Dying Patient Informed of His Condition
A number of colleagues have been asked by Jewish physicians whether Jewish law and tradition permits or forbids them to inform a patient that he is dying.
This question has been raised often in the last few years. Evidently it has recently been widely discussed in medical circles. I have been informed that a certain well-known medical clinic makes it a regular practice to give such information to the patient. What is the attitude of our tradition on this matter?
The Prophet Isaiah made exactly such a blunt statement to King Hezekiah (II Kings 20 : 1 ff.). He said: “Set thy house in order; for thou shalt die, and not live.” Yet, as a matter of fact, the king did not die, but through a combination of prayer and medicine he was healed. The Talmud (b. Berachoth 10a; see also Yalkut Shimoni to the verse) discusses the incident as follows: Isaiah told the king that his case was hopeless, that “the decree is already decreed against thee,” to which Hezekiah answered: “Son of Amoz, away with thy prophecy; for this I have learned from my father’s house [i.e., from my ancestor David] that even if a sword is laid against a man’s neck, he should not cease from praying for God’s mercy.”
In other words, the Talmud, in rebuking even the great prophet, says that a man should never tell another that his situation is hopeless (that “the decree is already decreed”), and that certainly a man should not believe it of himself. If there is any possible chance of the patient’s improvement, his own hopefulness is surely an element on the positive side. It cannot be right to destroy a man’s hope.
The traditional literature is extremely sensitive to the psychological effect upon the patient of what we say and do, and therefore definite laws have developed against saddening him. If while a man is dying a close relative of his dies, the dying man must not be informed of the death, lest “his mind grow distraught.” Nor may the mourners tear their garments in his presence; and we silence the women (lest they weep) in his presence.
This prohibition against informing a dying person of the death of a close relative is repeated, enlarged upon, and finally codified in the Shulchan Aruch (Yore Deah 377), including these words: “We do not mourn in his presence [for the dead relative] so as not to break his heart” (L’shaber es libo). In fact, one of the scholars, Eliezar Minz (Shaare Deah, ad loc, quoted by Greenwald in “Kol Bo Al Avelus”), says that if the sick man asks about the departed relative, it is permitted to deceive him and to say that the person is still alive. Even if the patient already has learned that the relative has died, it is nevertheless forbidden to practice any of the ritual of mourning (such as the tearing of the garments) in his presence, lest he be saddened and become worried about himself (cf. Joel Sirkes, “Bach” to the Tur, Yore Deah 337).
It was customary, however, for dying people to utter a prayer of confession (Viddui). Originally, only criminals convicted by the courts were required to confess (m. Sanhedrin VI : 2), but this confession was later extended to all who are dying (Sifre to Naso, near the beginning, to the verse, “Then they shall confess their sin” [Leviticus 5:7], Cf. Higger, Introduction to Semahot 4 : 1). The Talmud (b. Shabbas 32a) states it as a rule: “To all who are dying we say: ‘Confess.'” But even this call to confession is to be made in such a way as not to terrify the patient. He is told that many confess, and do not die; many do not confess, and die; the merit of confession may bring him healing from his sickness (cf. Semahot d’Rabbi Hiya, 1 : 2).
Thus the confession is not made in a mood of desperation but in one of calm serenity. This is evident from the prayer which Nachmanides transmits: “O Lord, my healing and my death are in Thy hands. May it be Thy will to send me healing. But if I die, may my confession atone for all my sins.” This mood may well calm the patient, and the sense of forgiveness bring him serenity and even renewed strength. Nevertheless, the suggestion of a confession must never be made in the presence of the ignorant, the young, or of women, “lest they weep and terrify his heart” (Semahot 1 : 3).
We see, then, that this confession is not an “indispensable sacrament” in Judaism, since it may be omitted under such circumstances as may terrify the patient. With most mod-ern Jews, the custom of a dying confession has largely faded away. Thus we do not have even this well-intentioned reason for informing a patient that he is dying.
It may, of course, be necessary to inform a man that the time has come for him to arrange his affairs, as Isaiah told Hezekiah, “Set thy house in order.” But even so, it is not necessary to add, as did Isaiah, “for thou shalt die” (for which he was rebuked, according to the Talmud). The necessity for arranging his affairs can be tactfully suggested to the patient, on the basis that no one is sure of his future. In fact, it is better that his friends and relatives, and not the doctor, discuss these matters with him. If the doctor tells him “to put his affairs in order,” it is equivalent to pronouncing the death sentence. If his friends tell him, he may dispute the urgency, and yet be persuaded to make necessary plans. The tractate Semahot d’Rabbi Hiya shows precisely the delicacy and consideration which Jewish tradition commands. It begins as follows: “When a man is sick we speak to him, not of life nor of death. We say: ‘Perhaps you have loans outstanding, or perhaps you owe money, et cetera.'” In other words, practical matters can be discussed by friends without terrifying the patient.
The attitude of Jewish law and tradition on this matter is quite clear and quite firm. No one has the right to destroy a patient’s hope for healing. No religious duty, such as mourning for a deceased relative, must be imposed upon him. He must be guarded against wailing and sorrow, lest, as the law puts it, “his mind be distraught” or “his heart break.” In the light of Jewish law and tradition, it is clearly wrong to tell a patient that his case is hopeless and that he is dying.