believes that a treatment is required and there is some risk to life then the normal religious legislation is suspended(Shulhan Arakh 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 patients, 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 chose the appropriate path for herself. Now as she is suffering from end stage renal disease as well as congestive heart failure, it is not a question of saving her life, but possibly prolonging it at the expense of her dignity and with some pain both physical and psychological.
This patient rejected dialysis while living independently at home and should not have dialysis imposed upon her now that she is dependent upon the services of a nursing home. Her attitude has led to a full, long life. Additional medical attention which she does not wish should not be forced on her; it is only likely to shorten her life. The physician has done his duty by suggesting the treatment. The patient who knows that she is close to the end of her life with or without the treatment is not obligated to accept the suggestion.