A dramatic halachic ruling determines for the first time when it is permissible to avoid resuscitation and resuscitation of terminally ill patients, even when the patient did not say he wanted it or when his family members did not think it was his wish.
The rabbis of the "Sanctity of Life" wing of the Poa Institute (fertility and medicine according to Halacha) held a meeting this week, where they defined for the first time the watershed - where it is permissible to avoid penetrating breath and heart massage, and in practice causing the death of the patient.
Doctors, illustration, photo: Oren Ben Hakon
There are two stages in dementia and Alzheimer's diseases that may last for many years, and in the opinion of all the arbitrators it is clear that there is no reason to avoid medical treatments, since it is not in our power to determine the meaning of a person's life - this is how Rabbi Zvi Arnon, one of the heads of the division, explained.
This is the first stage, when the disease is known, and the final stage.
Even in difficult situations, where the patient is already disconnected from reality but it is not at all certain that he is suffering, according to the Halacha it is obligatory to provide full medical care - just like any other person.
And here, at the meeting, they clearly determined when the patient entered a terminal state, where resuscitation and resuscitation operations would not be able to return him to his previous state under any circumstances and would only prolong his suffering.
This is a very complex situation, because it is difficult to determine when a dementia patient enters a terminal state.
Doctors also know that what is defined as "terminal dementia" can last for years.
Rabbi Ariel Vider told the gathering about a family in which the patient was defined as terminal but continued to live for many years.
But at a certain point, when the patient undergoes CPR and ventilation, it is about entering a distinctly terminal state, where they will not be able to bring him back to his condition, and therefore CPR and intrusive ventilation will only prolong his suffering.
Three conditions
In such a situation, three conditions were defined that are required to decide to avoid CPR and invasive ventilation according to the Halacha: the patient is fully nursed, without movement or walking;
He does not communicate and talk;
And he is fed artificially and does not swallow independently.
Even in such a situation, the rabbis emphasized, the maximum medical treatment must be provided, from advanced resuscitation drugs to non-invasive ventilation. The rabbis emphasized that a rabbi should be asked privately about any medical procedure, but ventilation and resuscitation are operations that there is not always time to ask about, so it is important to know the rules in advance.
Even doctors know that what is defined as "terminal dementia" can last for years, photo: Getty Images
"to fulfill their desire"
Rabbi Vader clarified that this only applies if it is not known that the patient would have wanted it: "There are people who want to prolong life even at the cost of suffering. According to the Halacha and the law, their request and desire must be fulfilled."
According to him, a personal judgment should not be derived from the gathering.
The meeting also dealt with the question of artificial feeding.
Dr. Debi Shapira, MD, director of the geriatrics department at Shaare Zedek Hospital, described the complexity and the various studies.
The rabbis explained that, unlike CPR and CPR, food and fluids are basic needs that almost always need to be given, but they recommended consulting about it.
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