Jewish Ethical Views Differ on Schiavo


 

As a federal court considers whether to reconnect Terri Schiavo’s feeding tube, Jewish scholars are turning to halacha, or Jewish religious law, for guidance on the issue.

Schiavo, the severely brain-damaged Florida woman whose parents and husband have been battling in state and now federal courts for more than a decade, is the insensate center of a swirl of emotion and legal action.

Religious leaders have been involved as well. Schiavo and her parents, Mary and Robert Schindler, are Roman Catholic, and many of their most fervent supporters are fundamentalist Protestants.

The Schindlers want to keep their daughter’s feeding tube in; Michael Schiavo, her husband, wants it removed so his wife can die a natural death.

Jews, like others caught up in the debate, have a range of beliefs, and their understanding of how to apply halacha varies accordingly. Virtually all the rabbis interviewed, though, told JTA that they did not agree with attempts by some conservative Christians to tie Schiavo’s case to the public debate about abortion.

At the traditional end of the spectrum, Rabbi Avi Shafran of the ultra-Orthodox Agudath Israel of America said the Schiavo case is “straightforward from a Jewish perspective: The most important point from a halachic standpoint is that a compromised life is still a life.”

“In the Schiavo case, you’re not dealing with a patient in extremis,” he said, noting that until her feeding tube was removed, Schiavo was not dying.

In halacha, there is a category for a person at the edge of death; the rules for such a person, called a goses, are complicated.

“There are times when certain medical intervention is halachically contraindicated,” Shafran said. “There may be times when it’s OK not to shock a heart back into beating, not to administer certain drugs. You do not prolong the act of dying.”

However, Schiavo was not a goses, Shafran said. Instead, he added, before the tube was removed, she “had the exact same halachic status as a baby or a demented person. Like a baby, she was helpless, could not feed herself and was not able to communicate in any meaningful way. But a life is a life.”

Rabbi Tzvi Hersh Weinreb, executive vice president of the Orthodox Union, the central arm of modern Orthodoxy, agreed that from a halachic perspective, the Schiavo case is straightforward.

“It’s not permitted to do anything actively that would stop the process of a person’s staying alive,” he said. “In this case, that would be withdrawing a feeding tube, which is tantamount to starving a person to death.”

Like Shafran, Weinreb said the wishes of the patient or the family are not relevant.

“It might have a bearing on whether new measures are undertaken, but once a person is on a support system, removing it is not possible,” Weinreb said.

“Doing something to actively interfere with a person’s ability to continue to live technically is murder,” he said. “I can’t imagine a scenario that would make removing the feeding tube permissible.”

Rabbi David Feldman, who had an Orthodox ordination and defines himself as “traditional,” is rabbi emeritus of the Conservadox Jewish Center of Teaneck, N.J.

“There’s a dispute here between a husband and parents, but none of that makes any difference as far as halacha is concerned,” said Feldman, author of “Marital Relations, Birth Control and Abortion in Jewish Law” (Schocken, 1975) and the dean of the Jewish Institute of Bioethics. “You can’t hasten death yourself, with your own hands. If death comes, you can thank God because it’s a relief, but you can’t decide yourself that it has to be done.”

The only time it would be acceptable to remove a medical device, Feldman said, would be if “something worse would happen — if leaving it in would cause infection or more pain.

“You can kill someone pursuing you, you can kill the soldier in the enemy army, maybe very cautiously you can kill if there is a death penalty, but you can’t kill an innocent person because of illness,” he said.

Rabbi Joel Roth is a member of the Conservative movement’s Rabbinical Assembly’s Law Committee. In 1990, when he was the committee’s chair, the group studied end-stage medical care and accepted two opposing positions on artificial nutrition and hydration.

One, by Rabbi Elliot Dorff, “would permit withholding and withdrawing” the tube; the other, by Rabbi Avraham Reisner, would not.

The divide comes from how the tube that provides food and water is defined. If it is seen as a medical device, as Dorff does, it may be removed, Roth said. If it is seen as a feeding device, as Reisner does, it may not be removed.

Dorff puts a person dependent on a feeding tube “in the halachic category of ‘treifah,’ which, he argues, is a life that does not require our full protection — an animal that is treifah is one that has some kind of physical defect that will prohibit it from having a prolonged life. So he argues that a treifah is a life that does not require our full protection,” Roth said.

Reisner, on the other hand, “treats these people as goses,” Roth said.

“And even in the end stage,” he noted, “there is the value of ‘chaya sha’ah,’ the life of the hour.” In other words, Roth said, even when there is very little life left, that life still matters.

The Conservative movement accepts both decisions, but Roth, a professor of Talmud and Jewish law at the Jewish Theological Seminary in New York, sides with Reisner, and with Schiavo’s parents.

“She should be kept on the feeding tube,” he said. “She’s not being medicated, and she’s breathing on her own.”

