AN ELDERLY PATIENT WHO REFUSES DIALYSIS Walter Jacob
QUESTION: An intelligent, articulate, eighty-three year old widow has renal disease which can be treated by kidney dialysis. She was diagnosed eight years ago and refused dialysis. Since then her health has generally deteriorated with a hip fracture, incontinence and heart disease. She has now entered a nursing home and suffers from end-stage renal disease as well as congestive heart failure. She has made it clear to her brother, as well as those at the nursing home, that she wishes no drastic treatments (CPR, mechanical ventilation, feeding tubes, etc.) but wants to die peacefully and without pain. One of the attending physicians feels a strong obligation to save this patient’s life. He argues that he cannot let her die of renal kidney disease and wants to impose dialysis upon her. Should she be forced to undergo dialysis? What are her rights and obligations and what are those of the physician in this case?(Rabbi Dayle Friedman, Philadelphia PA )
ANSWER: A good deal has been written about the obligations of a physician to heal. Our tradition from Talmudic times onward has encouraged the use of every possible medical procedure in order to save lives. The discussions were based on"He shall cause him to be thoroughly healed"(Ex 21.20) and"You shall not stand idly by the blood of your fellow"(Lev 19.16). Even risky procedures may be undertaken if the physician thinks that there is a reasonable hope for recovery(San 73a; A Z b; J. Reischer Shevut Yaakov 111#85; Eliezer Waldenberg , Tzitz Eliezer 10#25 Chap 5 Sec 5; Moshe Feinstein Igrot Mosheh Yoreh Deah 2#59: I. Y. Unterman Noam 12p 5; W. Jacob(ed) American Reform Responsa#15, 76, 717, 719; W. Jacob Contemporary American Reform Responsa#17, 85). We have gone somewhat further and permitted a patient who understands the risks, to be part of a dangerous medical experiment in which the chances of recovery are slim (W. Jacob Contemporary American Reform Responsa#17).