Laws Concerning a Dangerously Ill Patient and a Dying Person - Part 2

Confession

We do not tell a dangerously ill patient to confess his sins, lest he become disheartened and lose hope. However, if the patient is approaching death, we tell him: "Confess your sins." And we say to him: "Many people have confessed and did not die. And many who did not confess, died. And as a reward for confessing, you will live, and everyone who confesses has a portion in the World to Come." If he cannot confess verbally, it is effective for him to confess in his heart. All these things are not said in the presence of common people, women, or children, lest they cry and break his heart. It is appropriate to recite the poem "To You, My God, Is My Desire" that is said on the night of Yom Kippur, which contains elements of confession. (Section 338:1, A 75)

If he does not know how to confess, we tell him to say: "May my death be an atonement for all my sins." (Tractate Sanhedrin 43b)

Ideally, one should recite the confession verbally, as Maimonides wrote (Laws of Repentance 1:1-2): For all commandments in the Torah, if a person transgressed any of them, whether intentionally or unintentionally, when he repents and turns from his sin, he must confess before Hashem... How does one confess? He says: "Please, Hashem, I have sinned, I have transgressed, I have rebelled before You and have done such and such, and I regret and am ashamed of my actions, and I will never return to this thing again." This is the essence of confession. And whoever elaborates in confession and extends this matter is praiseworthy. And one must confess with his lips and articulate these matters that he has resolved in his heart.

However, if he cannot express it verbally, it is sufficient to confess in his heart, as we find that repentance in the heart is effective, as explained in the Talmud (Tractate Kiddushin 49b): If one says to a woman, "You are betrothed to me on the condition that I am completely righteous," even if he was completely wicked, she is betrothed out of doubt, for perhaps he had thoughts of repentance in his heart. And Rabbeinu Bachya wrote that we find in the Midrash Tehillim on the verse (45:1): "To the conductor, upon shoshanim, by the sons of Korah... My heart is stirred with a good matter; I say my works to the king," to inform you that anyone who cannot confess verbally, since his heart is stirred with repentance, Hashem accepts him. And so the sons of Korah, when the abyss was opened beneath them, and fire was blazing around them, and they could not confess with their mouths, until their hearts were stirred with repentance, and He accepted them immediately. "I say my works to the king" - if stirring is in the heart, why mention saying? Rather, they said, if we stirred in our hearts, we have already said our works to the King of kings, Hashem. And because of this, their repentance was accepted, and a great chain of Levites came from them, including the prophet Samuel, who was equal to Moses and Aaron. (A 75)

Order of Confession

"I acknowledge before You, Hashem, my God and the God of my fathers, that my healing and my death are in Your hands. May it be Your will to heal me completely. And if I die, may my death be an atonement for all the sins, iniquities, and transgressions that I have committed before You, and grant me my portion in the Garden of Eden, and grant me merit for the World to Come that is reserved for the righteous." And if he wants to elaborate like the Yom Kippur confession, he may do so. (Section 338:2)

What is Repentance?

The essence of repentance consists of three elements: confession, regret, and commitment for the future. Meaning, one should confess his evil deeds as mentioned above, regret them and feel pain for what he has done, and accept upon himself wholeheartedly never to return to them at all. In other words, from now on he will fulfill the commandments and not return to his old ways. But if he does not intend to abandon his sins, his repentance is ineffective.

Don't Give Up on Repentance

The patient's relatives should make every effort to help him repent for his sins, because this may be his last opportunity to repent; and if, God forbid, he dies without repentance, woe to him for all his deeds for which he will be punished in the World to Come. But if he merits to truly repent, Hashem is merciful and gracious and abundant in kindness, forgives him, and his sins will not be mentioned after his passing, and through this merit he will rise in the resurrection of the dead. Therefore, even on Shabbat and holidays, it is permissible to recite the confession with him, because if not now, when?! (Ma'ayan Omer, 2008 edition, Part 4, 222)

Maimonides wrote (Laws of Repentance 2:1): One who repents in his old age, at a time when he is no longer able to commit the sins he used to commit, although it is not the highest form of repentance, it still benefits him and he is considered a penitent. Even if he transgressed all his life and repented on the day of his death and died in a state of repentance, all his sins are forgiven, for if he remembered his Creator and repented before dying, he is forgiven. See there. And in Otzar HaMidrashim (p. 579) it is brought that Rabbi Eliezer the Great asked from Heaven: Will Hashem resurrect only some of Israel or all of them? And they answered him: Anyone who repents before his Creator before his death, even if he transgressed all positive and negative commandments, and all those liable for excision and court executions, and desecration of God's name, if he repented, death atones for him along with repentance, as it is said (Ezekiel 37:12): "And you shall know that I am Hashem, when I open your graves and bring you up from your graves, My people," from here that the resurrection of the dead applies to all Israel, if they repent. But one who says 'I will sin and repent, I will sin and repent,' meaning he will commit sins and then repent, Heaven does not provide him the opportunity to repent. (Maimonides, Laws of Repentance 4:1)

Final Rebuke

A person whose children did not merit to follow the path of Hashem should use the final opportunity to rebuke them gently before his passing, urging them to abandon their evil ways and return to the path of Torah and commandments as Hashem has commanded us, because at that time hearts are broken and words are more readily accepted. This is hinted at in what is said (Genesis 18:19) about Abraham our father: "For I have known him, that he will command his children and his household after him, and they shall keep the way of Hashem."

