IN-DEPTH FEATURES
Court Approved Murder

The terminal patient lay on his hospital bed motionlessly, hooked up to medical apparatus and unable to move even one part of his body, accept for his eyes and lips. While his family crowded around his bed, flustered and on the alert, he was interviewed by the media.

"My entire life was has always been one large battlefield, and I have always struggled. Now it's time to redeem myself, time to go," he said. "I would be happy to continue living, but reality is different. As long as life was interesting and I could communicate with people, I didn't want to die. Now, I have difficulty speaking. I only have one vocal chord left, and can't talk, eat or move. Life has stopped being interesting. As my means to communicate with people decreased, my decision to die began to crystallize. I know that my condition is irreversible. The illness will grow worse; the pains will grow stronger. So why should I drag it out? I fought in all of the country's battles. But one must know when to end this type of battle."

These shocking words stemmed from the depths of the heart of a man whose mind and feelings were healthy and functional, while no limb in his body functioned. It was a person who could, with medical help have lived quite a few more years, but who was disgusted with his life, because it wasn't at its best. He suffered from the incurable neurological and muscle disease amyotrophic lateral sclerosis (ALS), known as Lou Gehrig's disease.

"A devastating disease -- the worst disease I know," Professor Avinoam Rechess, a senior neurologist in Hadassah Ein Karem, and the chairman of the Ethical Committee of the Israel Medical Association, told Yated Ne'eman.

"I hereby declare, although with a heavy and pained heart, that the patient has the right to be detached from his respiratory device, or to refuse to be connected to the artificial respirator," Justice Nissim Yeshaya determined on Sunday, 22 Teves.

"In light of the opinion of the psychiatrist and the neurologist, I don't regard detaching the patient from the respirator -- an act which will result in his death -- as a criminal act," Attorney General Eliakim Rubinstein announced on Friday, 20 Teves.

The live broadcast from the Hillel Yaffeh hospital in Chadera of the murder of the patient, after his family felt certain that his wishes should be honored, proceeded calmly. "Even after my death, we will keep in touch," the patient said before the apparatus was disconnected. Then, while the potent anesthetics began to work, he suddenly hesitated. "I hope that I am not making a mistake," he said. A brief while after that he died. His physician, Dr. Sergio Bluman detached the respiratory device and killed him.

"Why didn't his wife do her beloved husband's bidding by herself and disconnect the devices with her very own hands? Why did she leave that `chesed' for the doctor?" a person who heard the interviews asked.

Murder = Murder

He, like all of us, understands that behind all of the hype stands the simple truth, which gives one no rest. That truth is that every taking of life, even the briefest span, is murder -- plain and simple murder. For secular Jews that may be only a vague uneasiness. However a chareidi Jew knows that the halocho clearly and unequivocally states: every expediting of a person's death, in whatever manner or form whatsoever, is murder.

The great poskim, headed by Maran HaRav Yosef Sholom Eliashiv, were shocked by the fact that Jews can sink to so low a level that they can't understand that whoever abets such a crime, even if only by issuing a legal opinion, is no different than one who places a knife in the hand of the murderer.

Maran HaRav Eliashiv regards as especially grave the fact that the Attorney General, a kipah wearer, thinks that he is permitted to speak in the name of the halocho and to base his ruling in Jewish sources, while in fact distorting the information.

The decision to sanction this killing was made on Sunday 22 Teves, when a court judge issued a permit to detach him from a respirator that kept him alive. The permit was given at the request of the patient, who filed it with the consent of his family.

Usually, legal procedures take a long time. This one though took exactly one week. Within a week, the court secured the scientific opinions of a psychiatrist who examined the patient and confirmed that he was of a clear mind when he requested to be killed, as well as the opinion of a neurologist who determined that the illness is terminal, and the legal opinion of the Attorney General that killing [this patient] by detaching him from his medical respiratory apparatus is not a criminal act.

