Dear Editor,

While this may be the very first time in my life that I reach out to an official platform to share a public opinion, perhaps it is fitting to make a Shehecheyanu for the occasion.

I feel compelled to bring to light another side of the discussion raised by the thoughtful and sincere letter recently written by a dedicated and deeply concerned critical care nurse practitioner. I appreciate—and truly understand—the emotional and professional weight behind the points she raised. They reflect genuine compassion, integrity, and firsthand experience at the bedside.

At the same time, it is essential—using the strongest and clearest language—to clarify several vital points that may help frame this conversation more accurately from a halachic standpoint, particularly as we navigate the complex intersection of medicine and end-of-life care in 2026.

What I am about to share is largely based on a powerful talk I once heard from one of the foremost poskim of our generation in the field of medical halacha, Rabbi Zischa Ausch. Rabbi Ausch is uniquely positioned in that his halachic authority is broadly accepted across the Orthodox spectrum—from the most stringent circles to the Modern Orthodox community. Across the aisle, he is respected not only for his encyclopedic knowledge, but for his clarity, wisdom, and unwavering fidelity to halacha.

In that talk, Rabbi Ausch highlighted several fundamental differences between the worldview of secular medicine and that of halachic Judaism. Secular medical training—whether for physicians, physician assistants, or nurse practitioners—is deeply rooted in values such as patient autonomy, quality of life assessments, and outcome-based decision-making. These principles, while ethically grounded and often compassionate, are not always congruent with the halachic framework.

Halacha approaches life not as a negotiable commodity but as a divine trust. The preservation of life (pikuach nefesh) is not merely a value—it is a mandate. Decisions at the end of life are therefore not guided primarily by subjective measures of suffering or perceived dignity, but by objective halachic criteria developed over centuries, informed by Torah sources, Chazal, and contemporary poskim who grapple daily with modern medical realities.

This does not mean that halacha is indifferent to suffering—quite the opposite. Halachic literature is rich with nuanced discussions about pain management, proportional treatment, and when certain interventions may or may not be obligatory. But these determinations are never made in isolation, nor are they left solely to personal judgment or emotional instinct. They require careful analysis, humility, and consultation with recognized halachic authorities who are fluent both in Torah and in medicine.

To compare the level of care in an average community hospital to that of one of the top five institutional hospitals in America is, quite simply, far removed from reality. These are not interchangeable systems, nor are their resources, experience, or institutional cultures comparable.

Would anyone seriously compare the care one receives from Hatzolah to that of a standard municipal or state ambulance service? Of course not. The devotion, level of expertise, speed, and sheer commitment demonstrated by these extraordinary volunteers is universally recognized—even by those outside the Jewish community. The difference is not merely technical; it is philosophical. It reflects a culture in which saving a life is not just a profession, but a sacred mission.

The same distinction applies within hospitals. Elite tertiary and quaternary care centers operate with a depth of specialization, interdisciplinary collaboration, and institutional memory that fundamentally alters clinical decision-making—especially in complex end-of-life situations. Outcomes, prognostication, and even ethical framing can look dramatically different when evaluated by teams that handle such cases daily, rather than sporadically.

This distinction matters enormously when discussing questions of futility, prognosis, or whether “nothing more can be done.” Too often, conclusions reached in resource-limited or experience-limited settings are presented as absolute, when in truth they may be context-dependent.

From a halachic perspective, this is not a technical footnote—it is central. Decisions of such gravity cannot be made based on partial data, constrained environments, or generalized assumptions. Halacha demands that when life is at stake, every reasonable avenue be explored, every relevant expert consulted, and every assumption carefully examined.

There is little dispute that much of today’s healthcare system is increasingly driven by financial metrics, institutional pressures, and outcome-based efficiency, often at the expense of the singular, unwavering focus on fighting for the patient as an individual. This reality, while uncomfortable, is widely acknowledged—even within the medical community itself.

In that context, one must ask a fundamental question: Would this nurse—or the broader medical establishment—expect a Rav to factor in the growing acceptance of physician-assisted suicide when rendering a halachic decision at the end of life? After all, within contemporary medical ethics, assisted suicide is increasingly framed as an act of compassion, a means of alleviating suffering.

The answer is, of course, no.

Such considerations are categorically irrelevant to halachic decision-making, because they violate one of the core and immutable principles of the Torah: that human life is sacred, inviolable, and never subject to intentional termination. No reframing of language, no shift in cultural norms, and no professional consensus can override this foundational truth.

This contrast makes something abundantly clear. Halacha and modern medicine—as it is trained, practiced, and ethically framed in 2026—do not always walk hand in hand. While medicine may redefine compassion, autonomy, and dignity in ways that evolve with societal values, halacha remains anchored in eternal principles that do not bend to trends or pressures.

Therefore, it is essential to distinguish between medical input, which is indispensable for understanding facts and possibilities, and halachic authority, which alone determines obligation, limitation, and permissibility. Confusing the two does a disservice not only to Torah, but to the very patients we seek to protect.

Of course, any Rav who is asked to rule on such weighty she’eilos must be medically knowledgeable and must engage seriously and responsibly with the treating physicians. Halacha does not operate in a vacuum. Dialogue with doctors is essential, and medical facts must be clearly understood.

However, the final determination—the pesak—rests unequivocally in the hands of the Rav.

The Torah itself is explicit: “ועשית ככל אשר יורוך”—you shall act in accordance with that which they instruct you. And Chazal teach us, “אפילו אומרים לך על ימין שהוא שמאל ועל שמאל שהוא ימין”—even if they tell you that right is left and left is right, we are commanded to listen. This is not blind obedience, but a divinely mandated framework for preserving clarity, continuity, and fidelity to Torah across generations.

From Moshe Rabbeinu onward, Klal Yisrael has lived by this principle: that the Torah guides every aspect of life, and especially matters of life and death. Nowhere is this more evident than in the realm of pikuach nefesh, which stands at the very foundation of Jewish existence. Shabbos itself—one of the most sacred pillars of Torah observance—is set aside when a Jewish life is at stake. This alone testifies to how profoundly the Torah values the life of a Yid.

Chazal go even further, teaching that when a Jew passes away, it is as though a Sefer Torah has been burned. Such a statement is not poetic exaggeration; it is a halachic and spiritual declaration of the infinite worth of every Jewish life.

It is for this reason that we must be exceptionally vigilant and extraordinarily careful when approaching end-of-life decisions. These are not merely medical judgments, nor are they ethical abstractions. They are Torah decisions—ones that demand humility, precision, and submission to halachic authority.

My intent in writing is not to dismiss the concerns raised, nor to diminish the invaluable role of compassionate medical professionals. Rather, it is to emphasize that when discussing end-of-life care within the Jewish community, halacha must be presented accurately, responsibly, and without being filtered through assumptions borrowed from a secular ethical framework.

These conversations are difficult. They are painful. And they demand sensitivity. But they also demand precision.

Respectfully,

Chaim Meisels

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