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מכון שלזינגר לחקר הרפואה על פי ההלכה

treating an end-stage liver patient with possibly life shortening procedure

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20 ביוני 2014

הרב המשיב: פרופ' אברהם שטינברג

שאלה:

Dear Team at Schlesinger Institute
 
I hope you are all well.
Just wanted your views and possibly to point us towards some literature about the following case:
Lady is 70s end stage idiopathic cirrhosis of liver. Patient had pedal oedema and pulmonary oedema from poor liver function
What is the consensus about giving such a patient sub cut fluids in the end stage of life.
I would think that it may actually shorten life as the  intra vascular oncotic pressure is so low that the fluid will be deposited in the extra vascular space making breathing and moving more difficult.

Please comment and try give us some sources to look at

Thank you

תשובה:

In principle, one should not administer a treatment that endangers the patient. This is true for any patient, and is true also for a patient at end stage. On the other hand, it is prohibited to stop fluids because of "ideological" reasons. I.e., when there is no danger to the patient from the feeding or hydration, it is prohibited to stop this because of low-quality life.
Addition of Rav Halperin: On the practical level, each case needs to be evaluated individually. In some cases, indeed, fluids should not be given in large quantities, on account of danger to the patient. There is still an obligation to give fluids in a smaller quantity, which will prevent dehydration, but will not endanger the patient. The details in each case are complicated and require a formal medical recommendation from an expert who is treating and familiar with the patient.
See entry "Terminally Ill" in Encyclopedia of Jewish Medical Ethics, vol. III, pp. 1046-1088.

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