Friday, 31 July 2009

Dying Well, Debbie Purdy and the Shema

Week when read Shema

Want to talk about death.



From the Talmud

When R. Akiba was taken out for execution, it was the hour for the recital of the Shema’, and while they combed his flesh with iron combs, he was accepting upon himself the kingship of heaven. His disciples said to him: Our teacher, are you prepared to accept the Kingship of Heaven even now?

He said to them: All my days I have been troubled by this verse, bcol nafshechah ‘you should love God with all thy soul’, [which I finally understand to mean, you have the love God,] ‘even if He takes thy soul’. And now I have the opportunity of fulfilling this? Shall I not fulfil it? He prolonged the word ehad as he died, and died saying it. A heavenly voice went forth and proclaimed, ‘Happy are you Akiba, that your soul has departed with the word ehad!’[1]


This recitation of the Shema is the classic death-scene of the Rabbinic period.

What the Rabbis would consider the ultimate a good death.

And there are others.


Moses, who, we are told, dies with the kiss of God – the original kiss of death.

And Rav Hiyya who is trapped by the angel of death who appears at his door begging for bread. First the great Rabbi sends out a minion. The angel insists Rav Hiyya hiself comes out.

He angel reveals himself to the Rabbi and the Rabbi amtzei lei nafshei - ‘yields his soul’[2]


Judaism knows such a thing as a good death.


Reflecting on this in the context of the reports of last ever decision of the House of Lords, sitting as a court.

Debbie Purdy, who has MS, wanted to get the Director of Public Prosecutions, to be clear about what her husband could and could not do if he wished to safeguard himself from prosecution if he assisted his wife in taking her own life.

And the Highest Court in the land has agreed that the DPP has an obligation to set out the situations in which it would or would not consider prosecuting someone who assisted a relative to die in what has been referred to as ‘circumstances of compassionate assisted suicide.’


It appears that religious pressure groups as revolting and protesting this decision.

Protesting at what they see is the legal world removing the absolute sanctity of life.

But, and it’s not for the first time, I find myself siding entirely on the opposite side of the argument from these so-called religious pressure groups.

And for entirely religious reasons.


Of course start from position that Jews love life and life takes pre-eminence over much else


1. Leviticus 18:5

And you shall keep the laws and ordinances and by doing them, live by them. I am GOD.


And not die by them.


Every human life is created in the image of God and you don’t need to tell a Jew what can happen when governments begin to suggest that some lives are worth more than others.

You don’t need to tell a Jew about the dangers of genocidal euthanasia.


But, and it is a huge BUT, we cannot view every religious decision from the crucible of Auschwitz.

Because the reality of our lives, and our deaths, thankfully free of the horrors of genocidal mania, is that end of life is complex.


Some nine years ago, right around this time of year, I was embarked on a training scheme at New York Presbyterian Hospital, as a Chaplain, and I would wander the wards and the waiting rooms listening to those who were suffering, and their loved ones.

I encountered a medical specialism I had never heard of before – the palliative care consultant whose job was not to cure the patient, but rather reduce pain, suffering, severity of symptoms.

And sometimes choosing to alleviate the severity of symptoms means that death will come on more quickly than if one continued to aggressively treat for cure.


I became involved in many of these conversations and found them always deeply moving, holy encounters.

Palliative care physicians, in my experience, are men and women of deep and serious spirituality. They spend a lot of time experiencing life and death at their sharpest.

And they care deeply. And they never walk away.

In many cases, though palliative care is of course more broad than this, they are trying to give their patients a good death when the other choice is not more life, but a worse death.


I’m aware that for many of us these terms are can feel meaningless.

If we’ve never been in these hospital rooms.

If we’ve never been part of these conversations on behalf of our loved ones.

We would rather pretend that these conversations don’t exist.

We would rather pretend that decisions never have to be taken.

And there is nothing wrong with a bit of this kind of innocence.

But the reality, like the Angel of death who came to visit Rabbi Hiyya is not easily put off.


Another tale, from the Talmud.

This one tells of the death of Yehudah ha-Nasi, known as Rebbi.

He died at the start of the C3.


On the day Rebbi died the Rabbis decreed a public fast and offered prayers for heavenly mercy. They announced that whoever said Rebbi was dead would be stabbed with a sword. Rebbi's handmaid went up to the roof and prayed, ‘The heavenly want Rebbi and the earthly want Rebbi. May it be Your will that the earthly overpower the heavenly.’

[The handmaid is, in contemporary terms praying for cure, but the story goes on]

When, however, she saw how often he had to go to the toilet, and take off the tefilin and put on the tefilin in pain, she said, ‘May it be your will that the heavenly overpower the earthly.’

[The handmaid starts to pray for Rebbi to be taken, she’s making a judgement about the quality of his life, at the end of his life]

And the Rabbis kept on with their prayer for mercy, she took a jar and threw it down from the roof to the ground. They ceased and the soul of Rebbi departed.[3]


I hope the technicalities of the story don’t detract from its message.

To me it feels like hospital bed-side with the patient and the one person who is able to understand what the patient is going through.

And the world outside refusing to see that the end of the patient’s life is coming.

I’m sure it’s a message poor


It’s a message about offering care and companionship to a person who is dyeing.

It’s a message about being willing to overturn a well meaning, but ultimately unhelpful piety of the praying students, replacing it with another kind of piety; one more dark, less obviously safe from heavenly prosecution, but ultimately a better kind of piety.


Let me be clear I am certainly not advocating open season on anyone who might have a disability, but who is not facing the end of their life.

I am certainly not advocating that, as soon as an end of life issue appears on the medical horizon cure care should be abandoned.

I am not even advocating doing away with the crime of assisted suicide. I am quite sure that certain acts, currently criminalised under the 1961 Suicide Act should remain criminal.

But not every act of accompanying a dyeing person on their last steps in this world should be criminal.

Certainly not every act of accompanying a dyeing person on their last steps is halachically illegitimate.[4]

This last statement is not only one I feel able to make from a halachic perspective, but also from an emotional perspective, a spiritual one.


The notion of standing with a person who is dyeing is incredibly important.

So many Jewish attitudes towards end of life are shaped by this notion of providing an escort.

The great mitzvah in the context of illness is bikkur holim – visiting, turning up, escorting a person through illness even if, especially if cure is not a possibility.

Escort – in Hebrew the term would be leviyah – the very term we use for a funeral.


Maybe this explains why the shema has come to so connected with the last moments in life.

As we are forced to leave behind those who have accompanied us on this planet, so we place our lives in the hands of God who we pray will accompany us in the World to Come.



One last thing.

When I began my Chaplaincy training we were asked to write down some learning objectives.

I wrote, and I dug out the paper this week, that I wanted to know what it meant to die a good death. How it was possible.


I remember my supervisor, a woman of incredible insight, responding, that people tend to die the way they live.

She wasn’t saying that good people live longer – or that good people don’t get ill or injured.

But rather that when the time comes to accept that which must be accepted people who have lived well find ways to do this well too.

In my experience since then it’s an insight that has occasionally failed, but it remains one of the most important observations I know, and certainly one well worth sharing here, amongst the living.

To die well, one must first learn how to live well.


Shabbat shalom


[1] Brachot 61b

[2] Moed Katan 28a

[3] Ketubot 104a

[4] AZ 18a, Sefer Hasisim 234, AZ 27a and Tosafot ad loc. DHM Le Chai Shah

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