Terminal Deception

Q. Is it permissible to mislead a seriously ill patient about his condition, if there is fear that letting him know may discourage him and harm his health? 

A. The consideration you mention is certainly acknowledged in our tradition. One example is the deathbed confession. This declaration is of profound importance and can perfect a person's repentance in his or her last moments, yet Jewish law says we should not mention it to someone whose spirit is weak. The reason is that mentioning the confession will make the person realize how serious his or her illness is, which could break the ill person's spirit and worsen their condition.

We also learn that if a person is very sick, we should avoid telling them about the death of a relative, since this may worsen their condition.

It would certainly follow that where there is a well-founded concern that telling the patient about his or her condition would be discouraging and harmful, it would be proper to keep this information from the ailing patient.

However, this consideration needs to be applied with great caution. After all, Jewish law tells us that the general rule is that we should help a person prepare for death. The person whose spirit is weak is mentioned as the exception to the rule.

The Rabbis of the Talmud made a remarkable interpretation of the Torah that emphasizes the importance of the awareness of advancing age and proper preparation for death. They tell us that before the time of Abraham, there was no old age. A person would appear young until his death. Abraham, our Sages tell us, prayed to God that a person should age before his passing. Before Yaakov, there was no illness; a person would die suddenly when his or her time came. Yaakov prayed that there should be illness, so that a person should have the opportunity to prepare for his passing, as Yaakov did when he called his sons before him to bless them. (Genesis chapter 48-49.)

The message of this story is clear: We should view normal manifestations of age and illness not as curses but rather as invaluable milestones which inculcate consciousness of our stage of progress in the journey of life. It could be a very serious mistake to deprive others of this special blessing of awareness by misleading them about their true medical condition. Perhaps there are certain things they are determined to do before death; imagine their frustration and disappointment when they discover that they were prevented forever from realizing their dreams by well-meaning but misguided relatives and caretakers!

Lack of information also may prevent patients from making informed choices about their treatment.

Another insight that should deter us from misleading a patient is that by the time people reach advanced age, they have usually acquired a generous measure of human wisdom. The Hebrew word “ziknah,” which means elderly in Hebrew, can also be read, “ze kanah” -- this person has acquired, that is, acquired wisdom. It's hard to pull the wool over their eyes, and chances are good that they have already figured out what their situation is.

What sometimes occurs is a tragic situation where elderly individuals are perfectly aware of their condition, but are unable to relieve their worries by discussing their illness with their loved ones, because they don't want to worry their relatives and friends with the knowledge of their awareness! In other words, everyone is burdened by the tragic illness yet all are prevented from sharing their burdens because of the elaborate charade of supposed ignorance.

Yet it is certainly wrong to be overly discouraging. Informing a person of their exact medical condition doesn't mean playing God by telling them that they have six months to live or similar absurd statements. Rather, accurate medical information should be presented in an encouraging way, pointing out the best opportunities for improvement and without resort to misleading and discouraging statistics.

There is a place for keeping up an ill person's spirits by false encouragement. But the importance of preparing properly for death, and the wisdom and resilience that generally come with age and suffering mean that in most cases the best policy is to give the patient accurate medical information presented in as positive and encouraging a light as possible.

SOURCES: Shulchan Aruch Yoreh Deah 337, 338:1; Babylonian Talmud Bava Metzia 87a, Kiddushin 32b.