Temple Beth El Series on Death & Dying Part I: Jewish Sources in Conversation with Contemporary MAiD
What is Medical Aid in Dying?
What is MAID: A trusted and time-tested medical practice that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep.
Medical aid in dying is sometimes incorrectly referred to as “assisted physician suicide,” “physician aid in dying,” “death with dignity,” and “euthanasia.” Medical aid in dying is not assisted suicide, suicide, or euthanasia. These terms are misleading and factually incorrect.
https://www.compassionandchoices.org/our-issues/medical-aid-in-dying
Jewish movements across North America have been reluctant to offer religious support for medical aid in dying. The 1990 work a “Comprehensive Guide to Medical Halakha,” by Abraham S. Abraham states for example:
“One may not hasten a death, even that of a patient who is suffering greatly and for whom there is no hope of a cure, even if the patient asks that this be done. To shorten the life of a person, even a life of agony and suffering, is forbidden;”
This sentiment was then echoed a year later in 1991 by Fred Rosner in “Modern Medicine and Jewish Ethics, ” which states, “Any positive act designed to hasten the death of the patient is equated with murder in Jewish law …. only the Creator, who bestows the gift of life, may relieve man of that life, even when it has become a burden rather than a blessing.”
“If we craft these laws carefully and have these conversations in our religious/spiritual traditions with great sensitivity, we can consider whether sometimes the extended agony of dying could be relieved in a way that actually enhances the dignity and honor of life. And I would like to see more of us have that conversation.”
Rabbi Rachel Timoner
https://www.sundance.org/blogs/last-flight-home-shows-a-different-meaning-of-success-
Commonly Cited Jewish texts Against MAiD
וַיִּבְרָ֨א אֱלֹקִ֤ים ׀ אֶת־הָֽאָדָם֙ בְּצַלְמ֔וֹ בְּצֶ֥לֶם אֱלֹקִ֖ים בָּרָ֣א אֹת֑וֹ זָכָ֥ר וּנְקֵבָ֖ה בָּרָ֥א אֹתָֽם׃

And God created humankind in the divine image,
creating it in the image of God—
creating them male and female.

הַעִדֹ֨תִי בָכֶ֣ם הַיּוֹם֮ אֶת־הַשָּׁמַ֣יִם וְאֶת־הָאָ֒רֶץ֒ הַחַיִּ֤ים וְהַמָּ֙וֶת֙ נָתַ֣תִּי לְפָנֶ֔יךָ הַבְּרָכָ֖ה וְהַקְּלָלָ֑ה וּבָֽחַרְתָּ֙ בַּחַיִּ֔ים לְמַ֥עַן תִּֽחְיֶ֖ה אַתָּ֥ה וְזַרְעֶֽךָ׃
I call heaven and earth to witness against you this day: I have put before you life and death, blessing and curse. Choose life—if you and your offspring would live—

לְפִיכָךְ נִבְרָא אָדָם יְחִידִי, לְלַמֶּדְךָ, שֶׁכָּל הַמְאַבֵּד נֶפֶשׁ אַחַת מִיִּשְׂרָאֵל, מַעֲלֶה עָלָיו הַכָּתוּב כְּאִלּוּ אִבֵּד עוֹלָם מָלֵא. וְכָל הַמְקַיֵּם נֶפֶשׁ אַחַת מִיִּשְׂרָאֵל, מַעֲלֶה עָלָיו הַכָּתוּב כְּאִלּוּ קִיֵּם עוֹלָם מָלֵא.

Adam the first man was created alone, to teach you that with regard to anyone who destroys one soul from the Jewish people, i.e., kills one Jew, the verse ascribes him blame as if he destroyed an entire world, as Adam was one person, from whom the population of an entire world came forth. And conversely, anyone who sustains one soul from the Jewish people, the verse ascribes him credit as if he sustained an entire world.

In the rabbinic imagination throughout the centuries, life saving needs supersede all religious obligations and restrictions. Violating human life, even one’s own human life, was viewed as a behavioral and spiritual transgression. Maimonides, a rabbi-physician writing in 12th century Spain calls for capital punishment for any person who takes the life of another, “whether they killed a healthy individual or a sick person on the verge of death, or even a dying person.” Many have used this text to liken those who take their own lives to murderers, with repercussions to be faced in this world and the world to come.

