***This story has been updated (Sept. 11, 12 p.m.)
As David Stern, a 61-year-old Orthodox Jew suffering from a rare neurodegenerative disease, lies conscious and hooked up to a respirator at Providence Tarzana Medical Center, the hospital and lawyers for two of Stern’s children are battling to determine whether the hospital should remove Stern from life support — as administrators say they are obligated to do — or perform a life-saving tracheostomy, as Stern’s family demands.
The dispute highlights a conflict at the intersection of modern medical ethics, Jewish medical ethics and civil law as it pertains to the validity of a living will and the extent to which “quality of life” measures should impact whether a life-saving procedure is appropriate.
In 2011, two years after he was diagnosed with cortical basal ganglionic degeneration (or CBGD, an incurable and ultimately fatal disease), Stern signed an advance medical directive. The directive names Shirit Gold, one of his two daughters, as his agent in medical emergencies where Stern is unable to make his own health decisions, such as this one. But it also stipulated that “life-sustaining procedures” that would only “artificially prolong” his life when he’s suffering from an “incurable and irreversible condition” should not be pursued.
Gold and her brother, Rayi Stern, argue that their father, who became Orthodox in 2003, never would have knowingly signed an end-of-life document that would violate Jewish law. The directive he signed allows for an autopsy, which is forbidden under Jewish law in most cases, and for organ donation, also forbidden in most cases (the directive did not account for the few instances in which an autopsy or organ donation would be permitted under Jewish law).
The family asserts he could not have understood the contents of what he was signing, and both Rayi Stern and Gold said their father was already two years into his neurodegenerative diagnosis, which has resulted in dementia and extreme loss of motor function, when he signed the directive. “I am 100 percent certain” he didn’t know, Rayi said. “He lived his life as a Jew. He wouldn’t want to end it in any other way.”, Jewish law demands he undergo a tracheostomy, for which surgeons would cut an incision in his windpipe to allow for a breathing tube attached to a permanent respirator. A tracheostomy, Rayi said, could extend his father’s life by several months or even a year.</p>
<p>
Since David Stern was admitted to Providence Tarzana on July 15 for complications stemming from CBGD, he has been hooked up to a temporary respirator with a tube in his mouth that goes down his throat. This sort of intubation generally is not used for more than two weeks, and can cause severe complications from infections as well as potential physical damage to the throat, chest and lungs — risks that increase with time. Four months ago, when Stern was hospitalized with pneumonia, he was intubated for three weeks, which has made it impossible for him to speak or even close his mouth, even after the respirator was removed.</p>
<p>
According to the family and the family’s attorney, Justin Gold (no relation to Shirit Gold) of Oldman, Cooley, Sallus, Birnberg & Coleman, said California law requires that even when a hospital has a legal basis to refuse an agent’s instruction, it is required to preserve the patient’s life while the instruction is in dispute. In this case, they say, Providence Tarzana must either perform a tracheostomy or transfer Stern to a hospital that will. “The law cannot be construed to allow the hospital to disregard the agent’s wishes, and while the disagreement is ongoing, refuse to provide treatment thereby resulting in Mr. Stern’s death,” Gold wrote on Aug. 12 to the hospital’s legal counsel of Davis Wright Tremaine.</p>
<p>
But the hospital, in a draft acquired by the Journal dated Aug. 16 of a petition to a State of California Superior Court in Los Angeles, is requesting permission, per the advance medical directive, to remove Stern from the respirator, which would likely result in his death soon thereafter, possibly from pneumonia. “The tracheostomy is an invasive procedure that would provide no medical benefit to Mr. Stern whatever, and instead serve only to artificially prolong Mr. Stern’s suffering and the moment of his death — and therefore performing a tracheostomy is prohibited by his Advance Health Care Directive,” the hospital wrote in the draft of the petition.</p>
<p>
On Aug. 17, Providence Tarzana Medical Center released a statement saying it “adheres to the law and its own core values to follow patients’ advanced directives,” and that in complex situations like these will “consult ethicists and other resources to ensure we act appropriately and legally.” Due to federal patient privacy laws, the statement did not refer to Stern specifically but was drafted as a response to the Journal’s questions about the current dispute.</p>
<p>
Rabbi Mordechai Einbinder, associate director of Chabad of the Valley in Tarzana, is close with David Stern and seconded his family’s belief that he would not have signed the directive had Stern understood its contents. “I have seen David Stern progress to become quite a God-fearing Jew, and he would only want to do what the halachah mandates,” Einbinder said.</p>
<p>
David Stern’s children assert he currently is very conscious; his eyes are responsive — he raises his eyebrows and blinks and responds to voices and sounds; and they say he recognizes people, has positive facial expressions when visitors come into the room and appears to concentrate when they speak to him.</p>
<p>
“The man is alive, and I don’t think anybody else can pull the plug,” Rayi Stern said.</p>
<p>
—–</p>
<p>
<strong>Update: Sept. 11, 12 p.m</strong><strong>.</strong></p>
<p>
According to Rayi Stern, his father, David, was transferred on Aug. 18 by Providence Tarzana Medical Center to Kindred Hospital in La Mirada, where he received a tracheostomy on Aug. 21. He's still at Kindred Hospital, and is now able to breathe without a breathing machine. Providence Medical Tarzana Center declined to comment. A spokeswoman said the hospital wouldn't comment “on another hospital patient.”</p>
<p>
<strong>Update: Aug. 21, 9:30 a.m.</strong></p>
<p>
This story previously misquoted Rabbi J. David Bleich as saying that removing David Stern from life support would violate Jewish law because he isn’t in a “persistent vegetative state.” Bleich corrected that by clarifying that removal from life support would only be appropriate if an irreversible process of death had begun. A persistent vegitative state wouldn't allow for removal from life support according to Jewish law.</p>
<p>
<strong>Update: Aug. 17, 11:15 p.m.</strong></p>
<p>
This story now includes excerpts of a statement released by Providence Tarzana Medical Center.</p>
</div>
</div>
<div class=)
Did you enjoy this article?
You'll love our roundtable.
Editor's Picks
What Ever Happened to the LA Times?
Who Are the Jews On Joe Biden’s Cabinet?
No Labels: The Group Fighting for the Political Center
Latest Articles
Lev Livitsky’s Very Complicated Second Act
Cantor Chayim Frenkel: Fulfilling the Promise of L’dor V’dor
