Compassion vs halacha: UK assisted dying bill sparks Jewish debate

"There’s nothing holy about agony. So if people are terminally ill and want to avoid pain, then why on earth should we not help them do so? That seems to me a Jewish response.”

This means that the bill has progressed further than any previous bill on assisted dying.

Over the last four years, Romain has been at the forefront of campaigning for the law on assisted dying to be changed. He has also written a book, A Better Death, about assisted dying and the history and morality of the subject, which is to be released on February 1.

Aside from being convenor of the Beit Din of Britain’s Movement for Reform Judaism, he also served as the former chairman of the Religious Alliance for Dignity in Dying, a group of religious people from different faiths across the UK fighting for a change in the law on assisted dying.

However, Romain was not always in favor of assisted dying.

Most of Judaism’s opposition to assisted dying is grounded in Halacha (Jewish law), which posits human life as sacred and divinely owned and not something a person may dispose of at will. This thus effectively prohibits taking a life, including one’s own, or assisting in death, which would also be deemed a form of killing.

Additionally, there is the principle of pikuah nefesh (the obligation to preserve life), which overrides almost all other commandments. And finally is the concept of a goses, someone who is about to die. Halacha says that a goses cannot be touched in a way that quickens their death, and any action that shortens their life is prohibited (Semahot 1:1-4; Aruch Hashulhan, Yore De’ah 339:1; Shulhan Aruch, Orah Hayim 329:4; Bi’ur Halacha).

These factors help form the mainstream Jewish law opposition to assisted dying; in essence, until someone is dead, they are alive, and therefore must be kept alive at all costs. Romain himself was once part of the mainstream view.

However, it was when he became a congregational rabbi for 2,500-3000 people (Maidenhead Synagogue) and began visiting terminally ill people in hospices and hospitals that he ultimately changed his mind.

“It seemed to me that although some people had very good deaths, others were dying in pain.”

The trigger point for Romain was during the hospice visit to a man named Colin. “He was not just in bed, he was on his bed, kneeling on his bed, with his head between his knees. And I said to him, in the nicest possible way, you know, Why are you in that rather strange position? And he said, ‘It’s the only way I can control the pain."

“And I thought there has to be a better way than this.”

When he began to research the topic, Romain said, he was pleasantly surprised to find out that assisted dying is not a free-for-all but actually is strongly regulated with specific safeguards.

According to the current bill, to be eligible, a person must be diagnosed with a terminal illness with six months or less left to live. They must be mentally competent at the time of request and must be over 18. Two independent doctors must confirm eligibility, and there must be a cooling-off period between the initial request and the final request.

If all is approved, a doctor would prescribe a medication which the patient has to administer themselves. A doctor does not administer it.

And the legalization of assisted dying is not new. The first place to formally permit assisted dying by law was the US state of Oregon in 1997. Since then, Switzerland, Australia, Colombia, and nine other US states have legalized it. Seven countries permit euthanasia (where the doctor administers the medication).

“I thought, my goodness, this isn’t a leap into the dark. We’re actually catching up with other countries,” Romain told the Post. “And we’ve got over a quarter of a century’s worth of medical knowledge and monitoring and methodology behind us.”

It was at this point in his journey that Romain also began to distinguish between suicide and assisted dying. “Suicide is when you take your own life for all sorts of different reasons, whether it’s out of depression or because of bankruptcy or political statement. But if you hadn’t done so, you may well have lived another 10, 15, 20 years, as opposed to assisted dying, which is when you are about to die anyway in the next few weeks or months. So it’s not so much a matter of shortening life. It’s more a matter of shortening death.”

Generally, Britons are in favor. A Dignity in Dying poll of over 10,000 people in 2024 found that about 75% of Britons supported it, with only around 14% opposed.

Nevertheless, for many Jews, and indeed religious Muslims and Christians, the idea of assisted dying is antithetical to religious adherence and therefore forbidden.

