As Florida lawmakers and judges weigh in on the question of whether a Florida woman should be kept alive with a feeding tube as her parents want or be allowed to die as her husband wishes, experts in Jewish law and ethics are split on the issue.
"Under no circumstances can they withhold it [the feeding tube]," said Rabbi J. David Bleich, a rosh yeshiva at the Rabbi Isaac Elchanan Theological Seminary in New York. "The purpose of removing it is to kill the patient and that is assisted suicide. Even those who would sanction withholding medication would not sanction withholding nutrition and hydration."
But Rabbi Aaron Mackler, a Conservative rabbi and professor at Duquesne University in Pittsburgh, disagrees, saying he views "artificial nutrition and hydration as
medical treatment, and usually if a medical treatment will help a person to stay alive it is good to give it. But it seems to me from what I read [in the Florida case] that the court found that this woman is permanently unconscious and that she would not have wanted a feeding tube in this condition. Her husband reports her preferences and agrees with them, so it seems to me reasonable not to coerce the treatment on her."
"Jewish authorities disagree with one another," Rabbi Mackler observed. "Rabbi Bleich is the foremost proponent of the view that is common among Orthodox authorities that nutrition and hydration need to be continued. There are a few Orthodox authorities who disagree and say that sometimes, with reluctance, a decision to forego the feeding tube should be honored."
Rabbi Mackler said the Conservative movement also has two "carefully developed opinions" that disagree with each other. One, propounded by Rabbi Elliot Dorf, "permits the foregoing of a feeding tube for patients who are permanently unconscious or terminally ill," Rabbi Mackler said. The other, by Rabbi Avram Reisner, said a feeding tube and medications must always be given.
"On this issue, the preponderance [of Conservative rabbis] are probably with Rabbi Dorf," he said. "The Conservative movement has a model of an advance directive, which is something like a living will, that includes both positions as approved reasonable choices."
"Many Orthodox, as well as Conservative and Reform rabbis, would say that to forego medical intervention because it merely extends the dying process is not killing the patient," Rabbi Mackler added. "Also, providing it is burdensome to the patient and delays the dying process. A patients’ choice not to accept the burdens involved should be respected."
Rabbi Moshe Tendler, a professor of medical ethics at Yeshiva University, pointed out that there is a difference between American law and Jewish law. Oregon, for instance, permits doctor-assisted suicide. And a federal law effective in 1990 allows a person to sign a health care proxy that permits a person to direct that no feeding tube be used to keep him or her alive.
"If we knew that was the person’s wish, someone putting in the tube would be charged with battery, a felony," he said.
And in 1986, the U.S. Supreme Court in the Cruzan case ruled that artificial feeding is to be deemed medical care that may be removed, Rabbi Tendler said.
"Jewish law would say that is murder," he said flatly, "because you know that the person canít live without water. Jewish law would interpret the removal of the feeding tube as active euthanasia, not a passive act."
In the Florida case, which involves Theresa "Terri" Schiavo, 39, who has been in a coma for 13 years following a heart attack, the issue being debated is the sanctity of life, Rabbi Tendler said.
He said it was proper to insert the feeding tube 13 years ago in the hope her body would repair itself, and that "taking it out is murder."
Florida Gov. Jeb Bush ordered the tube reinserted last week after the Florida Legislature permitted him to override a court order that permitted doctors to remove the tube at the request of her husband, Michael.
Rabbi David Teutsch, director of the Center for Jewish Ethics at the Reconstructionist Rabbinical College in Philadelphia, said a person who has an illness from which he will not recover, like terminal cancer or Alzheimer’s disease, is considered a "trefa" and is not subject to pikuach nefesh, the practice of doing everything possible to preserve life.
"No return to life is possible if the person is in a permanent vegetative state," he said.
"In the Florida case, we have to find out if her husband is credible," Rabbi Teutsch said, adding that under both Jewish and American law he is authorized to make decisions on his wife’s behalf.
"From my perspective, unless there is reason to believe that she would want to be kept alive in this situation, one would have to say that it is an indignity to be kept alive in this state," he said. "We are required to treat people in the utmost dignity … and preserving someone in a permanent vegetative state does not convey dignity."
Asked his reaction to those who say removing the feeding tube is condemning them to death, Rabbi Teutsch replied: "What condemns them to death is the fact that they are a trefa. The question is whether we will artificially force them to stay alive: if you call a permanent vegetative state real living."
But Rabbi Bleich argued that according to Judaism, "every human life is of infinite value, every moment of human life is of infinite value. Quality of life has no bearing on the infinite value of human life. That means that the life of a comatose patient is of infinite value and therefore has to be preserved."
Rabbi David Feldman, a traditional rabbi and dean of the Jewish Institute of Bio-Ethics in Teaneck, N.J., said however, that removing the feeding tube would hasten death and that is forbidden.
"You can pray for death and thank G-d for death, but you can’t do it with your own hands," he maintained.
Even if she had written a living will that ruled out the use of a feeding tube to keep her alive, Rabbi Feldman said Jewish law would view it as "irrelevant."
"She can’t commit suicide," he said. "What she says is interesting but not operative. A living will is accepted but from a halachic viewpoint it is wrong if it says kill me. … If medicine would help, you must take it. But if it is experimental or doubtful that it will help, you don’t have to take it."
Asked about the doctor’s removal of the feeding tube at her husband’s request, Rabbi Feldman said: "Assisted suicide is worse than suicide because they are doing it with a clear head, and halachically you can’t do that. … We believe in mercy, but not mercy killing."
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