When my small-group facilitator asked whether withdrawing life support is morally different from withholding it, my classmates offered the usual responses: autonomy, prognosis, and suffering. My mind was somewhere else entirely. It was the first time I had understood something that I had never questioned.

In medicine, categories exist to serve people; in Jewish law (Halakha), people often exist to serve categories. For years I never saw the cost until we talked about life support.

The boundaries of tradition

Jewish law often uses legal fictions to create normative categories. For example, I grew up with a widely accepted practice known as “selling chametz.” Instead of getting rid of all the leavened bread (chametz) from our home, my family, like thousands of other Jewish families, would “sell” the chametz to a non-Jew for a nominal sum for the duration of Passover and then buy it back.

As a child, this struck me as harmless, almost clever. The way I saw it, Halakha established certain normative boundaries we Jews had to live in. As long as we operated within those boundaries, there was no harm done.

But what about when those “harmless” legal fictions collide with the reality of someone’s suffering?

The reality of the bedside

The following scenario is a composite meant to reflect common end-of-life situations. An older gentleman with late-stage prostate cancer is lying in a hospital bed in severe pain. His family sits huddled around the bed, concern etched on each of their faces. The cancer has spread throughout his body, resulting in multiple organ failure.

The patient’s life is sustained only through the power of a miraculous assembly of machines surrounding him: one stimulates his lungs to breathe, another cleans his blood since his kidneys have long since failed. To remove him from these machines means certain death, but it also means an end to his incalculable suffering. After all, there is no recovery from this illness: It is a matter of when, not if.

Situations like this have to be handled every single day by physicians. In our small group discussions, we are encouraged to take on the role of a physician in the scenario. How would we handle this situation?

Our classroom discussion focused on what was truly best for the patient and his family. Does the patient want to continue living in pain? If he chooses to stop life-prolonging treatment, can his family live with that decision? What is the physician’s role in all this?

Legal fictions versus human suffering

While my peers discussed, I imagined myself in the room with that patient, the weight of responsibility heavy on my shoulders as I got ready to discuss the patient’s options with his family. How could I tell them that the most humane choice would be to pull the plug?

I found myself returning to a lesson I had internalized during my Orthodox upbringing. I was taught that every moment of human life is sacred. Even when help seems impossible, prayer and divine intervention could still make the impossible possible. Therefore, any actions that shorten a person’s life, even by a second, are nothing less than murder.

But take a more concrete question: If a patient dependent on life support must be briefly unplugged for maintenance, are we obligated to reconnect them? Some Jewish authorities say no in terminal cases, framing it as removing “mi’akvei mitah,” or “impediments to death.”

Is it truly meaningful to call this distinction anything other than a legal fiction?

Someone with a physician’s sensibilities would say that this kind of moral sleight of hand is dehumanizing. To my eyes, this reduces the patient’s life to an insignificant variable in a much larger divine calculus, an inconvenient legal reality that must be accounted for.

As a doctor-in-training, the legal fictions that had once seemed so clever to me suddenly felt deeply unsettling. How could I reasonably claim that my duty as a physician is to prolong the patient’s suffering for as long as possible? Would sparing another human being days or weeks of agony truly make me a murderer?

Certainty versus humility

As the debate swirled around me, something clicked. I had grown up thinking Halakhists were so clever, devising strategies to accommodate the needs of the present while not upending tradition. What clicked was the realization that Halakha was protecting its categories, while medicine was asking me to protect a person, and for the first time, the moral cost of that difference felt real.

To be clear, Halakhic opinions on end-of-life are diverse and often deeply compassionate, as is appropriate with an issue of this magnitude. Some authorities allow non-initiation of treatment in cases of irreversible suffering, while others maintain a stricter view rooted in the sanctity of every moment of life. But even within this diversity, Halakha remains a legal system. Its central task is to classify actions and outcomes within normative categories, even when those categories come at the cost of real human suffering.

Medicine, on the other hand, recognizes that these issues are complex and personal. Every family must make their own decision in their own time. Doctors can only facilitate discussion; they cannot direct it, because only the people involved can make the best decision for them. Medicine has its own limitations: DNR orders, prognostic scores, insurance limits. But even with those limitations, its compass always points in one direction: the patient’s best interests.

Halakha was operating with certainty; medicine was operating with humility.

One of the most powerful lessons I have learned in my clinical training is the value of ideological flexibility. To see patients in their lowest moments, where the difference between life and death is a few clicks on a computer or a plastic tube keeping someone alive, is to watch the distance between life and death collapse entirely.

The sacred ground of the patient’s bedside demands not clever legal fictions, but compassion, open-mindedness, and a profound humility that reminds me why I was called to medicine in the first place: not to defend categories, but to serve people.

Jonah Rocheeld is a medical student.