26 Nov, 2020
JERUSALEM WEATHER

The pandemic has placed great pressures on medical systems around the world, sometimes overloading the hospitals and forcing doctors to choose who receives lifesaving treatment and who is set off to the side to languish and perhaps to die. As a result, many health systems are requesting that higher-risk patients voluntarily sign an agreement that allows doctors to withhold attempts at resuscitation. In some cases, parents are being asked to sign a form telling the doctors to allow their parents or their children to die.

SIGNING AWAY THE LIVES OF THE CHILDREN AND THE ELDERLY

The dilemma of clinicians being forced to choose which patients will live and which will die first arose in Italy. The Independent reported that official guidelines for doctors in Italy stated that only patients “deemed worthy of intensive care” should receive such care and decisions based on a “distributive justice” approach balanced the demand for care versus available resources. At the height of the crisis, some regions of Italy were using a cut off of 65-years-old in case of pre-existing comorbidities. In the UK, the decision to not use resuscitative techniques including CPR rests with the physician, not with the patient or family. Patients can, while they have the ability, can request not to be resuscitated but patients do not have the right to insist to receive resuscitation. The ultimate decision lies in the hands of the physician. CPR will only be administered if a doctor believes it is in the best interests of the patient.

In the UK, patients with illnesses that are considered “life-limiting” are being asked to sign  ‘Do Not Resuscitate’ orders (DNR). Incurable cancer, motorneurone diseases, untreatable heart and lung conditions, are considered to be at especially high risk if they contract COVID-19 and are being asked to sign DNRs while still uninfected. The DNR notes that people with these conditions will be “unlikely to be offered hospital admission if they become unwell and certainly will not be offered a ventilator bed.” A letter from the health system informing them of this suggested that if they become ill with the virus, their best option is to “remain at home and be cared for by family.” The form from the health service informed the patients that one benefit of their signing a DNR was “scarce ambulance services can be targeted to the young and fit who have a greater chance.”

But it is not just the elderly and sick who are the focus of selective health care. In the UK, parents of vulnerable and sick children are being asked by physicians to sign a DNR if their children catch Covid-19. The order instructs medics not to perform CPR if a patient stops breathing or their heart stops. The National Institute for Health and Care Excellence initially instructed ­doctors to assess people with learning disabilities, autism, or cerebral palsy on a ‘clinical frailty scale’ which would deny some of them ­hospital treatment. The institute repealed those guidelines after public outcry.

DNRs are ostensibly for the benefit of the patient, offering a ‘dignified death’ and decreasing suffering in cases where an imminent death and/or suffering is deemed inevitable. 

Reductions in other care are not supposed to result from DNR, but they do. Patients with DNR are less likely to get medically appropriate care for a wide range of issues such as blood transfusions, cardiac catheterizations, cardiac bypass, operations for surgical complications, blood cultures, central line placement, antibiotics, and diagnostic tests. Patients with DNR, therefore, die sooner, even from causes unrelated to CPR. 

In the US, some guidelines for triage during a public health emergency put DNR status in the list of criteria for excluding patients from getting ventilators or other life-saving health care. In 2015, the New York State Task Force on Life and the Law issued  Ventilator Allocation Guidelines for health care institutions to use in an influenza pandemic if the demand for ventilators exceeded the supply. The guidelines rejected using DNR status in the list of exclusion criteria. But this is due to the expressed goal of triage being to maximize the number of survivors. According to those guidelines, in an institution facing a shortage of ventilators, a patient whose medical record has a DNR order would be denied access to ventilator therapy, even if their likelihood of survival is high. 

Critics claim that a DNR is a form of passive euthanasia when a patient passes away because the medical professionals either don’t do something necessary to keep the patient alive or when they stop doing something that is keeping the patient alive.

JEWISH LAW SHOWING THE WAY

Rabbi Moshe Avraham Halperin from the Science and Technology Torah Law Institute which investigates modern technology within a religious Jewish framework gave a more Godly understanding of how to cope with the medical crisis.

