PETER KNOBEL removing impediments to dying. 59. B. Sanhedrin 45a and Rashi ad. loc.

60. It is essential for this paper that we are dealing with a competent patient who has either chosen to exercise his/her own right to die or has explicitly waived his/her right not to be killed.

61. Ibid. p. 55 ff. Dorff while arguing that"individual Jews do not, under Jewish law, have the same degree of autonomy they increasingly enjoy under American Law,... nevertheless... individual Jews do determine considerable elements of their health care." Dorff Ibid. p.12

62. This flies in the face of the traditional halakhah which defines"a culpable suicide, subject to halakhic penalties is one carried out through responsible choice, with intent definitely stated by the perpetrator and clearly understood by the listener." Goldstein /bid. p.14

63. I recognize that there are significant problems with the terminology. My bias is not to allow, rather than to recommend, acts of killing in extreme situations.

64. This could either be the family rabbi- especially if he or she had ongoing involvement with the patient- or a specially trained rabbi. It would be advisable, in either case, that the rabbi have training in acquiring knowledge about an individual life plan. I believe that the skill necessary to elicit oral history would be important in this case.

65. Approval would, therefore, carry Judaic weight. The Bet Din would be in a position to weigh the Judaic considerations. This could have a powerful impact on this situation. I recognize a number

of practical, psychological and potential legal difficulties.

66. Dan W. Brock has a detailed description of a model of informed consent and of shared decision making in his book Life and Death pp. 21-54, 55-79.

67. Brock Ibid. pp. 225-226.

68. Ideally these are all people who know and love this person who could be expected to support what is consistent with the person’s biography and his/her best interests. However, checks and balances are required because of the seriousness and irreversibility of the decision.

59