Dying with dignity versus living without it

My father-in-law works in end-of-life care, so over the years we've had lots of conversations about the topic. While I personally have not experienced close friends or family going into hospice, I have come to have a greater appreciation for the palliative method over a "preserve life at all costs" approach. Still, I understand that this creates a bit of a mind for medical ethics and for those in the medical profession: one long-standing definition of a doctor, connected with the Hippocratic Oath, is the concept of doing no harm. It is one that I think many Jews can connect with as well-- Judaism is supposed to celebrate and venerate life, and I've read that the implication that comes with that philosophical orientation is that there is a very strong bias against ending life if it can be preserved.

However I think that at the end of the day, both Judaism and medicine have enough depth to them that, if one is interested in making the case, there is certainly enough intellectual ammunition to support a more palliative approach. The big question, I believe, revolves around the notion of what harm is and where "quality of life" intersects with the broader category of "life." Just as there are certain mitzvot that traditional Judaism commands Jews not to violate even if it leads to their death, it would seem logical that there are similar scenarios in which it is appropriate to re-evaluate priorities and, potentially, decide to discontinue treatment (particularly aggressive or debilitating treatment) in favor of a more dignified and comfortable end to the patient's life.

I've been thinking about these issues a lot lately as I've been following the news about R. Elyashiv in Israel. He has been a long-running Internet antagonist for the several years I've been blogging, a perfect example of how the Haredi community, particularly in Israel, seems to value authority over discussion, and isolation over engagement. In recent years, R. Elyashiv has banned books without reading them, technology he doesn't use or understand, and condemned whole swathes of people he has never met. In my eyes, he was the best example of the living anachronism that traditional Judaism must struggle to avoid becoming.

But a few weeks ago I read an article in Haaretz that changed my thinking a little.

On the top floor of a Jerusalem hospital lays a very old man. He is slowly dying, but he won't be left in peace. A small circle of courtiers around him continue to issue in his name edicts and rulings, ensure that his signature still appears on letters and when his medical situation improves temporarily, they will remove him from hospital and seat him in his chair at the synagogue, where everyone can see him. The hospital staff grumbles that all this just prolongs the old man's agony, but there is nothing they can do as the retinue controls all the old man's moves. 

Only a tiny handful of relatives and trustees are allowed to talk with him, and they jealously guard his real mental situation while everyone is told that he is fully lucid and talking with his family and doctors, praying and studying as normal. 

This is how the great rabbis die nowadays. These were the circumstances of the last years of the Lubavitcher Rebbe, Rabbi Menachem Mendel Schneerson, as the Chabadniks fought over him, manhandling him to the window of his study so he could wave to the crowds on Eastern Parkway, steadily deifying him as he descended into his last coma. His body died in 1994, at the age of 92, but many of his followers still believe he is with us. 

Rabbi Elazar Menachem Shach suffered similar indignities when visitors to his home in Bnei Brak were shown the volume of Talmud he was studying from, but were not told he had been on the same page for 10 years. Just before he turned 100, he was finally allowed to retreat from the public stage and given a few years of rest before he died at the age of 102. 

The retainers of Kabbalist miracle-maker Yitzhak Kadouri bodily carried him to events well into his 11th decade, making sure he muttered the required incantations, shouting in his near-deaf ear the names of those to be blessed, and continued a brisk trade in his handwritten amulets until death finally liberated him from their clutches at 106. 

By some accounts, 101-year-old Rabbi Yosef Shalom Elyashiv, the great sage of the "Lithuanian" ultra-Orthodox community, is undergoing the same treatment as these words are being written. For months now he is being shuttled back and forth from hospital to his tiny apartment in Mea She'arim; but despite growing reports on his frailty, he still seems capable of publishing momentous rulings on the pages of Yated Ne'eman, such as the one that appeared two weeks ago forbidding Haredi men and women from participating in military or academic vocational courses under non-Haredi auspices. While there are those who treat these verdicts as the word from up on high, speculation is growing that for months now, if not years, Rabbi Elyashiv's name has been appended to endorsements and prohibitions he has never heard of. 

