Igros Moshe (Choshen Mishpat II #75.1) Question Concerning someone with cancer which is viewed as incurable and treatment will at best prolong his life for a few months is there an obligation to treat him to prolong his life for a short time during which he is in terrible pain? Answer The patient should be informed about this and asked if he wants to undergo treatment and live a life of suffering rather than die. If he wants he should be given the treatment. However if he doesn’t want a life of suffering he should not be given the treatment. However if he wants to prolong his life to enable him to be seen by a greater doctor or even if it is not a greater doctor but he wants to consult that doctor than he should be treated.
Igros Moshe (Choshen Mishpat II #75.2) Question: What is considered temporary cure (chaye shaah). The importance of defining this is that if the doctor has two patients who have other treatable problems. Preference should be given to the patient who can live more than another year and thus hasn’t lost the presumption of life otherwise he is classified as a treifah. However once a patient is evaluated to be able to live for more than two years there is no difference to one who can be cured. The mere opinion of doctors that a person can’t live does not determine his status. In addition a doctor should give priority to the patient that consulted him first as well as the one who is closer to his home. He if doesn’t know than he should he should make a lottery.
Igros Moshe (Choshen Mishpat II #75.3) Question: A patient who is judged to be able to live only 2 or three months, is it appropriate or possibly obligatory to treat him to prolong his life with a treatment which might kill him immediately or shorten his life? Answer: I know no clear sources to answer this question. Based on human reasoning, it would seem reasonable that he should only be given treatments that at least are clearly not dangerous. According to this it would eliminate most operations both on internal organs as well as many operations on the limbs if the cancer has already spread which all entail a concern for danger. However, there is a clear source in the gemora (Keubos 77b) of an operation which is dangerous but is permitted since there is no other way to be cured. It is possible to rely on the view of an expert doctor who is presently treating the patient even though there is no consensus among doctors and there is no time to wait for another doctor who might have an alternative treatment. However a man who has no clear medical knowledge, his views are irrelevant and everything he suggests might actually cause harm. In the present case that you are asking about in which the patient , there is a treatment that 30% die within 7 days and 10% die within a number of days . That means that without this treatment they would have lived an additional short time, This doesn’t necessarily mean that 60% were actually cured. Thus it is prohibited to give this treatment which apparently 40 % die from. It is permitted only if the doctors claim the patient will definitely die and this will definitely be beneficial meaning 60% are cured or at lease continue living even if in a weakened condition. Even if only 50% are cured it is still worthwhile tp give. When there is nothing better. Even if ths treatment is given. It should not be viewed as the only treatment and continued efforts should be made to find other treatments.
I was recently at a Jewish medical conferences and one of the talks was on this subject. Naturally the rabbi with the long beard and peyos talked about prolonging life no matter what, no matter how much the suffering, that this was Daas Torah, etc.
ReplyDeleteAnd one thing struck me about his speech. He talked about the doctors and their prognoses, the family and their wishes but not once did he say "And I spoke with the patient". It was almost like the patient himself was irrelevant.
To GI -- was that the conference in Stamford CT sponsored by an extremist charedi medical center that makes money by keeping patients under care. The longer the care, the greater the income.
DeleteHaving said that, I tend to agree that doctors are gung-ho on ending life for a gosses.
I don't know what that company does but they put on an amazing conference. And the food!
Delete"continued efforts should be made to find other treatments."
DeleteSo Rav Moshe sees the value of mada..
Maybe not to the degree of Rav soloveitchik, but this is the first teshuva which says secular science - medicine, pharmacology are a chiyuv!
"Naturally the rabbi with the long beard and peyos" that's exactly how the Nazis talked. First thing they did was cut the Jews' beards and petos. GI is a self hating Jew
Delete"an extremist charedi medical center that makes money..." Jealousy? Anyone you don't agree with is an extremist? What a sad life you live.
DeleteIt's not that we're gung--ho on endling life for a gosses.
DeleteFrom the secular perspective, quality of life is more important than quantity. In halakha, every moment of life is of infinite value and therefore even if there's suffering, we keep the person alive for that value. In the secular system, a life of intractable suffering is not worth living and it's better to die with dignity than live in torment. It's very different from our system, yes, but it has its own rationale.
And then there are utilitarian considerations - I have one ICU bed, for example, and it's got this end-stage cancer patient with horrible pain who's begging to die and I know in the ER they're looking for an ICU bed for a young car accident victim who's got a good chance of surviving if he gets this bed. In the absence of sacred considerations like ours, it's a simple equation - do we tie up this bed for the dying patient because he's already in it or do we arrange to put him somewhere else because the other guy would benefit more?
Since Life with/of dignity as a weltenshuuang was long since scuppered,the next step was bound to be dressed up as right to die i.e.kill
DeleteI had a similar dilemma for treatment of leukaemia.
ReplyDeleteThe leukaemia was in remission but the doctors would scare me that it will most likely come back. The only potential cure they said is a bone marrow transplant, but this has a 20% risk of treatment mortality, another 30% risk it won't help at all. So maybe 50% will get a cure which they define as 5 year relapse free survival
B'H I'm still okay. Didn't take the treatment.
B'H you're doing well and should continue to be well until 120 but it's not that we want to scare you. We want you to understand the risks of accepting or declining any treatment offered.
DeleteThank you 🙏
DeleteThe statistics are on an aggregate level , eg for every 500 people. For the individual it is harder to predict.
The decisions are not easy. I didn't ask a Rov but Rav Feinstein is presenting a similar
Calculation to the one I used.
See, the problem from our side is that we have two considerations: the statistics and the individual. If we say it's a 20% mortality risk, well yes for a large group of people but for the individual it's 100% or 0%. Same with remission and other complications. One doesn't get 25% of a serious life threatening infection, one either gets it or doesn't. So quoting statistics is fine but the bottom line is: we don't know what will happen to you.
DeleteMy calculation was that it is like playing russian roulette up front, just as an entry fee into the casino. Even after that ordeal, it's still a gamble if it will work.
DeleteGI the doctor? From Canada? Learning more about this idiot daily. I hope you understand the double entendre
ReplyDeleteBack in 2009 article in the Canadian Medical Association Journal discussed the Polio epidemic in the 1950s. It stated how everyone scrambled to save every life. Gymnasiums were turned into wards and cots were lined up. Steel lung machines were made and people were kept alive in these big negative pressure boxes. It was an imperative to save as many lives as possible. Nobody considered the costs or quality of life of the people that were saved. They lamented then that by contrast today victims would be pushed to die
ReplyDeleteYes, today the doctor would tell the guy that he's going to need an iron lung and the guy would say "Fine, euthanize me instead."
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