Rabbi Yehuda Finchas
Telling the Truth to End-of-Life Patients
Rochelle’s dilemma kept her awake at night. Her mother, Miriam, has been diagnosed with a life-threatening illness. Understanding the gravity of the situation, Rochelle was unsure how to disclose the news to her mother. On one hand, Miriam had a right to know the truth about her condition, as patient autonomy is an essential ethical value. On the other hand, Rochelle wanted to protect her mother. She feared the news might harm her mother and Rochelle didn’t want her mother to lose hope or spirit. “Rabbi,” she asked me, “what should I do?”
Delivering Traumatic News
Delivering traumatic news requires care, especially for those who are ill. Hacham Ovadia, zt”l, (Hazon Ovadia, Avelut, Vol. 1, p. 76) offers a nuanced perspective on Rochelle’s dilemma. The Shulchan Aruch states that a dying person should recite Vidui (a special confession before death, Shulchan Aruch Y.D. 338:1, based on Shabbat 32a). However, Hacham Ovadia cites the Shach, noting that this applies only to a patient who is imminently dying. Prior to that stage, disclosing critical information may cause the patient harm, and therefore Vidui should be postponed until they are nearing death.
Hacham Ovadia explains that even if a patient asks their physician, “Will I make it through this illness?” the physician should respond, “Hopefully, with Hashem’s help, you will recover,” regardless of their personal belief. This approach is intended to shield the patient from harm and to help them to maintain their hope.
Hacham Ovadia’s rationale is supported by an exchange between Elisha Hanavi and Hazael, the messenger of King Ben Haddad, who was critically ill. Hazael inquired whether King Ben Haddad would live or die, and Elisha instructed him to tell the king that he would live, despite knowing he would not. The rationale was that disclosing the truth could have lethal consequences for the king (Melachim 2:8-10). The verse states that Ben Haddad would “not live,” “not” is spelled lamed alef. But the word “not” can also be read lamed vav – “to him: “Tell [to] him (Ben Haddad) he will live.” Similarly, Rashi notes that Sarah Imenu died after hearing the news of the Akedah, believing her son Yitzhak had perished (Rashi, Beresheet 23:3). This highlights the need for caution when conveying traumatic news.
Trust in Hashem and Do Not Give Up Hope
Hacham Ovadia also emphasizes that medical misdiagnoses are not uncommon, and treatment can still be effective, particularly early in an illness when the prognosis remains unclear. He stresses that patients should always place their faith in Hashem, never lose hope, and continue to pray “even if a sword is placed on their throat” (Berachot 10a) – meaning they should maintain faith even in dire circumstances, as Hashem can annul any decree.
Practically, it may be impossible or counterproductive to conceal the truth entirely. For example, cancer patients must provide consent for treatments like chemotherapy or surgery. However, this information should be communicated compassionately, focusing on the positive aspects of treatment in order to prevent distress and maintain hope. If a physician struggles to communicate appropriately with a patient, they should relay the information to family members who can convey it sensitively. Conversations that could distress the patient should also be avoided in their presence.
Compassion Is Key
Returning to Rochelle’s dilemma, while truth-telling is a fundamental aspect of Judaism, it is not always the highest priority. Sometimes, it may be appropriate to soften the truth or to emphasize positive aspects to protect an ill person from harm. Ultimately, these decisions should be made based on the illness, prognosis, and treatment plan. Discussions on how to proceed should include family members, the patient’s physicians, and the rabbi, to ensure the well-being of their loved one.
Rabbi Yehuda Finchas is a recognized expert, lecturer, and author on Medical Halacha. He is the head of the Torat Habayit Medical Halacha Institute. His latest book is “Brain Death in Halacha and the Tower of Babel Syndrome.” To contact Rabbi Finchas, please email rabbi@torathabayit.com.