Sunday, July 11, 2021

Halacha and Quality of Life Issues

Alta Fixsler (TOI)

I’m not sure what hypoxic ischaemic brain injury is. At least not the extent this injury affects the quality of life of a child to whom this happened. My guess is that the quality of life in this situation is extremely low, if it exists at all. Not even sure if such a child survives that injury whether it will even be aware of its own existence. I also believe that without life support that child will die. According to one article I saw in BMJ - Practical Neurology: 

Overall, the prognosis is extremely poor and only a quarter of patients survive to hospital discharge, and often even then with severe neurological or cognitive deficits. 

Which brings me to a very sad story in Hamodia about Alta Fixsler, the 2 year old daughter of Orthodox Jewish parents living in the UK. Alta was victim of this neonatal injury. And was placed on life support. Hamodia reports that Medical opinion claims that she has no conscious awareness. 

The doctors at the hospital where Alta lies want to pull the plug. Which will either kill her immediately or hasten her death. Halacha states that doing so is tantamount to murder. A British court has, however, ruled in favor of the hospital – against the wishes of Alta’s parents. They continue to want to follow Halacha. The court has refused to honor the parents wishes. And that has caused people of good will in both Israel and America to react on their behalf: 

Israeli President Reuven Rivlin wrote a letter to Prince Charles asking for his help in securing permission to allow Alta to be brought to Israel. Failing that, it was suggested that an Israeli medical team come to the U.K. to treat her. The British courts said no… 

 (L)ast Friday, at the behest of Senator Chuck Schumer and 10 Republican senators, the Biden administration granted the child a visa, which would enable her to be brought to the U.S. for continued medical care at no cost to the British government.

As Sen. Schumer said on Friday, “All the Fixslers want is to follow their faith and get their little girl the best care in the process. The images of little Alta make your heart melt, and to know just how much her parents love her inspires us to do all we can to ensure her best chance.”

In addition, as the senators wrote, “We are profoundly troubled that the child of an American citizen [Mr. Fixsler] is being treated in this way, in a country with which we have a deep alliance and special relationship.” 

I have to say that I am once again proud of being a Jew in America. The US shows us once again that they are living up to their reputation as a Medina Shel Chesed - a nation of kindness that values all of its citizens irrespective of how - or even if we worship God. 

That being said, from a personal standpoint, I have to admit that I have mixed feeling about this. Not that I would do anything different than Alta’s parents. I would not let anyone pull the plug on my daughter’s life support either. No matter how poor her quality of life because that is what Halacha demands. The Halacha is clear -  Chaye Shah matters. Shortening it in any way (like pulling the plug on life support) is as I said a form of murder. 

But  I'm not sure the UK is morally so wrong to want to pull the plug. That Hamodia paints their decision that way is somewhat troubling. 

The fact is that there are differences in Halacha that allows death to occur in some cases. If a patient is in pain and near death, we are not required to go to extraordinary measures to prolong their life. We may in such cases allow for a DNR (Do Not Resuscitate) order*. This would not be considered murder. 

There is another Halacha that allows us to use a DNR*. The Torah tells us Lo Samod Al Dam Re’eacha. We may not stand idly by when the blood of our fellow is being spilled. We are required to go to the greatest lengths possible to save or prolong a life – even if it is only for an hour (Chaye Shah). That is not the case if the patient suffers pain and will die shortly anyway without those extra measures. In these cases quality of life does matter. Halacha allows for a DNR* in such cases.  

Had these parents been asked whether their daughter should be put on life support in the first place, I believe that Halacha would permit them to say no. 

That of course is not the case here. But it should at least make the UK decision understandable. The choice to follow Halacha will no doubt result in a lot of long term pain for the parents. I cannot imagine what these parents will go through prolonging their baby's life in this way - for who knows how long. Possibly many years!  If that child will not even be aware of its own existence, prolonging her life seems almost cruel. Making this Halacha a very difficult one to understand. That faith requires this of us does not make it any easier to accept. At least for me.

* Determining when a DNR is allowed should not be inferred from this post - which is for discussion purposes only. This is a very sensitive Halachic issue and a qualified Posek should be consulted in all cases.