1. Treatments that support the patient’s natural biological needs must be continued, including medications that are given routinely, such as insulin for diabetics and medications that prevent blood clotting or bleeding. (The administration of antibiotics should be discussed on a case-by-case basis: Is it a routine treatment that provides relief to the patient? Or does it prolong his suffering? There is also the concern that giving antibiotics might cause new medical issues, such as nerve damage to the auditory and visual nerves or the weakening of the immune system)¹.

2. As a general rule, it is prohibited to stop medical treatment, even for a patient in critical condition. Therefore, we may not suspend intravenous medications – although in some cases, we may refrain from restarting an IV².

3. If the patient does not want to continue to suffer, we may refrain from administering medication that intends to treat the patient’s terminal illness, if it is determined that the medication will not cure him, but merely prolong his life of suffering³.

4. In the case of a patient receiving continuous medication who has experienced multiple organ failure (the collapse of three vital bodily systems), the dose may be reduced provided that it does not immediately change the patient’s condition⁴.

1. In footnote 73, above, we addressed the distinction between medical care and meeting the patient’s vital and natural needs. The accepted position is that there is a difference between medications that are part of routine treatment and those which go beyond the routine and treat the patient’s terminal illness. This is the ruling of Rabbi S. Z. Auerbach in the Minḥat Shlomo,I:91, 24. See also the ruling attributed to him, and the summary in Nishmat Avraham, (Yoreh De’a 339:4) that is primarily based on his opinion. See also Iggerot Moshe, Ḥoshen Mishpat, II:73, 1 and 5; 74, 1; 75, 1 and 4. This is also the opinion of Rabbi Y. S. Elyashiv, as cited in his name in Nishmat Avraham (ibid.). Rabbi Ovadia Hedaya (Yaskil Avdi, VII, Yoreh De’a, 40) rules that medication should not be administered to a patient whom the doctors have despaired of curing, without distinguishing between different types of medication. Compare this to Tzitz Eliezer, V, Ramat Rachel, 28–9; XIV:80–2. In his opinion, the patient should be treated by all available means, provided that he is defined as alive, even if he does not agree to it, as stated in footnote 56. For a summary of the various opinions, see Nishmat Avraham (ibid.); Encyclopedia of Medicine and Halakha, vol. 5, “A Terminally Ill Patient (a),” pp. 144–46, 152–53.
2. See footnote 54.
3. See footnotes 80 and 56.
4. For a precise definition of the medical situation referred to here, and the halakhic ramifications, see footnote 70.