Judaism is concerned about the quality of life. 

Illness can be associated with unbearable suffering, and the Torah mandates us to try to alleviate such agony. The patient’s assessment and perception of their pain and suffering must be taken into account.

Palliative care (which should not be confused with hospice care) should always be considered at every stage of treatment and is a critical aspect of providing support.

 Pain is generally divided into two categories:

1. Acute pain, which comes on suddenly and has a limited duration.
2. Chronic pain, which lasts longer and is frequently associated with a long term illness.

Both can become debilitating and affect (and be affected by) a person’s state of mind.

Pain is usually caused by nerve damage (“neuropathic pain”) or tissue damage (“nociceptive pain”). It can spur psychological responses like fear, depression, stress, or anxiety, which may in turn increase or prolong the pain.   Besides causing significant decrease in emotional wellbeing and spiritual disheartment, inadequate pain relief may also hasten death by reducing mobility, increasing the work of breathing, and other harmful effects on the body.

Severe pain kills, literally and figuratively. As such, it is a serious matter that must be treated like other physical ailments.

This perspective on the treatment of pain has a number of consequences:

1. Cannabis:  Narcotics which might be prohibited by Jewish law to consume for recreational purposes are permissible to utilize for medicinal purposes, as recommended by one’s physician. This includes, for example, medical cannabis.
2. Supervision: A person should only utilize such medications under the supervision of their certified health care providers. This will help ensure the efficacy of the treatment as well as reduce risks of side effects and addiction. 
3. Risk Taking: Some invasive procedures, which always come with a level of risk, may be performed for the sake of pain alleviation. 
4. Choices:  A person may elect not to undergo a painful procedure that will leave him or her in great agony if the treatment is uncertain, will only minimally prolong their life, and/or not offer a cure for their illness.
5. Alertness or Pain Relief?: Pain management may, at times, necessitate strong medications which can impact a person’s alertness.  A person may choose a course of treatment that puts them asleep, even as this will mean they cannot interact with others or fulfill mitzvot. Alternatively, they may choose to receive lower doses of pain medication so that they may continue to interact with others, provided that such a choice does not interfere with a course of treatment that could heal their ailment.   
6. End-of-Life: Especially toward the end of life, it is critical to provide patients with appropriate pain medication to prevent unnecessarily suffering. This is a fulfillment of the mitzvah to “Love your neighbor as you love yourself.” Some fear that pain medications like morphine can sometimes have the effect of depressing respiration which may hasten the patient’s death. Like all medicine, pain medications can have unintended side effects. Yet studies have repeatedly shown that the careful administration of pain medications does not hasten someone’s death. Even if that would be an unintended consequence in an individual case, Jewish law asserts that it is permissible to treat pain and ensure the patient’s comfort, provided that this is the sole intent. Palliative care specialists are trained on how to gradually increase dosages, if necessary, to ensure the patient’s comfort without causing harm. Fear of possibly hastening death should not prevent us from providing the medication necessary to ensure the comfort of the patient.

Ematai’s conversation guide includes a few questions regarding pain tolerance to prepare patients and their families for possible dilemmas regarding pain medication.