Modern medicine has created an intractable theological dilemma for Haredi Jewry. While it prolongs the lives of rabbis well in to their 90s and beyond, it does not guarantee soundness of mind. But how can a community brought up on the doctrine of "Da'at Torah," rabbinical infallibility, accept that their leaders' memory and reasoning can deteriorate. They liken their rabbis in old age to Moses, whom the Torah tells us that at the age of 120, "his eye was not darkened, nor his moisture ceased." And above all, their mind, this god-given gift to an entire nation, surely cannot fail, only gain strength and wisdom. But that is simply not the way of the human body.

Assuming even half of Anshel Pfeffer's article is true, it raises a fascinating point that, to my embarrassment, I had only half-recognized myself up until now. Yes, it is incredible, bizarre, and rather unbelievable that these gedolim are still giving pronouncements on issues of the day past the age of 100. And the reason it is all of those things is because they aren't actually doing it. These elders are not reading these books, not condemning these technologies. They've never seen them. Most of them spend most of their time going back and forth from home to shul to the doctor. It is their handlers, their advisers, their heirs, who are pulling the strings. In the height of chutzpah, these younger people manipulate, deceive or even impersonate their supposedly venerated leaders, men that their communities see as truly holy, to exert their own desires for power. And while doing so, not only do they undermine their credibility, their independence, and their reputation-- but they also turn them into political symbols to fight their pet battles, regardless of whether the sages know or care about the issue or not.

Even now, this is going on with R. Elyashiv.

Rav Elyashiv is listed in critical/stable condition. The gadol hador is in a medically induced coma and connected to a mechanical respirator, fighting the fluid buildup in his lungs, the result of diminished cardiac output as seen in congestive heart failure. 

Family members are in the hospital, where hundreds continue to gather, compelling hospital security and police to deploy additional manpower to keep people outside. Officials report that while the avreichim and rabbonim mean well, they are not assisting the rav’s situation and they are hampering hospital personnel, interfering with them. Additional security has been placed at the second floor entrance to the emergency room, the hospital’s night entrance.

Think about that: R. Elyashiv has not been conscious for days. He is in a coma. He is on a respirator. And yet there are so many people crowding into his room that the staff can't even do their job. I have no doubt the vast majority of the people visiting this man are sincerely there because they care about him. But the lack of understanding about what they need versus what he needs is pretty shocking.

There's yet another dimension to this: the idea that if R. Elysahiv goes, the entire community will suffer a major tragedy. There has been little thought as to who will succeed him, what training or support they might need, ways the community might be able to help the family grieve, etc. A month after another serious hospital visit, several days since he has been in a coma, and R. Elyashiv's community shows no sign of letting go. They will not consider what happens next because they will not admit that he is going to die. To that point: he cannot be allowed to die.

“If Rav Elyashiv in danger,” said Rav Edelstein, “we are all in danger.” 

In his morning shiur, Rav Edelstein linked Rav Elyashiv’s condition to the security situation in Eretz Yisroel, stating that Rav Elyashiv protects us. 

“We are in danger and need protection and are in grave danger… We are a lonely sheep among seventy hungry wolves. In such a situation, we need protection. ” 

The rosh yeshiva then described Rav Elyashiv as protecting the generation. 

...Later, the rosh yeshiva described how the power of the righteous can prevent wars and catastrophes, adding that it is known that before World War II, many gedolim, including Rav Boruch Ber Leibowitz, Rav Shimon Shkop and others,  perished, thus removing these “righteous defenders” from the world. 

“Now in our generation, we have an individual who defends us through his toil in Torah,” said Rav Edelstein. “Now he’s sick and we are compromised. We must all daven and learn Torah.”

This kind of personality worship cannot be healthy. This extreme identification of one mortal person's health with the entire community's well-being verges on the nutty. Sooner or later, R. Elyashiv is going to die. What happens once he does? The way people are talking about him is making it sound like they think he can't die. Are they going to deify him like Chabad did with Schneerson? One can only hope that people like R. Edelstein don't actually believe what they're saying-- in which case, the whole thing becomes one big PR stunt. Which is worse?

