IN-DEPTH FEATURES
Legalized Murder

Mussaf Shabbos Kodesh Achrei-Kedoshim 5761

Holland was the first country in the world to legalize "mercy killing." Is Israel to be the second to follow in this grisly path?

The Israeli court system is currently deliberating an issue that up to now has been taboo: euthanasia. The case involves a woman asking to be disconnected from the respirator that is prolonging her life. "Is there a doctor who will be ready to `pull the plug'?" asks the court.

"Unfortunately, such doctors abound," answers Dr. Menachem Chaim Breyer, director of Maayanei Hayeshua hospital in Bnei Brak.

The Upper House of the Dutch Parliament on April 10 legalized euthanasia in Holland making it the first country to sanction "mercy killing" of terminally-ill patients. The law, which will be formally enacted this summer, was passed by a majority of 46 to 28.

Before the vote, Health Minister Els Borst-Eiters pledged that a series of scrupulous supervisory measures would prevent possible abuse of the law. Outside the parliament a crowd of ten thousand concerned citizens demonstrated against the ruling.

The following are the conditions of the law which, incidentally, is restricted to Dutch citizens: Doctors involved in voluntary euthanasia or suicide must: (a) be convinced that the patient's request was voluntary, well- considered and permanent; (b) be convinced that the patient's suffering was unremitting and unbearable; (c) have informed the patient of the situation and the prospects; (d) have reached the conclusion with the patient that there was no reasonable alternative; (e) have consulted with at least one other physician; (f) have carried out the procedure in a medically appropriate fashion.

Nevertheless, the Dutch legislation has simply legalized what has already been widespread policy in Dutch hospitals for years. As early as 1993 Holland was the first country to permit euthanasia.

"Even if the law was only officially passed recently, this killing has been rampant in Holland even before the law was passed. And even then, it was almost legal," says Dr. Menachem Chaim Breyer, medical director of the Maayanei Hayeshua hospital in Bnei Brak. "In 1990 reports were published which revealed how the Dutch had been practicing euthanasia for ten years. In other words, to date, doctors have been killing patients in Holland for at least twenty years. They don't need this law to enable them to continue committing these mass murders.

"They did not even adhere to their own criteria. They killed patients who were unconscious, who almost certainly did not suffer very much. They simply made a unilateral decision to end their lives. They kill patients and seriously injured people who arrive at the emergency ward in a state of intense suffering or unconscious with multiple systemic injuries. While they are still in the emergency ward they kill them with an injection of KCL, a substance that causes instant death.

"Years ago the Dutch Pediatric Association already issued special procedures for the treatment of children born with what they consider a defect or disability -- defects or disabilities that in Eretz Yisroel would be considered relatively minor. According to these special procedures, such a child will not make it out of the delivery room alive. He is killed then and there.

"This sounds like ancient Sparta, but it is `progressive, enlightened' Holland. A 1990 report written by the Dutch government divulged that of those put to death in one year, 1000 people had not asked to die. That is what they revealed. What did they conceal? It is obvious that the actual number of patients who were put to death without asking is considerably higher.

"All this is happening under the nose of the World Court in the Hague. And the Dutch are celebrating their new law and are convinced that they are doing the best thing in the world."

Why, in your opinion, did the Dutch health minister need to commit herself before the vote, to a series of cautionary measures to ensure that the law would not be abused by the medical profession?

"In Holland, this issue is extremely distorted. When I hear of someone who is travelling to Holland I say, partly in jest, that without two security guards he has no business going there. He just might feel ill, go to the emergency ward and there, be done away with by doctors who think they are doing him a favor. The Dutch health minister may be committing herself to that promise simply because the Dutch had failed to comply with the rules regarding euthanasia that they themselves enacted years ago. And this being the case, who is to guarantee that once a bona fide law is passed they will adhere to it? I am convinced that they will not. They will do all in their power to shorten the lives of patients without being caught, so that they will not be in trouble with the law."

