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before a blind man.” See also the Radak (on Shmuel I, 31:3) and see the
Shulchan Aruch (Yoreh De’ah 345:3) who writes: “Similarly, an adult
who commits suicide, acting under compulsion like Shaul Hamelech
– nothing at all [in the way of honor] should be withheld from him.”

Another argument that can be added in support of the above ruling
is as follows. The Ramban (in his Commentary to the Torah, Bereishis
34:13), writes that Yaakov’s sons killed the inhabitants of the city of
Shechem because the latter could be assumed to have violated the
seven Noahide mitzvos. This implies that even though they did not
formally sentence them to death -- for it is unlikely that they judged
each and every individual and received testimony about him that he
had violated the seven mitzvos – they were nevertheless allowed to
kill them. Possibly, the Rambam who takes issue with the Ramban on
this point and writes that they killed them because they had failed to
implement a system of laws [as required by one of their seven mitz-
vos] is of the opinion that they were obligated to judge them and that
they could not be killed without first judging them.

See Tosfos in Avodah Zarah (64b, s.v. aizehu) who write: “Should
you ask, but a gentile is liable for the death penalty as soon as he
violates [any one of ] the seven Noahide mitzvos, because their being
commanded in the Torah [about their mitzvos] in and of itself con-
stitutes their death [sentence, for disobeying, without any need for
prior warning as is required for Jews]? The answer can be given that
so long as they have not been judged by a beis din, they do not incur
the death penalty. Know that it is so, for we say (ibid. 26a),‘Idolaters
should be neither taken out of, nor put into [a pit]’ [thus, we do not
put them into a pit to die, even though they are probably liable for the
death penalty because they worship idols].” The Rambam apparently
follows Tosfos’s opinion.

According to this, in South Africa where they practice idolatry and
are suspected of doing other sins, there are grounds for leniency in
regard to mercy killing.

At any rate, the director’s best option is to sign only that he has
examined the patient’s condition and that the patient is suffering
terribly and cannot be cured. He should also confirm that the patient

454 1 Medical-Halachic Responsa of Rav Zilberstein