Rabbi Gillman's opinion about end of life decision-making is detached from the world where I practice geriatric medicine. In my world, feeding tubes, Foley catheters, and continual nursing care can prolong life. But God, who creates and sustains life, and who commands me to do the same, would not recognize this life as being created in His image. Families who have "chosen life" sometimes find themselves watching loved ones exist for years in a state that they did not foresee. Unfortunately, opinions like Rabbi Gillman's can induce guilt that leads people to make choices that they will later regret. His opinion carries with it all the gravity of the seminary and the rabbinic authority that goes with it. Therefore he should be careful about expressing extreme views without any qualification.

He states that awareness is the quality that differentiates a human from a tree. However, at the extremes of life, awareness recedes into lethargy, stupor, and coma. Is there any point along this continuum at which we do not have to fight death to the end with all available resources? I think that there is such a point. I wish that Rabbi Gillman could spend a day making rounds with me to give me his opinion about real, living, breathing, but insensate people. Does Rabbi Gillman really want me to intubate, hydrate, amputate, and otherwise invade the integrity of my patient's bodies at the end of life, without there being some point when enough is enough?

Rabbi, this is not a detached, philosophical, academic debate. If you want to help those of us who grapple with problems raised when a person is at the intersection of life and death, you need to give us more than the slogan to "choose life" in every case.