WHO SHALL LIVE AND WHO SHALL DIE -- Genesis 48:3

 
The Genesis:3 Project

And Jacob said to Joseph, “El Shaddai appeared to me at Luz in the land of Canaan, and He blessed me,         Genesis 48:3
 
A couple of years ago in these columns, I wrote about the last years of my grandmother’s life.  My father’s mom had descended into dementia and then declining physical health.  I was barely a rabbi at the time and I was asked to eulogize her; I spoke about the city of Luz, a town relocated when the Israelites entered Canaan, as a reward to the woman who assisted the Israelites, Rahab. 
 
Luz, says a story from the tradition, was unique in that the Angel of Death had no dominion there.  When old people wanted to die, they had to step outside the walls of the city.  And I noted that although “Luz” means “almond” in Hebrew, it means “light” in Spanish.  When old people wanted to die, they stepped outside the light.
 
Last week I had the opportunity to hear (and meet) one of my heroes – Dr. Atul Gawande. His book Being Mortal ought to be required reading, less for the answers he offers (though they are great) than for the questions he asks.  In short, as a surgeon he has admiration for the advances in medicine that put more sophisticated and effective technology at our disposal.  As a member of the human family and a (recently bereaved) son, he wonders whether the purpose of that technology is getting lost in our celebration of it.
 
Last week I also connected with another physician-thinker, Dr. Ezekiel Emanuel.  (It was his birthday – he turned 60, which is significant, as you will see.)  More than any public figure, Zeke has been considering the resources we invest in extraordinary medical treatments.  Like me, he agrees that faced with a specific case, there is no price that can be put on a human life.  But he also believes that there are resources that can do greater good for more people than the “extraordinary means” used to preserve a single life that will shortly ebb away.
 
Zeke’s courage in raising the questions as part of a broader discussion of health care in the country earned him a certain scorn from some segments of the “religious right.”  And he got a lot of grief from me when he declared that when he reaches the age of 70 his instructions to his health care providers will be to dispense with expensive tests and treatments.  Hence, my birthday wishes for many healthy decades.
 
But whether the reason for critiquing the efforts we expend derives from a love for greater humanity (the Emanuel approach) or a love for the autonomy of the patient (the Gawande approach), the questions that are raised fly in the face of a central tenet of Judaism and, in most readings, Christianity.
 
What does life represent?  Is it something vouchsafed to humanity to protect and preserve in the aggregate?  Is it the “possession” of the individual body that contains it?  Is it the realm of God which must be preserved lest we usurp the divine prerogative?
 
Nothing will agitate someone who believes that life is God’s domain alone than suggesting that we mortals can decide “who shall live and who shall die.”  That agitation may be focused on reproductive choice, criminal sanctions, euthanasia or the conduct of war, but it stems from a deep belief that life is sacred and therefore not for the human taking.  (BTW, not all such people put God in the equation.)
 
But it is hard to argue with Atul Gawande’s statement, “People have priorities in life other than living long.”  I know it myself; in thinking about my own wishes, I would much rather forego debilitating treatments if they rob me of my ability to enjoy the company of those I love and, in the process, leave them remembering me in some spiral of misery.  My attitude is a quantum shift for me; I once told my wife that if I got sick, she could sell the farm to keep me alive.
 
The decision to relinquish extraordinary treatments, which amounts to passive self-eradication, might be made for reasons admirable, shameful or morally neutral.  A great deal of debate has taken place (and will continue) on which of those judgmental adjectives pertains to any given individual.
 
But both as a matter of personal choice (Gawande) and public policy (Ezekiel) – and even for those of us like me who take an approach more influenced by theology – what is undeniable is the insight offered by a young woman named Sarah who received Atul Gawande’s full endorsement when she suggested, “you can’t decide what kind of health care you want if you don’t know what kind of life you want.”
 
I hope that the nature of life in Luz – city, orchard or light – will come clear to me and be for a blessing before my time comes to step out.

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NOTE: You may be noticing that there are 50 chapters in Genesis and we are getting very near the end.  After a brief hiatus, the Genesis:3 Project will become the Exodus:5 Project.  And from there?  We’ll see.