Podcast 8: A Jewish Perspective

Dwight:
Welcome. This is our next episode of Current Perspectives in Medical Aid in Dying. I’m Dr. Dwight Moore, the chair of Arizona End of Life Options. And it’s my pleasure today to have Rabbi Gregg Wolfe as our guest. I’m going to ask Greg a number of questions so that we can better understand a Jewish perspective about medical aid in dying, as well as maybe even a perspective from the Torah and some of the rabbinical works. I really have great pleasure in welcoming you, Rabbi Gregg.

Greg:
Well, thank you, Dwight. It’s such a pleasure and a great honor to be with you on your program.

Dwight:
I like to have our audience get to know our guests just a little bit. So would you tell us a little bit about growing up and early influences for you?

Greg:
Well, sure. I grew up in San Francisco and went to school at UC Berkeley and grew up in a pretty active Jewish family. I never went to Jewish camp, but I did become a counselor at our local reform Jewish camp called Camp Swing in Saratoga, California. And that had a huge impact on me in my desire to become a rabbi and share the excitement, enthusiasm and great wisdom of Judaism, both with kids and teens and their families. My first pulpit was in Milwaukee, Wisconsin, which is where I met my wife, and then we moved back to California, where I became the director of the camp that was so influential in my own Jewish growth and served there for a couple of years. And then when I was there, I met families from Davis and they invited me to interview for the job in Davis, and that was over 27 years ago. So I just retired from Congregation Bet Haverim Davis, where I served as the senior and sole rabbi for 27 years, and now I’m the rabbi emeritus, which is a wonderful position to hold right next to being a grandfather, which I became yesterday. So I feel like I’ve got all these ends of the spectrum. I retired and became a grandfather. I just lost my own father. So it’s very much kind of in my mind and heart that whole sense of loss and what that means for families to lose loved ones.

Dwight:
Thank you for that introduction. It sounds like the rabbinical camp has a special place in some folks hearts. Is that a tradition? Tell us about that.

Greg:
I think because it’s an immersive experience where you’re living and breathing Judaism, it’s such a powerful experience and it brings you in touch with Judaism and its teaching, its values and the friendships that people form there in a way that is very hard to replicate out of the real world. So I think many people are just so moved and so they may become rabbis, they may become candidates, they may become Jewish educators, or they might just get very involved in their own home, synagogues or Jewish life. But it is probably one of the biggest impacts on people’s Jewish identity that and probably trips to Israel. Those are the two major experiences that I think in my own life. That was probably true. And of course, your home life plays a big part as well.

Dwight:
Well, that’s kind of a trilogy then, in a sense. You’ve got the camp, you’ve got the trip to Israel and your family. Whatever practice is your family is doing, it’s the home.

Greg:
Right.

Dwight:
It sounds like you were sort of doomed to become a rabbi.

Greg:
Although I have no other rabbis in the family. So who knows, down the road?

Dwight:
I’m sorry to hear about the loss of your dad and delighted about your grandson.

Greg:
Thank you. And that’s sort of life, isn’t it? With sort of, you’re always in the the bookends of this, these life experiences and cycles and my dad did know about the baby coming. He was so excited and unfortunately just did not live to see the end. But he was able to put his hand on the belly and to feel the baby. And so that was really nice.

Dwight:
That full circle is amazing, isn’t it, when you think about that.

Greg:
It really is. Yeah.

Dwight:
Tell us a little bit about some of the messages you got early on about death and dying, either in the camp or in your family or later on.

