Should a tube that provides food and water to a person unable to swallow be considered medicine that may be withdrawn at any time, or is it a basic necessity of life whose withdrawal would be tantamount to murder? Must a feeding tube be inserted if the surgery would be so dangerous it might kill the patient?
Those are some of the questions experts in Jewish law and ethics pondered this week as the case of Terri Schiavo moved from Florida’s state courts to the federal courts following the intervention of Congress and President George W. Bush.
Rabbi David Teutsch, director of the Center for Jewish Ethics at the Reconstructionist Rabbinical College in Wyncote, Pa., said there is a “split within the Jewish community of bioethicists between those who say a feeding tube is like medicine and those who say it is like eating. But eating involves taste, mastication, swallowing and pleasure. None of those are present when a feeding tube is used.”
Rabbi Teutsch insisted that because “most Jewish bioethicists would classify the feeding tube as medicine,” the question is “whether we should provide additional medicine.”
“That is an ethical question that can be asked anew each time [food and water] is provided,” he said.
The rabbi argued that a feeding tube is comparable to a respirator — that one can make a decision to stop or start it based on what is in the patient’s best interest. And he said it is no different than stopping chemotherapy if the treatment proves ineffective.
“Jewish tradition opposes suicide. However, human beings have a right to decide within reason what they choose to eat,” he insisted. “Suicide requires a positive act, like squeezing the trigger of a gun or drinking poison. Deciding to abstain from an activity is something different. … You have the right to decide what treatment you want to receive or not.”
But Rabbi J. David Bleich, a rosh yeshiva at Yeshiva University’s Rabbi Isaac Elchanan Theological Seminary in New York, maintained that a feeding tube “is not medicine, it’s meals on wheels. It’s nothing more than food, and I don’t think it is ever appropriate to withhold food.
“A person who starves to death is committing suicide, as far as Jewish law is concerned,” he said. “And those who have a duty of care have a duty to provide food and water. You can’t withhold it.”
Rabbi Bleich pointed out also that “Jewish law says that your life and body are not yours, that it belongs to the Lord and only He can reclaim it. You and I have an obligation to eat whether we like it or not.”
Avi Shafran, an Orthodox rabbi and director of public affairs for the Orthodox group Agudath Israel of America, agreed.
“I don’t know of any halachic [Jewish law] authority who would say anything but that she must be kept hydrated and fed,” he said.
Rabbi Avram Reisner, a member of the Conservative movement’s Committee on Jewish Law and Standards, said that as a “general rule, I feel that feeding a living person is a requirement. A newborn baby who is not fed won’t survive; it is not capable of feeding independently. And if a baby is not fed, [the care giver] is criminally liable. I would say the same for the disabled who are not able to feed themselves.”
He said that one might consider removing nutrition in a case “where a person is clearly dying — where the physical system is not functioning anymore — so that one could withdraw a respirator if he was not breathing on his own. It could be said that this person is dying and [disconnecting the respirator was] removing what Jewish law calls an impediment to death.”
Rabbi Kassel Abelson, chairman of the law committee, said the Conservative movement also recognizes as valid an opinion by Rabbi Elliot Dorf, who argues that a feeding tube is not a requirement.
“So we have a pluralistic approach and each rabbi may choose one of the two positions,” Rabbi Abelson said. “We say to rabbis, read the material and make your own decision. You could leave [the feeding tube] disconnected or reconnect it, and you would have very good support [for both positions] in the law committee.”
Later, Rabbi Abelson said, “The courts have decided that the husband is the legal guardian, [Schiavo’s husband Michael] said what he believes his wife would want, and the Conservative movement would not quarrel with that.”
Leonard Fein, a former director of the Commission on Social Action of Reform Judaism, cited polls indicating that “70 percent of Americans believe Congress was inadmissibly intervening and that 60 percent agree with the husband” of Schiavo, who directed that the feeding tube be removed.
Fein, who stressed that he is not a rabbi but rather an author and social activist, said he agrees with “74 percent of American physicians who think she should be allowed to die.”
“Somebody put the feeding tube in. She was forced to live against her will, according to her husband,” he said.
Fein asked, “Is it murder when you reverse an action in the absence of which the person would surely have died?”
He added that the “simple notion that we have a positive obligation not to allow a person to die becomes clouded given modern technology. You can’t just say that Jewish law says ‘A’ and that settles the argument.”
Rabbi Marc Gellman, a Reform spiritual leader on Long Island and former chairman of the now defunct UJA-Federation Medical Ethics Committee, said it is clear that the feeding tube must be reinserted because Schiavo was not near death when it was connected.
“Hydration and nutrition must be provided,” Rabbi Gellman, known for teaming with Rev. Tom Hartman to form the “God Squad,” said emphatically. “It shouldn’t have been taken out. They are starving a brain-damaged woman to death.”
And Shmuel Goldin, an Orthodox rabbi in New Jersey and a Bible instructor at Yeshiva University, said that although it is difficult to talk in general terms, “the overarching principle is that food is considered a basic need and you cannot starve a patient.” But he pointed out that “if a case could be made that reinserting the feeding tube would itself be a danger [to the patient’s life], that might be a reason not to insert the tube.”
The Union of Orthodox Jewish Congregations applauded federal intervention in the Schiavo case, noting that “Jewish tradition holds the preservation of human life as one of its supreme moral values.” But Phyllis Snyder, president of the National Council of Jewish Women, said the case had been fully litigated by Florida’s courts and that Congress and Bush “intervened in a wholly inappropriate way.”
Snyder said federal elected officials would spend their time better “ensuring that Medicaid … is maintained at adequate levels and that all who need medical care across the country can receive it.”
Several Jewish leaders were among the minority who protested loudly when Congress intervened in the Schiavo case.
“What Congress has done is substitute its own judgment for the judgment of medical professionals and the courts,” said Rep. Robert Wexler (D-Fla.).Marshall Wittmann, a scholar with the Democratic Leadership Council, said that although this issue “appeals to the socially conservative base of the Republican Party, it falls flat with the rest of the electorate. It [also] casts light on tensions within a party that on one hand preaches limited government, and on the other uses the long arm of the federal government to get involved in a family dispute.”
University of Virginia political scientist Larry Sabato said the congressional action would just energize the religious conservatives without having much of an impact on the rest of the electorate.
“Politics,” he said, “is not just a game of poll numbers but of intensity.”
Washington correspondent James D. Besser contributed to this report.