The divide comes from how the tube
that provides food and water is defined. If
it is seen as a medical device, as Rabbi
Dorff does, it may be removed. If it is seen
as a feeding device, as Rabbi Reisner does,
it may not be removed.
Rabbi Dorff puts a person dependent
A Life Is A Life
on a feeding, tube "in the halachic cate-
gory of treita which, he argues, is a life
Rabbi Avi Shafran of the fervently
Rabbi
Nevins
that does not require our full protec-
Orthodox Agudath Israel of America in
tion," said former Detroiter Rabbi Joel
New York said the Schiavo case is
Roth, a member of the Conservative
"straightforward from a Jewish
movement's Rabbinical Assembly's law
perspective."
committee, who, in 1990, was the chair
"The most important point from a
of the committee on end-stage medical
halachic standpoint is that a compromised
care.
life is still a life," he said.
Rabbis Reisner and Roth disagree with
"In the Schiavo case, you're not dealing
Rabbi Dorff.
with a patient in extremis," said Rabbi
"Even in the end stage," Rabbi Roth
Shafran, noting that until her feeding tube
noted, "there is the value of chaya shaah,
was removed, Schiavo was not dying.
the life of the hour." In other words, he
In Jewish law, there is a category for a
Rabbi Syme
said, even when there is very little life left,
person at the edge of death; the rules for
that life still matters.
such a person, called a goses, are compli-
A living will document was created dur-
cated.
ing
the end-stage meetings with medical
"There are times when certain medical
consultant New Jersey-based Dr. Michael
intervention is halachically contraindicat-
A. Nevins, father of Adat Shalom
ed," Rabbi Shafran said. "There may be
Synagogue Rabbi Daniel Nevins.
times when it's OK not to shock a heart
"Because we are a pluralistic movement,
back into beating, not to administer certain
and because each position received the req-
drugs. You do not prolong the act of
uisite support, Conservative rabbis can
dying."
choose whichever position they find most
But Schiavo was not a goses, according
Rabbi Freedman compelling," Rabbi Nevins said.
to Rabbi Shafran. Instead, before the tube
A member of the Conservative move-
was removed she "had the exact same
ment's Committee on Jewish Law and
halachic status as a baby or a demented
Standards and the movement's bioethics
person. Like a baby, she was helpless, could
subcommittee, Rabbi Nevins wrote the
not feed herself and was not able to com-
responsum approved unanimously by the
municate in any meaningful way," he said.
movement regarding the halachic defini-
"But a life is a life."
tion of death.
"If death comes, you can thank God
"Over the past 20 years, Jewish bioethi-
because it's a relief; but you can't decide
cists have struggled with the best course of
yourself that it has to be done," said Rabbi
therapy for patients who, like Terri
David Feldman, who had an Orthodox
Schiavo, linger in a persistent vegetative
ordination and defines himself as "tradi-
state," he said. "Jewish law requires us to
tional." He is rabbi emeritus of the
Rabbi F inman
do everything possible to heal, but not
Conservadox Jewish Center of Teaneck,
everything possible to extend the dying
N.J., and dean of the Jewish Institute of
process. Many of our rabbis have taught us to view
Bioethics. "You can't hasten death yourself, with
artificial nutrition and hydration as a medical thera-
your own hands."
py — if it is not helping the patient regain health, it
The only time it would be acceptable to remove a
may be viewed as futile and be discontinued.
medical device, Rabbi Feldman said, would be if
"I personally have advised families in similar cir-
"something worse would happen — if leaving it in
cumstances that they are not obligated to continue
would cause infection or more pain."You can kill
artificial feeding, but may allow their loved one to
someone pursuing you; you can kill the soldier in
die if there is no reasonable expectation of his or her
the enemy army. Maybe very cautiously you can kill
if there is a death penalty, but you can't kill an inno- recovery. "
cent person because of illness," he said.
"I am shocked at what happened to Terri,
but I know that people are killed every sin-
gle day in our hospitals when they are
taken off food and water because someone
has deemed it is OK to do."
What Hastens Death?
Pluralistic Choice
The Conservative movement's 1990 study of end-
stage medical care resulted in the acceptance of two
opposing positions on tube-supplied nutrition and
hydration.
One, by Rabbi Elliot Dorff, "would permit with-
holding and withdrawing" the tube; the other, by
Rabbi Avraham Reisner, would not.
The Reform movement also does not speak with one
voice on this issue, according to Rabbi Mark
Washofsky, who teaches rabbinics at the movement's
Hebrew Union College-Jewish Institute of Religion
in Cincinnati and sits on the movement's responsa
committee.
Like the Conservative rabbis, the Reform rab-
bis base their view of whether a feeding tube
can be removed on their understanding of the
tube's function.
"We cannot claim that Jewish tradition categori-
cally prohibits the removal of food and water from
dying patients," Rabbi Washofsky said. "But we
consider food and water, no matter how they are
delivered, the staff of life. So what we ultimately
do is express deep reservations about their with-
drawal; but in the end we say, nonetheless, that
because we cannot declare that the cessation of
artificial nutrition and hydration is categorically
forbidden by Jewish moral thought, the patient
and the family must ultimately let their con-
sciences guide them."
Rabbi Daniel Syme of Temple Beth El said, "In
Jewish law, we are not allowed to do anything that
hastens or causes death. But if doctors are convinced
that someone like Terri Schiavo would not recover,
we are not required to use heroic measures to keep
her alive and the patient can be disconnected from
life support machines."
Rabbis generally agree on that point, but some
strongly disagree that the removal of a feeding tube
is a heroic measure.
Orthodox Rabbi Finman says that removal of a
tube that brings nutrition and hydration is not.
Rabbi Syme, however, said, "The Halachah is very
clear to me. We would be permitted to remove the
feeding tube."
Rabbi David Teutsch, director of the Center for
Jewish Ethics at the Reconstructionist Rabbinical
College in Philadelphia, agrees that the question is
how a feeding tube is defined.
"If it were a form of eating, a position held by a
number of more traditional halachic authorities,
then you're required to feed those who are hungry,"
Rabbi Teutsch said. "But if it's medicine — a posi-
tion held by Conservative authorities like Rabbi
Dorff, and by me as well — then you serve the
interests of the patient, which may involve not pro-
viding medicine."
Rabbi Teutsch believes a tube is a medical device,
so it can be removed. "It's pretty clear that it's closer
to regular intervention than to eating," he said.
Making Wishes Clear
In the heart-wrenching case of Terri Schiavo, rabbis
of different streams tend to agree one positive result
is that more people are discussing their wishes
regarding end-life care.
A living will established before illness could have
spared Terri Schiavo's family the agonizing battle
over her care. With that realization, some individu-
als are creating written, legally binding living wills
that spell out their wishes.
Rabbinic viewpoints differ here as well, with some
suggesting that written instructions include removal
of both life support and feeding and hydration
tubes, while others saying it is OK to ask only for
removal of life support machines.
The Conservative United Synagogue Review pub-
lished "Biomedical Ethics: A Conservative Jewish
Perspective," an article by Dr. Sander H. Mendelson
that includes these suggestions:
SHUTTING DOWN on page 18
3/31
2005
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