Death is part of life. All people die. Judaism, which is rooted in the real world, knows this. Yet some of this pragmatism seems to be getting lost. The elders of our communities should be honored and allowed to pass in peace, not have their accomplishments be sabotaged in their final years by the very people who should be protecting them and preserving their dignity. There is something seriously wrong when leaders don't pass the torch until they reach 100... only to give it to people in their 90s. When did we start acting like the Catholic Church?

I cannot in good conscience wish R. Elyashiv a refuah shleima, a complete healing. I believe he is beyond that. I wish him the same wish I have been wishing for my own grandmother, a woman thirteen years his junior but just as mentally and physically compromised as him. I wish that they both be allowed to go in peace, comfortable, content, and with dignity. Not a refuah shleima, but a sof shleima (complete end). Or, perhaps more poetic, a chayim shleima (complete life).

If R. Elyashiv's people truly respect him, if they truly believe that he is the best of their generation... and if they truly believe their prayers have the power to keep him alive until 120...

They should stop.

And let him go.

Someone flunked Math

Interesting journalism question: when you interview a source and he says something strange, is it the editor's job to clarify the statement?

Joseph Farah doesn't seem to think so. He ran an election update a day ago quoting Fritz Wenzel, the head of a polling group about why a sizable minority of Republicans are leaning towards voting for Obama in the upcoming election, even after sitting through four years of Farah screaming about how illegitimate, Communisty and Muslimy he is.

The only problem is... Wenzel can't count.

“The improvement in Obama’s prospects compared to the four remaining Republican challengers stems largely from two factors,” suggests pollster Fritz Wenzel. “First, Obama has largely avoided the political limelight while the GOP candidates savage each other with increasing intensity. Second, a smattering of evidence indicates that the economy is getting a little better, which helps the White House in the eyes of the voters. Secondly, the bloody fight for the Republican presidential nomination – by most estimations the nastiest GOP fight in memory – has really hurt the images of the challengers in the eyes of both Republicans and, especially, independent voters. For Republicans, each candidate carries with them now some taint that cannot be ignored.”

If nothing else, it seems like Wenzel needs a crash-course in Numbers 101. Or, you know, a better editor.

A new contender for King Jackass

I though Glenn Beck had locked up the offensive Jewish appropriation stuff a while ago, but apparently while he's been sitting on his laurels in his virtual ivory tower, a new dope in town has been hard at work in America's churches trying to one-up him.

Sorry Glenn, but if you want to stay on top, you have to be willing to put in the face-time with other ignorant and easily manipulated goofballs. Ralph Messer has repeatedly shown that when it comes to exploiting Jewish culture, showing off his incredible ignorance of Jewish religion and history, and just plain old having zero shame, he's the new man to beat. Yarmulkes off to you, Ralph. You truly are a gigantic embarrassment to Jews and Christians everywhere.

Now seriously, go jump off a cliff or something.

How do you spend Shabbat?

It's been a few months into my Shabbat experiment, and I won't lie, it's been hard to stick to it. At the beginning it was quite nice; I would wake up, daven shachrtit, and then spend most of the day reading various Judaica. But the combination of Mrs. Yid rarely getting Saturdays off and me being a little too shy to go to services on my own has resulted in a bit of a stall. The last few weeks I've gone back to using the TV and Internet on Shabbat, simply out of boredom. Not ideal.

So, my question to my readers: How do you spend Shabbat? Specifically, what do you do besides going to synagogue? What other things do you make it special or meaningful?

Better theologians, please

Chuck Colson may be a former Marine, a top Nixon aide, a prison ministry founder, a published author, a popular radio host, and have 15 honorary doctorates, but that still doesn't mean that his arguments are convincing. Take this gem, in which Chuck tries to argue for why Biblical sexual ideas were powerful enough to change the world, but apparently not resilient enough to withstand gays and lesbians agreeing with them:

So often we hear that allowing two men or two women to marry will not hurt anyone, and certainly not "straight" people. Well, the truth is, we already know what happens when a society promotes sexual license and devalues marriage. We just have to look at history.

Way to bypass the argument by ignoring it. "Lots of people make this point that I don't feel like responding to. Next!"

