36 Mark Washofsky
want to stretch that analogy beyond its reasonable breaking point.
For these reasons the responsum develops, in section III, “another conceptual framework for thinking about the terminally ill patient whose death is not yet imminent.” This framework is the commandment(mitzvah) to heal the sick. The argument, reminiscent of if not identical to the theory presented by R. Immanuel Jakobovits,'”' is that like the more general duty to save life, the mitzvah of medicine is obligatory only as long as it promises a reasonable chance of success.'” Treatments that do not effect“healing” are not, therefore, regarded as“true medicine”(refuah vadait or bedukah)'” and are not obligatory. Under this logic, a person who is terminally ill may refuse treatment that may extend her life expectancy a short time but that holds no prospect of curing or controlling her illness. The predominant consideration here is not necessarily that the patient will experience prolonged or greater suffering by accepting the treatment, although such might be the case, but rather that the treatment is medically futile.
The Responsa Committee acknowledges the difficulty in defining the term“medical futility”;“[i]n many situations it will be problematic if not impossible to determine when or even if the prescribed regime of therapy has lost its medical value.” In the face of this systemic uncertainty, the text suggests, some may prefer to take refuge in the traditional Jewish doctrine of the sanctity of every moment of human life, which may lead them to the conclusion that one is never permitted to refuse medical treatment but is rather obligated to fight disease and cling to life until its very last instant. The Committee responds to this objection in the following manner: