Jewish Teaching and Cancer Care

This page explains what Jewish law and practice say about cancer care. It covers accepting treatment and what happens after death. It is for Jewish patients and families. It is also for care teams who want to understand their choices.

The Rabbinical Council of America (RCA) is an Orthodox body. It says Jewish law "emphatically emphasizes the preservation of life." For most people, that means accepting cancer treatment is the starting point. Some questions are best taken to your own rabbi. These include Shabbat, fasting, or a particular medicine. Your rabbi can apply the law to your situation.

Accepting treatment is the easy part. Stopping it is where Orthodox, Conservative and Reform authorities part ways. The differences are real. Flattening them would be misleading.

Orthodox. The RCA's 2009 guidelines are blunt. "Removal of a respirator, when it will directly result in the patient's immediate death, is unequivocally prohibited." They say a do-not-resuscitate order may sometimes be halachicly appropriate. (Halacha means Jewish law.) They also warn that staff can read a DNR order as an order for "DNT, Do Not Treat". So families should state exactly what they intend. On feeding, the guidelines say halachic authorities generally recommend nutrition for all patients. There may be circumstances when it is stopped in accordance with halacha. Brain death is a point of dispute. The guidelines say to discuss it with a halachic authority.

Conservative. The Committee on Jewish Law and Standards adopted Rabbi Elliot Dorff's paper on 12 December 1990. Rabbi Avram Reisner's paper offers a different approach. A subcommittee of the committee later wrote a comparison. The legal reasoning of the two papers differs strongly. Rabbi Dorff's paper permits pain medication in doses sufficient to dull the pain. This is so even if it may hasten death. It also discusses when nutrition and hydration may be withheld. Rabbi Reisner insists on protecting even a short remaining life. A Conservative patient should ask their own rabbi which paper to follow.

Reform. Responsa from the Central Conference of American Rabbis say that "there are times when it is ethically permissible to withdraw most forms of medical treatment, to allow nature to take its course and to let the patient die without further heroic measures." They also hold that "we are forbidden to practice active euthanasia or assisted suicide." Reform decision-making puts the most weight on the patient's own judgment.

The Orthodox guidelines are emphatic. "The alleviation of pain and suffering is a mitzvah and should not be withheld out of concern for potential adverse effects." (A mitzvah is a religious duty.) They permit narcotic medicine, even where it may possibly hasten death. This applies when the only intent is to relieve suffering. The dose should be raised gradually as needed. The Dorff paper also permits doses sufficient to dull pain, as above.

Details are easier to sort out before you need them. Raise these with your care team:

• Kosher food.
• Shabbat and festival dates when treatment is scheduled.
• How your family can be reached.
• Any questions about medicines.

Ask your own rabbi about specific rules. You may need a medicine and worry about its ingredients. Do not stop it. Ask your pharmacist and your rabbi.

NCI notes that many hospitals have chaplains. They support people of different faiths. NCI also says the care team can refer you to your own religious or spiritual leader. Ask for both. Give the team your rabbi's contact details early, rather than during a crisis. For an Orthodox patient, the RCA says end-of-life questions should go to a halachic authority.

Burial customs and religious practices after death are a matter for your rabbi and your funeral home. Tell the hospital about your wishes in advance. Include who your funeral home is, so staff know who to contact.

NCI says sperm banking is the most common fertility preservation method for males who have gone through puberty. It advises talking with your doctor and a fertility specialist before starting treatment. This matters if having a biological child may be important to you. Religious questions about methods are for your rabbi. Raise fertility at your first oncology appointment.

• NCI — Spirituality in Cancer Care (PDQ), Patient Version
• NCI — Male Fertility and Cancer
• Rabbinical Council of America — Halachic Guidelines for End-of-Life Medical Decisions (2009)
• Rabbi Elliot N. Dorff — A Jewish Approach to End-Stage Medical Care, adopted by the CJLS on 12 December 1990
• CJLS Biomedical Ethics subcommittee — Mai Beinaihu?, comparing the Dorff and Reisner papers
• Central Conference of American Rabbis — Responsum NYP no. 5763.3, on determining death