Past generations of Jewish thinkers and sages never anticipated modern medicine’s ability to mechanically keep alive for years hopelessly incurable or brain dead individuals, or the emotional bankruptcy and financial ruination of family members resulting from maintaining a patient whose center of human consciousness has irreversibly ceased.

But today, moral, ethical and legal traditions, as well as the needs of the individual and families, have come into conflict with modern medical technology, forcing the rethinking of our moral standards for determining when life ends and death begins.

Jewish tradition is clear about prohibitions against hastening death, but it also recognizes that nothing needs to be done to prolong life in the cases where there is no hope of recovery. The Jewish principle of pikuach nefesh, “the saving of a life” or literally “the reviving of a soul,” is an obligation to maintain life by ordinary means. It emphasizes the affirmation and preservation of life.

However, when death is inevitable, heroic measures are not preferred over death with dignity and humaneness. Furthermore, Judaism teaches that all human beings are created b’tzelem Elohim — in the divine image.

When a person has died, we are taught to treat the body with the greatest respect. For example, we do not speak casually, eat or worship in the presence of a body, because such actions are considered essential acts of living and doing them in the presence of the dead shows contempt for the dead by emphasizing those characteristics that they can no longer enjoy.

By extension, there are also times when a person, though still technically alive, cannot participate in the essential activities of life, and such continuation of life makes a mockery of it. Under such circumstances, physician-assisted death may be an act of sanctifying and reaffirming life, rather than denying or desecrating it.

The Terry Schiavo case initiated millions of intimate conversations about what people would like to happen were they to be kept alive when there no longer was any quality of life left. To others, this discussion seemed irrelevant, but it is estimated that there are over 10,000 individuals in the United States in persistent vegetative states — chronic wakefulness without any awareness.

The agony of families who watch and wait for a death that comes only after the exhaustion of endless days or even years of life in limbo was illustrated by the media account of Rudy Linares who, knowing that his child’s persistent vegetative state could go on for years, held the medical staff of a Chicago hospital at gunpoint while he removed the respirator and held his son Sammy in his arms until he died.

There are those who believe that once mercy killing is allowed for the terminally ill or those in vegetative states, nothing can stop this from being used for other patients, or those who just wish to get rid of burdensome family members. They argue that insurance companies, hospital doctors or even family members having to deal with exorbitant costs of life support systems might be tempted to use assisted death to control costs and deal with patients who cannot speak for themselves or fully comprehend their circumstances. Still others suggest that the motives of an individual who requests assisted death must be questioned, especially if the patient is overcome with pain or depression.

Critics ask if a person in such a state is in any condition to make an irreversible decision like this. Furthermore, some argue that with the development of modern drugs for pain which keep distress and discomfort to a minimum, the need for doctor-assisted death has been minimized.

Of course, there are imperfections in any means of dealing with issues of life and death, but states like Oregon that have permitted physician-assisted death have stringent requirements to prevent the abuse of such laws. Thus, in this modern era, the ability of medical technology to prolong life makes it necessary to rethink means of sustaining individuals who are technically alive, but for all intents and purposes are dead.

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Stephen S. Pearce is senior rabbi of Reform Congregation Emanu-El and author of “Flash of Insight: Metaphor and Narrative in Therapy.”

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