On halakhic approaches to medical care for the terminally ill: a response.

It has been a privilege and an extraordinary learning opportunity to serve on the Law Committee's Subcommittee on Biomedical Ethics. Most especially, it has been a deeply rewarding experience to sit as one of the midwives attending the birth of these two superb papers on halakhic approaches to medical care for the terminally ill, the one by Rabbi Avram Reisner and the other by Rabbi Elliot Dorff. Now that both papers have been birthed, although I must say that I favor one over the other, I have deep appreciation for both. Rabbi Reisner's paper is surely one of the finest statements in the field, combining the strictest articulation of halakhic principles surrounding the sanctity of life with keen awareness of the clinical issues at the bedside. This is no view from the ivory tower, no empty proclamation of bookish teachings regarding the sanctity of life. Rabbi Reisner, as wellinformed on the medical issues as a layperson can be, wrestles honestly with the day-to-day realities of the Intensive Care Unit, and still, with his eyes open to the contemporary medical scene, maintains a very traditional stance in terms of the basic halakhic principles surrounding care for the terminally ill. His suggestion of the distinction between mechanical and biological intervention is helpful, if slippery (as are all such distinctions in the literature of medical ethics!), and he uses it deftly to soften in practice the harsh conservatism of his basic philosophical stance. Most importantly from my perspective, Rabbi Reisner adds a unique spiritual view to the voluminous literature on these issues, by suggesting an image of the patient's internal dialogue with God. For Rabbi Reisner,