Greg:
A good friend in college died very suddenly, maybe 20 years old. And I remember going to the funeral and in Jewish funerals; he was a Jewish friend. You participate in the burial and the casket is lowered into the ground and earth is placed onto the casket. And what a visceral, powerful moment in the family, you know, it just, it left an impact on me for many, many years that that moment and that experience. The sound of the earth hitting the grave, and particularly the first shovels or handfuls of earth make this sort of very dramatic sort of echoing sound right, you know, these clumps of earth hitting the coffin. Part of the wisdom, I think, of the Jewish tradition is this design to really confront the finality, because, you know, our brain can play all kinds of tricks on us, and then I think our ancient rabbis understood that in order to heal, we have to go through the grieving process and actually confront the reality. And so that’s why it’s important that you’re there and that you actually participate in the burying, which is considered to be the greatest gift, the greatest deed that we can do for someone. Because if I do something nice for you, you know, maybe you’ll do something nice for me back. But when you bury your loved ones, you know that they’re not going to come back and do something. So it’s really considered to be a truly selfless act. And, you know, we’re not expecting anything in return, and a very loving act. At the cemetery just before the funeral, the tradition is to tear either a piece of clothing or a cloth that represents kind of the tear in the family fabric and in our own hearts. There is a statement when you hear of a death in Judaism, you’re supposed to say “Baruch dayan he’met,” “blessed is the true judge”. It was always it just felt kind of a strange thing to say. And it makes a lot of sense that we’re not saying that this is the judge of goodness or this is what was the right thing to happen or this is the best possible world, but this is the truth of the moment. And so we’re acknowledging the death is the truth, and that is the most important thing for us to be able to heal and move on is, that you really have to sort of acknowledge the reality that is before you and to grieve, and part of the grieving in this funeral was is to cry and to laugh and to have that emotional catharsis, and then you’re surrounded by your family and friends who come to the house and you know, bring you food and nourish you and take care of you. And there’s this kind of slow process. And first there’s like seven days of Shiva, which is sitting at the home when people come to visit you and support you. And you don’t have to really worry about anything. And you could just be with your thoughts and share memories. And then there’s like a next period of like 30 days where you sort of move from the shiva into a little bit more, you know, entering back in the world. And then after 30 days, you can kind of go back to your more or less normal routines, but you’re still in a process of mourning for about 11 months through your kind of closest relatives you know, parents, siblings, spouse, children. And then after 11 months, you know, you kind of are fully out of the period of mourning. But every year we come back and on the anniversary of the death, you recite the Kaddish prayer, which is a prayer of sort of extolling God. But in some ways it doesn’t really talk about death, but it’s a reaffirmation of life. So in some ways, it’s interesting at the moment of the deepest sort of loss and despair, the central prayer is one that affirms life and kind of says life has to go on, right? And there’s this sense of continuity which is so powerful because, you know, there’s this feeling like the rug is pulled out from you and your world is collapsing, and the tradition sort of folds you and says, “No, life is okay and life will continue”, right? “And life is precious”. And of course, in Judaism, this kind of brings us to our topic in some way, is that in Judaism, life is the most precious thing that we have, something that I mean, you could break every commandment in the Jewish tradition just about in order to save a life. So you can eat on Yom Kippur. Not in fact you can, you must eat on Yom Kippur, which is a very holy day. You’re supposed to fast, but you have to eat if it’s for your health. So if you are a diabetic, you have to eat. So it’s very, very powerful, this drive in Judaism to preserve life almost at all costs.

Dwight:
Well, in these rituals and traditions that you’re describing from sitting shiva to on through at least a year or more are comforting, aren’t they? Because they provide a structure and a knowledge and a sense of history, and we’re not alone in this journey. This is occurring for us now, it’s going to repeat for others later. So a wonderful sense of safety, maybe, or closure in that process.

Greg:
Well, right. And just saying the words of the Kaddish and having this sense of community, like one interesting thing is when you say the Kaddish, you don’t say it by yourself at home. You have to be in community, you can’t just go under the covers, right, and try to ignore the world. You have to go and be in community and the community knows, right? They have a role to support you. And so people, they know what to do, and it’s nice because if you’re not, it’s not just when you’re the mourner, but when you want to support your friends or your family who’ve lost somebody, there are things you know you can do that will be comforting. And I think that because a lot of people don’t know what to do, they don’t know what to say, they don’t know how to support somebody. And it’s nice if your tradition provides kind of at least a kind of a general map and, you know, everyone will make it their own, right, and find their own path and what works for them. And of course, there are people who are more observant and more traditional, and they’re going to say the Kaddish every day and there are other people, maybe they’ll just go on Shabbat, they’ll find their own way. But it’s like you have all these resources at your fingertips that you can choose from and draw from for your sense of safety and comfort and support.

Dwight:
Does the Torah talk directly in any way about medical aid in dying or related topics?

