The Fringe of Life And Death
WASKOW, ARTHUR
The Fringe of life and Death ARTHUR WASKOW On the edges of my property, my self, my life, I do not simply stop; I fade away. There is a zone that is both me and not-me. For ancient Israelites, it...
...For information, contact 84 William Street, New York, New York 10038, (212) 797-9000...
...The modernist life path that gave us so much new power to heal the world as well as to heal our own bodies has sometimes been twisted into a refusal to allow the pause of death that is necessary to go forward on the spiral...
...A committee of the Rabbinical Council of America (Orthodox), is currently drafting a living will, which will be available December 15, 1991...
...I also understand that the standard could be misused to encourage suicide or homicide...
...Therefore I expect my family, doctors and everyone concerned with my care to regard themselves as legally and morally bound to act in accord with my wishes and in so doing to be free of any legal liability for having followed my directions...
...Sam Johnson once said, "Nothing so wonderfully concentrates the mind as being about to be hanged...
...Three areas were hard for me to work out: What to do if I were alive and awake but demented with Alzheimer's or something similar so that my identity could no longer make decisions...
...I understand that the standard I am suggesting is fuzzier than the traditional end-of-breathing (or more recently, brain-death as well) used as a definition of death by most halachah (Jewish religious law...
...Living wills, durable powers of attorney and health care proxies provide these instructions legally...
...While they differ somewhat, all agree that individuals should draw up documents giving instruction as to medical treatment in the event extreme illness or trauma leaves the person incapacitated and unable to give instructions...
...I direct that the simplest, cheapest available coffin be used for my burial and that I be buried in the kittel (white robe) and tallit (prayer shawl) given me by...
...In general, I affirm its distinction between taking positive action to bring about death (which is forbidden) and withholding or withdrawing extraordinary or heroic measures intended to prolong some semblance of physiological life that actually prolong the process of dying (which is permitted...
...Signed: _ Date: _ Help in Preparing A Living Will Federal regulations effective December 1, 1991, require every hospital and other health care facility participating in Medicare or Medicaid to inform patients of their right to decide how they want to be cared for, especially at the end of life...
...But only advice and counsel...
...I further direct that my treatment be limited to measures to keep me comfortable and relieve pain, and that medication be given me to alleviate pain even if that may hasten the moment of my death...
...3> Traditionally a line is drawn between sustaining a person's life, a requirement, and prolonging the process of dying, a prohibition...
...Rabbi Dorff says., "a living will can be drafted [in consultation with a lawyer] as long as it is consonant with one of these papers...
...For many generations of Jews, it was the corners of clothing—or at least of prayer shawls— where clothing and self faded away by attaching fringes or tzitzit (from tzitz, "to fade...
...Out of them have come hard cases in the technological extension of life for the dying...
...For almost a week, my father, my brother and I worked with her to help her weave the tzitzit of her living-dying (see 'To Catch a Breath," April 1986...
...and what to do about organ transplants...
...Contact 192 Lexington Avenue, New York, New York 10016, (212) 684-4990...
...But it was expected that a dying person would die within three days...
...The Federation of Recon-structionist Congregations and Havurot adopted a resolution in March 1988 that supports "the principle of a living will...and advocates passage of living, will provisions where not currently allowed by law...
...So also on the edges of my lifetime...
...These comments are only suggestive, and I leave the actual decision in the hands of my proxy to be made in response to the real situation as it unfolds...
...Since our tradition and community are just beginning to work out what is a holy life path under these new conditions, I want only to say what I desire for myself and to ask others to wrestle with my view along with other views...
...In such a situation, it seems to me that taking steps to allow my body to free itself from mechanical functioning is desirable and honorable— that is, to be honored...
...I draw this distinction at a different place from that which is usual in most halachic circles...
...They were mine...
...So far as I am aware of my own feelings, I do not fear it...
...Contact 275 Seventh Avenue, New York, New York 10001, (212) 807-7888...
...Nevertheless, its seems to me that I myself or people who love me and whom I designate can apply it in sacred awe and trembling to bring about a holy result...
...We were not alone in watching that moment...
...If the treating facility will not make such a commitment, then I direct that cardiac resuscitation, mechanical respiration, artificial feeding, fluids by tube or similar treatments not be administered to me...
...I therefore direct my loving and beloved family that if they find me to be in such a situation, they take whatever steps are necessary to free my body from such a functioning-without-neshamah, so long as they can do so without endangering themselves...
...In situations other than the one I have described above, if I become unable to take part in decisions about my medical care and if I am in an incurable or irreversible mental or physical condition with no reasonable hope of recovery, I direct my physician to withhold or withdraw treatment that merely prolongs my dying...
...I have wresded with Jewish tradition on these matters and find that I have both learned from it and in part disagree with it...
...These offer one's family and friends an inheritance not of property but of comment on the world—perhaps advice and counsel...
...Each state may have its own regulations as to how patients are informed of their rights...
...yet I could not harvest their fruit but had to leave that grain for the poor...
...what to do, and for how long, if I were unconscious and doctors thought I could, with extreme measures, be restored to consciousness...
...What fringes can I weave...
...Patients may specify cessation of treatments that cannot cure them...
...If I enter a state of incurable and irreversible dementia in which, in the judgment of my proxy as designated below, I am no longer able to integrate my thoughts, to express love or to remember who I am—then in my view the part of my identity that is capable of growing up another spiral on the life circle is already seeking to do so and is hindered by my body's minimal functioning...
...The committee on health and the bio-ethics committee of the Central Conference of American Rabbis (Reform) are proposing a resolution that advises Reform Jews to make their own health care decisions, to write living wills or durable powers of attorney and to advocate enactment of legislation that would make them legally binding...
