EXOD566 Does Jewish law require doctors to do all within their power to prolong the life of a patient in chronic pain and suffering from a terminal illness? In a seminal ruling specifically addressed to physicians, Rabbi Moshe Feinstein wrote: "If a patient is terminally ill and in intractable pain, so that there is no hope of surviving in a condition free of pain, but it is possible, through medical or technological methods, to prolong his life, then it is improper to do so. Rather, the patient should be made as comfortable as possible and left without any further intervention" Igrot Moshe, Choshen Mishpat 2:73. [In the context of this response, Rabbi Feinstein goes on to make the statement previously cited that actively hastening the patient's death by even a moment is "murder"] On the other hand, if medicines can be found to make the patient comfortable, "so that he will not be in pain, [then] efforts should be made to prevent the patient from dying." Thus, for Rabbi Feinstein, the key concern regarding terminal patients, particularly those who can live for only a few more months, is the absence of "intractable pain." ... Dr. Kenneth Prager, an observant Jew, argues that even in instances in which pain can be contained, there are still reasons why it might be wrong to prolong a terminal patient's life. He feels, therefore, that Rabbi Feinstein's ruling "does not address the ever-increasing number of patients in Intensive Care Units on life support with no hope of leaving the hospital alive or are being kept alive by ventilators, dialysis machines, pressors (potent medications to maintain their failing blood pressure), potent antibiotics, and even artificial pumps that assist a failing heart. These patients are nearly always prevented from feeling pain by the administration of narcotics that render them unconscious. They cannot communicate with their families. Patients may be kept in this condition for literally weeks or even months during which time they developed horribly large and deep ulcers of their skin, disfiguring bloating of their entire body, and undergo repeated skin punctures for IVs and catheters. My experience with the Orthodox rabbinate is that they have been loath to allow withdrawal of life support in these situations even though the intensive care is clearly prolonging the misery of the dying process. These treatments, in my view, also violate the dignity of patients because of this disfigurement and breakdown of their bodies, sometimes with actual putrefaction of their tissues. I have even had rabbis who were loath to withhold attempts at recitation in these patients, thereby subjecting these poor people to the degradation of chest compression, rib fractures, and electric shocks in attempts to prolong the dying process for an even longer period. I believe that such efforts are in direct contradiction to those posekim (decisors of Jewish law) who have declared that if the physician cannot help a patient, but can only cause prolonged suffering, these physicians do not have permission to treat the patient. Verapo yerapeh ("And heal shall he heal") the biblical expression from which the Talmud derives reshut (permission) for doctors to practice medicine [this verse and Bava Kamma 85a) only pertains when the physician can help the patient. However, 'permission' to be a doctor ceases once a doctor can no longer help the patient. For too many rabbis, the sanctity of life has become an end in itself and they feel that efforts should be made to prolong the lives of patients at all cost, as long as the patients are not suffering, regardless of the breakdown of their bodies." [in Prager's view," the ancient notion of a goses (a legal term referring to a patient so sick that it is presumed he will be dead within 72 hours) is a very useful one. But unfortunately the definition of this term has been muddled in the halachic mind because of the sophisticated technology that can keep virtually everyone, no matter how sick, alive for a while, without, however, healing the patient. We need a new invigorated definition of the term goses by the rabbinate to accommodate the realities of changing medical technology."