Euthanasia: History, Definitions and Clinical Guidelines from Classical Jewish Sources.

Background: End-of-life care is a central ethical problem for clinicians. The definition of euthanasia is complex and difficult causing confusion for its practical application. Historically, the term was abused leading to medical atrocities. We trust that during medical training and in continuous medical education programs ethical topics relevant for clinical practice should be addressed systematically in their cultural context. The awareness for these crucial topics will improve clinical performance.

Objective: To define philosophical concepts, to present historical events, to discuss classical attitudes in modern bioethics and to analyze classical Jewish sources which are helpful to elaborate practical guidelines for clinicians in euthanasia and end-of-life care. Reflection on these concepts by discussing classical Jewish sources might help clinicians in their judgment and process of decision-making.

Methods: A historical overview with philosophical definitions of the concepts of active versus passive euthanasia, physician assisted suicide etc are given. Sources from the classical Jewish literature are presented and analyzed also according to later traditional interpretation. Their relevance and application in modern clinical medicine is elaborated.

Results: Philosophically, the distinction between active versus passive euthanasia is crucial. Jewish sources certainly support the obligation to ease the ongoing process of dying; there is no duty to prolong the agony of the actively dying patient, which is actually prohibited. On the other hand, no practical involvement is allowed to actively induce death of the terminal patient.

Conclusion: The historical overview and the review of the literature support the need to define concepts of euthanasia for clinicians dealing with end-of-life issues, since this term caused historically and philosophically major confusion. Therefore, ethical issues should be included in formal training for physicians and other health care providers, in order to improve the clinical approach for these challenging aspects of clinical medicine. We believe, that classical Jewish sources might contribute to elaborate clinical definitions and to provide meaningful approaches for practical guidelines for clinicians.