Rabbi Yehuda Finchas
David sat at his father’s bedside in the ICU. Two weeks had passed since his catastrophic stroke. He had not regained consciousness, and the doctors saw no realistic path to recovery. David’s brother, his voice breaking, said quietly, “It is time to let him go comfortably. He would not have wanted this.” The family turned to me and asked, “Rabbi, can we ask the hospital to switch off the ventilator? What does halacha say?”
In Masechet Semachot (1:3–4), Chazal teach: “One may not move a dying person… until he dies… One who touches or moves the gosses is considered as one who spills blood.” Rabbi Meir likens the dying person to a flickering flame: “Just as touching a fading flame can extinguish it, so too, touching the dying person can shorten their life.”
Based on this principle, Hacham Ovadia Yosef, zt”l, rules that one cannot actively hasten the death of a person even if they are dying (Hazon Ovadia, Aveilut, vol. 1, p. 81). Likewise, Hacham Yitzhak Yosef(Yalkut Yosef, Shabbat, p. 276) rules explicitly that it is forbidden to disconnect a ventilator from a patient who depends on it.
Depriving a Person of Respiration as an Act of Killing
The Rambam’s analysis helps explain the basis of this ruling. In Hilchot Shabbat (11:1), he rules that one who strangles an animal is liable as a tolada (a derivative) of the prohibition against slaughtering. He extends this principle even to removing a fish from water. Liability arises already when the area between its fins dries such that it “can no longer live.”
The Rambam (Hilchot Rotzeach 3:9) also considers one liable for murder by covering a person’s mouth and nose, confining them in a room and filling it with smoke, or enclosing them and depriving them of breathable air. Although these cases appear very different, they all share the same underlying feature. In none of them does the perpetrator necessarily inflict a fatal wound. Rather, he deliberately interrupts the victim’s ability to breathe by removing the conditions necessary for continued respiration.
A Contemporary Parallel
The fish is not injured by a knife or a blow; rather, it dies because it has been removed from the environment that enables respiration. A modern parallel may be found in a deep-sea diver breathing through an external air supply. If another person were to deliberately sever that air supply, one would not describe the diver’s death as merely the consequence of being underwater. Rather, that deliberate act would ordinarily be regarded as the cause of death.
The Rambam’s example of smoke suggests a similar comparison. Imagine a victim rescued from a smoke-filled building who survives only because firefighters provide oxygen through a mask. Disconnecting the oxygen supply would cause that person’s death. The smoke explains why assisted respiration became necessary; the deliberate disconnection of the oxygen supply explains why the victim died at that moment.
Mechanical Ventilation
Although the Rambam was not discussing modern ventilators in intensive care medicine, his underlying principle extends to situations in which respiration depends upon an external source. A ventilator does not independently create life; rather, it provides the patient’s present means of respiration by enabling ventilation and oxygenation to continue when the body can no longer perform those functions on its own. Disconnecting a ventilator from a patient who remains dependent upon it interrupts that respiratory support and predictably results in hypoxia and death.
The patient’s illness explains why assisted ventilation became necessary, but the deliberate withdrawal of that respiratory support explains why the patient died.
Conclusion
Returning to David and his family: halacha does not permit them to direct the hospital to switch off the ventilator if doing so will cause death. Their love, and their genuine desire to end his suffering, does not transform a prohibited act into a permitted one. At the same time, every effort should be taken to relieve pain and suffering through appropriate care.
As with all complex end-of-life questions, one must seek guidance from a competent halachic authority. Organizations such as the Sephardic Division of Chayim Aruchim, launched specifically to address our community’s needs, are dedicated to offering sensitive, informed halachic support during these delicate and difficult moments.
Rabbi Yehuda Finchas is a worldwide expert, lecturer, and author on Medical Halacha. He heads the Torat Habayit Medical Halacha Institute. He is the author of Brain Death in Halacha and the Tower of Babel Syndrome and his latest book is Nutrition and Hydration in Halacha. To contact Rabbi Finchas, email rabbi@torathabayit.com.