Assisted Dying

Written by Rabbi Elliott Karstadt — 9 July 2023

At the end of our Torah portion this morning, we read of how God promises Moses that ‘when you have seen the Land, you too shall be gathered to your kin, just as your brother Aaron was’ (Num 27:13).

There are numerous accounts of Moses’ death through the Bible and Rabbinic Literature. A great many of them involve Moses struggling against the inevitability of death: Lo amoot, lamah amoot an anonymous medieval Hebrew poet has Moses say when God decrees that his time has come: ‘I will not die! Why should I die?’. He even quotes the Bible back to God: ‘I will not die, but live and tell of the works of God’ (Psalm 118:17), he quotes from the Psalms in the hope of persuading God to reverse the decree.

But here, the commentators read Moses’ acceptance of his death. All Moses hoped for, they argue, is that his death be like that of his brother Aaron. So, when it says ‘you too shall be gathered to your kin, just as your brother Aaron was’, Moses is reassured that his death will be a good one.

Of course, not everyone is able to choose the nature of their death. In our own community, we know of those whose lives were drawn short far too early, in circumstances they would never have chosen. To have the ability to choose the time and nature of one’s death might be considered a luxury.

It is also something that, in many countries, is illegal. To take one’s own life, or to be assisted by others in taking one’s own life, is both taboo and forbidden by many cultures and many states throughout the world.

This week, one of my colleagues, Rabbi Jonathan Romain of Maidenhead Reform Synagogue, took up the role of chair of Dignity in Dying, a group that campaigns for people who are terminally ill to have the right to determine the manner of their own deaths.

Interviewed in the Guardian this week, Rabbi Romain said, ‘If someone is terminally ill, mentally competent and wants to end their life, rather than carry on in great pain, then in whose interest are we forcing them to stay alive? Now, of course, many people will want to carry on to their last breath and that’s fine. But for people who’ve got awful conditions and who have less than six months to live and are suffering, then it’s the right thing to give them that option.’

For Rabbi Romain, taking the lead on a campaign for dignity in death is to be in-step with the majority of current public opinion. Indeed, 84% of the British public support a change in the law to allow for assisted suicide in cases in which people are terminally ill. And this number is barely different within those describe themselves as religious, among whom 80% support such a change.

So, for many of us, when the question came to the Assembly of Reform Rabbis and Cantors a couple of years ago, it seemed like an obvious thing to support. And yet there was a spectrum of perspectives on the proposal to support the legalisation of assisted suicide.

Rather than saying we would fight and campaign on either side of the debate, we resolved that we would commit ourselves to supporting those who might in the future decide to take this course of action.

A statement from Reform Judaism added: ‘As a movement, we are guided by the Jewish value of the preciousness of life balanced with the right to personal autonomy, along with the overriding Jewish principle of compassion.’

This decision was branded a ‘landmark resolution’ – a groundbreaking moment for our movement. For some, though, it was not. Did anyone really think that before this decision as reform clergy we would have refused to provide pastoral care and support to those who chose this option?

And yet what might seem obvious to some is not always obvious. What made the Reform declaration so powerful was that it said that, regardless of our personal views on the issue, we would support those who decide to take this root – or indeed, those who are considering it. Whatever is our own personal halachah, whatever our personal interpretation of Jewish law, the most important thing is our love and compassion towards the real people who are involved.

For those on both sides on the debate, of course, this was a cop-out. To refuse to fight for the right to die on the one hand, and on the other hand to refuse to oppose it outright on grounds that it challenged the rights of other people, could seem cowardly.

When around 80% of people in our communities support such a change, why would we not simply come out in favour?

I think the answer lies in what it means to be Progressive, and what it means to be Progressive Jews. To be Progressive means, yes to move with the times, but at the same time to be sensitive to and compassionate towards the concerns of minorities and oppressed groups.

And there are voices that speak out against assisted dying, particularly amongst those in the disabled community.

