November 19, 2018

Opinions Conflict on Ending Life Support

The Florida case of a woman on life support for 13 years has put issues of how we die and when and how doctors and others should intervene on the front page. Whatever the courts say about that case, however, will only apply to federal and Florida law.

What would Jewish law say about such a case? That question is important because the issues raised in that case confront Jews often as they care for their parents, spouse and other loved ones and as they contemplate their own dying process.

The basic Jewish principle about these matters is clear: 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.

Until just a few decades ago, it was easy to adhere to that prescription, because there was little, if anything, that doctors or anyone else could do to prolong or reverse the dying process. Now, however, we are faced with the old Kantian problem: specifically, as Kant pointed out, as soon as one can do something, then one has to ask whether one should.

Our ancestors, of course, could never have contemplated these new powers that we have. As a result, we cannot just look up the answer as if we were looking up a recipe in a cookbook. We, instead, must use judgment in applying Jewish laws, principles and sensibilities to the new situation.

When we examine the tradition, we find that there is a strong imperative to save life and health when we can, but there is also a clear recognition that we are not immortal, that Adam and Eve could not eat from the Tree of Life and that, in the words of Kohelet (Ecclesiastes), "There is a time to be born and a time to die."

Medieval Jewish sources also announce that we must do what is in the best interests of the patient, and while they assumed that that always meant trying to save the patient’s life, in our own day, when that can mean years in a coma supported by machines, that is not always as clear.

Most Jewish authorities from all movements would agree that we may and, in some cases, should remove machines or medications that are not curing the patient, whether dying or earlier in life, for every medical intervention has side effects and both emotional and financial costs.

Rabbis differ, however, regarding artificial nutrition and hydration. Some — for example, Conservative Rabbi Avram Reisner and Orthodox Rabbi Moshe Tendler — understand them to be the equivalent of food and liquids, for they function to nourish the patient. These rabbis assert that if a person cannot eat normally, we need not insert feeding tubes but may rather let nature take its course. If we do insert feeding tubes, however, we may not remove them.

I, however, maintain, as I did in a ruling approved by the Conservative movement’s Committee on Jewish Law and Standards, that artificial nutrition and hydration should be classified as medicine. That is because 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. 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.

Thus when Jews face these issues, they should think carefully about whether they should permit feeding tubes to be inserted into their loved one in the first place. If they do and the patient does not recover, they may, in my view, take the tubes out and let the person die a natural death, making sure that comfort care is administered.

In such cases, it is not the person removing the feeding tubes or the one who authorizes that who is killing the person; the underlying disease is. And they should do this as soon as it becomes clear that nothing can be done to bring the person back to independent functioning — long before the 13 years that it has taken the Florida courts to resolve this issue.

That is not only the wisest way to spend our limited health care dollars; it is also the most humane and theologically correct way to acknowledge that God has made us mortal.

Rabbi Elliot N. Dorff, rector and distinguished professor of philosophy at the University of Judaism, is the author of "Matters of Life and Death: A Jewish Approach to Modern Medical Ethics" (Jewish Publication Society, 1998).