Greg:
Well, you know, not really, because, of course, I think about that, you know, the torah’s 3500 years old or something. So, death then was very much the end. There are some hints about going to all this sort of netherworld. We don’t know too much about it. But and often in the biblical times, too, sort of a matter of fact idea that if you’re a good person, you’d have a long life. And if you were had a short life, you must have done something bad and you were being punished. And obviously there was an evolution to that. But what we do see in the Torah for sure is, I mean, death is certainly acknowledged. There’s this idea of going to be with your ancestors and there’s weeping and mourning. So there’s this real sense that there’s a loss, that there’s a period. And again, these numbers of seven days and 30 days, like when Moses and his brother Aaron die in the Torah, that people weep for them for 30 days and there was other mentions of other kind of time periods. So acknowledging the loss was clearly an ancient practice and something that was recorded in the Torah, burial was recorded in the Torah. purchasing a burial plot. Abraham marries Sarah and has to buy a plot in the land of Israel to bury her, and that’s where all of the ancestors, the early ancestors, were buried. But there’s other deaths there, sort of battle deaths as well, which is a kind of aid in dying, but not when we like to think about in that way. But this kind of helping people along in the process of death is something that is discussed only much later in our tradition and even during the rabbinic period. You know, we are living at a time that has access to so much medical know how and technology I mean, we could keep people alive forever, basically, right? You know, if we wanted to, which is sort of a blessing and a curse. Right? I mean, it’s good as long as there’s sort of a prospect for our life after. But to simply be hooked up to tubes does not seem… But it was interesting with my dad had a very he had a very bad case of pneumonia at the end and he was aspirating and even if we could solve the pneumonia, he would just continue having this problem. And so we were not thinking about like, we’re going to put in a feeding tube and we’re going to do this. I mean, I’m sure there are things we could have argued for. I said, we have to do everything. But but that would not be a life that we would want for my dad or he certainly wouldn’t have wanted for himself. So at some point, families kind of have to make a decision about what makes sense. And we always it’s always good. You know, you ask the doctor, well, this was your father or this was your mother, You know, what would you do? What would you want? And I think that’s where you kind of get to the heart of compassion, because really it is about the quality of life. And of course, those resources, of course, weren’t available 2000 years ago to the rabbis when they’re writing the Talmud. Right. So I don’t think it ever really even entered their mind that it was even possible. But they did know, and this is interesting, they did know that there were ways to prolong people’s life. And there’s an interesting story, if I can share the story about one of the probably the greatest rabbi of the early rabbinic period, his name was Judah Hennessey. He was kind of the head of the all the rabbis in the first century. And he was on his deathbed and he was really on the way out. And there was really no prospect that he was going to survive but he was being sustained and kept alive by a group of his disciples who were standing outside his window. And you could say he was a life support, he was on “prayer life support”. They were praying and praying to keep him alive. And it was sustaining him and his, his assistant or maybe it was his maidservant saw what was happening. And so she went to the top of the roof of the house and she took an earthen jug and she dropped it on the ground. And she startled the rabbis and they stopped praying for that moment to see what had happened. And at that moment, the rabbi was able to die in peace and his soul was able to ascend. So in some sense, we get this idea that the rabbis understood really prolonging somebody’s this dying process is not helpful and they sort of tell the story, I think, as a way of acknowledging that they didn’t condemn the woman. In fact, they tell the story as a way of kind of lauding her that she was able to allow the rabbi to die with dignity and peace. And so they do talk about that you could sort of withdraw things that are keeping people alive, but you’re not supposed to technically actively do things. And of course, they didn’t really need to do things in those days because nature would take its course. Nobody would hang on for months and months and years and years the way that they might today, right? So I think there’s an interesting tension in Judaism between this deep desire to preserve life and life being sacred, but also recognizing the dignity and respect of the human being and to doing things to to preserve that dignity of a person.

Dwight:
So let me ask you, as a rabbi, what is your belief about medical aid in dying? California got the law in 2016. There are 11 states around the country that have it. What’s your belief about it?

