Risky surgery: to undergo or not?

Dear Rabbi Fried,

My uncle, who is 72, was in excellent health until recently diagnosed with a rare form of cancer. The doctors feel that with his condition, he only has six to nine months to live. There is, however, an experimental surgery which could cure him completely, allowing him to live many more years. The problem is that this surgery is so risky, that there’s a 70% chance he could die on the operating table. He’s inclined to take the risk to live for years but is concerned that perhaps it isn’t the right thing to do, as it may lose him the months that he knows he has left. He’s concerned it’s like committing suicide. What is the right thing to do in this situation?


Dear Ben,

The Talmud discusses a case which is in some ways similar to your uncle’s query: There was once a Babylonian medical center where the doctors were known to be very proficient and cutting-edge in their field. There was, however, one small problem: They were known to kill most of their Jewish patients. The Talmud rules, of course, that one should not use these doctors, even if one had a sickness which could be life-threatening. If, however, one suffered from a terminal illness that would surely cause his demise within a year, he would be permitted to seek medical assistance even from these doctors, since there is a chance of being healed — and not killed — by them. The Talmud asks: What about the months of life that he would have lived that may be forfeited if they would kill him? The answer given in the Talmud is a profound principle: “l’chaye sha’ah lo chayshinan.” This loosely means that we are not concerned about short-term life in the face of potential, long-term life. (Talmud, Avoda Zara 27b)

Many authorities of Jewish law over the last 250 years have applied this Talmudic principle to myriad medical questions that have arisen. Since the flourishing of the medical field and its many procedures which have been developed during this time, your question has been asked in numerous forms. The core principle, however, is the same. Even when the likelihood of success is relatively small, your uncle is morally within the bounds of Jewish medical ethics to elect to undergo this procedure. This is predicated upon the prognosis that without the procedure he is terminal with no hope for recovery. This is also based on the life expectancy of less than one year, which is the time considered by Jewish law to be terminal, or “short-term life.” If he were diagnosed to have over a year to live, the ruling may be different. 

I would like to clarify: This ruling is not meant to minimize the tremendous importance the Torah puts upon every moment of life. The concept of “chaye sha’ah” or “short-term life” is one of complete life in the eyes of Judaism. We are commanded to desecrate the Sabbath to save the life of a Jew who we know will not live long enough to see another Sabbath. Conversely, to kill a person who only has moments to live is still considered murder according to Jewish law! The point of the above ruling is for the same person to put upon the scales the terminal aspect of his life on one side to weigh against the possibility of prolonged life on the other side — with the risk of losing even the “short-term life” that is relatively sure he will have if no action is taken. This is the painstakingly difficult, soul-searching decision the patient, and only the patient (assuming the presence of full faculties), can and must make. 

This is one of the exceptional examples in Jewish law where the decision lies in the hands of the patient, since either decision — to operate or not to operate — would be morally acceptable. At times a patient may opt out of surgery, so as not to risk missing the wedding or bar mitzvah of a family member or dear friend which will take place a couple of months away and may be all-important to the patient. Another may prefer the risk, to have a chance of enjoying additional years of life, as your uncle is inclined to. In this type of scenario there is no obligation either way, and to choose the experimental surgery would not be tantamount to suicide even if, God forbid, the surgery would turn out not to be successful. 

May your uncle enjoy a complete and speedy recovery, and may you spend many more happy and healthy years together.

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