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Talmudic Treasures by Rabbi Ziona Zelazo is licensed under a Creative Commons Attribution-NoDerivs 3.0 Unported License.

Monday, October 24, 2011

Prayers at end-of life and advanced directives – Ketubot 104a

It is often that I am invited or asked to offer a prayer for healing for people who are sick. Even those who claim that they do not believe in prayer per se are willing to listen to a prayer when they are ill. And those who claim that they do not believe in praying for someone, are found to express verbally in some way or another encouragement and hopes for their loved one. The difficulty arises when there is so much pain involved, when there is no quality of life anymore, and no hope left for recovery or survival. Not always we feel that we have the permission or feel free to pray for a speedy death. Some tell me that they feel phony by giving ‘false hope’ and they also feel guilty when they wish that suffering should end with death.

In the Gemara in Ketubot 104a we read of a case, where prayers for healing could make the difference between life and death;

     On the day when Rabbi [R. Judah haNasi (135-220 C.E.) compiled the Mishnah] died the Rabbis decreed a public fast and [before that] they offered prayers for heavenly mercy [that he would not die].

     Rabbi's handmaid ascended the roof and prayed: 'The immortals [the angels] desire Rabbi [to join them] and the mortals [humans] desire Rabbi [to remain with them]; may it be the will [of God] that the mortals may overpower the immortals'. When, however, she saw how often he resorted to the privy [He was suffering from acute and painful diarrhea] painfully taking off his tefillin [These must not be worn when the body is not in a state of perfect cleanliness] and putting them on again, she prayed: 'May it be the will [of God] that the immortals may overpower the mortals'. As the Rabbis incessantly continued their prayers for [heavenly] mercy she took up a jar and threw it down from the roof to the ground. [For a moment] they ceased praying and the soul of Rabbi departed.

While Rabbi Judah’s handmaid, but not the rabbi's. students, is praised in the Gemara for her actions, as she understood when enough is enough, the Jewish law sanctions passive euthanasia -- at least in those cases in which the dying individual is incurable and/or is in great pain. Take this Talmudic story and parallel it with what is going on in our society. If prayer could be paralleled with our advanced medical technology to prolong life (many times at all costs), there is an awareness that actions such as termination of life support create potential moral and medical conflicts between health care providers, family members and patients. The ongoing discussion whether it is or it is not ethical to disconnect the machine causes terrible tension to arise. It is especially very sad when family members or health care providers insist on providing care where there is no hope for recovery.
In the USA, the term ‘euthanasia’ has a negative connotation and implies helping death even when there IS hope. This is not what I am talking about. I am clearly advocating for assisting death with Comfort Caring Care when the time is right.   
Similarly, Reform Rabbi Solomon Freehof of the 20th century claims that just the way a man and woman have the right to live; they also have the right to die with dignity. He concludes that if one may pray for the death of the hopeless ill, one may take other measures which will promote the inevitable end.
In light of my experience as a chaplain, I know that there are some ways to bypass some of the ethical questions and dilemmas that family members and health care providers are faced with and deal with. I refer to the Advance Directives form that everyone can complete even way before sickness strikes -- and this can be achieved even without any attorney. This advanced medical decision allows our given autonomy to instruct family and physicians in advance, what kind of treatment should be given when End of Life knocks at the door. Some patients choose the DNR, some want no heroic measures and others want all to be done. I have to admit that Advanced Directives are not always followed… or patients change their mind during crisis, but at least for the most part, it gives family members a peace of mind (ideally, but not always) and dignity could be achieved.
Today's concepts of Advance Directives presume an individual autonomy that was not presumed in Talmudic times. But the account in Ketubot 104a of the anonymous maid of Rabbi Yehudah haNasi, and how she changed her prayer as Rabbi was dying, remains a powerful primary resource for Jewish end-of-life decision-making. 

I have presented a very complicated topic in a rather simplistic way. But, I still would like to send out my encouragement that we keep praying for our loved ones when they need the extra energy to go on. Together with my suggestion to let the conversations of Advanced Directives start with family members as we exercise the ability to listen to one another with love, understanding and – prayers.