In order to illustrate the depth of depravity that the Dutch have reached, Dr. Breyer says that "they also kill patients suffering from depression who are not terminally-ill. A Dutch doctor was sued for killing one of his patients who was depressed. Instead of administering anti-depressant medication and supportive psychiatric care, the simplest solution was to get rid of her.

"Instead of helping patients cope with suffering and dealing with terminal illnesses with the many medical means available, which admittedly demand a substantial investment of energy, money, manpower and patience--which, unfortunately, are not always at the doctors' disposal--the Dutch opt for the easy way out: killing them."

The Height of Scientific Knowledge--The Dregs of Humanity

In 1933, the year Adolf Hitler yimach shemo took power in Nazi Germany, a law was passed, almost sanctioning euthanasia against epileptics, the mentally disabled and alcoholics. Six years later, in 1939, with the outbreak of World War II, Hitler authorized Leonardo Konti, the head doctor of the Third Reich, to perform euthanasia on terminally-ill patients "according to the highest degree of human understanding and after an extensive evaluation of their condition" since they are "a burden to society." This is how the Nazis described it.

"The `depth of their human understanding' was expressed by killing patients," says Dr. Breyer. Accordingly, between 1939 and 1941, they actively killed patients: people suffering from senility and Alzheimer's, the mentally ill and children with birth defects. During the course of these two years they killed a total of about 170,000 people. In 1941 the Nazis began to work towards the Final Solution, at which time they ceased these `mercy killings.' "

Francis Harry Compton Crick, British biophysicist and 1962 Nobel Prize laureate for his discovery of the molecular structure of DNA (1953), published a lengthy article in the prestigious science journal, Nature. He suggested that babies born should not be considered alive from a legal standpoint until they are four days old. During this interval it will be possible to decide whether or not they will be allowed to live. If, for whatever reason, the baby is not "deserving," it will be left to die, and this would not be considered murder since he or she was not "alive" in the first place.

Crick does not stop there. He goes on to propose that each person at the age of 75 undergo a series of tests to evaluate brain functioning, cognitive abilities and the level of dementia. Among other things checked will be memory, understanding, and reasoning. If he stands up to the baseline criteria, he will earn the right to life, in other words, he will receive medical treatment if necessary. If he does not pass the test then he will be left to die.

This is reminiscent of the Eskimos who divest themselves of the burden of their aged by leaving them on a deserted ice floe in the middle of nowhere. "This just proves how a person can reach the pinnacle of scientific knowledge, and yet at the same time have totally distorted ethical and moral beliefs," says Dr. Breyer.

The Slippery Slope of Sparta and Sdom

Although Holland is the first independent country to enact the law permitting euthanasia, it is not the first place in the world to officially sanction it. In February 1996 the Northern Territory of Australia passed a law allowing for "mercy killing," in spite of the opposition of the federal government.

What is really happening today in the western world?

"Palliative medicine, meaning that branch of medicine that provides care, support, and various means to deal with suffering, is underdeveloped in Holland. Britain, in contrast, is considered very progressive in this field. Palliative treatment includes IVs, analgesics, and other measures not necessarily associated with pain. As a result, fewer patients ask to die in Britain because they are being treated with an array of means to cope with their illness."

The western world generally did not recognize euthanasia as a legal issue until 1976, when the case of Karen Ann Quinlan got a lot of publicity in the United States. Quinlan requested to be disconnected from the respirator that prolonged her life, and for the first time ever, the court ruled that it is permissible to disconnect a terminal patient from the respirator.

"This was essentially the first step in the degeneration of this issue in the United States," says Dr. Breyer. "Unfortunately for them, however, Quinlan did not die immediately. She lived for another ten years. And this was just the beginning.

"It was then decided in the United States that it is even permissible to cease life-extending treatment, such as medication, dialysis, surgery, and blood transfusions. Later they decided that even feeding through a tube and administering fluids intravenously was also medical treatment and as such, could be ceased in the case of a terminally-ill patient. In short," sums up Dr. Breyer, "in the United States patients are killed by starvation, in accordance with the court's ruling."