Way back before anyone was talking about so-called "gay marriage," radio talk show host and Jewish theologian Dennis Prager wrote a fascinating article called -- get ready for this -- "Judaism's Sexual Revolution: Why Judaism Rejected Homosexuality."

Wait, so now Prager claims to be a theologian? This was a new one for me, perhaps because when I hear the term "Jewish theologian," I tend to assume that it describes someone actually qualified to hold the title. While Prager did attend Jewish day school, he attended a secular college and his degrees are in History and Middle Eastern studies. I find it interesting that in his first book in 1986, he merely described himself as a talk show host and author. Apparently by the time his second book came out in 1996, Dennis had gone to underground theology school, because on the dust jacket it proclaims, "Dennis Prager, theologian and philosopher turned talk-show host"  Interesting, so now the theology/philosophy cred predated his radio career? It's true that Dennis was a professional lecturer (big irony there)  before he got into radio, but I'm still not sure that makes him a theologian. Prager calling himself a theologian is about as accurate as him claiming to be a "passionate moderate"-- which he repeatedly does in that same book, so at least he's consistent.

Long story short: when Chuck talks about Dennis the "Jewish theologian," what he really means is, "right-wing Jewish guy who agrees with me."

Before the Jews were placed in the Ancient Near East, the pagan world was already a sexual free-for-all that debased women, boys, and religion itself in the service of male lust. Every aspect of life was sexualized. The pagan gods engaged in no-holds-barred sex, and so did the people. Homosexuality had almost unquestioned acceptance in the ancient world.

Back up, bucko. First of all, I'd love to see some sources, including some quotes from Lord Rabbi Prager's hallowed essay (link here for the curious or masochistic) documenting any of this. I'm already suspicious given that my understanding is that a lot of our knowledge about Ancient Near East pagan society (particularly people's sex lives) is sketchy due to limited information. Exactly how many 3,000 year old Letters to Babylonian Penthouse have you uncovered? Also, "every aspect of life," really? What about daily chores or occupations? I'm having trouble envisioning how you sexualize making a sandal or domesticating a goat. Last, of course, there is the huge problem of conflating a patriarchal, misogynistic "sexual free for all" with modern homosexuality, which is now overwhelmingly conceptualized through the framework of monogamy and consent-- a far cry from, say, pederasty.

Colson eventually does starting quoting Prager quoting academics- but that still doesn't help his argument.

But the key issue wasn't gender, it was power. Prager quotes Brown University philosopher Martha Nussbaum, who wrote, "The central distinction in [ancient] sexual morality was … between active and passive roles." Because boys and women were on the receiving end of sexual activity, they were "very often treated interchangeably as [simple] objects of [male] desire." 

Not surprisingly, then, women were relegated to the sidelines, important for giving birth and running the home, but not important as real and equal partners to men, who had other sexual options -- with boys and other men.

Hmm, sounds like the problem with pre-Biblical paganism is that it was extremely self-centered. People in power could bed whoever they wanted, and no one else mattered. No respect, no love, and no stability. Yeah, that's just like the various gay people I know in committed relationships (some for decades) who have loving homes, and some of whom are raising children. In the same way that being a straight man in a relationship is equivalent to being Hugh Heffner. Exceptions aside, the fact that a sexual act or identity can be taken to an extreme conclusion doesn't inherently invalidate the act/identity itself.

That's why Judaism's claim that God created sex only for a man and a woman in marriage was so revolutionary -- and despised by pagans ancient and modern pagans I might add as well. 

Inasmuch as we're going to give Judaism exclusive credit here, the real revolutionary values have less to do with outlawing who you can't have sex with, and much more to do with establishing the parameters for a model relationship-- which may have been straight historically, but was really important because it emphasized relationships (not even monogamy, look at the patriarchs), love and respect, values which are not-- and should not be-- exclusive to straight relationships. By focusing so much on gender, you're actually greatly reducing the scope of these tremendous ideas.

Prager writes, "This revolution forced the sexual genie into the marital bottle. It ensured that sex no longer dominated society, heightened male-female love and sexuality (and thereby almost alone created the possibility of love and eroticism within marriage), and began the arduous task of elevating the status of women." No wonder, Prager notes, that the "improvement of the condition of women has only occurred in Western civilization," which historically has been the "least tolerant of homosexuality."

