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Terminal Agitation in a Goses

Question:

A גוסס who is in a lot of pain and/or is agitated (referred to as terminal agitation – a very common occurrence in the end of life scenario) can be given relaxants and/or painkillers in order to ease the above mentioned symptoms. There are a number of ways in which these medicines can be administered 1. Insertion of an intravenous (IV) line which would then allow IV administration of relaxants and pain killers to ease the suffering in the last stages of life OR 2. Intramuscular or subcutaneous injections OR 3. Oral administration of the drug through the mouth or sublingually. All of the above involve touching or moving the גוסס in one way or another. Based on the principle of ׳דהנוגע בו ומזיזו ה׳ז שופך דמים’ is one permitted to do any of the above or not. What is the Rav’s opinion on this? Many thanks

Answer:

The point at which a terminally ill patient becomes halachically classified as a goses is something which is unclearly defined in the poskim. It is possible that many terminally ill patients are not yet classified as goses, in which case there would be no such restrictions. Even if we are stringent and do treat an end of life patient as a goses, it would be permissible to administer medication to alleviate his pain. The restriction to move a goses as described in Y:D 339 refers to moving him for a reason other than his personal and medical needs. Most of the examples brought there refer to preparations for death and burial, which is forbidden at that stage. Alleviating pain however is considered a basic need of an ill person, which may extend his life. Even if only for a short time, this qualifies as pikuach nefesh for “chayei shaah” for which we would even violate Shabbos to perform. See Pischei Tshuva at the begining of the above siman who quotes the Shvus Yaakov [3:13] who permits medical procedures even if they run the risk of causing early termination of life. The Poskim [on the above siman] quote various other permissible forms of contact with a goses, including washing his hand’s before the petirah, removing him from a place of danger, removing something from his mouth, and others. Certainly pain medication would be  included in this heter as well. The above is the opinion of Moreinu Harav.

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