Those who are "lenient" claim that instant death is in the best interests of the patient. And this is exactly what is happening in Holland, where life has been deemed worthless if not accompanied by quality of life. They maintain that under conditions of inferior quality of life it is permissible, even necessary, to shorten that life.

"What is the definition of `inferior quality of life'? Who is to decide? And what are the limits?" asks Dr. Breyer.

Inferior quality of life comprises a wide range of diseases and disabilities in Holland, from a stroke patient who is left paralyzed to a dying patient who is suffering and struggling to stay alive. Perhaps every patient can be described as "terminal," and not just one who is terminally- ill. A case in point would be a person who has been diagnosed with cancer and who does not know what will happen to him. And what about an elderly 90 year-old man who needs geriatric care and is confined to a wheelchair?

"This is the slippery slope," explains Dr. Breyer. "Terminology which can be interpreted any which way is left to the judgment of individuals who, lacking the perspective of Toras Yisroel, can arrive at the most macabre conclusions, just as in Sparta, Sdom, and their modern counterpart, Germany."

But all is not lost. In the February 2000 issue of the New England Journal of Medicine, an article appeared discussing euthanasia in the state of Oregon, where "mercy killing" is accepted. Recent statistics show that approximately two-thirds of patients' requests to die in Holland were ultimately cancelled after they received appropriate medical care that alleviated their suffering. In Oregon itself, doctors prescribed a deadly injection for one out of six who requested it, pointing to a real quantitative decrease.

Other important data appearing in a different study performed recently indicated that out of 30,000 people who died in the previous year, 150 voluntarily took lethal doses to end their lives. That is only 0.5 percent or one in 200. Here again we see a quantitative decrease.

"How Does It Feel to Kill a Patient?"

"Professor Shimon Glick is an Orthodox Jew, an extraordinary person, one of the world's most scrupulous individuals," says Dr. Breyer. "At one of his lectures I heard him tell about a doctor who specialized in alleviating the suffering of his patients, to the point where he sent one of them to Gan Eden. Professor Glick asked him, `How does it feel to kill a patient?' The doctor answered, `The first time it was hard, but then . . .' He did not continue."

How is "mercy killing" regarded here in Eretz Yisroel?

"HaRav Yaakov Wiener is the head and rosh kollel of the Institute of Medicine and Halacha in Yerushalayim. He travels all over Eretz Yisroel and the world and gives lectures in various Israeli hospitals. He works in cooperation with the Medical Histadrut and speaks once every two months at the Medical Histadrut building in Ramat Gan. He brings professors specializing in diverse areas as guest speakers and then he presents the halachic viewpoint. From time to time his articles appear in the Histadrut's periodical, Harefuah.

"Rav Wiener tells me about arguments he has with people who come to his lectures about euthanasia. They argue, `How can you, as a member of the religious, chareidi public, who believes in the Torah, be so cruel that you close your eyes to patients' suffering?' He says that he leaves these lectures deeply shocked.

"He takes part in the Kollel Lerefuah Vehalacha of Maayanei Hayeshua Hospital, headed by HaRav Yitzchok Zilberstein, which meets every Thursday at the hospital in Bnei Brak. When he hears from me how at Maayanei Hayeshua we treat our patients--the elderly, people suffering from Alzheimer's, the terminally-ill, and babies born with birth defects--he says it is a kiddush Hashem.

"We literally fight for every additional second of life. We conduct evaluations almost daily together with the rabbonim of the hospital and, when necessary, also with the Vaad Hahalocha, shlita. In special cases we even take our questions to poskei hador, shlita . At other times we make do with involvement of the hospital rabbonim together with the directorate and the heads of each department. Together we decide whether the patient in question is considered terminally-ill or gosseis, and which treatment we will administer; what is forbidden and what is permissible, what we can give and whether or not we will hook him up to a respirator."