(ז) אֶחָד הַהוֹרֵג אֶת הַבָּרִיא אוֹ אֶת הַחוֹלֶה הַנּוֹטֶה לָמוּת. וַאֲפִלּוּ הָרַג אֶת הַגּוֹסֵס נֶהֱרָג עָלָיו. וְאִם הָיָה גּוֹסֵס בִּידֵי אָדָם כְּגוֹן שֶׁהִכּוּהוּ עַד שֶׁנָּטָה לָמוּת וַהֲרֵי הוּא גּוֹסֵס. הַהוֹרְגוֹ אֵין בֵּית דִּין מְמִיתִין אוֹתוֹ:

(7) Whether a person kills a healthy person, a sick person who is on the verge of dying, or even a person in his actual death throes, the killer should be executed. If, however, one kills a person in his death throes because of wounds inflicted upon him by others - i.e., he was stricken until he was on the verge of death, and he is in his death throes, the killer should not be executed by the court.

What's in a (normal) death?
המת ליום א׳ מיתה של זעף. המת לשנים מיתה של בהלה. המת לשלשה מיתה של מגפה. לארבעה לחמשה מיתה חטופה. המת לששה מיתה האמורה בתורה. המת לשבע מיתה של חיבה. יתר מכאן של יסורין: רבי חנינא בן אנטיגנוס אומר זקן שאכל את החלב או שחלל את השבת מת בהכרת וכי מה מודיענו שמיתתם בהכרת אלא שמת לשלשה מת בהכרת לארבעה מיתה חטופה המת לששה מיתה האמורה בתורה וכו׳. א"ר יהודה חסידים הראשונים היו מתייסרין בחולי מעיים כעשרים יום קודם מיתתן כדי למרק את הכל כדי שיבואו זכאין לעתיד לבא שנא׳ (משלי כ״ז:כ״א) מצרף לכסף וכור לזהב ואיש לפי מהללו:

If one dies after [an illness of] one day, that is a death by [divine] wrath; after two days, it is a precipitous death; after three days, it is a death by pestilence; after four days, it is a hurried death; after six days, it is the death decreed in the Torah; after seven days, it is a death of [divine] love; after a longer period, it is a death of suffering. R. Ḥanina b. Antigonos said: An old man who eats forbidden fat or one who desecrates the Sabbath dies by kareth. And what is there to show us that they died by kareth? But he who dies after [an illness of] three days dies by kareth; after four by a hurried death; after six, it is the death decreed in the Torah; after seven it is a death of [divine] love; after a longer period it is a death by suffering.
R. Judah said: The pious men of former times used to suffer with stomach trouble for about twenty days before death in order to be cleansed of everything, so that they should come pure into the World to Come; as it is said, The refining pot is for silver, and the furnace for gold, and a man is tried by his praise. [45a].

Dying with Dignity (and help)
דְּמִדַּלְיָא וּבְסִים אַוֵּירָא. הָהוּא יוֹמָא דְּנָח נַפְשֵׁיהּ דְּרַבִּי, גְּזַרוּ רַבָּנַן תַּעֲנִיתָא, וּבְעוֹ רַחֲמֵי, וְאָמְרִי: כֹּל מַאן דְּאָמַר ״נָח נַפְשֵׁיהּ דְּרַבִּי״ — יִדָּקֵר בַּחֶרֶב. סְלִיקָא אַמְּתֵיהּ דְּרַבִּי לְאִיגָּרָא, אָמְרָה: עֶלְיוֹנִים מְבַקְּשִׁין אֶת רַבִּי, וְהַתַּחְתּוֹנִים מְבַקְּשִׁין אֶת רַבִּי. יְהִי רָצוֹן שֶׁיָּכוֹפוּ תַּחְתּוֹנִים אֶת הָעֶלְיוֹנִים. כֵּיוָן דַּחֲזַאי כַּמָּה זִימְנֵי דְּעָיֵיל לְבֵית הַכִּסֵּא וְחָלַץ תְּפִילִּין וּמַנַּח לְהוּ וְקָמִצְטַעַר, אֲמַרָה: יְהִי רָצוֹן שֶׁיָּכוֹפוּ עֶלְיוֹנִים אֶת הַתַּחְתּוֹנִים. וְלָא הֲווֹ שָׁתְקִי רַבָּנַן מִלְּמִיבְעֵי רַחֲמֵי. שָׁקְלָה כּוּזָא, שָׁדְיָיא מֵאִיגָּרָא [לְאַרְעָא], אִישְׁתִּיקוּ מֵרַחֲמֵי, וְנָח נַפְשֵׁיהּ דְּרַבִּי.
which is situated at a high altitude and whose air is scented. § 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.
נח נפשיה דר' שמעון בן לקיש והוה קא מצטער ר' יוחנן בתריה טובא אמרו רבנן מאן ליזיל ליתביה לדעתיה ניזיל רבי אלעזר בן פדת דמחדדין שמעתתיה אזל יתיב קמיה כל מילתא דהוה אמר רבי יוחנן אמר ליה תניא דמסייעא לך אמר את כבר לקישא בר לקישא כי הוה אמינא מילתא הוה מקשי לי עשרין וארבע קושייתא ומפריקנא ליה עשרין וארבעה פרוקי וממילא רווחא שמעתא ואת אמרת תניא דמסייע לך אטו לא ידענא דשפיר קאמינא הוה קא אזיל וקרע מאניה וקא בכי ואמר היכא את בר לקישא היכא את בר לקישא והוה קא צוח עד דשף דעתיה [מיניה] בעו רבנן רחמי עליה ונח נפשיה

