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How do You Define Quality of Life?

on Friday, June 15 2012. Posted by Rabbi Efrem Goldberg

He was a complete stranger when I sat down, but after a three and a half hour delay, I had made a new friend.  My flight to NY to attend what would be the magnificent Tirschwell wedding was delayed significantly and so I foundmyself a comfortable seat to settle into for a few hours.   The elderly gentleman sitting next to me bemoaned our unexpected wait and we proceeded to exchange pleasantries for a few moments.  It turns out he lives in Boca too and while he had a more traditional upbringing, he confessed that he hasn’t been to “Temple” for many years.

I took out my laptop and my cell phone and began to use the newfound time to get some work done.  A significant amount of time had passed in which I returned email, made phone calls and spent some time learning.  All the while, my new friend stared at his iPad.   When I inquired what he wasdoing he told me he was watching his stocks.  For three straight hours, he literally stared at the screen and watched his stocks go up a few cents, down a few cents.    He didn’t read a book or newspaper, talk to family on his cell, or even watch a movie.  He just stared at his portfolio endlessly.

As I observed my new friend and his singular activity, I couldn’t stop thinking of an expression that dominated two difficult conversations that I had this week – “quality of life.”  You see, the culture of medicine has shifted radically of late, particularly in end of life situations.   Two separate individuals struggling with their health, heard the same thing from their Doctors independently.   Their Physicians, who had taken the Hippocratic Oath which includes a pledge to never do harm to one’s patients, did just that through their biased judgment and slanted statements.

Both men were told almost the identical thing by their Doctors.  Both Physicians refused to perform minor procedures to heal their patients claiming it was unkind to extend the lives of people with such little “quality of life.”  One Doctor actually told his patient, “you can no longer care for yourself and you can’t do anything meaningful.  Just accept the fact that you are dying.”   Not surprisingly, these words have had a horrific impact on this person and his attitude towards recovery.

Unquestionably, Jewish law takes the concept of quality of life into account in sophisticated end of life dilemmas like DNR orders, etc.  A patient or their family may decide to forgo heroic or life saving measures if they determine that quality of life will not be restored should they experience cardiac arrest or another life ending incident.

However, Jewish law leaves the determination of what is quality of life to the patient and their family.  Halacha values every single moment of life and each and every breath is considered precious no matter the level of cognition or function. Jewish law mandates doing everything in our power to sustain a person and keep them alive, assuming that is their wish.   That is why having a Halachic Living Will or Health Care Proxy is so critical.  To violate the patient’s wishes and withhold care that could lengthen their life is tantamount to a form of murder.

The approach and insensitive words of these two Doctors was egregious, harmful,irresponsible and inexcusable.  In the end, both were persuaded to follow the family’s orders and carry out the procedures.  But the damage donethrough their earlier statements is irreparable.  Not only are the patients themselves disheartened, despondent and pessimistic about their future, the families of these individuals feel like they have been punched in the gut.  Of course they understand the poor prognosis of their loved ones and are realistic about their diagnosis.  But while they once saw the Doctors as being their greatest source of support and hope, they now view them as adversaries in the fight to keep their loved ones alive.

As I sat next to my new friend in the airport having just spoken to these two families, I was struck by our society’s approach to end of life issues and the distorted contemporary definition ofquality of life.  The elderly man sitting next to me, at least superficially, looked healthy.  And yet, given his chosen activity for 3 hours straight, it seems to me he lacks a real quality of life.  The two men I described are struggling withtheir health, and rely on lots of medicine, care and therapies.  And yet, simply interacting with their wives, children and grandchildren, putting tefillin on and davening every day, makes them feel like their lives have great quality, despite what their Physicians may say.

It is up to each and every one of us to determine and achieve quality in our lives.   Meaning, purpose and worth can be found no matter our health or condition.   Whether we are young or old, healthy or God forbid ill, working or retired, let’s fill our time inmeaningful ways and use our energy now matter how great or how little to connect and bond with those we love, including Hashem.

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