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Assignment: Healthcare Leadership

There are three main principles in Jewish medical ethics: life is of utmost value; ageing,

illness, and death are a natural part of life; and improvement of the patient’s quality of life

is a constant commitment (Padela 2006). When applied in the context of end-of-life care,

the Jewish position is that dying is a natural part of life’s journey that should be addressed

with dignity and compassion (Loike et al. 2010) and human beings have both the per-

mission and the obligation to heal (Zahedi et al. 2007). The principle of sanctity of life

126 J Relig Health (2016) 55:119–134

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connotes that any decision that may directly or indirectly result in hastening death is

prohibited. However, Jewish law recognises that ‘‘if situations necessitate foregoing certain

rules and regulations for a higher purpose, for example, that of saving life or improving

quality of life or avoiding harm, then one is allowed to do so’’ (Padela 2006). According to

the Jewish legal system or Halacha (which to those of the Jewish faith represents a

comprehensive guide to human life, regulating all aspects of behaviour through assigning

moral values to actions as well as determining sacred law), there are several basic

guidelines related to end of life that distinguish between: (a) acts of omission and acts of

commission; (b) treatments pertaining to the dying process (or illness) and treatments

unrelated directly to the dying process; (c) treatments that are continuous in nature in

which withdrawing of such treatments is considered an act of commission and treatments

that are cyclic in nature in which the withholding of the next cycle of treatment is con-

sidered an act of omission; and (d) patients who are expected to die within 6 months and

those patients with less serious medical conditions (Loike et al. 2010).

Based on the above, on the issue of withholding and withdrawing life-sustaining

treatment, Jewish law allows for such act or omission to be carried out only if such

treatment is of a recurrent nature and provided that the patient has clearly consented to it.

This includes withholding any life-prolonging activities such as intubation, surgery, che-

motherapy or dialysis, even after initiation of the same, because such action is viewed as

omitting the next treatment rather than committing an act of withdrawal (Bülow et al.

2008). If the same constitutes a continuous form of life-sustaining treatment, for example, a

respirator or cardiac pacemaker, then such withdrawal is forbidden. The strictest position

in Judaism restricts permission to withdraw or withhold treatment to cases where doctors

assume that the patient will die within 72 h (Dorff 2005; Zahedi et al. 2007). Patients and

doctors are allowed to withhold or withdraw clinical treatment in cases where the patient is

diagnosed with incurable terminal illness, as long as it is within the patient’s best interests.

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