Can a Terminally-Ill Patient Undergo High-Risk Surgery?
Provided courtesy of Real Clear Daf
We learned about this on 27b this week. The mishnah on 27a rules that it is prohibited to accept medical treatment from a pagan doctor. The Mishnah’s ruling was relevant to the lawless pagan societies of the day in which murder was rampant. We therefore had to be concerned that a pagan doctor might purposely try to surreptitiously kill the Jewish patient under his care. On 27b, R’ Yochanan limits this ruling: if an ill person might recover without the pagan doctor’s intervention, then he may not submit to his care. But if without any intervention the ill person will certainly die, then he may accept treatment from the pagan doctor.
On its surface, this ruling appears very logical, for, what does this terminally ill patient have to lose? However the Gemara questions the permissibility of this by raising the point that as a result of submitting to the pagan doctor’s care, the patient might die sooner than he otherwise would have. How can we permit this patient to do something that might destroy some additional moments of life?
The Gemara replies that the chance (however slim--see further) of completely recovering under the pagan doctor’s care outweighs the risk of possibly extinguishing additional moments of life. The Gemara then proves that this is the correct Halachic assessment from the incident of the four lepers that is found in Melachim II. A terrible famine had stricken the land and these four lepers (i.e. stricken with tzaraas) made the very risky decision to search for food in the enemy encampment of Aram. They reasoned: we anyways face death (because of the famine) if we remain here. Lo and behold when they came to the Aram encampment they discovered that it had been deserted with plenty of food left behind. From here we learn that we do not concern ourselves with the increased risk of ending a life sooner in an attempt to preserve that life.
Rav Moshe Feinstein in his Iggros (Y.D. II, Siman 58) explains how far this ruling goes in response to a question asked of him about whether a terminally ill patient was allowed to attempt a high-risk surgery. Rav Moshe, after citing our Gemara, points to the words of Rashi. When explaining the prohibition of submitting to a pagan doctor where the patient is not terminally ill, Rashi explains that it’s prohibited because the pagan doctor “will certainly kill him.” Therefore, better to refuse this intervention and hope that the patient will recover without it. So Rashi is saying that we’re discussing a situation where it is almost certain that submitting to the pagan’s care will mean immediate death. And yet the Gemara later says that we take this great risk and do submit to the pagan’s care in a case where the patient is terminally ill. Rav Moshe continues that we can also prove this point from the incident of the four lepers. There as well, by all accounts their decision to waltz into the enemy camp would mean immediate death. And yet they correctly reasoned that this extremely high risk was worth it, in order to attempt something that might save their lives.
This Gemara speaks to two core values that run deep in the Jewish psyche: the preciousness of life-each and every moment of it, and hope-even in the most desperate of circumstances. May Hashem always protect us and obviate the need to make these kinds of difficult life-and-death decisions.