A woman was admitted recently to the hospital and she died shortly afterward. "There was an opinion not to hook her up to the respirator. I did not agree. She was admitted with a very serious illness that had already spread extensively, but then she contracted a secondary illness unconnected to her primary malignant disease. (In general, if a patient with a terminal illness develops, at some stage, a secondary illness, such as a sudden heart attack or pneumonia, I treat this secondary illness. And if this secondary illness causes respiratory distress we attach the patient to a respirator.)

"Since we had a difference of opinion I brought the issue to one of the hospitals' poskim, HaRav Moshe Shaul Klein, and he supported my view. We connected her to the respirator and were able to overcome the secondary illness. We did our part by treating the secondary illness, but then her primary malignant disease took over and brought her to the brink. At this point I said, `I give up,' because I had done my job of treating her. We gave her oxygen and an IV. She received every possible treatment, but was not connected to the respirator. She passed away with no lack of oxygen and with every possible attempt to alleviate her suffering, but was not given artificial respiration. This is what we do on a daily basis, but with continuous halachic deliberation when faced with such cases.

"An elderly patient is now being treated at Maayanei Hayeshua. A few months ago he was given CPR by the mobile intensive care unit after having choked, and was immediately rushed to one of the leading hospitals in Eretz Yisroel with aspiration pneumonia. But after being treated by the Intensive Care Unit he was no longer given artificial respiration. A family member asked what would happen if the elderly man would once again suffer from respiratory distress. He was told, `That's the end.' Still the family member insisted, `What do you mean?' The hospital staff made it clear that they would not connect him to a respirator. `But why not?' the relative asked. `Because we do not hook up such patients to a respirator,' was the laconic answer.

"Indeed," asserts Dr. Breyer, "this is official policy at that hospital. In several wards they will not attach elderly patients to respirators. Why? Because they do not want an elderly person to occupy a respiratory machine. They defend their standpoint with statements such as, `He does not have to live at the expense of the public' and other such claims.

"When I heard of this story from the elderly man's relative I was not surprised. I am aware that this is how things work today. The family informed the uneasy doctors that they would be moving the man to Maayanei Hayeshua because `under such conditions we will not leave him with you. You are liable to shorten his life.'

"The elderly man was admitted to the intensive care ward at Maayanei Hayeshua. Boruch Hashem we administered all necessary treatment and he was released to a nursing home. After a while he was readmitted to the internal medicine ward. Some time after being readmitted he stopped breathing. The doctor, a secular woman who had been doing her rounds on the floor, caught him just before the end, and performed CPR on him. When I came to the ward, this doctor came to me and said, `Dr. Breyer, I have such a feeling of satisfaction. Today I saved the old man at the last minute. Now he is conscious and attached to a respirator. My young son blessed him last Shabbos with the special brochos said for the sick.'"

Last year Maayanei Hayeshua received a strange request from the Ministry of Health to admit a certain patient from the above mentioned hospital because they did not want to treat him. "I didn't understand. What is the meaning of don't want? There is no such thing," says Dr. Breyer. "I answered them, `You are the Ministry of Health. Exert your authority and force them to treat the patient. What kind of business is this transferring patients to us because that hospital refuses to treat them?'

"Sadly, they saw the patient as nothing more than a piece of meat; a burden on society. To make a long story short, I conducted an inquiry over the phone. The patient in question was a 96 year-old man, who was responsible for the mikvo'os in Kiryat Gat. The hospital refused to give him artificial respiration. He was suffering from respiratory distress due to a lung ailment. Now, sometimes they do not give artificial respiration because they claim that they are dealing with a patient with Alzheimer's and it would be better for him to die quickly. But this patient did not have Alzheimer's, he was totally lucid. And he was a rav.

"I told them that the Ministry of Health had ordered him transferred to Maayanei Hayeshua. They answered that the patient was in danger of dying en route, and that they wouldn't mind transferring him as long as I would assume all responsibility and that whatever happened would be on my conscience. I asked them, `If he is in such critical condition, why don't you attach him to a respirator?' They didn't respond and I answered for them: `Because he is 96 years old and you are afraid that if you hook him up to a respirator it will be impossible to wean him off of it.' They admitted that this was true."