All of these experts rushed, supposedly in the name of mercy and compassion, to fulfill the wishes of a person who sought to shorten his suffering. It should be stressed that, at least according to the media, his greatest suffering involved his alienation from his social circle and from an interesting life, and not the pain which could surely have been relieved with medication, nor his mental suffering over his inability to help himself. The patient didn't speak about his inability to fulfill the mitzvos according to the halochoh, even though he said that he was mitzvah-observant.

Precedents

That wasn't the first time a court permitted killing a sick person at his request. In October 1998, Itai Arad, a former combat pilot who had contracted muscular dystrophy, conducted a prolonged battle over his right to die by being detached from a respirator. The Israeli judicial system at that time hesitated to establish dangerous precedents. The court found then that it is possible to expedite the death of a patient passively, such as by not originally connecting him to a respirator (or other necessary apparatus), but not actively, such as by detachment from a respirator.

The medical system also was in no rush to take action. In the end, the "brave" doctor was found -- Professor Avinoam Rechess -- who detached the patient from the machine. He did that with the permission and knowledge of top-ranking officials in the health system and in the Hadassah Ein Karem hospital.

The second time was half a year ago, in June 2001. A terminal patient of 58 was detached from her medical apparatus in the Meir hospital in Kfar Saba, after Justice Uri Goren determined that the detachment from medical apparatus by a doctor is not an active deed, but rather a passive one. Attorney General Eliakim Rubinstein hastened to accept the opinion of the judge and approved the murder.

Behind the Reasoning

What was shocking about that story, was that the killing took place a week after the ruling was issued and not right away, because of a wedding in the patient's family. Note that the patient was in such a terrible situation, that she saw no purpose to continuing her life. Nonetheless, she was willing to prolong her suffering in order not to spoil her family's celebration. So we see that not causing her family agony at such a time was a purpose and goal which gave her enough reason to keep on living.

It is thus clear that, had she or her family made an effort to give her life meaning in another manner (perhaps by explaining to her that suffering has a purpose and that there is a din and a Dayan Who governs the world), she might have retracted her request to die. The fact that she postponed her death by a week shows that even her devoted family, who truly wanted to prevent their mother from suffering, sealed their hearts to her pain when there was a wedding.

The Dutch Law

In the very same week, on January 1, 2002, a law permitting mercy killings went into effect in Holland, which became the first country in the world to permit euthanasia -- mercy killings -- on terminal patients. The Dutch law says that regional committees comprised of jurists, doctors and experts on "ethics" will carefully examine every request made by a patient. The patient will have to prove that his suffering is unbearable. This pertains not only to patients suffering from severe illnesses such as muscular dystrophy, but also to every patient who finds it hard to suffer and seeks to end his life with the help of those who are supposed to be his healers.

Despite the many options available to those granting the permission, some in Holland still say that the restrictions are still too rigid. A doctor who helped a healthy elderly person to commit suicide simply because he was tired of living wasn't brought to justice, and even got good press.

A year before, a Dutch doctor injected a lethal dose of medicine into the veins of a muscular dystrophy patient, in front of the news-thirsty (or bloodthirsty) media.

In Oregon where such murders are permitted almost freely, the US Attorney General is currently trying to curtail the practice, and has announced that he will press charges against doctors who prescribe lethal medicines to people who seek to take their lives with their own hands. According to the law in that modern Sodom, it is permissible to help end the life of a patient who only has six more months to live.

An Interview with Professor Rechess

Our conversation with Professor Avinoam Rechess, a top neurologist and one of the chief champions and supporters of euthanasia, highlighted the extent of the difference between the erroneous outlooks prevalent in the country, and Jewish halochoh and hashkofoh.

He believes that there is no difference between withholding treatment from patients and disconnecting them with one's very own hands. "The difference," he says, "is only in the filters," by which he means the various committees, psychiatrists, doctors, jurists, the Attorney General and perhaps the media.