Ultimately, Rabbi Shimon ben Lakish, Reish Lakish, died. Rabbi Yoḥanan was sorely pained over losing him. The Rabbis said: Who will go to calm Rabbi Yoḥanan’s mind and comfort him over his loss? They said: Let Rabbi Elazar ben Pedat go, as his statements are sharp, i.e., he is clever and will be able to serve as a substitute for Reish Lakish. Rabbi Elazar ben Pedat went and sat before Rabbi Yoḥanan. With regard to every matter that Rabbi Yoḥanan would say, Rabbi Elazar ben Pedat would say to him: There is a ruling which is taught in a baraita that supports your opinion. Rabbi Yoḥanan said to him: Are you comparable to the son of Lakish? In my discussions with the son of Lakish, when I would state a matter, he would raise twenty-four difficulties against me in an attempt to disprove my claim, and I would answer him with twenty-four answers, and the halakha by itself would become broadened and clarified. And yet you say to me: There is a ruling which is taught in a baraita that supports your opinion. Do I not know that what I say is good? Being rebutted by Reish Lakish served a purpose; your bringing proof to my statements does not. Rabbi Yoḥanan went around, rending his clothing, weeping and saying: Where are you, son of Lakish? Where are you, son of Lakish? Rabbi Yoḥanan screamed until his mind was taken from him, i.e., he went insane. The Rabbis prayed and requested for God to have mercy on him and take his soul, and Rabbi Yoḥanan died.

אמרו לא היו ימים מועטים עד שנפטר רבי יוסי בן קיסמא והלכו כל גדולי רומי לקברו והספידוהו הספד גדול ובחזרתן מצאוהו לרבי חנינא בן תרדיון שהיה יושב ועוסק בתורה ומקהיל קהלות ברבים וס"ת מונח לו בחיקו הביאוהו וכרכוהו בס"ת והקיפוהו בחבילי זמורות והציתו בהן את האור והביאו ספוגין של צמר ושראום במים והניחום על לבו כדי שלא תצא נשמתו מהרה אמרה לו בתו אבא אראך בכך אמר לה אילמלי אני נשרפתי לבדי היה הדבר קשה לי עכשיו שאני נשרף וס"ת עמי מי שמבקש עלבונה של ס"ת הוא יבקש עלבוני אמרו לו תלמידיו רבי מה אתה רואה אמר להן גליון נשרפין ואותיות פורחות אף אתה פתח פיך ותכנס בך האש אמר להן מוטב שיטלנה מי שנתנה ואל יחבל הוא בעצמו אמר לו קלצטונירי רבי אם אני מרבה בשלהבת ונוטל ספוגין של צמר מעל לבך אתה מביאני לחיי העולם הבא אמר לו הן השבע לי נשבע לו מיד הרבה בשלהבת ונטל ספוגין של צמר מעל לבו יצאה נשמתו במהרה אף הוא קפץ ונפל לתוך האור יצאה בת קול ואמרה רבי חנינא בן תרדיון וקלצטונירי מזומנין הן לחיי העולם הבא בכה רבי ואמר יש קונה עולמו בשעה אחת ויש קונה עולמו בכמה שנים