This was the end of the conversation, and a day or two later the levaya of this elderly Jew took place in Kiryat Gat.

But Dr. Breyer also has a story about exceptional behavior on the part of doctors at the internal medicine ward at Shaarei Tzedek hospital in Yerushalayim. "HaRav Yitzchok Zilberstein received a sheila from Shaarei Tzedek hospital about a terminally-ill patient who was being fed through a tube and whom they wanted to transfer to a hospice in the Jerusalem area. I still have the letter, dated July 9, 1998, that they sent. The hospice stated that they were not willing to accept the patient as long as he was being fed with a tube. `We don't perform tubal feeding,' was the answer.

"The hospital, though, would not back down. They argued and in the end the hospice staff answered them, `Send the patient with the tube, and we will remove it.' Incensed, the staff at Shaarei Tzedek sent a letter to Rav Zilberstein, and as a result of his decision they kept the patient in the ward, feeding him through the tube until he died.

"In Eretz Yisroel, unfortunately, not everyone behaves according to our guidelines because not everyone heeds daas Torah. In very few Israeli hospitals do rabbonim have an active role. Professor Avrohom Steinberg, chair of the ethics committee at the faculty of medicine at Hebrew University, and Professor Eran Dolev, head of the department of internal medicine at Ichilov hospital in Tel Aviv, both told me that the ethics committees in some thirty hospitals throughout Israel do not function, even though they are legally obligated to do so. They are breaking the law. Did anyone take this to the High Court?"

The Terminally-ill Patient

What does the halochoh say on this matter?

"When describing a terminally-ill patient there must be a clear-cut definition," says Dr. Breyer. "The problem is that, the distorted perception embraced by most of the world notwithstanding, we do not know how to define what is "terminal." This opens the door to opinions such as `All patients are terminally-ill because every person who is born dies in the end.' One must be cautious not to make sweeping generalizations about the terminally ill. If a patient is "given" between three and six months to live, many patients will effectively fall into that category. As a result many patients will not receive the maximum treatment that they could.

"Alzheimer's patients, for example (an incurable disease, that on average, claims victims within three and a half years) are very taxing on their families and on the health system. Nevertheless, we are not exempt from treating them. The Aron Kodesh contained both the broken luchos as well as the whole luchos.

"The definition of a terminally-ill patient according to the Institute for Halacha and Refuah is as follows: `A terminally-ill patient or a patient who is on the verge of dying is a patient with an incurable disease,' but this is insufficient, because diabetes is also incurable," explains Dr. Breyer. "The disease must be malignant and deadly, one that cannot be cured and whose progress cannot be halted. The patient must experience disability in his daily functioning that gets progressively worse, when during the initial stages he is conscious, until he reaches a stage of unconsciousness. Moreover, the time left for him to live is short--between two and three months.

"A dominant feature of terminally-ill patients is suffering. Therefore, according to this definition, a patient with Alzheimer's is not terminally- ill since he does not suffer. The suffering felt by the terminally-ill patient can take the form of pain, dyspnea (shortness of breath), weakness, heartburn, hot and cold flashes, hiccups and belches, numbness and tingling, drowsiness, continuous dryness of mouth, and mouth sores. Most of these patients are in a state of depression, brought on by knowledge of their illness.

"Primarily those who fall into the category of terminally- ill are patients with malignant diseases. But it must be stressed that this does not refer exclusively to cancer patients; there are various other terminal diseases. For example, acute or terminal coronary artery disease, which causes the patient extreme weight loss and much suffering; some chronic lung diseases, in which the patient is constantly on the verge of suffocation; and cirrhosis of the liver.

"The final stage in terminal illness, when the soul leaves the body, can last from a few minutes to seventy-two hours, i.e., three days. According to halochoh, whoever kills a gosseis, a dying person, is considered as if he has killed a healthy person. (See box.)

"Some doctors wish to provide moral justification for causing the early death of a terminal patient. They will never admit that they are undermining the holiness of life, or say that the patient was a burden on society. Rather, they will cite medical grounds in order to vindicate their beliefs. They claim, for example, that a transfusion can do more harm than good since it could cause pulmonary edema which only adds to his suffering. Many hospices hold by this viewpoint.

