In 2016, Lucy Booth was dying of cancer. First diagnosed in 2011, the disease had by then spread from her breast to her bones, liver and lung. When her doctor, Adrian Tookman, visited her as she lay in a hospital bed, she told him she wanted to be able to choose when her life ended.
The Jewish palliative care specialist, who served as the medical director of Hampstead’s Marie Curie Hospice, told her that this was not permissible under the law. If she wrote him an email explaining her position, though, he said he would share it with people so they could understand.
“I’m writing to you to outline how I would like the end to be,” Booth later wrote to Tookman. “Frankly I would like to know a day (at least), preferably a time and to have a degree of control over the process. Realistically I know that isn’t the case and I just have to wait until I’m ready to go. That terrifies me – the thought of feeling like this indefinitely is horrifying to me.”
Later this month, members of parliament are due to debate and vote on legislation that could allow assisted dying in Britain to take place legally for the first time.
Proposed by backbench Labour MP Kim Leadbeater, the Terminally Ill Adults (End of Life) Bill has provoked criticism from the health secretary and concerns that it could lead to vulnerable people being pushed into ending their lives prematurely, but is widely supported by the general public.
According to a poll published by Ipsos UK earlier this year, 65 per cent of people say it should be legal for a doctor to assist a patient aged 18 and over to end their life by prescribing medication that they can take themselves. Just 17 per cent said they opposed it.
For the Jewish community, however, the issue is more complex.
Judaism traditionally places the sanctity of human life at its centre, viewing it as a precious gift from God that cannot be disposed of at will.
In evidence given to a parliamentary select committee in 2005, the Chief Rabbi’s Office quoted Rabbi JD Bleich, an expert on Jewish law and ethics, setting out the Orthodox line.
“Any positive act designed to hasten the death of the patient is equated with murder in Jewish law, even if the death is hastened only by a matter of moments,” he wrote.
“No matter how laudable the intentions of the person performing an act of mercy-killing may be, his deed constitutes an act of homicide.” Asked this week about his position on the Terminally Ill Adults Bill, the Chief Rabbi said he believed it had the potential to “fundamentally alter the way we regard life as uniquely precious”.
Sir Ephraim Mirvis continued: “The quest to bring peace to those who are suffering unimaginable pain is a noble one – undoubtedly rooted in compassion and empathy.
“But this proposed law will have the unintended consequence of creating at least as much anguish as it alleviates.
“The burden it would place on our most vulnerable patients, on their families and on medical staff, as well as the profound effect on the conscience of those left behind, is surely too high a price to pay.
“The devastating evidence from other countries is clear: when we numb, or remove altogether, our reverence for the precious gift of life itself, we withdraw from a moral standard, to which we might never return.” Others have argued that as medical science and societal attitudes change, the Jewish position ought to move with it.
Speaking to the JC, former senior rabbi of West London Synagogue Baroness Neuberger said her experience as a rabbi had led her to change her mind on the issue.
“I had always been opposed to any form of assisted dying but I have changed my view in that in that I think given the way healthcare has gone, and given that we are ageing longer, I think there are times when individuals find their suffering unbearable.
“I think it’s really important to keep healthcare professionals out of this but there are limited circumstances where it should be permitted.
“I have been with a lot of people who have been dying as a pastoral rabbi.
“People near the end of the road find the last few days and weeks really hard. Their lungs might be filling up with water, or they might have bone cancer, which is very painful.
“You might say that’s part of being alive, but having seen it when there is no question this person is going to die anyway it is hard not to think they should be allowed to end their life.” The crossbench peer’s view is also informed by her experience chairing a 2013 inquiry into the care pathway used for dying patients in Britain, which led the government to change its policy on the issue.
“Death has improved enormously,” Neuberger said, adding, however, that “you can’t have a straightforward blueprint. There’s not enough palliative care.
“They say it can sort everybody’s pain but that’s not true.”
Rabbi Jonathan Romain said he had also changed his mind after meeting terminally ill people.
“I would say on a general level the only reason why there is a bill in the first place is because so many people have been dying in pain. Most people will know someone in their family or a friend who has had a painful end. Many people who have a range of diseases have a truly awful death.
“As a rabbi I went around hospitals and saw people dying in pain and wanting to let go.
“One person told me, ‘Every night I pray to God that I will go.’ The tipping point for me was when I spoke to a man named Colin in a hospice receiving really good care.
“He was on his bed kneeling with his head between his knees. He said,’This is the only way I can control the pain.’ I thought there had to be another way.”
Romain, the former rabbi of Maidenhead Synagogue, is now the chair of Dignity in Dying, a campaign group that lobbies for a change in the law, and has been advising Leadbeater on her bill.
“There are all sorts of safeguards. You will need two doctors to examine you and for you to be terminally ill.
“This system has been going on in Oregon for 27 years. It has worked well, there hasn’t been a dramatic uptake. I thought we have to catch up with a system that’s been working successfully.
“Frankly, everywhere I go, whether synagogues or other places, I find I’m pushing at an open door. I expect to be heckled but I’m absolutely not.
“People have seen friends or family suffering. Most people say that if things got really awful, we want an option. This seems to me to be the religious choice.”
Orthodox rabbinical leaders who oppose legalising assisted dying, he claimed, are out of step with their congregations.
“I think they’re using an ancient criterion for a modern problem and it’s simply no longer applicable.
“It’s the same in the church, the Archbishop of Canterbury is opposed but most priests and the laity are in favour. Opinion poll after opinion poll shows this.”
For Tookman, who is now retired but practised palliative care for decades, the important question is how assisted dying is regulated.
“In terms of the Jewish community, my understanding is that Orthodox Jews don’t want to allow it. I suspect they will be very opposed,” he said. “At one level that is understandable but if you’re looking at this from an Orthodox Jewish perspective, God has designed us to die in a certain way. You relax, close your eyes, and switch off. But a lot goes on in medicine now that challenges that anyway.”
The issue, he said, is not black or white but grey.
Tookman added: “When I used to see my punters, my patients, when I used to say to them, ‘What do you think about legalising euthanasia?’ virtually all of them said the same thing. ‘You know what, I do not want euthanasia, but I would like to know that it’s around if things got really tough.’ That’s what they all said. I feel that we need to support that.”