“The truth is that this is new territory for Judaism, so it’s actually very hard to quote the past. What you can do is quote values like compassion.

“And it seems to me that if somebody is dying and they’re in pain and they’re mentally competent and they want to let go, and there are so many horrible diseases around like cancer, motor neurone, heart disease, then in whose interest are we keeping them alive? In whose interest are we denying them the right to say, I’d like to let go.

“And therefore, it just seems to me more moral and more religious and more Jewish to let people have that choice, providing those three redlines are observed. In other words, they’re terminally ill. They are mentally competent. And it’s of their own free will.”

While Romain draws a line between suicide and assisted dying, he acknowledges that many rabbis do not, and will deem assisted dying to be suicide.

“The Orthodox are 100% against it, whereas the progressives are divided. And it’s one of these issues that really is a conscience vote, as it will be in the House of Lords. But perhaps the greatest split is between the religious hierarchy and the religious membership.” In other words, although many rabbis across the spectrum (Orthodox and progressive) are opposed, a very high percentage of their congregants are in favor.

And Romain noted that the interesting thing is that, even with rabbis who oppose it, some have still said that they know the law is potentially coming, and though they don’t approve of it, they will give pastoral support to anyone who does.

Another interesting observation for Romain is that the same split found with Jews on assisted dying was seen with Catholics and the Church of England. (Not with imams, of whom 100% were against.)

“Many bishops and priests are against it, whereas in terms of the membership, ordinary Catholics, ordinary Church of England, there is a wide approval for it.

“And again, just to be clear, not for assisted dying, but for the option of assisted dying.” For Romain, this distinction is really important, as it is a choice.

“If most people are asked, if you are dying, you’ve been told you’ve only got a few weeks or months to live, and you are in great pain, would you like to have the option? Not necessarily have an assisted death, but would you like to have the option of an assisted death? Then most people will say yes.

“When you’re approaching death, you have a menu of options, whether it’s carrying on to the last moment, having chemo, having transitive care, going to a hospice, staying at home, having an assisted death. It’s your body, your choice. And just like we choose everything else in life, there’s another principle for you.

“We choose what career to pursue, where to live, who to marry, whether to divorce. We choose everything. Why should we not be able to choose the way we die as well?

“Particularly if it’s a matter of avoiding pain and avoiding suffering. I mean, for me, as a Jew, as a rabbi, there’s nothing sacred about suffering. There’s nothing holy about agony. So if people are in that situation and want to avoid pain, then why on earth should we not help them do so? That seems to me a Jewish response.”

“Though I fundamentally differ with the proponents of this bill, I have nothing but respect for the deep humanity which has clearly motivated them,” Mirvis said.

However, while he said he would not presume to dictate to a person “suffering unbearable pain at the end of their life,” he nevertheless felt a moral obligation to express deep concerns about the bill’s implications.

Mirvis argued that the granting of a right to end one’s own life imposes a new and immeasurable pressure on terminal patients, who are already extremely vulnerable, and that such a choice cannot be protected against all manner of external influences, “regardless of the proposed safeguards.”

Mirvis said data from the state of Oregon have shown that between 30% and 40% of terminally ill patients who have opted to end their life cited being a burden on their friends and family as one of their motivations.

“The emotional or practical strain that we place on those around us would never be considered a factor in determining the value of our lives in any other context, and we must not allow it to be so in the case of a terminal patient,” he added.

The chief rabbi also argued that assisted dying would constitute a major ethical paradigm shift in medicine, but also in society. “Medicine is, and has always been, to heal and ease pain – never to end life. The effect of this bill would be to alter the ethical landscape in which doctors work forever, even for those who might choose to opt out.

“Over the years, I have heard countless heart-rending stories of those desperate to take control of the end of their lives and to end their suffering by ending their lives,” he said. “No decent person could fail to be moved by their experiences.

“Yet, my appeal to you is on behalf of those whose stories will never be heard – those who would never let it be known that if not for the emotional or financial burden they felt they had become, they might just choose life.”