Writing in the British Medical Journal in 2019, Jane Campbell, who is herself disabled, argued that giving the right for terminally ill people to be legally assisted to die creates an inequality between the value we give to different lives, particularly of disabled people.

She argues: ‘Proponents of a change in the law believe that a line can be drawn between terminal illness and disability … But terminal illness and disability do not exist in a vacuum. We all have views about them. Often these views include widely held perceptions involving loss, decline, and fear of the future. It is hard to be positive as a disabled person, especially when the media is full of stories of abuse, neglect, cut-backs, and overstretched resources. Even when medical and social care are at their best, our fear of the future remains.’

For Campbell, the legalisation of assisted suicide would potentially mean a withdrawing of the right of a suicidal disabled person to support and treatment – since, for many disabled people, a chest infection is a terminal illness unless it is treated.

And what of the poor and the old – those who might worry or be persuaded that they are a burden on their families or a drain on the state.

And while many of my colleagues were firmly in favour of changing the law, others recognised that the ability to confidently decide the timing and nature of one’s death is the preserve of the few. In the Torah, Moses – the leader of the Israelites, the Prince of Egypt who has direct access to God – is the only one who is able to have this conversation about his own death. Other figures in the Torah, often psychologically tortured (figures like Elijah, Jeremiah, Jonah) call out to God for death, but are ignored. The silent message of our ancient sources is that the poor and the vulnerable are unlikely to get such exclusive treatment.

Another colleague, Rabbi Lev Taylor, gave a sermon in response to the debate within Liberal and Reform Judaism, in which he asked: ‘What message does it send out now if we say that we support assisted suicide? We may have been silent on the great attacks on disabled people’s lives, but, don’t worry, we are liberals, we will let you die. Just to show how caring we are, we’ll let you commit suicide, with support from the very state that has made your life so difficult.’

Rabbi Taylor continues: ‘If we are moving with the times, we are moving very much in the wrong direction. Publicly championing euthanasia is not defending the vulnerable, but attacking them.’

None of this is to say that we should either support or oppose the legalisation of assisted suicide. Rather, it is to try to understand how difficult it is to take on side or the other without paying attention to the voices of equally vulnerable groups.

There is an inescapable tension between the right to choose the timing and nature of one’s death, and defending the value of every human life. And I don’t necessarily have a way to resolve that tension – except to say that Judaism is a religion in which we are encouraged to see as many of these perspectives as we can, before ultimately having to decide for ourselves where we stand. In the words of the ancient rabbis, ‘make for yourself a heart of many rooms’ (Tosefta Sotah, 7:12) – make your heart and your mind big enough and open enough to encompass as many perspectives as you can.

And this is not a modern innovation. The rabbis of the Talmud recognised this too. That is why they juxtapose all their legal wrangling with the stories of real people who go through the ethical conundrums they have so for debated in the abstract.

The Talmud tells the story of the death of Rabbi Yehudah HaNasi (BT Ketubot 104a). On the day of his death, the other rabbis decreed a fast and spent the entire day in prayer. They were desperate to hold on to Rabbi’s precious life in this world. They stood outside his house, praying without stopping, all day long.

But inside the house, Rabbi’s maidservant saw how many times he arose to go to the bathroom, in his aged dying state, having to remove his tefillin and put it back on every time, and how much he was suffering. She recognised that both the upper realms and the lower realms were both demanding Rabbi’s presence, and she prayer that it be God’s will that the upper realms impose their will on the lower.

She went up to the roof of Rabbi’s house and threw down a jug, so that it shattered up the ground. The sound that it made disturbed the rabbis’ prayers for long enough that Rabbi was allowed to die.

There was no right answer here. Both the rabbis and the maidservant act out of love and compassion for Rabbi. The Talmud itself does not seem to take sides.

At the root of it all should be compassion for the real people that are involved. Ethical questions like this can seem to be abstract – but we need to recognise that for many, including many already in our communities, the question is real.