Difficult Decisions at the End of Life - A Reconstructionist Approach

Rabbi Steven Carr Reuben, Ph.D.

I once heard someone describe the difference between a dog and a cat like this: You love your dog so you take care of it and feed it and give it treats. So your dog is grateful and it looks up at you and thinks to itself, “You must be God.”

You love your cat so you take care of and feed it and give it treats. So your cat is grateful and it looks up at you and thinks to itself, “I must be God.”

Some of you may remember a High Holy Day sermon I gave four years ago with the disturbing title, “My cat had a better death than my grandfather.” In it I shared the reason that I don’t have pets in the house any more, and how like so many others I had grown to love our cat through the many years of companionship and how traumatic and painful it was to witness the end of her life and have to be the one responsible for making what we knew was the humane and loving decision to end her pain and suffering. So we took her to the vet hospital while Didi, Gable and I shared our final loving words of encouragement as she received an injection that quickly and painlessly ended her suffering in as gentle and loving a way possible.

Yes it was gentle, and yes it was loving, and yes it was the humane and “right” thing to do. But I still cried, and I was still torn up inside with that unique sense of “pet grief.” It’s a kind of warring inside between the certainty of how painfully “real” your grief and loss truly is, with the sophisticated part of your brain that is telling you, “It’s only an animal.”

If we know anything about grief and the human soul, we know that learning to live with loss, to be able to experience the shock and pain of loved one’s being taken from our arms and our lives long before we could possibly be ready, struggling with that most difficult of all human challenges, is THE single most universal human challenge as well.

Loss comes to us all. Grief comes to us all. The indescribable pain of learning to let go of someone we love is the inevitable price we pay for living, for loving, for letting another human being into our hearts in the first place – and no one escapes unscathed from this, life’s most universal emotional challenge.

When I spoke about having to put my cat to sleep those years ago, I was sharing the personal experience that I and so many others have unfortunately had in dealing with the realities of the medical establishment in the United States. The intense complexity of issues arising year after year from the combination of newly invented medical technology, drugs, experimental high-risk procedures and high profile medical malpractice law suits, all resulted in the tragic reality that my cat had a better death than my grandfather.

I am not alone. After that sermon scores of people wrote and shared their own end of life traumas. The pain of loss compounded so often by the frustration of feeling so out of control of the ultimate decisions that would mark the difference between a loving end to life and a prolonged and difficult death.

Many of you in this sanctuary tonight have been right there. I know your stories, I have heard your pain. I have seen your tears. I have stood often along side of you feeling that very same frustration, anger, resentment at exactly the time in life when you most want to simply feel grateful for the love you have shared, blessed to have had your loved one – father, mother, sibling, child, friend as a gift in your life.

The Talmud teaches that the end of life should be as gentle as lifting a hair out of a glass of milk. For thousands of years our tradition has recognized that death and life go hand in hand, that the very fact of being human means that every life will end and it isn’t a matter of “whether,” but only a matter of “how” and “when.”

That is why for Jewish tradition it is ultimately a mitzvah when the end of life comes to remove obstacles to a peaceful death, why palliative hospice care is such a central value in Jewish medical ethics, why we recite the wisdom of the Biblical Book of Ecclesiastes which reminds us, “To every thing there is a season and time for every purpose under heaven – a time to be born and a time to die” at the bedside of those we love, and at every funeral and memorial affirm adonai natan adonai lakah, yehee shem adonai mevorah – “God gives and takes away, and in between is a life filled with the possibility of blessings and love.”

A Reconstructionist approach to the end of life recognizes that just as we believe that everyone has a right to live in peace, we believe there comes a time when everyone has a right to die in peace as well. You may remember an interview with Jeanne Calment who was the oldest living human whose age could be verified. On her 120th birthday she was asked to describe her vision of the future. “Very brief,” she said.

Medical miracles can become medical nightmares if they are designed to merely add minutes to our lives and not meaning. The truth is that there are more suicides then homicides in America every year. In fact, each year there are tens of thousands of identified suicides in North America and no one knows how many others end their own lives quietly with prescriptions they have saved for just that purpose. It’s time to allow them all to come out of hiding and embrace a commitment that both life and death deserve to be lived with dignity – to the very end.

I have had many conversations over the years with medical professionals of all kinds who admit acting to relieve patients of pain and suffering and thereby hastening their deaths. And they do it with compassion, and they do it with love, and they do it to provide grace and dignity to the last moments of their patient’s lives. This I believe is acting in the highest moral and ethical realm. Those of us who are physical, emotional, or spiritual helpers of others, must see our role as helping them to experience life as full of love, and joy and meaning as is in our hands to create.

I believe that a dying person should have the right of personal control and choice over their destiny and over their death. Period. And I don’t think they should have to do it alone. We don’t even want the pets we love to have to die alone, and every one of us would do anything within our power to help the family we love, they who have been the very essence of our lives to leave this world with as much grace, and caring, surrounded by as much of our love as we possibly can.

The Reconstructionist approach to end of life decisions, is simply the common sense approach – it is recognizing the inevitable reality of life and death, it is doing our best to put as much control as we can into the hands of our loved ones who must face these final decisions about how their own lives will end, it is showing respect and dignity for the human spirit in us all, and it is knowing that being human means learning to live with loss even as we celebrate the gift of love which is the true legacy of the losses we endure.

That is why the famous words of the Torah are repeated year in and year out at every High Holy Day season – “See I set before you today good and evil, life and death, blessing and curse…” because our ancestors knew that it was not a choice of good OR evil, life OR death, blessings OR curses – but rather living itself means every single one of us gets them all. The bad with the good, the curses with the blessings, and death as an inevitable part of life. The choice we do have, always, is to choose life with dignity and love to the very end.