“In Judaism, there is no difference between morality and Torah law,” Rabbi Halperin explained. “What others call morality is how Jews serve God. This especially includes difficult life and death decisions, what we call the sanctity of life. Life is holy, the holiest thing in the world, because it is through life that we serve God.”

“Therefore, no person can be the master over life; not his own and certainly not someone else’s. Life belongs to God and He is the only one who decides over when it begins and when it ends. So even a person who is in a vegetative state, his soul being in the world increases the Glory of Heaven that is in the world.”

“Morality that is not based in the Torah is selective, placing Man at the top, in the decision making role. A person can destroy his own property or tell someone else to destroy it because it is his property to do with as he chooses. In selective morality, if a man chooses to end his life, since it is his life, he is within his right to do so.”

“But if you believe that the essence of life is the soul that was placed there by God, and that belongs to him, is part of him, then taking life is the worst crime possible.”

“It is absolutely forbidden under any condition to remove someone from life-saving measures, even if he is suffering, even if he requests it. Similarly, it is forbidden to withhold normal treatment, or food and water and medicine, that will extend his life. These things are murder, plain and simple. You can pray for his suffering to end but you cannot actively end it.”

“If a person has a chance to live after resuscitation or CPR, even if he will be disabled, then every effort must be made to lengthen his life. But if there is no chance for him to return to life, if he will for sure never return to consciousness, then there is no necessity to resuscitate the person.”

In the case of many people and limited resources, of course the doctors must choose who they have the greatest chance of saving. But the doctor may not make a judgment between the value of two lives. It is not his place to do so.”

SAVING LIVES: PAVING THE WAY TO REDEMPTION

Rabbi Yosef Berger, rabbi of King David’s Tomb on Mount Zion, emphasized that shortening life in any way is most assuredly a sin and delays the final redemption. He quoted the last verse in Psalms to illustrate how every moment of life is a unique opportunity to praise the Creator.

Let all that breathes praise Hashem. Hallelujah. Psalms 150:6

“God breathed life in Man,” Rabbi Berger said. “The purpose of life is to praise God. Anything that lessens life, reduces God’s praises and delays the Redemption. Euthanasia denies the inherent sanctity of life, denying that life comes from God.”

Rabbi Berger noted that the Children of Israel were supposed to be enslaved in Egypt for 400 years but were actually in Egypt for much less.

“The Bible describes that the Children of Israel multiplied greatly,” Rabbi Berger said. “It was this increase of life, this love of life, that shortened the exile in Egypt. Pharaoh tried to lengthen the exile by throwing the male babies into the Nile, offsetting the Israelite’s fertility, thereby lessening the power of life and increasing the exile.”

“There is a very simple rule: anything that increases life is from God and brings the Messiah closer,” Berger said. “Anything that increases death is precisely the opposite and delays the Messiah.”

Rabbi Berger noted that killing children was a pagan ritual, most notably burning children alive for Ba’al.

“When Pharoah ordered the Israelite children thrown into the Nile, it was only the boys since this was a more ‘worthy’ sacrifice to the Egyptian gods,” Rabbi Berger noted. “The natural order is for the parents to protect their children, which is why Moses refuse Pharoah’s offer to leave Egypt so long as the children and elderly stayed behind. Sacrificing the children and elderly in the name of survival is a trait of the godless and doing so certainly delays the Redemption.

EUTHANASIA, SOCIALIZED MEDICINE, AND THE UNITED NATIONS

Euthanasia and choosing to withhold life-saving healthcare has been shown to be related to the socialization of medicine. Though not all countries with universal health care have legalized euthanasia, all of the countries that have legalized euthanasia (Netherlands, Belgium, Columbia, Luxembourg, Canada, Switzerland, and Germany) have universal health care. There are currently six states in the U.S. with legalized euthanasia.

The United Nations Human Rights Council has declared that abortions and euthanasia in the form of assisted suicides are universal human rights

 Abortions and assisted suicides are both prohibited by the Noahide Law which prohibits the spilling of blood. This is based on a verse in Genesis.

Whoever sheds the blood of man, By man shall his blood be shed; For in His image Did Hashem make man. Genesis 9:6