Resuscitation of Aged Nursing Home Patients

Question

Recently, there was a story about an 87-year-old woman who suffered a heart attack in a nursing home. The nursing home called 911 and the dispatcher begged the nurse to do CPR on the patient until the paramedics arrived. The nurse on duty refused as it was against the nursing home's policy. This policy was roundly attacked by Orthodox rabbi and educator Rabbi Yair Hoffman who equates the denial of emergency medical treatment to murder. Rabbi Hoffman's analysis, however, seems at odds with those of Rav Moshe Feinstein who, in his responsa at Iggros Moshe, Choshen Mishpat Pt. 2 No. 73:1, outlines various circumstances in which a terminally-ill patient could be denied medical treatment. Comparing the two points of view seems to require that we need more information about the original patient, including, whether the patient gave the nursing home advanced instructions not to take drastic measures to save her life -- an instruction commonly known as a "DNR" (Do Not Resuscitate) order.

In making decisions about the care of our elderly or terminally-ill family members, especially for those who can't speak for themselves, what information do we need to know before (a) signing up with a nursing home/hospice facility, and (b) speaking to a rav about specific care issues?

Answer 1

I know a lawyer who writes living wills who is close with Rabbi Breitowitz; here's the language I've seen:

RABBI YITZCHAK BREITOWITZ ... HAS DETERMINED THAT ANY LIFE SUSTAINING TREATMENT, SUCH AS CPR, WHICH MUST BE EMPLOYED IMMEDIATELY TO AVOID DEATH SHALL BE EMPLOYED. ANY DECISIONS FOR LIFE SUSTAINING TREATMENT, SUCH AS A RESPIRATOR, THAT DO NOT NEED TO BE EMPLOYED IMMEDIATELY, MAY ONLY BE EMPLOYED AFTER CONSULTATION WITH RABBI BREITOWITZ.

But I'm not sure everyone agrees to that. As I'd heard from Dr. Fred Rosner, we have two classical cases to work with on this. On the one hand, "if someone is in the middle of dying, for someone else to push their eyes closed [could accelerate their dying] and is considered murder." On the other hand, "if someone is dying but can't relax because of loud noise outside of wood chopping, we silence the noise." Thus -- we don't hasten death, but we also don't prolong it! My impression from Dr. Rosner's talk was that in his opinion, CPR on someone elderly who's already had several heart failures may in fact be considered "prolonging death", but that was my impression, and there may be different opinions on this. Dr. Rosner's general approach is that we avoid "heroics" when dealing with the terminally ill patient. But "elderly" can mean a lot of different things, health-wise.

Rabbi Herschel Schachter is generally of the opinion that many difficult questions of treatment may actually be up to the patient and have no halachic preference, provided they are "reasonable." (And if the patient can't be asked, presumably the family has to make their best judgment as to their wishes; Rabbi Kenneth Brander mentions it's surprising how often people say "I wish they would have stopped treatment.")

In short, this is a conversation that should be had with the patient, the family, and the rabbi all present.