The Sages said: Not even a few days passed before Rabbi Yosei ben Kisma died of his illness, and all of the Roman notables went to bury him, and they eulogized him with a great eulogy. And upon their return, they found Rabbi Ḥanina ben Teradyon, who was sitting and engaging in Torah study and convening assemblies in public, with a Torah scroll placed in his lap. They brought him to be sentenced, and wrapped him in the Torah scroll, and encircled him with bundles of branches, and they set fire to it. And they brought tufts of wool and soaked them in water, and placed them on his heart, so that his soul should not leave his body quickly, but he would die slowly and painfully. His daughter said to him: Father, must I see you like this? Rabbi Ḥanina ben Teradyon said to her: If I alone were being burned, it would be difficult for me, but now that I am burning along with a Torah scroll, He who will seek retribution for the insult accorded to the Torah scroll will also seek retribution for the insult accorded to me. His students said to him: Our teacher, what do you see? Rabbi Ḥanina ben Teradyon said to them: I see the parchment burning, but its letters are flying to the heavens. They said to him: You too should open your mouth and the fire will enter you, and you will die quickly. Rabbi Ḥanina ben Teradyon said to them: It is preferable that He who gave me my soul should take it away, and one should not harm oneself to speed his death. The executioner [kaltzatoniri] said to him: My teacher, if I increase the flame and take off the tufts of wool from your heart, so that you will die sooner and suffer less, will you bring me to the life of the World-to-Come? Rabbi Ḥanina ben Teradyon said to the executioner: Yes. The executioner said: Take an oath for me, that what you say is true. Rabbi Ḥanina ben Teradyon took the oath for him, and the executioner immediately increased the flame and took off the tufts of wool from his heart, causing his soul to leave his body quickly. The executioner too leaped and fell into the fire and died. A Divine Voice emerged and said: Rabbi Ḥanina ben Teradyon and the executioner are destined for the life of the World-to-Come. Upon hearing this, Rabbi Yehuda HaNasi wept and said: There is one who acquires his share in the World-to-Come in one moment, such as the executioner, and there is one who acquires his share in the World-to-Come only after many years of toil, such as Rabbi Ḥanina ben Teradyon.

What are our American movements saying?
Revising his own previous rabbinic ruling, Rabbi Elliot Dorf writes for the conservative movement in 2020, “This, then, is not “suicide” in the sense that we normally mean it – that is, that a physically healthy person intentionally and willingly takes his or her own life; it is instead alleviating pain and suffering, and that we also have a duty to do”
https://www.rabbinicalassembly.org/sites/default/files/2021-04/Assisted%20Suicide%20Revisited%20final.pdf
“in an era in which medical technology can prolong life to the point where a person’s existence becomes torture to them, when (Healing the body) refuat haguf is no longer possible, we can, at least, support the choices of those individuals for whom death is (healing the soul) refuat hanefesh.”
2022/5782 CCAR Responsa
https://www.ccarnet.org/ccar-responsa/5782-
Conclusion

הִלֵּל אוֹמֵר, אַל תִּפְרֹשׁ מִן הַצִּבּוּר, וְאַל תַּאֲמִין בְּעַצְמְךָ עַד יוֹם מוֹתְךָ, וְאַל תָּדִין אֶת חֲבֵרְךָ עַד שֶׁתַּגִּיעַ לִמְקוֹמוֹ

(4) Hillel said: do not separate yourself from the community, Do not trust in yourself until the day of your death, Do not judge your fellow man until you have reached his place.

"Only God knows whether I would actually make that choice, but choice will be the final blessing of my individuality I will ever have."
Rabbi Donald R. Berlin, Temple Oheb Shalom, Baltimore, Maryland
“The idea that Judaism is afraid of, and I know the disability rights community is very aware of this, is the danger of saying when a person doesn’t have quality of life is that life would be cheapened or that we would start ranking the value of life and decide that certain lives were not worth spending money on as a society or working to save or prolong. That’s a real specter here… there’s a real danger-...But some voices actually matter more. I think that the dying person’s voice matters more.” [Timoner pauses here and with laughter adds] “that’s what makes me a reform rabbi probably… but I’m not going to tell someone to follow tradition if that’s not where the conscience is”
https://www.shomercollective.org/events/respecting-our-parents-a-rabbis-personal-experience-with-medical-aid-in-dying
I want to invite us this morning to consider a reality where the obligation to “choose life” is one which requires us to confront death honestly and compassionately as a facet of spiritual living. Perhaps, as we hold the medical, spiritual, psychological, and social developments that shape our contemporary landscape in 2023, we can affirm the sanctity and dignity of each person’s life by supporting individuals with terminal illness to discern for themselves the difference between staying alive and living. What might it look like for us as faith leaders to affirm that for some terminally ill individuals, “choosing life” might mean “choosing death” on their own terms?
Erev Rav Heather Shore, in an address to RI multifaith clergy on MAiD
https://docs.google.com/document/d/1lM39mWAGrEPrxm6qRMR6cAUiIqx-x3m17KRWsNdRj3g/edit?usp=sharing