Tag Archives: medical ethics

Opioids, pain control and suicide

I want to say a perhaps untimely word on being – on occasion – pro- proper medical use of opioids. Although there is a raging, deadly opioid crisis in the USA, it is due to a huge misuse of science and medicine, but not due to medicine itself.
 
The Committee on Jewish Law and Standards, the official halakhic body of Conservative Judaism, published a teshuva on suicide and assisted suicide in the summer 1998 issue of “Conservative Judaism” Vol. L, No.4. The authors hold that there are cases – for instance some cancers, where we do need to proscribe very strong pain killing drugs.
 
The CJLS teshuva notes that suicide is forbidden by Jewish law: this includes assisted suicide. Yet there’s a trend of Americans and Europeans who are asking their friends/family to help kill themselves. As the Conservative teshuva points out, many people get sick, often with terminal illnesses, but most people don’t try and commit suicide. So why do some people ask for this? If we can find out, we should remove these reasons, so people don’t want to do this.
 
The author of the teshuva, Elliot Dorff, note that “those who commit suicide and those who aid others in doing so act out of a plethora of motives. Some of these reasons are less than noble, involving, for example, children’s desires to see Mom or Dad die with dispatch so as not to squander their inheritance on “futile” health care, or the desire of insurance companies to spend as little money as possible on the terminally ill.”
 
Some patients want to die because they are pain, but Rabbi Dorff points out that the proper response to pain is better pain control.
 
There is a new crisis in medical care of elderly and terminally ill patients : Many doctors are keeping such patients in perpetual, constant pain by refusing to grant them adequate pain killers. Some do this out of ignorance, others because they claim they want to avoid any possibility of the patient becoming a “drug addict”. Others claims that a good patient will grin-and-bear-it with the least amount of pain medication possible. The CJLS teshuva states that such reasoning is “bizarre”, and cruel. With today’s medications, there is no reason for people to be in perpetual torture.
 
The teshuva outlines theological reasons why Judaism is opposed to suicide. Another section discusses the social and economic forces that conspire to drive many people to this decision. Most importantly, the teshuva investigates the psychological reasons for the hopelessness felt by some patients.
 
It points out that “Physicians or others asked to assist in dying should recognize that people contemplating suicide are often alone, without anyone taking an interest in their continued living. Rather than assist the patient in dying, the proper response to such circumstances is to provide the patient with a group of people who clearly and repeatedly reaffirm their interest in the pateint’s continued life.”
 
“Requests to die, then, must be evaluated in the terms of degree of social support the patient has, for such requests are often withdrawn as soon as someone shows an interest in the patient staying alive. In this age of individualism and broken and scattered families, and in the antiseptic environment of hospitals where dying people usually find themselves, the mitzvah of visting the sick (bikkur Holim) becomes all the more crucial in sustaining the will to live”
 
None of this, of course, is to downplay the serious opiate crisis in the united states. It has affected even those close to me. I know that the producers of opiate drugs have engaged in unethical, possibly criminal activity, in pushing these drugs to doctors for the past 30 years, and doctors themselves pushed these drugs unwisely, helping create the current deadly crisis. So I just am noting that there is a legitimate medical role for such drugs, under clearly defined circumstances.
 
 
See
 
Elliot N. Dorff, “Assisted Suicide” YD 345.1997a
Statement on Assisted Suicide YD 345.1997b
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