...If the treating facility makes the commitment described above and begins treatment, I leave the decision whether to continue or halt treatment to my proxy as designated below, with the following general indication of my wishes: • If the treatment is not excruciatingly painful, I prefer my proxy not to demand withdrawal of the treatment during a period of 72 hours after it begins...
...I affirm both kibud hameit and pekuach nefesh—both the traditional Jewish obligation to honor the body of the dead and the traditional Jewish obligation to save the life of the living...
...One of the dangerous aspects of the modern age in which we have lived (and which still has great power in our lives, even as we try to go beyond it) is that—in this immediate body-aspect of life as in others—it has made an idol of control, doing, making—and denigrated the outbreath, rest, meditation, being...
...I also do not seek it, since, like other growings-up, it comes when one is ready for it...
...Death is, in the spiral of life, another curve toward growing up...
...Imagining one's own near-death or lingering near-life is the next best thing...
...As Dr...
...This living will specifies an agent who makes decisions in consultation with a rabbi "competent in Jewish law and the field of Jewish medical ethics...
...Such wills direct one's family, physicians and others how to treat a patient in a medical emergency in which that person is not able to state her or his own desires...
...I affirm that part of the rhythmic spiral of the Breath of Life is the outbreath—including death...
...Many American lawyers and medical authorities have urged that people make living wills that say in advance what their intentions are...
...I affirm that no consciousness is blotted out and that every consciousness finds its place in the overarching Unity...
...Contact Church Road and Greenwood Avenue, Wyncote, Pennsylvania 19095 (215) 887-1988...
...I commend the process—and offer my results as a sketch of possible approaches...
...Rabbinical organizations that have drawn up sample living wills that are available on request are: • Agudath Israel of America (Orthodox...
...How shall I deal with such times...
...When I began working on my living will, I quickly realized it was like weaving the tzitzit on the corners of my life—not just talking about it...
...For ancient Israelites, it was the corners of the fields...
...Local health care advisors, however, are sometimes uninformed about traditional Jewish views of permissible actions in the face of impending death...
...I therefore direct that where the transplanting of an organ from my dead body can save the life of a living person that be done—and that immediately afterward my body be given into the loving care of the community of my friends, a chevrah kaddishah to be made up of_ to prepare my body for burial in the tradition of taharah (purification...
...Here I had to decide not in airy theory but in all too meaty practice when is life and what is death, what to do with my nose, mouth and heart if I become unconscious, what is my own body and what corners of it I may owe to the community...
...My Living Will 1affirm, with the Shema, that the Breath of Life is God and that the Breath of Life is One...
...Lawyers and doctors have now seen many such moments...
...All these directions express my legal right to request or to refuse treatment...
...The major Jewish religious movements in the United States have grappled with the complexities of end-of-life questions...
...Gasping for breath in a Baltimore hospital, she fell unconscious, was put on a respirator, awoke to demand that it be removed and found the hospital refusing...
...If 72 hours elapse and there4 is no further indication that I am likely to return to my ability to form and communicate my wishes, I prefer my proxy to demand that the treatments stop and I be allowed to die...
...There are times on the verge of death when I am still—or maybe not—alive...
...During Passover in 1985, my mother came to such a moment...
...Traditionally, Jews have drawn a line between sustaining a person's life—a requirement—and prolonging the process of dying—a prohibition...
...The writing felt even more serious than the ancient and not-quite-parallel Jewish tradition of making ethical wills...
...Additional information about living wills: • Rabbis Elliot N. Dorff and Avram Israel Reisner prepared papers on end-of-life issues for the Rabbinical Assembly law committee (Conservative...
...I commend the process of imagining one's own near-death or lingering near-life...
...Union for Traditional Judaism (Conservative...
...For those reasons, I think it is necessary to explain my desires, intentions and directions in regard to death to my family, my friends, my physician, my lawyer, to any medical facility that may be caring for me and any individual who may become responsible for my health and welfare...
...I designate the following person (s) as proxy to act on my behalf if I am unable to communicate my instructions: _or if s/he is unable to act on my behalf, I designate . If it is clear that I am in the process of dying, I prefer to die at home, even if the steps necessary to get me there would hasten my death...
...The document names an agent who makes decisions for the patient in accordance with strict Orthodox interpretation and tradition in consultation with a specified Orthodox rabbi...
...Contact 261 East Lincoln Avenue, Mount Vernon, New York 10552, (914) 667-1007...
...Like sleep, winter and the waning of the moon, like the inward festival of Shemini Atzeret—a somber eighth day just after Sukkot that gives us a moment to turn inward from the expansive harvest festival—and the sleeptime prayer of hashkiveinu, like Shabbat and the sabbatical year and the jubilee, death is a stage of inward turning, boundary making, the recognition of limitations that leads toward another level of broader consciousness and identity...
...If I become unable to communicate my own wishes or decisions, or by reason of a dementia unable to develop or communicate coherent thoughts and plans, and if my physician determines that my mental or physical condition may be curable or reversible, with a reasonable expectation of recovery to the point where I can coherently form and communicate my wishes, then I direct the following approach be used: ? If the hospital or other treating facility makes an explicit and binding commitment to withdraw any or all treatment as soon as requested— either by me or by my proxy designated below—then I want cardiac resuscitation, mechanical respiration, artificial feeding, fluids by tube or similar treatments to be administered if necessary to prevent my death...
...I direct any physician or facility that is treating me to follow the directions of my proxy...
...In particular, I am thinking about cases of advanced dementia where the neshamah (soul) has departed but the body continues to function...
...Contact 3080 Broadway, New York, New York 10027, (212) 678-8060...
Vol. 16 • December 1991 • No. 6
