An example of the reevaluation of these positions is found in a letter written decades ago by Rabbi Yaakov Yisroel Kanievsky zt”l (1899-1985), author of the sefer ‘Kehilot Yaakov’ and one of the leaders of the Lithuanian Chareidi movement of the last generation. Rabbi Kanievsky tells of the existence of a false perception regarding this matter and the need to evaluate it once again:

Regarding the basis of the fundamental principle that whatever one may do to prolong the life of a patient (even if only temporarily) must be done – the truth is that I have also heard this saying in my childhood, and I did not know if it was reliable. But in my eyes this matter requires great analysis, for in Yoreh Deah [Shulchan Aruch, see later on] article 339 it is explained that it is permitted to remove an object preventing the death of a patient, and only active procedures are prohibited to perform. Therefore, I do not seemingly find a prohibition in passively abstaining (instead of adding on suffering) [from treatment], and just the opposite: one should learn from this to abstain from [treatment] […] However, anyone who is living only temporarily life and there is no actual life-saving [treatment] is comparable to the status of a dying person (גוסס), for a dying person is considered alive in all manners, and all of this requires great analysis.¹

Let us analyze his words and begin the discussion. To start, Rav Kanievsky describes how in his youth he also was confronted with the popular notion that states that halacha requires prolonging the life of a patient even if we are not dealing with full rehabilitation (or even remission, a lapse in the disease) but ‘temporary life’, i.e., prolonging life for a few seconds or minutes. This position disseminated within the batei midrash and the halachic world; and Rav Kanievsky was exposed to it at the beginning of his studies and reasoned that this indeed was the halachic position.

However now, after reaching his halachic prime and maturing in his studies, he understands that the matter “requires great analysis”. The use of the term “requires analysis” (צריך עיון) – as is commonplace in the language of those learning in yeshiva – is a method to express the existence of a great challenge to a certain preexisting rationale which the studier wishes to abolish. When using the expression “requires great analysis”, a very secure position is being proposed, which practically contradicts the previously discussed notion and even overrides it.

Rav Kanievsky remarks that when learning the sources in depth, “I do not find a prohibition” in this matter, i.e., there is no basis for the claim that this is a halachic position. Yet, he goes even further and instructs that “one should learn to abstain from this [treatment]”. In his eyes it is not only that the claim that the obligation to fight for every second of life “requires great analysis”, but it is possible that in specific situations it is prohibited to prolong a patient’s life! With these statements Rav Kanievsky begins this sensitive discussion once again, and even writes at the end “and all of this requires great analysis”.

It is important to emphasize that the ‘Kehilot Yaakov’ is not the only person to assume this halachic position. On the contrary – many halachic authorities have taken a similar position and their opinions will be brought later on in this compilation as sources for the different rulings brought within. Yet it seems that from the perspective of societal perception these rulings have not succeeded at changing the halachic approach in a significant way, and the majority of the public believes that the previously existing opinion is the only halachic position. It seems that a part of this perception comes from the basic human drive to fight for each moment of the lives of our loved ones, and from the fear of deciding to stop the fight for life and moving to palliative care (see later on).

Before we discuss the evidence that Rav Kanievsky brings for his opinion, it is important to stress that we are practically dealing with two separate discussions. The first discussion surrounds the very obligation to be healed and the question of whether it is a forbidden for a person to raise their hands in the fight for the rest of their life because they are not interested in continuing. Here we are not dealing with taking a life or actions of suicide or death of one’s own initiative – actions prohibited by halacha, and early Midrash Halacha already determined that these are unequivocally forbidden – but the reverse: the person is very sick and without medical intervention will die imminently, however medical care can save their life. Is there a halachic obligation to undergo this treatment? Is abstaining from them considered suicide?

Almost all of the halachic authorities have determined that any person who can be healed – is obligated to do so, even if the source for this is not entirely clear. As stated, the main source for medicine is the statement of the Talmud “‘and he shall surely be healed’ – from here doctors are given the permission to heal” (Berachot 60a), and the terminology used by the Gemara is “permission” to be healed and not “obligation”. However, later in history, especially the last couple of centuries, it has become clear to halachic authorities that a person is obligated to be healed and it is prohibited to deny this obligation. Even the authorities who encourage abstaining from going to doctors (such as the Ramban in his statements regarding tzaddikim: “[…] but God wills that the ways of man should not deal with physicians”²) do this from the starting point of turning to a prophet or prayer to be healed – actions that are also considered pursuit after recovery and not giving up hope on life.

Yet even the obligation to be healed has its limits. Now we are discussing situations where one cannot heal any more, and the issue is what is the proper thing to do in this situation. The authority granted to physicians is to heal, but it is unclear if they were granted authority to prolong life artificially when there is no hope for recovery, and we are not dealing with a case of rehabilitation at all. And thus, the words of the ‘Kehilot Yaakov’, like the words of many other poskim brought in the endnotes later on in this compilation, evaluate this position differently when dealing with great suffering and the personal feeling that one’s death would be better than their life.

The second discussion is the manner of permitted activities to perform when a patient is in a state where there is no more obligation to fight for their life, whether due to great suffering (as stated earlier) or due to lack of any hope for recovery that renders treatment useless. The ‘Kehilot Yaakov’ emphasizes that even here one must evaluate what is permitted to do and what is prohibited.

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Treatment of the Elderly and the Sick – “Until 120”? – Introduction and Table of Contents

For Additional Reading:

• Ending Life-Prolonging Treatment
• Position Paper: Reducing Oxygen Therapy from the Ventilator of a Terminally Ill Patient
• Abstaining from Treating an ALS Patient and Euthanasia – Compare and Contrast Between Halachic and Judicial Rulings

1. Karyana DeIgrita, Bnei Brak, 5746-5758, letter 190. It is possible that there is a divide between his opinion there without the parentheses and that which is added in parentheses. See Rabbi Shai Weissbrodt, “Treating the Terminally Ill”, Tchumin, 41 (5781), page 293, footnote 22.
2. Ramban’s Commentary on the Torah, Vayikra 26:11.