Confession and End-of-Life Teshuvah: Practical Guidance, Compassionate Boundaries, and Eternal Hope

The Torah instructs that we do not tell a dangerously ill patient to confess their sins, so as not to cause them despair. However, if the patient is close to death, we can suggest: “Confess your sins. Many people have confessed and did not die; many who did not confess did die. In the merit of confessing, you will live, and everyone who confesses has a share in the World to Come.” If they cannot speak, confessing in the heart is effective.

If the patient doesn’t know how to confess, teach them to say: “May my death be an atonement for all my sins.” (Sanhedrin 43b)

Ideally, vidui (confession) should be spoken aloud 

As Rambam writes (Hilchot Teshuvah 1:1–2): If a person violated any of the Torah’s commandments — whether intentionally or inadvertently, when they repent and return from their sin, they are obligated to confess before the Blessed God. 

They say: “Please, Hashem, I have sinned, I have transgressed, I have rebelled before You, and I did such-and-such. I regret and am ashamed of my deeds, and I will never return to this matter again.”
This is the essence of vidui. One who expands and elaborates is praiseworthy. One must verbalize with the lips what the heart has resolved.

If they cannot move their lips, confession in the heart suffices. We find that inner teshuvah is accepted (Kiddushin 49b). 

Rabbeinu Bachya cites Midrash Tehillim (45:1): “For the leader… A Song of the Sons of Korach… My heart overflows with a good matter; I speak my work to the King.” One who cannot confess with the mouth — if the heart stirs with repentance, God accepts it. The Sons of Korach, with the earth opened beneath them and fire all around, could not confess aloud; their hearts stirred in repentance and they were accepted. “I speak my work to the King” — if it is in our heart, it is as if we have already spoken before the King. From them came a great line of Levites, including Shmuel the Prophet, who was equal to Moshe and Aaron.

Text of the Vidui

“I acknowledge before You, Hashem my God and God of my fathers, that my healing and my death are in Your hand. May it be Your will to heal me with a complete healing. And if I die, may my death be an atonement for all the sins, iniquities, and transgressions that I have sinned, erred, and rebelled before You. Grant me a portion in Gan Eden, and merit me for the World to Come reserved for the righteous.” 

If one wishes to lengthen it like the Yom Kippur vidui, they may do so. 

What Is Teshuvah?

The core elements are as follows:

1. Vidui (confession),

2. Charatah (regret),

3. Kabbalah la’atid (commitment for the future).

One must confess as above, regret the deeds with heartfelt pain, and resolve never to return to them — meaning, from now on fulfill mitzvot and do not revert. If one has no intention of abandoning the sins, the teshuvah is ineffective.

Don’t Give Up on Teshuvah

Relatives should do everything possible to help the ill person return in teshuvah, as this may be their final opportunity. If, God forbid, one dies without teshuvah, woe for the deeds for which they will be punished in the World to Come. If however they merit true teshuvah, the Merciful One forgives and their sins are not recalled after death, and in that merit they will arise at Techiyat HaMeitim (resurrection). Therefore, even on Shabbat and Yom Tov one may say vidui with them.

Rambam explains (Hilchot Teshuvah 2:1): One who repents in old age, when they can no longer commit what they once did — even though this is not the ideal form, it still helps, and such a person is a ba’al teshuvah. Even if one sinned all their life but repented on the day of death and died in teshuvah, all sins are forgiven — if one remembers the Creator and returns before dying, they are pardoned.

Otzar HaMidrashim records that Rabbi Eliezer the Great asked from Heaven: will God revive only some of Israel or all? The answer is that everyone who repents before death — even one who violated all positive and negative commandments, incurred spiritual excision, capital punishments, and profaned God’s Name — if they repent, death with teshuvah atones. As it says (Yechezkel 37:12): “You will know that I am Hashem when I open your graves…” — techiyat ha’meitim applies to all Israel if they do teshuvah.

One who says, “I will sin and repent, sin and repent,” Heaven does not grant him the opportunity to repent. (Rambam Hilchot Teshuvah 4:1)

A Final Admonition

If one’s children are not walking in the ways of Torah, seize this final chance to gently urge them to abandon harmful paths and return to Torah and mitzvot. At that moment, hearts are broken and words are more readily accepted. As it says of Avraham (Bereishit 18:19): “For I know him, that he will command his children and his household after him, and they will keep the way of Hashem.”

Touching an Actively Dying Patient

A goses (actively dying patient) is considered fully alive. It is forbidden to touch them at all, lest one hasten death; one who does so is like a shedder of blood. The Talmud explains (Shabbat 151b): One who closes the eyes at the moment of the soul’s departure is like a murderer. Like a flickering candle — touch it and it goes out.

Even if a patient has been a in this state for a long time and suffers greatly, it is forbidden to cause their death to come sooner.

Withdrawing Life Support

A terminal patient whom doctors say has no chance to live must still receive all medications and treatments. It is strictly forbidden to disconnect machines to hasten death; this is murder. Family must ensure the patient is fed (e.g., via feeding tube) and properly cared for. Be very careful — some neglect the care of the terminally ill.

“Because of You!”

A senior professor in a London hospital — known as a completely non-observant Jew, suddenly began coming to work wearing a kippah. To the staff’s astonishment, he told this story: “A very elderly man was admitted with high blood pressure, kidney and heart issues, and a severe stroke. He lay suffering, connected to machines. After days without improvement, I advised the family to perform ‘mercy killing’ — to disconnect the machines that were keeping him alive in agony. They agreed, and I myself disconnected them, out of pity. 

That night, the old man appeared to me in a dream, furious: ‘What have you done to me? Why did you bring my death closer? Why such injustice?’ Trembling, I stammered: ‘I only meant your good! I saw your pain and thought it better to die than to live like this.’

He became angrier: ‘For my good?! I had four days left on the machines. I would have suffered, but then I would have entered Gan Eden cleansed and pure. By shortening my life by four days, you deprived me of cleansing through worldly suffering, and now I must undergo far worse suffering in Gehinnom for the remaining sins. Suffering in this world purifies far more than in the next.’

I woke in a cold sweat and resolved to change my life. If I have seen with my own eyes that there is a World to Come, judgment and accounting — even for a person’s suffering, how can I remain indifferent?” (Story told by Rav Yaakov Galinsky, Leshichno Tidreshu vol. 1, p. 310)

Throughout life the evil inclination distracts us with skepticism, temptations, trivialities, and anything to divert us from our purpose. Sometimes Heaven sends a hint, we awaken, remember why we came; but sometimes we do not, and remain lulled by seduction. It is on us to awaken, to be wise, and to store up Torah and mitzvot — for today is to do them, and tomorrow to receive the reward.

“Better Death Than Life” — How to Pray

For a patient in excruciating, unrelenting suffering with no medical hope, one may whisper a prayer: “Please, Hashem, have mercy and compassion on [name], to give him life and healing. And if a decree has already been issued, please remove his suffering, and do what is good in Your eyes.”