PETER KNOBEL
be reviewed by impartial medical and rabbinic experts. The decisionmaking seems cumbersome, but is necessary to avoid conflict of interest and rash decisions. This might be a permissible limitation on autonomy.
For a terminally person in unremitting pain:
1. Suicide would be seen a morally permissible act when undertaken to preserve the sacred quality of a person’s life, i.e. consistent with a person’s biography. As noted above care must be taken to prevent suicide which is the result of temporary depression.
2. Assisted suicide is permitted when the decision is rational and can be demonstrated as consistent with the person’s own biography.
3. Active voluntary euthanasia is permitted when the person has waived his/her right not to be killed and it is consistent with the person’s biography.
Notes
1. The use of the term"killing" is deliberate. Avoiding euphemisms makes the moral seriousness of the issue clear.
2. By framing the question in this way my goal is to limit the parameters of the discussion to a single class of cases. However, this is no easy task because terms such as"terminally ill,""dying" or even"end stage medical care" have a certain ambiguity. It is beyond the scope of this paper to define these terms, but definitions are essential. While this essay is meant to be a general halakhic discussion of the issue of suicide, assisted suicide, and active voluntary euthanasia, actual decisions are made on a case by case basis. This is a theme to which I return in the body of the paper.
3. Arguments against sanctioning suicide, assisted suicide and active voluntary euthanasia invoke the concept of the"slippery slope" or the"wedge." Ethically one must always attempt to deal with unintended consequences. How does our desire to help an individual in a particular situation create circumstances that will harm others e.g. if we sanction suicide for a severely handicapped person who finds life intolerable, do we inadvertently pressure other handicapped persons to"do the right thing" and take their own lives? Do we not encourage society to consider them a burden rather than an ethical responsibility?
49