Professor Avinoam Rechess' "compassionate" outlook doesn't end with patients with muscular dystrophy, which in his opinion is the worst illness of all because the victim feels and understands but has absolutely no control over his body. Professor Rechess is ready to extend mercy killings to cancer patients as well, in the event that their remaining life expectancy is very short, as well as Alzheimer's patients who have asked, in advance, not to lengthen their lives and other invalids who find life difficult and whose chances of recovering are nil.

We didn't ask for his opinion on the problem of infants born with severe deformities or disabilities. However, hospital reports indicate that this problem has already been solved by passive consent. Certain hospital personnel simply don't treat such babies (even starving them) and let them die, sometimes without the knowledge of the parents.

The Opinion of Someone who Should Know

"In my opinion if the patient's close circle of friends had made him feel wanted, and would have conveyed to him the message that they will care for him lovingly under all circumstances, he might have reached a different decision," Dr. Rachamim Melamed-Cohen said when we asked him about the recent mercy killing, Dr. Melamed-Cohen clearly earned the right to say this.

"When you won't be able to brush away a fly perched on the edge of your nose, then you've reached the difficult stage of the illness," a physician told Dr. Rachamim Melamed-Cohen, who has been suffering from a rare and particularly difficult type of muscular atrophy for the past seven years. His life expectancy is long in comparison with those of muscular dystrophy victims, but the quality of his life is far worse than theirs. He hasn't been able to brush away a fly from his nose for quite a long time. He is connected to a respirator and his entire body is paralyzed. Nonetheless, he is constantly busy "brushing away flies" from the erroneous outlooks of those who support either the active or the passive murders of invalids like himself.

With chasdei Shomayim, Dr. Melamed-Cohen (a professor of education) has been blessed with an outstanding, supportive, tolerant understanding and loving family all of whose members have positive and optimistic personalities. His smile was perpetual when he was healthy and served as the supervisor of religious education in the Education Ministry. That same smile which is still perpetually on his face, is reflected in his voice too, even though today he is only able to speak by means of a special device, perhaps the only one of its kind in the country.

That device is also part of the story. It indicates what can be achieved when one really has a will to live and when one's family does not regard its sick member as a burden which should be gotten rid of elegantly, but makes every effort to learn about the latest innovations for muscular dystrophy sufferers, and to secure them at all costs.

Rachamim gives interviews to the media in order to promulgate his firm opposition to mercy killings of all types (he recently was interviewed by N. Katzin in Yated Ne'eman). Even indifferent and secular newspapers are stirred by his strong faith, his yiras Shomayim and his natural amiability and love of life.

"Instead of worrying about the quality of the deaths of terminal patients, worry about the quality of their lives," he says. He also says that the past two years, during which he has been attached to a respirator, have been the best years in his life, because he is creative (recently publishing a guide for teachers), he learns, and he enjoys his grandchildren and the many visitors who come to be inspired by him and to draw the courage which enables them to cope with life.

We asked Rachamim Melamed-Cohen for his opinion on the killing which took place on a live broadcast last week, with the approval of Dr. Eliakim Rubinstein, in total defiance of the halochoh.

"I saw the patient and heard him in a broadcast," Rachamim and says. (They showed only the lower part of his face.) "I heard a lot of doubt and hesitation in his voice.

"In my opinion, social pressure, society's messages, the feelings conveyed by those taking care of him, prodded him to conclude that it was better for him to die. Had he been taken care of at home, in a warmer and more supportive atmosphere, he might have felt differently. In an interview with the press he said that he used to write poems and stories. There was no reason for him not to continue while he was sick. He could have continued to create, and to produce thoughts which could have contributed to society."

Dr. Melamed is active in the Temicha organization which offers support to terminal patients. "This organization doesn't regard the patient only through medical eyeglasses, but takes a holistic, comprehensive approach. It strives to improve the patient's quality of life, especially that of the terminal patients -- and to make their lives as good as possible."

Dr. Melamed-Cohen's wife adds: "If we begin to permit killings, what will be the end?"

What particularly bothers her is the celebration in the media. Such festivals, they say, create social pressure on people in similar situations. The publicity engenders ideas like: "Why be an egoist and burden the family? See how nice that patient who wanted to shorten his family's suffering was?"

