The right to information for a terminally ill patient

However, when a person becomes ill to the extent that he feels weak throughout his entire body - indeed, because of his illness, his strength has dwindled to the extent that he cannot walk on his feet in the market place, and he is confined to his bed - he is referred to as a sh'chiv me'ra. The laws applying to his gifts differ from those applying to the gifts given by a healthy person.

What is implied? When a sh'chiv me'ra gives orders and says: "Give so and so such and such, and so and so such and such" the intended recipients acquire all the property apportioned to them when the sick person dies. This applies whether he issued his instructions during the week or on the Sabbath, and whether or not a written record was drawn up.

Nor must his instructions be confirmed by a kinyan for the statements of a sh'chiv me'ra are considered as if they have been written down, and transferred. This is a Rabbinic decree. Nevertheless, although it is only a Rabbinic decree, our Sages conveyed upon this convention the power of Scriptural Law, so that a dying person will not become exasperated, knowing that his words are of no consequence.

The Gemara resumes the discussion with regard to the gifts of a person on his deathbed: And Rava says that Rav Naḥman says: The halakha that the gift of a person on his deathbed does not require an act of acquisition is merely by rabbinic law, and it is instituted lest he see that his will is not being carried out and he lose control of his mind due to his grief, exacerbating his physical state.

Rav Sheisha, son of Rav Idi, said: Let one not visit a sick person, neither during the first three hours of the day, nor in the last three hours of the day, so that he will not be diverted from praying for mercy. Rav Sheisha elaborates: During the first three hours the sick person is relieved, as after a night’s sleep his suffering is somewhat alleviated and the visitor will conclude that there is no need for prayer. In the last three hours of the day his weakness is exacerbated, and the visitor will despair of ameliorating his suffering and will conclude that prayer is futile.

One who seeks to embark on a journey and wishes to know if he will return and come to his home or if he will not, let him go to a dark [daḥavara] house. If he sees the shadow of a shadow he shall know that he will return and come home. The Sages reject this: This omen is not a significant matter. Perhaps he will be disheartened if the omen fails to appear, and his fortune will suffer and it is this that causes him to fail.

The Master said in the baraita: If a woman giving birth were to need a lamp, her friend would light the lamp for her on Shabbat. The Gemara asks: This is obvious. The Gemara answers: It is necessary to teach this halakhaonly in the case of a blind woman giving birth. Lest you say: Since she cannot see even with the light it is prohibited to bring a lamp for her, it teaches us that lighting the lamp is permitted to settle her mind. The blind woman thinks: If there is something that needs to be done in the course of childbirth, the lamp will enable my friend to see and she will do it for me.

Question: (why is it permitted to light a lamp for a blind woman) let them say to her that they lit the lamp and her mind will be calm?

A: The blind woman can possibly see the vision of a lamp.

A2: Another explanation is that she can try to show them 1 finger or 2 fingers in order to see if they know.

Anyway, it needs thought, why does (the Talmud give) the reason to settle the woman's mind? Don't we need to light a lamp to see what she needs?

Rav was the son of Rabbi Ḥiyya’s half brother and the son of Rabbi Ḥiyya’s half sister, as Ayevu, Rav’s father, married his own stepsister, Imma. When Rav ascended there, to Eretz Yisrael, Rabbi Ḥiyya said to Rav: Is your father, Ayevu, alive? He said to him, replying with a question: Is your sister, Imma, alive? He said to him: Indeed, is Imma alive? He said to him: Is Ayevu alive? Upon hearing this, Rabbi Ḥiyya understood that both Ayevu and Imma had passed away, and Rav did not wish to say so explicitly. Rabbi Ḥiyya said to his attendant: Remove my shoes and carry my garments after me to the bathhouse.

One who suffered a bereavement and it was not known to him, — [the law is that] it is not obligatory that they inform him [thereof], even in [the case of] his father and/or mother [who died], and regarding such a one, [i.e., who does inform], it is said, 'And he that uttereth a slander is a fool'; and it is permissible to invite him to a feast of betrothal and marriage and [likewise to] every [type of] festivity since he knows not thereof. However, if he asks about him, one should not lie and say that he is alive, for it is written, 'Keep thee far from a false matter.' Gloss: Nevertheless, in [the case of surviving] male children it is customary to inform [them thereof] so that Kaddishbe recited, but in [the case of surviving] daughters it is not customary to inform them at all.

The great Rabbi Chiyya saw a Babylonian and asked him, 'how is my father doing?' The man replied, 'Your mother asked about you.' Chiyya asked 'I asked you like this (about my father) and you responded to me like this (about my mother).'

The man replied, “We ask about the living and we don't ask about the deceased.” So too (when Yosef asked) "Is your father well?” It is referring to Yaakov ,

“The elderly whom you mentioned, is he still alive?" Is referring to Yitzchak.

And the brothers replied "Your servant, our father, is well; he is still alive."

The Sages taught the following baraita: When a relative of a sick person dies, those around him do not inform him that this relative died, lest he lose control of his mind due to his emotional state and his grief exacerbate his physical health. And other people may not rend their garments in his presence, so that he will not know that one of his relatives passed away. And we silence the women who weep in his presence, so that he will not know that his relative is no longer alive.

One who is sick and suffered a bereavement, must not be informed, lest he loses control of his mind; nor is his garment rent; nor is it permitted to cry or make lamentation [for the dead] in his presence, so that his heart be not broken, and we silence the comforters in his presence.

