Even when we are dealing with end-of-life issues, we find ourselves in a unique situation. These questions do not exist in a vacuum; they are based on a specific background and on previously existing societal perceptions. It requires halachic integrity, spiritual bravery, and broad shoulders to determine the starting assumptions. Additionally, decision makers must deal with false perceptions of halacha, some communal, but others found deep within the beit midrash – via looking at the sources anew and standing in the face of positions perceived as halachic.

These endeavors are undergone in our generation in a host of different discussions; and one of the most significant examples of rulings such as these is found regarding organ donation.¹ The basic halachic position, and the perception of the halacha that accompanied it, created a unilaterally false perception that halacha prohibits saving the life of someone else by donating organs. Halacha is perceived as not recognizing brain death and therefore many believe that according to halacha, one cannot donate vital organs, a process requiring prior recognition of brain death by medical halacha. However, the past Chief Rabbis of Israel, Rabbi Avraham Shapira zt”l and Rabbi Mordechai Eliyahu zt”l, evaluated this topic once again – through their great spiritual might and broad shoulders – and ruled in the year 5747 that halacha fundamentally recognizes this death; and this is the ruling of Rabbi Ovadiah Yosef zt”l as well. It is important to emphasize that each of them determined specific conditions under which this classification granted the ability to donate organs. The process of actualizing their beliefs was long and complex – even requiring legislation of a unique law dealing with determining brain death and leaving room for other halachic positions which do not recognize brain death – however this topic demonstrates the constant assessment of the reality halacha is found in and the importance of precise decision making.

First and foremost, one should evaluate that we do not find any mention of an obligation to be healed in the Sage’s source work. On the contrary, from a certain point of view one can see the opposite as true: from the very fact that a special source is required to teach that physicians may practice medicine, it is possible to conclude that the starting point is that medicine is prohibited. However, halachic authorities have determined that the expounding of this verse is required to grant immunity to physicians – so that the authority granted to them to heal exempts them from damage negligently caused due to a medical procedure – yet there is no fundamental source explicitly obligating man to fight for his own life.

Yet, there are categorically adjacent principles, such as the prohibition to commit suicide (which one may use to conclude that a person who shies away from treatment of their condition is like one who passively kills themselves), the prohibition to harm oneself, or the obligation of “and you shall be very careful for your souls” (Devarim 4:15), which, even though it is stated regarding spiritual preservation against deterioration into idolatry, is expounded to include an obligation to conserve one’s body. All of these sources indeed teach the positive perspective towards a person who chooses to be healed, however there is no explicit source obligating a person to heal themselves.²

It is also possible to claim that if halacha requires the violation of Shabbat in order to perform pikuach nefesh (a life-saving act), this proves that there is an obligation to be healed³, however one can argue against this proof, and this has been the path of some of the Achronim. Thus, halacha deals more with the permission to be healed and not the obligation to do so; and this fact has a tangible effect on the approach of halacha towards different topics, mainly patient autonomy. Beyond this, the authority given to doctors is to “heal”, and it is not entirely clear if they are also allowed to perform medical procedures that do not heal a person but extend their life without any chance of recovery.

This is also the case regarding innovation in end-of-life discussions, whether dealing with new technologies or dealing with a shift in the fundamental values of medical ethics, especially patient autonomy, as previously stated. Even here, the discussion doesn’t occur in a vacuum. A halachic misperception exists that it is prohibited to scale back treatments until the very last breath. Many hold that according to halacha there is no decision at all when dealing with the obligation to fight for one’s life: life doesn’t belong to us but to the Master of the World, and we thus are not permitted to give up or resign ourselves to our fate. This leads many people to believe that halacha obligates performing anything possible to prolong life, unconditionally and with no restriction. This perception is accompanied by the adage that we do not understand the tremendous value that one moment of life has, and therefore we are required to fight at any cost for each breath. There were even those who ruled that all this is true even if the patient refuses to comply at all.

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

For Additional Reading:

• Even at the End of the Road Halacha is with You
• Position Paper: Patient Fulfillment of Mitzvot
• Dementia and Jewish Values – Conference of the NGO Emda and Tzohar Rabbinical Organization

1. See position paper ‘Organ Donation’.
2. It is worthwhile to note the words of the Chazon Ish, Kovetz Igrot Chazon Ish, volume 1, Igeret 136: “and when I [wonder] to myself, I think of the natural effort [one performs] using natural methods regarding health, mitzvah, and responsibility, and at the same time the obligations [one performs] to complete man’s form as infused by its Creator through its very nature. And we find Amoraim, who went to non-Jewish doctors and even ‘heretics’ to be healed. And many of the plants and animals and minerals that were created for the sake of medicine, and even the gates of wisdom that were created to allow anyone to think and introspect and understand.”
3. As the Ramban held in his compilation Torat Adam, Sha’ar HaMeichush, Inyan HaSakanah (Chevel edition, page 42).