Midrash Rabbah Exodus 21.7; see also I. Jakobovits Jewish Medical Ethics pp 201 ff). On the other hand skepticism about physicians has also played its role in Jewish life; the Mishnah quotes R. Judah:"The best among physicians is destined for hell",(M Kid 4.14). All of these sources establish the physicians duty to heal as well as the patient's obligation to maintain good health and to do whatever is considered reasonable to regain health.
It has been established that nothing positive may be done to hasten death even in a terminal patient, yet, there is also no obligation to intervene in a hopeless situation to minimally prolong life(S. B. Freehof Modern Reform Responsa#34 and#35). In most instances in which this has been discussed the terminal patient is no longer capable of making rational decisions and must rely completely on those who are providing treatment. In this instance we are dealing with an individual who has made her wishes known.
We may understand the role which the patient and the physician play in their inter-relationship by looking at the frequently discussed theme of treatment for illness overriding various religious obligations. It has long been permitted to violate the Sabbath laws not only in order to save a life but even for someone who is dying(Yoma 84b; 1. Lampronti Pahad Yitzhaq, Holeh Beshabbat etc). The general principle is that if either the physician or the patient believe that a treatment is required, and there is some risk to life, then the normal religious legislation is suspended(Shulhan Arukh Orah Hayim 328.5 and commentaries). The decision favored the patient who considered a treatment necessary even if a hundred doctors considered it not sufficiently urgent to override religious obligations,"because a heart knows its own bitterness." This and other discussions indicate that the patient is heavily involved in the treatments and not merely a quiet and subservient recipient.
In the instance of our patient, proper persuasion might have
brought the widow to dialysis eight years ago. The fact that she lived eight years without dialysis at this advanced age may indicate that she
170