"Gedolei Yisroel generally try not to refer patients to such institutions, because they do not act in accordance with halochoh. In these places they often say that giving a patient fluids harms him and causes him great discomfort. This, of course, is simply not true. They claim that if the patient is deprived of food and drink he will begin to lose his clarity, eventually sinking into unconsciousness, and this will lead to death. Depriving of food and drink will help the patient die. This is the way they operate.

"Euthanasia is derived from Greek meaning `easy death.' In truth, even in the gemora, (Pesochim 75a) lehavdil there is an injunction to `choose for him a dignified death.' There, however, the gemora is discussing capital punishment. Look at the difference between the words of the living G-d and those of the murderers in white cloaks. Toras Yisroel, even when it enforced the death penalty, made sure that the offender did not suffer unnecessarily, and saw to it that he was put to death painlessly. The implication of voluntary euthanasia necessitates causing death either actively (by administering lethal drugs), or passively (by impeding medical treatment). The halochoh considers disconnecting a patient from a respirator to be active euthanasia."

Many years ago a world conference on medicine and halochoh took place at Shaarei Tzedek hospital in Yerushalayim. One of the speakers, a non- chareidi rabbinical figure who has since passed away, argued that the hetter of removing the preventive force [to death] that appears in the halochoh regarding terminally-ill patients refers today to "pulling the plug" of the respirator.

"I jumped up and voiced my protest, that the speaker's suggestion was an active life shortening act, in other words, murder," relates Dr. Breyer. "All the Gedolim agree that to disconnect a patient from a respirator is murder. There is no other definition."

"Unfortunately, It Won't Be Difficult to Find a Doctor Willing to Pull the Plug!"

The case of a terminally-ill patient who wanted to be disconnected from her respirator was brought before the president of the Tel Aviv district court on April 16 of this year. The judge decided to appoint a medical specialist to deliver his opinion regarding the condition of the patient within two weeks. The patient, a fifty-eight-year-old woman suffering from progressive muscular dystrophy, was kept alive via a respirator. Her only way of communicating with the outside world was by blinking her eyes. Her request, which she had expressed several months ago to her daughters and which was brought by her lawyer, was to be disconnected from the respirator and then to be given an injection with a sedative that would allow her to die painlessly.

The judge appointed Professor Nathan Gadot, head of the neurological department at Meir hospital in Kfar Saba, to examine the patient and to check her medical records. The doctor will be asked to offer his opinion and to answer the following questions: Does this woman answer to the criteria of terminally-ill? How long is she expected to live? What will be the immediate result of disconnecting her from the respirator? How is this to be done; does it necessitate a physical act on the part of the doctor, or would a technical act suffice? After disconnecting the patient, is there a need for any medical treatment? Does the patient want to be disconnected? And does she comprehend her situation? The judge asked the doctor to answer these last questions, not within his capacity as a physician, but rather as a person able to communicate with her.

The judge also wanted to verify whether there would be a doctor willing to disconnect the patient in case the court decided in favor of her request. Mr. Choshen, the patient's lawyer, asked the specialist to determine the level of physical suffering that the patient was undergoing as a result of the respirator. The doctor must give his opinion within two weeks, after which the case will be judged in court.

Dr. Breyer recalls the Doctors and Nurses Conference in Sivan 5759 (1999) after which Rav Zilberstein published in the chareidi newspapers an emotional call to all Israeli judges "to be mindful of the serious prohibition of lo tirtzach when they judge cases concerning terminally-ill patients."

Are there really any doctors who would agree to actively disconnect a patient?

Dr. Breyer says yes and no. "In the secular community you can also find many people who oppose euthanasia and who are not willing to cooperate in any way with such a step."