Touching a Dying Person

A dying person (goses) is considered alive in every respect. It is forbidden to touch him at all, lest it hasten his death. And one who touches him is considered a shedder of blood. In Tractate Shabbat (151b) they said: One who closes the eyes with the departure of the soul [meaning, closes the eyes of a dying person], is considered a shedder of blood. What is this comparable to? To a candle that is going out and dripping, that as soon as a person places his finger on it, it immediately goes out. (Section 339:1, A 76)

Mercy Killing

Even if the patient is dying for a long time and is in great pain, it is forbidden to cause him to die quickly. (Rema, Section 339:1, A 81)

Disconnecting Life Support

A terminally ill patient whom doctors say has no chance of survival must be treated with all medications and treatments, and it is forbidden to disconnect the machines to hasten his end and ease his suffering, as this is actual murder. The family members should ensure that the doctors feed the patient through a feeding tube and treat him properly. One must be very careful about this, because there are those who disregard proper treatment for terminally ill patients. (D 69)

Because of You!

A senior professor at a hospital in London, who was known as a Jew with no connection to Judaism, suddenly began coming to work wearing a kippah. To the astonishment of the doctors, he told them his story as follows:

"As you recall, about a week ago, an elderly man was hospitalized in our department, suffering from high blood pressure, kidney and heart disorders, and recently had a severe stroke, and was lying in pain connected to machines. After several days without change, I recommended to the family that it would be better to perform 'mercy killing' for the elderly man and disconnect him from all the machines that were forcibly keeping him alive, suffering and in pain. Better to release him from his suffering! The family agreed with me, and I myself disconnected him from the machines, out of compassion, to save him from the suffering.

That night when I went to sleep, I saw him in my dream, standing before me, angry and shouting at me: "What have you done to me? Why did you hasten my death? Why did you do this injustice to me?"

And I, out of fear and trembling, could barely stammer and say to the old man: "I meant only for your benefit! I saw your pain, the great suffering you went through, and I thought it was better for you to die than to live in such severe suffering"!

And the old man became even angrier with me and said: "You intended for my benefit"?! He explained that his condition was such that he had four more days to live on the machines and to endure more severe suffering, and then he would have entered Paradise directly, pure and clean, having been cleansed through his suffering. But now, since I removed the machines from him and caused him to die four days earlier, he is missing the suffering of those four days, and he doesn't know how long it will take until he is cleansed from the remainder of his sins. Because suffering in this world cleanses much more than the sufferings of Gehenna. Now he has to pay in the sufferings of Gehenna for all the transgressions that remained for him.

The doctor continues to tell: I woke up in panic, trembling and drenched in cold sweat, and on the spot I decided to change direction! If I merited to see with my own eyes that there is a World to Come and there is judgment and accounting above, there is reward and punishment, and there is also a precise accounting for every suffering of a person, I cannot remain indifferent!" (Told by Rabbi Yaakov Galinsky. Brought in the book "Leshichno Tidreshu" Part 1, page 311)

My dear brother, know that throughout life, the evil inclination distracts us with heretical views or temptations and vanities, just to turn us away from our main purpose in this world. Sometimes a person receives a hint from Heaven and becomes aware of the truth and remembers why he came here, but sometimes he does not become aware and continues to be lulled by the temptations of the inclination. A person is obligated to try to awaken himself and be wise and intelligent, and to store up Torah and commandments with great strength, because only today is for doing them, and tomorrow is for receiving their reward.

Kohen Physician

It is permissible for a specialist physician who is a Kohen to enter a place where a dying person is located and treat him, because perhaps he will be able to heal him. For even doubt regarding saving a life overrides the entire Torah. (A 76)

Digging a Grave

One should not dig a grave for a dying person until after he dies. (A 82)

Better Death Than Life

A patient who is suffering greatly from severe and bitter pains, and the doctors have given up on his life, and he asks his acquaintance to pray for him to die, because death is better for him than life, if it is clear that the patient has no chance of living, one may pray quietly to Hashem: "Please, Hashem, have mercy and compassion on the patient so-and-so to revive and heal him. And if a decree has already been decreed upon him, please remove his sufferings from him, and do what is good in Your eyes." (A 39)