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Religion & End of Life

The Forward

The End-of-Life Battle Over Jewish Souls
– by Paul Berger

Many Orthodox Jews, particularly ultra-Orthodox Jews, believe that as long as the heart beats, the soul is alive. For such Jews, withdrawing life support is akin to murder.

Rabbi Shmuel Lefkowitz, vice president of community services at Agudath Israel of America, an ultra-Orthodox group, said that a few years ago his organization received a spate of calls from families complaining about doctors who wanted to remove brain-dead patients from life support.

During the same period, Lefkowitz said that Agudath Israel also became concerned about pending legislation in New York State that required doctors to discuss palliative care options with terminally ill patients. The bill’s authors believed that the Palliative Care Information Act would ensure that patients were offered the option of a more dignified, less painful death. But in Agudath Israel’s eyes, the bill was one more step in society’s march toward helping people to die instead of treating them.

Agudath Israel launched Chayim Aruchim in 2010 in response to both of these issues, Lefkowitz said.

Chayim Aruchim persuaded New York State legislators to amend the Palliative Care and Information Act so that in addition to palliative care, doctors in the state must also discuss patient options for aggressive care.

In September, Morton Avigdor, the same lawyer who overturned Sodden’s health care proxy, filed a petition in Brooklyn Supreme Court in the case of Eileen Kramer, a 60-year-old developmentally disabled woman who was on life support at Brooklyn’s Maimonides Medical Center.

Avigdor represents the Hebrew Academy for Special Children, which runs an adult residential home where Kramer has lived for the past 40 years.

HASC’s director, Samuel Kahn, claimed in his petition that Kramer’s legal guardian, her brother Howard Kramer, had instructed Maimonides to withdraw life-supporting treatment. “This must be stopped at all costs,” Kahn stated in court papers, first reported by DNAinfo. “Having known Ms. Kramer for many years, I know that she would not want her life to be ended by being denied life support. She is an Orthodox Jew.”

But Howard Kramer told the Forward that he and his sister were raised in a Reform Jewish household. Besides, Kramer said, his sister’s developmental disability, which includes severe cognitive limitations, has prevented her from ever being able to grasp the concept of being religious, let alone Orthodox.

Kramer flew to New York from his home in Denver in mid-September when his sister became critically ill. Doctors recommended withdrawing life support. Initially, Kramer agreed. But he began to receive calls from people associated with HASC, “some of them very self righteous and strident” telling him that every moment of life is precious and that he must keep his sister alive as long as possible.

Kramer said he was grateful to HASC for looking after his sister so well. As a compromise, he agreed to keep his sister on life support, as long as other aggressive, life-extending procedures were discontinued. Kramer thought HASC had accepted the compromise. He said he felt blindsided when HASC took him to court.

Kramer said HASC falsely claimed in its petition that he had asked Maimonides to withdraw life support. (The hospital, citing HIPA laws, would not comment.) He was most offended that HASC claimed in court papers that he had little contact with his sister and that he “does not understand [her] wishes.” Kramer said that he used to speak to his sister regularly by phone and that he visited New York, on average, twice a year. He said HASC’s own files describe him as a “devoted” brother.

“I really see it as dishonest,” Kramer said. “On top of the whole situation, to have somebody say that is really outrageous.”

Chayim Aruchim is, in many ways, a response to a shift in medical ethics. During the past 20 years, physicians have increasingly come to question the value of Western medicine’s ability to keep patients alive — in pain and suffering — with no chance of improvement. “I think the goal of medicine is to sustain the patient’s life and to make the patient’s life better,” Dubler said. “I certainly don’t think it’s the goal of medicine to extend organ function for a patient who is no longer capable of making decisions, when extending that organ function causes pain and suffering for no benefit.”

This philosophical shift mirrors a dramatic growth in palliative care during the past decade.

A recent nonpartisan report commissioned by the Institute of Medicine found that dying patients are often put through needless, aggressive treatment when they would have been better off with palliative care in a hospice or at home. The report, “Dying in America,” cited “perverse financial incentives” for hospitals to pursue aggressive treatment. It recommended that insurers pay physicians to consult patients early on and regularly about their wishes for end-of-life care.

The philosophy of dying a “good” death is anathema to many Orthodox Jews who believe that life should be sustained at all costs. In a 2005 court case involving a disagreement over the insertion of a feeding tube into a Jewish woman’s stomach, a Queens Supreme Court justice noted that “the first halachic principle of medical intervention is that whenever it is possible to increase the longevity of a patient, it should be done.” Judge Martin Ritholtz added that Orthodox rabbis are divided on how much a person should be allowed to suffer and for how long. One prominent rabbi, Moshe Feinstein, believed that it is not obligatory to aggressively treat a dying person who is in pain and is suffering. But Ritholtz noted that another influential rabbi, Eliezer Waldenberg, believed that “suffering serves to increase a person’s merit, and therefore prolonged suffering is a good reason to prolong life, in order to erase sins and to allow the person an opportunity to repent.”

The emphasis on preserving life at all costs is not a uniquely Jewish value. Christian, Muslim and secular families may have myriad moral, ethical and religious reasons to reject palliative care or to pursue aggressive treatment to the end. In many cases, physicians themselves are reluctant to give up treatment, even after it has become obvious that the patient is dying.
[The Forward]

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