The Sages taught: One who became ill and tended toward death, they say to him: Confess, as all those executed by the courts confess. Even if he is dying of natural causes, it is worthwhile for him to consider his death atonement for his sins. The Sages said:

If one feels death approaching, he is instructed, 'Confess [your sins]!' They say to him, 'Many confessed [their sins] and didn't die, and many who have not confessed, and did die; and as a reward, should you confess, you will live; and he who confesses [his sins] has a portion in the world to come.'

And if he is unable to make a confession with his mouth, he should confess in his heart.

If he doesn't know what to confess, they instruct him, say, 'My death should be an expiation for all my sins.' 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.

It is understood that only when death is imminent (do we tell him to confess), otherwise we do not tell him to confess in order not to break his heart, even though we tell him “many that are walking in the marketplace (have) confessed” nevertheless when we tell a person “as all those executed by the courts confess” he understands that he's in a very critical situation, otherwise no one would mention his death in front of him, therefore we only say it when he is tending toward death

Nevertheless it seems that only death is imminent (do we tell him to confess) otherwise we do not tell him to confess because he will think that he's in a critical situation and he will be heart broken.

"As all those executed by the courts confess"

this does not refer to “one whose death is imminent” rather it's the words of the book that one is obligated to confess...

(1)In those days Hezekiah became critically ill, when Isaiah the son of Amoz, the prophet, came to him and said to him, "So has the Lord said, 'Give orders to your household, for you are going to die and you shall not live. (2) And Hezekiah turned his face to the wall, and he prayed to the Lord. (3) And he said, "Please, O Lord, remember now, how I walked before You truly and wholeheartedly, and I did what is good in Your eyes." And Hezekiah wept profusely. (4) And the word of the Lord came to Isaiah, saying, (5) "Go and say to Hezekiah, 'So has the Lord God of your father David said, "I have heard your prayer; I have seen your tears. Behold I will add fifteen years to your life.

God instructed Isaiah to inform Hezekiah "Give orders to your household, for you are going to die and you shall not live". Hezekiah reproved the prophet saying, "Customarily, when one visits the sick, he says, 'May Heaven have mercy upon you.' A physician who visits [a patient] tells him, 'This you may eat and that you may not eat. This you may drink and that you may not drink.' Even if [the physician] sees that [the pa tient] is about to die he does not say to him, 'Leave a testament to your household' lest the [patient's] mind faint. Why, then, did you instruct me to put my affairs in order because I will not live?" and I don't fear you and will not listen, all I have is what my grandfather said...

So that they will not say that out of fear he has died Elisha said to Hazael "Go say to him, 'You will live," and this is a worthy thing for the prophets.

2. The second question concerns the issue of triage, or who should be treated and who should not be treated? The case you pose concerns two patients who are brought into the hospital, both in need of immediate emergency or critical care. One of them has a good possibility of being cured, but it is not absolutely certain that he needs intensive care, although [this] would be the preferred method of treatment. However, the second patient, for whom intensive care could only provide a postponement of death, cannot live at all without the attention of an ICU [intensive care unit]. Which patient should be given the only bed available? In my opinion, if both arrive at the same time, the decision should be made on the basis of medical suitability. The one who has the best chance of being treated and cured should be given the available bed. However, if the one who can only live for a short time has already begun treatment before the arrival of the second patient, for whom there is an expectation of a cure, but he can only be saved if the first patient, whose life can only be prolonged for a short time, is removed [from life support], it is forbidden to interrupt the treatment of the first patient in order to save him. The logic is obvious. The individual who can live only a short time is not obligated to forfeit his life for anyone else. Once he has taken possession of the hospital facility and his life depends upon continued treatment, even if his life be but of short duration, his claim takes precedence over all other claims. I see this as a contractual relationship with the hospital and the physicians. The care they provide was assigned to this terminally ill patient and no one can take it away from him. The patient himself is not required to give up his place to the patient who can be cured, and possibly not even permitted to do so voluntarily. [However, as noted in the case where both arrive at the hospital at the same time,] the selection of the patient more medically suited for treatment should be made even if the first patient, for whom there is no hope of actual cure, arrives first at the hospital. The one with the better chance of survival should be treated. The only time he should not be given preference is when the critically ill patient, who has no hope of cure, has actually begun his treatment, has actually been already placed in the bed in the critical care unit. It goes without saying, of course, that even if the critical care facility cannot accommodate both patients, the one who is not to be admitted to the critical care unit should be provided with the best care available in some other department of the hospital.

If absolutely nothing can be done to ameliorate the condition of the dying patient, it is forbidden to act in a way that reveals to the patient the pessimistic prognosis as to the outcome. Even if no medication is indicated, all supportive care should be maintained. Nutrition, hydration, even a placebo effect is valuable to a patient, since despondency is in itself damaging to him. Similarly, it is certainly forbidden to cause any unnecessary pain to the patient. If no medical care is indicated, there is no rational reason why routine blood chemistry should be done on the patient; nor should he be bothered having his temperature and blood pressure taken, if death is indeed imminent. Only that which is clearly for the patient's benefit should be done. Psychotropic drugs, such as antidepressants, should be used to make the patient as comfortable as possible. The imminence of death does not relieve the physician from the obligation to do everything for the comfort of the patient.