Greg:
You know that the dignity and life of the person, and also preventing suffering is a very important value. And so one of the challenges is when, what happens when you have competing values? Yes, life is important, but on the other hand, if a person is suffering or they have no dignity, or they have no quality of life, the idea that we would say, life at all costs, right, is more important than death with dignity and just being able to help people end their lives without prolonging their suffering. And so I think the real tricky part is at what point are those decisions made and making sure that the person is not just having a bad day or is upset about a diagnosis. I remember when my father-in-law was diagnosed with Lewy body dementia and it hit him very hard and it just felt like a death sentence. And there really wasn’t a cure, but there were things that he could still do, and there were ways of managing it and keeping social and active and and things. And he was able to live for a few years with fairly good quality of life. And then towards the end, things were definitely difficult. But we never considered expediting the process because we could visit him and he always enjoyed the visits. And even though he wasn’t very communicative, it seemed fine. And eventually, of course, he passed away. I suppose other people might have made other choices, but kind of by the time it got to the point where he was not really in a position to make a decision anymore, it was left to the family to decide, and that’s hard to decide on behalf of another person unless they have expressed what their wishes are or would be, you know, if this happens or that happens. So I think that would probably be an important conversation to have with somebody early on, so you know what their wishes will be, at what point.

Dwight:
That would be the value, obviously, of medical powers of attorney and POLST forms and advanced directives. But let me go back just a second, in the stories that you’re telling me, and I’ll test this hypothesis with you, what I hear is it’s very individual choice that the situation around each of these cases can be quite different. And so to prescribe a solution for it; anybody, a state, a group… would be silly, because it’s so individual. What do you think of that hypothesis?

Greg:
No, I think that’s right. And one of the things that I have heard and you can affirm this as true, but just the possibility of having access to compassionate aid in dying gives people a lot of comfort. And I don’t remember the exact statistics, but many people make the decision, get the medications even, but they never end up having to go through with it, and they die a natural death. And yet the possibility that they could do that, I think, empowers people, right? It’s not saying you have to take this path, but it says this is an option that you have. And I think that together with their doctors and with the family, they can decide if they’re going to go through with the final steps or not. And that’s what, again, what I think is helpful about medical aid in dying is it doesn’t prescribe when people say, “Oh, now there will be death panels”, right, in making decisions about, “Now, you’ll die and now you’re not going to die.” But it does provide more opportunities. You know, I mean, in any system, there are always going to be pitfalls that you wonder about, what about people who don’t have family? Or don’t have, say, the resources or means to continue the care for a person, for example, who needs care? Will decisions be made on their behalf based on finances as opposed to the higher ethical principles, right? So those are always concerns; my feeling is we have to make sure that there are procedures in place, stopgap measures with making sure that you actually have the right doctors and people are really looking at this carefully. But I think if that’s the decision people made and it really is the case that they’re going to go through a painful end of life and they’ve gotten to that stage, then I think, why, what is the point, right? Of people just saying, “You have to suffer till the end, sorry.” Right?

Dwight:
Yes, exactly.

Greg:
It seems almost like cruel and unusual punishment, right?

Dwight:
Yes. You’re you’re right about the comfort that having the prescription gives to the patient and a number of folks never use it, even though they have it.

Greg:
Right.

Dwight:
And then the other is that there are a number of safeguards built into these laws across the 11 states, to be sure that it’s not an impulsive decision, or a last minute decision, and that there is not coercion, and there isn’t some financial angle to all of that. That’s all built into the law.

Greg:
And the person has to be able to administer the drugs themself, I understand, at least in California.

Dwight:
All states, yes.

Greg:
Right. So therefore, it’s always the patient taking the initiative, and it’s very clear that it’s their choice.

Dwight:
This is not euthanasia, this is medical aid in dying. I’ve heard that there may be some difference in the support of medical aid in dying based on the, I don’t know whether the word sect is correct, it’s conservative, is that correct?

Greg:
Yeah, I think that would be very accurate. I should also say that I’m speaking from a very personal understanding and interpretation of Judaism and certainly don’t have the credentials or authority to speak on behalf of an entire people and religion. But, yes, I certainly think that among the more orthodox, I think you would find more hesitancy in support of medical aid in dying. The sanctity of the body in death and the respect and honor given a person who’s died, you’re supposed to treat that dead person the same way you would a living person. So they’re not supposed to be left alone or just tossed out like they’re supposed to be treated with respect. And there’s this sort of an integrity to the body, to it. In fact, in orthodoxy, there’s a belief in a kind of a bodily resurrection. So you need all your parts. And yet saving a life is the most important thing. And so even in many Orthodox circles, organ donation after death is actually allowed. So, well, it seems like from an orthodox perspective, that wouldn’t be allowed because you’re sort of taking apart the body, but again, the idea of if you could save a life by donating your liver or your eyes or your heart in some way. So my sense is always that traditional Judaism eventually will catch up to liberal Judaism. We were the first to have women rabbis and conservative women then were conservative women rabbis. And now there are orthodox women rabbis that are not accepted by all Orthodox, but there are Orthodox women rabbis. So there is a kind of a progression. So I definitely think, and again, there may be other progressive rabbis, reform rabbis who are not necessarily supporters of medical aid in dying, and one of the great things about being a rabbi is everybody gets to interpret things in their own way. But I think in general, there will be more support among the more progressive camp than in the more traditional or orthodox sort of streams of Judaism, for sure.

