Dear Rabbi Fried,
In last week’s column you quoted a letter from an Orthodox Jewish organization to Barack Obama stating that his health care proposal could lead to infringement of religious rights as they might require cessation of medical care for a dying patient and the like. Obviously, the rationale for such a proposal would be for the greater medical benefit of many more people who could actually have their lives lengthened and improved by the care they would receive but are currently not getting due to the high cost of end-of-life care currently given and paid for, partially, by taxpayers. Studies have shown that the lion’s share of the average patient’s lifetime health care cost is spent in the very last years of their life, at a time that they usually no longer contribute to society and often no longer enjoy any quality of life. Is there no concept of triage in Jewish law?
Bernard L., M.D.
Dear Dr. Bernard,
The concept of triage in halachah, or Jewish law, has been developed by the Talmud, codified in the “Code of Jewish Law” and expounded upon greatly by contemporary authorities. Triage has been employed, based upon halachah, in the many unfortunate situations of wars and bombings in Israel.
The concept of triage in halachah deals chiefly with a physician who is faced by two or more patients who are all deathly ill, and has only the ability to treat one of them. The question can arise in any emergency room which has insufficient critical care apparatus to deal with all those in need to sustain their lives. How does one choose who gets the care?
Myriad possible situations, as you well know, could arise. According to halachah, if one patient could certainly be saved by the available care and the other is doubtful, or at best will have his life prolonged for a short time while the first could live normally, one is required to save the first patient even though that spells imminent death for the latter. This applies only if the two patients are brought before the doctor simultaneously, and the question is which one to accept. If, however, the doctor has already attached the terminal patient to an apparatus and afterward the younger patient arrives with a greater chance of survival, halachah would prohibit removing one patient for the sake of saving another. This would be true even if the patient engaged in the care is an old, deaf and blind person who is of no use to society and is a burden on his family and the other, a young father of children who runs the local charity helping thousands of poor.
Triage, explained my late mentor Rav S. Z. Aurbach, of blessed memory, is applicable only to saving life, not to actively ending one life to save another, no matter who is involved.
This is based upon the halachah’s understanding of the inherent preciousness of every moment of life. Even the oldest, most sick person’s life is priceless and each moment, a new gift from G-d. To actively end such a life, as little “quality of life” is left in him, would still be murder.
Furthermore, if the elderly, terminal patient is already in the ER, and a call comes from the ambulance that a young patient is on his way with a great chance of survival, the doctor could potentially wait for the younger one. This is because an actual patient is on his way, and technically under his care. He could not, however, delay the care to the terminal patient so as not to tie up the machinery in case a better candidate might come along, even if that likelihood is very high. This would not be triage in halachah.
To discontinue care or not offer it out of financial consideration of the greater good of society is comparable to the second case — where there’s no actual patient but the system is waiting for the better candidate to arrive.
The solution to this crisis certainly needs to be worked out, and is certainly quite complicated. I am not an expert on the details of President Obama’s proposal. It is very important that all Americans have recourse to health insurance, and halachah would certainly applaud the president’s passionate desire to ensure just that. We just have to ensure that our morals and religious rights are not sacrificed along the way.
Rabbi Yerachmiel D. Fried, noted scholar and author of numerous works on Jewish law, philosophy and Talmud, is founder and dean of DATA, the Dallas Kollel. Questions can be sent to him at yfried@sbcglobal.net.