The Organizers of the Festivities

The Lilach organization is responsible for much of the merry- making in the media.

"The moment its members learned that the patient had muscular dystrophy, they came to him with their brochure," says Professor Avraham Steinberg of Sha'arei Tzedek who is known for his battle against those killings which are murderous and not merciful. Lilach is the organization which purveys the right "to live and die with respect." It is not known what steps it takes to help one live with respect, nor how it knows which is the correct way to die with respect.

The purpose of Lilach's struggle is to institutionalize legal murder, just like in Holland. There is no doubt that if, by chance or by mistake, a law forbidding such killings, or one which is very rigid in its demands is passed in Israel, all of the champions of democracy will either to kill it in the Supreme Court, or simply not obey it, just like they don't obey the anti-abortion law.

Professor Avraham Steinberg, who is in the center of the storm, is trying to do the impossible in this area. Today, he heads a committee founded by the Health Ministry to write the regulations for the law on mercy killings.

The committee has sixty members from various fields and with different views, and it is difficult to believe that they will be able to reach a consensus. When we tried to ascertain the content of regulations, it became clear that the regulations still have not been presented to the Health Ministry, and were still turned over to the Constitution, Law and Justice Committee of the Knesset.

"Right now, I am in an official position, and I can't comment," Professor Steinberg cordially answered us when we asked for his reaction to the current murder.

One of those interviewed (who, seeking to remain loyal, asked us not to publicize his name) gave us a hint of what might happen. He said: "There is a majority opinion and a minority one, and it isn't certain that the majority opinion will be the decisive one." Dr. Avraham Steinberg, who is very involved in medical ethics has stated his firm opposition to euthanasia in interviews with Yated Ne'eman. Other humanitarian and G-d-fearing doctors feel and behave like him. Some of them don't dare grant interviews in the general media, because they are afraid of being considered "politically incorrect."

Halachic Ruling

Like in many other battles, Yated Ne'eman is fighting this one nearly by itself. There can be no compromise on such an issue, and no comprising of the pure and clear halocho will ever be made. A halachic ruling on this subject was issued in 5755, which stated: "According to din Torah, one is obligated to treat a sick person, even a terminally ill one, and to give him all of the routine medicines and medical treatments he needs. It is forbidden to expedite the death of a terminal patient in order to ease his suffering, by withholding food from him or refraining from dispensing other medical treatment, all the more so to expedite his death in an active manner."

This halachic ruling was signed by HaRav Shlomo Zalman Auerbach, zt"l and yibodlu lechayim tovim ve'arukim, Maran HaRav Yosef Sholom Eliashiv, HaRav Shmuel Halevi Wosner and HaRav Nissim Karelitz.

The gedolei haposkim are now reiterating these halochos with added strength. They once more stress that there is no valid basis for legal directives of any sort whatsoever, including the opinion of the Attorney General. Murder is murder, regardless of the type of package in which it is presented.

Legal Experts and Halachah

Last week, Maran HaRav Eliashiv expressed shock and pain over the opinion issued by the Attorney General. He was especially upset by the Attorney General's intervention in a purely halachic matter which pertains to dinei nefoshos.

Rabbi Moshe Gafni wrote a sharp letter on the matter to Attorney General Rubinstein in which he said: "In addition to the issue itself, the precedent you have established is very serious from every aspect. Tomorrow, a different Attorney General will say that the doctors may, in reliance on the foundations set by your opinion, comply with the request of person who wishes to terminate his life because he feels that it is meaningless and is one long saga of suffering. You are lending your hand to a very serious breach of the halochoh and to the forming of a dangerous precedent whose end results cannot be foreseen."

We, as believing Jews, know that suffering also has a function, and that only Hashem knows when a person's suffering must end. We know too that as long as the candle is burning it is still possible to correct, pray and to hope that He who said to His world, "enough," will say "enough" to our tsoros too.