Dwight:
The last question I want to ask you, is what have I not asked you that is relevant, and that I should have paid attention to.

Greg:
I guess I would reemphasize the idea of choice and dignity. There is a Jewish notion of Tza’ar ba’alei chayim, like don’t do anything that would cause suffering to animals. So the way that an animal is killed for kosher meat has to be done in the most quick and painless way. So if that’s the case for an animal, then for human beings, why would we allow people to suffer? Why would we allow people to go through these long, agonizing processes if truly there’s no way we can save them, there’s no prospect for any kind of quality of life. So, I mean, I think there’s a message there, right? If we’re not going to let our dog suffer, why would why would we want our mother, our sister, our brother, anyone in our family to suffer unnecessarily? So I think that that is sort of the balance to, of course, we want to preserve life as long as we can, as long as it’s possible, and as long as there’s a quality to that life. And quality of life is very subjective. I know somebody. She got a diagnosis of congestive heart failure. But the doctor said, you know, “You’ll be fine, you’ll watch your diet, You’ll be able to manage this.” And she decided, if I can’t live the way I want to live, that’s it. I don’t want to live anymore. And she went to the doctor and she said, “I want you to put me on hospice.” And he said, “What are you talking about? You’ll be fine, everything’s going to be fine.” And a week later, he put her on hospice. She did not have medical aid in dying, but she, in her own mind, just decided, this is not for me if I can’t be who I was. So that was like a quality of life issue. And she made this decision in her mind. And in some ways just, you know, she lost the will to go on, and that’s all it took. By the time she went back to her doctor, she went downhill so quickly because just in her mind, that’s not what she wanted. But it’s interesting, in that same family, there was a suicide of a 69 year old person. And he had had some health issues, but they were not from an outside objective perspective, they did not seem life threatening, but he could not live the way he wanted to live. And so he took his life. So the question then is, well, if he had just gone to the doctor and said, you know, “I want to end my life, you know, my life is untenable the way it is.” You know, probably doctor probably would have said, you’re nuts. You know, I’m not going to support you. And then he had to take this extreme view. So then it becomes kind of sad when people’s own vision is clouded. And I don’t know how you feel about that. If hejust said, “My life is not worth living,” even though from an objective sense they certainly could have a good quality of life. How do you how do you balance those things out?

Dwight:
Yeah, we’re very clear of the difference between suicide and medical aid in dying. They are diametrically opposed to one another in all kinds of facets. So, some of the safeguards that we talked about earlier are essential, in my estimation, to maintain. One example specifically to this is if one of the physicians who’s writing the script believes that the patient is not mentally competent to make medical decisions, and for example, clinical depression may be included in that, then they can be not allowed to get the medication. In order to maintain the integrity of the medical in dying law, I want to keep real clear the difference between the choice of medical aid in dying and suicide itself.

Greg:
So what happens if say, someone comes to you and they say, you know, “I have some incapacity; in my whole life is exercise outdoors. I’m a hiker and a biker and I just can’t do that. And if I can’t do that, my life is really not worth living.” And to me, they might not be clinically depressed. So under that circumstance, is that a valid reason to end one’s life under medical aid in dying?

Dwight:
Not in the United States. That kind of patient would be considered in Belgium and in Canada, but not in the laws of the United States at this point.

Greg:
Interesting. Okay. Yeah. So it’s good. I mean, that sort of makes sense to me, Right?

Dwight:
I like the boundary also. I agree with you. I think we ought to keep a real clear distinction between those things. You have been great. Thank you very much, Rabbi Wolfe. And thank you for your participation in this podcast.

Greg:
Oh, well, this has been such an honor, Dwight and I hope this was helpful and a little bit of a Jewish perspective in some of these issues, and be well and nice to talk to you. Take care. Thanks.