Dr. Breyer brings as a case in point the exemplary behavior of the Beit Rivka nursing hospital in Petach Tikva. When the district court issued a ruling to cease tubal feeding of a certain patient at the request of the patient's son, the hospital director, Dr. Shai Brill answered, "We are not the court's executioners. Don't ask us to kill patients." Dr. Brill specified that the job of his staff is to treat the patient and to alleviate suffering.

On the other hand, in a survey given to the Medical Union, physicians were asked whether they would cooperate with "mercy killing" if it were to become legal. The survey's conclusions were alarming. Forty percent answered that they had never shortened a patient's life since it was against the law. Eleven percent admitted that they had cooperated in shortening the life of a patient at least once. Twenty- four percent stated explicitly that, if unhindered by constraints of the law, they would actively perform euthanasia.

Precedents exist. Two years ago Professor Avinoam Rechess of Hadassah hospital and chairman of the Israel Neurologists Association "put to sleep" IAF pilot Iti Arad after a special court ruling allowed it. Arad had been totally paralyzed for many years due to muscular dystrophy. "Unfortunately," concludes Dr. Breyer, "there is no question about it. The physician is likely to be found."

Daas Torah Dr. Breyer has the original psak halochoh hanging on his wall that was issued in Kislev 5755 (1995) by all the gedolei hador. It states that it is obligatory to treat terminally-ill patients with all the conventional treatments and drugs, as necessary. "What about CPR, artificial respiration, dialysis, complicated surgery, chemotherapy, and radiation therapy? Gedolei Yisroel stipulated all these things with their far-reaching vision and deep insight," says Dr. Breyer. "The psak was given because of the hospices for terminally-ill patients. It all began with the story mentioned above about the Israeli hospital that was not willing to admit a patient from a chareidi family into its hospice. The family turned to the beis din and afterward spoke with me. I went to verify the story and was shocked. After checking the medical records I argued with the doctor but to no avail. I brought the case to gedolei Yisroel. They wanted to publish a harsh letter in the newspaper but the rabbonim held up the letter and asked that first a psak halochoh be issued. HaRav Arye Leib Shteinman and HaRav Chaim Kanievsky sent me to HaRav Eliashiv. We also went to HaRav Shlomo Zalman Auerbach zt'l . I then returned to the poskim in Bnei Brak. It continued in this way, back and forth, until three months later all the poskei hador signed the psak halochoh which instructs how one must treat a terminal patient. This was the last major psak that HaRav Shlomo Zalman Auerbach zt'l signed. Letter: Din Torah obligates one to treat a patient--even if according to the doctors he is a terminal patient on the verge of death--with all the conventional medical treatments and drugs, as necessary. It is absolutely forbidden to hasten the end of a terminal patient in order to reduce his suffering, by way of not giving food or other medical treatment. It is all the more forbidden to hasten death by way of an act (unless it is clear that these are the patient's final hours, in which case, it is forbidden even to move him, since he is considered a gosseis). In light of the above it is incumbent on the families of terminally-ill patients to request and verify that the patient receives all necessary treatment according to the guidelines presented above. Signed: Yosef Shalom Eliashiv, Shlomo Zalman Auerbach, Shmuel Halevi Wosner, Sh. Y. Nissim Karelitz

The Value of an Hour in the Life of a Gosseis Who can calculate the value of an additional hour in the life of a person who is on the verge of death; he can still do mitzvos and good deeds during this hour, and even do teshuva as it is written in Pirkei Avos ch.4: "One hour of teshuva and good deeds in this world is better than all of olam habo." The gemara states (Yoma 85): It is permissible to clear away a mound of rubble and to profane the Shabbos in order to save a life for even one hour"--even if we know for certain that after we have profaned the Shabbos in order to save a person's life that person will not live for more than a few hours, it is still permitted to profane the Shabbos for him. This is the psak in Orach Chaim 329. The Meiri (see Yoma there) explains that the reason for this is that the dying person can benefit from an additional hour of life to do teshuva and maasim tovim. (See Igros Moshe Choshen Mishpat II 75, and Yoreh Deah II 174 She'eilos Uteshuvos Netzer Mato'ai 30.)

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