Rabbi Mark Washofsky teaches rabbinics at the Reform movement’s Hebrew Union College-Jewish Institute of Religion in Cincinnati, and he sits on the movement’s responsa committee.

The movement does not speak with one voice on the issue, Washofsky said, but in 1994 it issued a responsa on the treatment of terminally ill patients.

Like the Conservative decisions, the Reform rabbis 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 categorically prohibits the removal of food and water from dying patients,” 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 withdrawal, 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 consciences guide them.”

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,” Teutsch said. “But if it’s medicine –a position held by Conservative authorities like Rabbi Elliott Dorff, and by me as well — then you serve the interests of the patient, which may involve not providing medicine.”

He believes that a feeding tube is a medical device, and so it can be removed, Teutsch said.

“It’s pretty clear that it’s closer to regular intervention than to eating,” he said.

 

Purim Saga


 

How fitting that the heartbreaking saga of Terri Schiavo is coming to a head during Purim. Granted, the connection to a holiday known for merrymaking is not obvious. On its face, Purim celebrates the rescue of Persian Jewry from certain destruction in the time of King Ahasuerus. They tried to kill us, they failed, let’s eat.

But the Purim holiday is not so simple; it is full of mystery and hidden meanings. It is a religious holiday whose central text, Megillat Esther, never mentions God. Its heroine is a Jewish woman who has intermarried and is urged to hide her identity. The very name “Esther” is said to derive from the biblical verse, “haster astir panai,” “But I [God] will surely conceal my face.”

The Schiavo case is no less murky (see story, page 21). To start with the most disturbing parallel first, there is Terri Schiavo’s face in the video footage. This young woman who most doctors agree is as close to the living dead as biologically possible displays a strained smile. Doctors say this reflex reaction is a result of a still-functioning brain stem, but there it is — a kind of Purim mask hiding both body and soul.

The political firestorm over the case obscures the Schiavo’s family deeply personal dilemma. Doctors have diagnosed the 39-year-old woman as being in a permanent vegetative state. Her parents, devout Catholics, want to keep her alive. Her husband and guardian, Michael, has said his wife made clear to him on two occasions she would not want to live under such conditions, and he has fought for 15 years to have her feeding tube removed.

After a Florida court ruled that doctors could remove the feeding tube that has kept her alive, congressional leaders and the White House intervened. On Monday, President Bush signed the bill passed by the House and Senate, which transferred jurisdiction in the case to a federal judge for review. U.S. District Judge James D. Whitmore immediately declined to order the feeding tube reinserted.

By the time you read this, other events are likely to have played out, including appeals to higher courts and maybe even Schiavo’s death.

A Republican Party bent on undermining states rights is just another topsy-turvy aspect to this case. Are the interventionists’ motives moral or political? Is this Purim-period legislation a model or a masquerade?

“This isn’t about Terri Schiavo. It’s about abortion,” Neal Boortz, a pro-Bush conservative talk show host, wrote on his Web site. “The anti-abortion movement saw an opportunity to take Terri’s tragedy and turn it into a spectacular pageant in support of life. The Republicans in Washington have essentially taken Terri Schiavo hostage — a hostage designed to please their anti-abortion constituency. Can it be said that the Republicans are torturing the soul of Terri Schiavo, and doing it for votes?”

There is no clear-cut, painless resolution of the Schiavo case, as thousands of families who face similar end-of-life decisions for their loved ones know. Jewish opinion on the matter is open to interpretation and disagreement.

A year ago, writing about Schiavo in these pages, Rabbi Elliot Dorff laid out the guiding Jewish principle on end-of-life issues: “We are, on the one hand, not allowed to hasten the dying process, but on the other, we are not supposed to prolong it either.”

Many Jews, especially among the Orthodox, would argue that Schiavo’s feeding tube is a source of nourishment.

“To remove it from a patient whose only impairment is cognitive is simply murder,” Dr. Daniel Eisenberg of Albert Einstein Medical Center in North Philadelphia told a reporter.

But other observant Jews, like Dorff himself, would argue that in Schiavo’s case, a feeding tube should be classified as medicine.

“It does not come into the body in the usual way food does and thus lacks all the qualities associated with food, such as taste and varying temperatures and textures,” Dorff wrote. “Furthermore, one of the natural features of the dying process is that the person stops eating, and so by using tubes, we are effectively force-feeding a patient and thus prolonging the dying process.”

As medicine has advanced far beyond what the rabbinic sages could have imagined, the answers to these questions become murkier, and more critical.

For that reason, we must think about their implications for ourselves and our loved ones, and make our desires explicit before it is too late.

According to her husband, this is what Terri Schiavo did, and the doctors, the courts and the president should respect that choice. It would have helped if Schiavo had clearly documented her wishes, but how many of us do, especially when we’re in our 20s? Now what should have been a private, painful decision has been turned into another macabre skirmish in the culture war.

How very much like Purim: A story begins as looming tragedy and ends as farce.

The Schiavo case, sadly, has managed to become both at once.

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