Like nearly everything in Israel, Ariel Sharon’s condition touches both the hard-edged logic of the secular world and the vagaries of faith.
For doctors, the next medical challenge could come Monday when they start bringing Sharon out of his drug-induced coma. After that — should he need life support or fail to awaken — his case could become drawn into the thorny disagreements among Jewish scholars about the boundaries of life and what measures should be taken to sustain it.
The prime minister and his family hold the ultimate sway over vital medical decisions that may come.
But the power of Sharon’s legacy could exert itself even in those critical moments — becoming a possible example for others at a time when Israeli leaders and rabbis increasingly confront issues such as the right to refuse life-prolonging measures, when to declare death and how it fits with “halacha,” or Jewish law.
“When is a person alive? When is he dead? What level of intervention is appropriate? These are questions that no longer have clear-cut definitions in the modern world,” said Rabbi Noam Zohar, a professor of philosophy and bioethics at Bar Ilan University.
Sharon has shown some improvement in vital signs, including the pressure inside his skull, said Dr. Shlomo Mor-Yosef, the director of Jerusalem’s Hadassah Hospital, where Sharon was taken after suffering a major stroke on Wednesday. Doctors next plan to being reducing the sedative level that’s kept the 77-year-old Sharon in a coma.
Questions of intervention
How he responds could raise critical questions about the powers of medical technology and the influence of Jewish traditions.
Under established Jewish legal codes, it’s forbidden to do anything to hasten death. But other teachings say its permissible to remove an “impediment” standing in the way of the natural end of life, such as a feeding tube or respirator. Rabbis remain deeply divided over what constitutes an unreasonable obstacle to death.
It’s likely all available medical measures would be taken for Sharon, who led a secular lifestyle that paid little heed to Orthodox Jewish views. Yet any need for life-sustaining equipment could open the kind of religious showdowns in Israel that gripped the United States over Terri Schiavo, the brain-damaged Florida woman who died last year after her feeding tube was removed.
1986 rabbinate ruling
“When you have the situation where someone can live for years on life support, it no longer becomes a question of theology. It’s also brings in ethics,” said Dr. Mordechai Halperin, a rabbi who heads The Schlesinger Institute, a Jerusalem-based group that studies medical technology and Jewish law.
In Israel, physicians typically defer to families or patients about whether the treatment should follow secular or religious codes.
Many rabbis follow a 1986 decision by Israel’s chief rabbinate — the government’s highest religious authority — that defines death as irreversible inactivity of major parts of the brain stem, which controls breathing, swallowing and other basic bodily functions.
Head vs. heart
The opinion is based on various Jewish texts including the Mishnah, an early source of rabbinical tradition, which establishes decapitation as an irrefutable sign of death. In the modern sense, the rabbis interpret a nonfunctioning brain stem as the same thing.
But others see the core of life in the heartbeat, which can occur even with a severely damaged brain stem and can continue with artificial respiration. Some rabbis cite ancient texts that say death occurs only when there is both no respiration and no “movement” in the body.
They consider a heartbeat a life-signifying movement even if maintained through life-support and may counsel followers not to remove life support.
There is also an array of other rabbinical opinions on “brain death” that adds complications in Israel to issues such as organ donation which very few Israelis agree to for both cultural and religious reasons. Jewish tradition calls for keeping the human body intact both before and after death — a provision which discourages many Jews from cremation among other things.
Sharon reportedly signed an organ donor card last year, but his age would likely prevent his organs from being transplanted.
“There is no sweeping ruling on brain death ... It’s a very tangled subject,” said Haim Cohen, an assistant to Rabbi Yosef Shalom Elyashiv, a leading authority of Jewish law.
Religion adjusts to reality
The issues are so delicate that it took six years for Israel’s top rabbinical scholars, physicians and other experts to hammer out legislation to allow the terminally ill to refuse life support. It passed last month with one unique provision: the equipment could only be turned off by an automatic timer to avoid having a health care worker do it.
As a concession to Orthodox Jewish lawmakers, the law extends the right only to patients diagnosed with six months or less to live — and not to those in a coma or in a vegetative state.
“With all the life-sustaining measures available, it’s hard to describe when death occurs in a modern hospital or intensive care unit,” said Zohar. “Religion is still trying to adjust to this reality.”