong as in the confession for the Day of Atonement,7Yoma 86b. he has the right to do so.8Kol Bo — G.
[A modern interpretation by Rabbi Ronald Roth]
Eloheinu v'elohei avotainu v'imotainu,
Our God, and God of our ancestors, accept our prayer. We turn to You, acknowledging that life and death are in your hands. If it is Your decree that ____________________ be taken by death, may it be in peace and love.
We know that in life he (she) left many deeds undone. He (she), like all of us, led an imperfect life. We pray for You to forgive those failings. May he (she) be protected by the righteous deeds that are his (her) legacy. May those deeds live on. Guardian of the helpless, Source of compassion, protect and comfort his (her) family and friends. Their souls remain tied to him (her) with limitless bonds.
May, ________________, be granted an eternal existence in Your presence.
Into Your hand he (she) commits his (her) soul.
(Silent meditation or time for those gathered to express their personal farewells, or give voice to unfinished concerns)
Sh'ma Yisrael, Adonai Eloheinu, Adonai Echad.
Hear O Israel, the Lord is Our God, The Lord Alone.
Baruch Shem kevod malchuto l'olam va'ed.
Praised be His glorious sovereignty throughout all time.
Adonai Hu Ha-elohim, Adonai Hu Ha-elohim.
The Lord is God, The Lord is God.
(After the moment of death)
Adonai natan, v' Adonai lakach, y'hi shem Adonai m'vorach.
The Lord gave to us, and now the Lord has taken away, despite our grief, may we still praise the name of the Lord.
Baruch dayan ha'emet.
Praised be the ultimate Judge of all truth.
§ It is related that on the day that Rabbi Yehuda HaNasi died, the Sages decreed a fast, and begged for divine mercy so that he would not die. And they said: Anyone who says that Rabbi Yehuda HaNasi has died will be stabbed with a sword. The maidservant of Rabbi Yehuda HaNasi ascended to the roof and said: The upper realms are requesting the presence of Rabbi Yehuda HaNasi, and the lower realms are requesting the presence of Rabbi Yehuda HaNasi. May it be the will of God that the lower worlds should impose their will upon the upper worlds. However, when she saw how many times he would enter the bathroom and remove his phylacteries, and then exit and put them back on, and how he was suffering with his intestinal disease, she said: May it be the will of God that the upper worlds should impose their will upon the lower worlds. And the Sages, meanwhile, would not be silent, i.e., they would not refrain, from begging for mercy so that Rabbi Yehuda HaNasi would not die. So she took a jug [kuza] and threw it from the roof to the ground. Due to the sudden noise, the Sages were momentarily silent and refrained from begging for mercy, and Rabbi Yehuda HaNasi died.
(1) One who is dying is like a living person for all his affairs... They do not remove the pillow from under him, and they do not place him on sand nor on clay nor on earth, and they do not place a pot or a trowel or a pitcher of water or a grain of salt on his stomach..., and they do not close his eyes, until his soul departs. And anyone who closes with the departure of the soul, behold this one spills blood... And so it is forbidden to cause the dead person to die quickly. Such as one who was dying for a long time and he could not separate, it is forbidden to remove the pillow or the mattress from underneath him, because they say that there are feathers of some birds that cause this, and similarly they should not move him from his place. And similarly it is forbidden to place the keys of the synagogue under his head, in order that he take leave. But if there is something there that is causing delay in the departure of the soul, such as if there is a banging noise next to that house, such as a wood chopper, or there is salt on his tongue, and these are preventing the departure of the soul, it is permitted to remove it from there, that in this there is no activity at all, rather he removes the barrier.