Classic Prager; a million sweeping statements with zero documentation. While Colson may be happy to accept those arguments on faith, color me unconvinced. Among other things, I like how this argument presumes that homosexuality is incompatible with women's rights. Does this mean lesbians are anti-feminists? Someone should let Pat Robertson know. Maybe Dennis should do it, since he's a fellow theologian.

Colson wouldn't be a good evangelical if he let the Jews have all the credit for... bottling the sex genie (??), so he reminds us that Christianity has been pretty good at caging the sexual urges, too.

Of course, I should note, that it was the Apostle Paul who further carried this Jewish sexual revolution throughout the ancient world. As Sarah Ruden wrote about in her recent book Paul Among the Peoples, predatory homosexuality was common in Rome and Greece; women and children were just property. 

Through Paul, however, Christianity ensured that Western Civilization promoted sex within the confines of marriage between one man and one woman, and placed off limits the sexual abuse of boys and slaves.

Again, huzzah for creating social and emotional standards for relationships. Those are all good things. Notice, however, that one does not have to be engaging in straight sex to be able to believe in or perpetuate those values.

The point is simply this: God instituted marriage for the good of man (restraining and channeling his sexuality), for the protection and dignity of woman, and the flourishing of human society. 

Western civilization, the greatest ever, took this to heart, but forgets it now at its own peril.

You know, given that conservative Christians often like to accuse Judaism of being over-legalistic, the amount of willful myopia here is kind of amazing. Colson is willing to give Judaism and Christianity tons of credit for reining in people's sexual urges and kickstarting a social evolution when it came to romantic and sexual relationships, but if gays and lesbians buy into those same values and try to apply them to their own lives and relationships, the values somehow break down. Colson seems to view love and dignity like a phone charger; they only work when you use them with the right plug.

Hey Chuck: if Biblical relationship values are so strong and powerful that they took over half the world and have become the cornerstone of Western civilization, they should be able to withstand gays using them. Just saying.

Who needs to moderate what?

Jay Michaelson had an essay in the Forward this week pleading for more civility and honesty in Jewish civil discourse. As with political discourse, I'm always for that. However he started with some assumptions that seemed a little off for me.

I have my approach to Jewish values that allows me to say that Eric Cantor, Sheldon Adelson and William Kristol are wrong — pluralism is not the same as relativism, after all — but what I won’t say is that they are somehow un-Jewish.

Granted, I don't spend tons of time in liberal Jewish circles, but I'm a little suspicious of how often this charge actually gets made. Michaelson notes that the converse occurs regularly among the Jewish right-- religious and otherwise, but doesn't seem to have any particular examples for the left.

Relatively few progressives come out and say [that Jewish conservatives are outright wrong] directly, because to do so violates a cardinal progressive principle, that of pluralism and toleration. (Of course, conservatives don’t hesitate to make these claims, painting critics of Israel as self-hating Jews, or social progressives as rebels against the Torah.)

This seems like a case where Michaelson may be trying to be too even-handed for his own good. While the rest of his essay has some good advice, particularly about being honest about how wide and divergent the various opinions in the Torah are, the fact that he seems to start the piece off with a fallacy-- that Jewish liberals have no good response to Jewish conservatives because they either ignore them or dismiss them-- kind of spoils it for me. Michaelson isn't wrong with his end thesis-- that the best option is to admit that Judaism and Jewish thought contains a multiplicity of views (though one can still find patterns suggesting which values the Torah seems to prefer, such as mercy over vengeance)-- but I don't think the reason more liberal Jews don't do this is that they're too busy saying conservatives aren't real Jews. Rather, I would guess that the issue either isn't on their radar (liberal bubble syndrome) or that they simply haven't given the issue much thought (a third possibility is that they may hear about these critiques and simply not have much in the way of a response).

It seems to me that in an attempt to not cast blame or appear biased, Michaelson does his readers (and argument) a disservice by diagnosing two patients with the same illness. One group needs to work on reducing de-legitimization. The other one needs to recognize that it's happening and start pushing itself to generate some positive and constructive responses.