4/5/99

To go in peace

    Promise me this, Masha Lebowitz had said: if I cannot live with dignity, let me die. I do not want to be humiliated.
    That was before her devastating stroke. Today she is 91, unalive, undead -- and an unwilling participant in a precedent-setting legal wrangle.
    Her son Benny (their names have been changed) petitioned the courts to let nature take its course, by discontinuing the invasive, technological manner in which she is kept alive.
    But there's a complication: she is not connected to a breathing apparatus, as in most such cases. Masha is being sustained by a feeding tube: in essence, Benny is asking that his mother be starved to death.
    "She doesn't feel anything, she's brain dead, vegetative, so she wouldn't feel hunger. The doctors said so," Benny says. "It would save her from this terrible end. My mother was a woman who spoke seven languages, she was highly cultured -- and she was very afraid of this."
    If he speaks about her in the past, it is because "she died long ago."
    Deborah Opolion-Honig, a Tel Aviv-area lawyer, says this is "a major precedent worldwide. Usually these cases are about respirators, but this woman is breathing on her own. She just can't swallow. The District Court ruled in mid-April that doctors could disconnect her, so she could die more quickly. It's the first time the court has determined that a feeding tube can be disconnected."
    The problem is, the management of Kupat Holim Clalit has refused to comply with the court's opinion. It can legally do so, because the court issued a declarative judgment: a recommendation, not an order.
    And so the medical staff at Beit Rivka, in Petah Tikva, is still providing her sustenance. In the meantime, a whorling debate is brewing that involves medicine, law, ethics, halacha and, inevitably, politics.
    Lawyer Yitzhak Choshen represents the family. This is his specialty: he has handled all 20 such cases in the past, with two more upcoming.
    In 1987 he founded Lilach -- the Israeli Society to Live and Die with Dignity. With a membership of over 4,000 strong, its aim is twofold: to assist people in preparing a "living will" by which they express a desire not to be kept alive on life-support systems; and to win legislation making a living will legal.
     Lilach supporters emphasize that this is not euthenasia, assisted suicide or mercy killing: it is a choice of peaceful, natural death over pointless medical intervention.
    "It's not a political issue, it's sociological -- but in the end, the politicians have to decide," says Choshen, who can't understand why an enlightened society is so afraid to deal with the issue. "I was expecting opposition from the religious parties, but there's been only silence. Yet who's stopping the law? Religious politicians. They're afraid of the slippery slope," even though there is halachic justification for disconnecting a life-support apparatus.

RITA GUR became involved with Lilach after her long-suffering husband, Mordechai "Motta" Gur, committed suicide in 1995. 
    "Motta was terminally ill with bone cancer, he knew he was ill for 6 years and sometimes he was in great pain, but he continued. He decided to commit suicide when the cancer reached his brain. He knew he could not control his life, and he decided that was it. He couldn't read anymore, and his brain-eye coordination was worsening.
    "I became active in Lilach because when I thought of Motta I thought he was an extremely courageous man, but he wanted to die with dignity. I see so many people who are suffering -- many of my friends have parents in terrible situations, and we think the law should be changed, and the living will respected."
    Tellingly, Lilach's membership, which used to consist almost entirely of pensioners, has attracted many younger people to its cause. 
    "In the modern world, people live much longer but not necessarily in good health. The medical profession is stopping nature. We're saying, don't kill people, but don't force them to continue living an artificial life.
    "It's not a choice of life and death, but a choice between ways of dying."
    Motta Gur was the IDF's chief of staff. He was commander of the battle for Jerusalem in the Six Day War. He was deputy minister under Rabin, continuing his work even after finding out he had cancer.
    The war hero was up to any battle, but fearful of a prolonged, undignified death, he surrendered.
    Masha Lebowitz cannot determine her own fate. She can't even die in peace. The last thing she'd want to hear is that her fate is to be appealed in court in a month.