The case in both sources is one of a person literally on his deathbed. In our time, however, people can be "on their deathbeds," as it were, almost indefinitely, sustained by heart and lung machines as well as by other medical paraphernalia. Thus definitions of "mortally ill" (goses) in terms of a specific number of hours (commonly held to be within 72 hours of death) are inappropriate to today's medical realities, such as our ability to maintain artificial respiration. Even if one restricts the use of such a definition to the expectation of one's remaining life unaided by medicine, one still must face the problem which this definition has always entailed, namely, how can one know ahead of time the moment of a patient's impending death with such certainty? Moreover, the distinction between direct and indirect means of letting people die has become increasingly difficult to recognize and maintain and, according to some contemporary ethicists, it can easily mask highly immoral activities...however we define the category of goses all agree that the person in that category is still considered alive. Therefore, any withholding or withdrawing of treatment from such people always comes with not a small amount of ambivalence and guilt. The halakhic category which describes these situations much more accurately and appropriately, he suggests, is that of terefah a person with an incurable disease. Such a person is, according to medieval authorities, a terefah, an already dead person, and consequently one who kills him or her is exempt from human punishment although subject to divine and extra-legal penalties. When applied to animals other than human beings, the term terefah refers to one suffering from a fatal organic defect, such as a pierced windpipe or gullet. It is presumed that a terefah animal will die within twelve months. A human terefah is also defined on the basis of medical evidence- specifically, as Maimonides says, "it is known for certain that he had a fatal organic disease and physicians say that his disease is incurable by human agency and that he would have died of it even if he had not been killed in another way." Since the death of a iltl',~ is inevitable, evidence of n1tl,~ is equivalent to evidence of death, and therefore, according to the Talmud, the deserted wife of a iltl',~ may remarry. 39 According to most authorities, twelve months must elapse before permission to remarry may be granted, analogous to the presumption regarding animal terefah. Tosafot, however, argue that fundamental physiological differences between humans and other animals (and, I would add, the expenditure of considerably more human energy and resources in caring for sick humans) often enable people to survive for a longer period. These factors underscore the fact that for all of these authorities, the twelve-month period with regard to humans is only an estimate, and the crucial factor in the definition of terefah is the medical diagnosis of incurability.
As Sinclair says, then: The outstanding feature of the category of human terefah for the current debate concerning the treatment of the critically ill is the exemption of the killer of a terefah from the death penalty. This feature focuses attention upon the fact that a fatal disease does detract from the legal status of a person, and also introduces a measure of flexibility into the issue of terminating such a life. This is in direct contrast to the category of goses, which is based on the premise that a goses is like a living person in all respects. Indeed, almost all the laws of the goses confirm his living status and, as already observed, can only be appreciated against the background of the domestic deathbed. The category adopts a different perspective (the effects of the critical illness upon a person's legal status), and as such, it is much closer to the current debate on the termination of the life of a critically ill patient
On December 12, 1990, the CJLS debated two papers submitted by Rabbis Elliot Dorff and Avram Israel Reisner, members of the CJLS’s sub-committee on bio-medical ethics, on end-of-life issues. Both papers were adopted by the Committee, Rabbi Dorff’s by a vote of 11-2-5, Rabbi Reisner’s by a vote of 13-1-4 (members were given the option of voting for both papers). Thus both positions are valid views. The key points of each are summarized below.
1. The key category for dealing with end-of-life issues is the טריפה . [terefah]
a. When the patient has an irreversible, terminal illness, medications and other forms of therapy may be withheld or withdrawn. Artificial nutrition and hydration may be considered a sub-category of medication in such circumstances, and therefore may also be withheld or withdrawn.
b. The category of terefah may also be applied to the person in a permanent vegetative state, and it would be permissible to remove artificial nutrition and hydration.
c. Terminally ill persons may, if they choose, engage in any medical regimen which has the slightest chance of reversing their prognosis. So long as the intention is to find a cure, they may do so even if they thereby simultaneously increase the risk of hastening death. Jewish law includes permission for the patient to refuse any treatment he/she cannot bear, including forms of therapy which, though life-sustaining, the patient judges not to be for his/her benefit. Terminally ill patients may choose hospice or home care. A patient may reject CPR and/or issue a DNR order when these measures are unlikely to restore the patient to meaningfully healthy life. Pain medication may continue even if its probable effect is to hasten the patient’s death.
(Teshuvah by Rabbi Elliot Dorff, A Jewish Approach to End-Stage Medical Care; approved December 12, 1990; YD 339:1.1990b)