The Schiavo Case: A Jewish Perspective
Sermon, April 1, 2005
Rabbi Bruce Kadden

With the death of Terri Schiavo, this personal and family tragedy that has become a national spectacle has drawn to a close, although its repercussions will no doubt continue to be felt.  With so much attention on this one case, we almost forget that each day families are faced with similar decisions of whether to continue to aggressively treat a disease or to let it run its course, of whether to continue artificial feeding and hydration or to stop such measures. 

These are often difficult and painful decisions for the family; family members sometimes, like the Schiavo case, do not agree on the proper course of treatment.    Having a Living Will and a Durable Power of Attorney for Health Care are helpful, although they are no guarantee that one’s wishes will be followed.

This evening I want to discuss the Jewish perspective on these issues to help guide us when we face such a situation.

I am sure that you are aware that Judaism places a supreme value on life.  To save a life is equivalent to saving the whole world and to destroy a life is equivalent to destroying the whole world.  There is no question, therefore, that anything one might do to actively take a life is not acceptable according to Jewish law. 

Traditional Judaism would not permit physician-assisted suicide under any circumstances.  Similarly, the Conservative movement, in a responsum written by Rabbi Elliot Dorff, concludes that “A Jew may not commit suicide, ask others to help in committing suicide, or assist in the suicide of someone else.”  A task force of the CCAR, the Reform rabbinic group, reached a similar conclusion, although the resolution it proposed has yet to be adopted by the conference.

Classical Jewish texts further argue that one must treat a dying person, called a goses, as a living person in all respects.  For example, one may not do anything to that person that would in any way hasten death.  (Mishnah Semachot 1). 

On the other hand, some sources differentiate between actions that hasten death and those that “cause a hindrance to the departure of the soul” (Rema Yoreh De’ah 339:1).  Examples of hindrances include loud noise, such as wood chopping outside one’s window, or salt on the tongue.  Such acts are unnatural occurrences that apparently serve to stimulate one’s senses and prevent the person from dying.  So even according to strict Jewish law, one is allowed to do certain limited things to allow a person to die peacefully.

However, these teachings only apply to a goses, to someone who is about to die.  They do not apply to someone with a terminal illness, but who might still live for months, or even a few days; and they do not apply to the Schiavo case, because although she was in a persistent vegetative state with no chance of recovery, she was kept alive by feeding indefinitely.

Rabbi Dorff points out that “the appropriate Jewish legal category to describe people who have incurable diseases but who may live for months and even years is . . . terefah (in imperiled life), that is, a person diagnosed as having a terminal illness.  He goes on to argue that a person in this situation may choose to treat the illness aggressively or may opt for experimental therapies, but he or she is under no obligation to do so and, indeed, may decide “to have machines and medications withheld or withdrawn.”  Many, but not all, Orthodox authorities disagree with this conclusion and insist that all reasonable therapies be continued until the person becomes a goses.

The issue of artificial nutrition and hydration is much more controversial because withholding food and drink for a person is essentially starving that person to death.  Indeed, most traditional sources insist that artificial nutrition and hydration be provided when a patient is terminally ill, even against the patient’s wishes.  Refusing such sustenance is tantamount to suicide, which is prohibited by Jewish law.

The rabbis draw a distinction between medications and machines which are used specifically to cure an illness or to sustain a person while they heal and are not a part of one’s normal regimen, and food and water which are basic necessities for life.

However, Rabbi Dorff offers a variety of arguments to support the decision to refuse or withhold artificial nutrition and hydration for terminally ill patients.  He points out that the way food and water are provided “in form and administration . . . is much closer to medication,” than normal eating and drinking and can therefore be refused.  We do not have to subject ourselves to feeding tubes or other artificial means of providing sustenance.  Furthermore, one who is terminally ill may refuse medications which might prolong life but have not hope of curing the disease; therefore, such a patient could refuse artificial nutrition and hydration which is essentially medication in this instance.

So far, we have been speaking of terminal illness.  What about those who, like Terri Schiavo, are in a persistent vegetative state?  In many ways this is a more difficult situation, since such a person could be kept alive indefinitely.  And indeed, Orthodox authorities, like those on the Christian right, categorically forbid withholding food and water these circumstances.  Even those authorities that permit the removal of respirators or other machines do not allow the removal of artificial nutrition and hydration.

Rabbi Dorff, however, offers two approaches that would permit the removal of such sustenance.  The first is to consider artificial nutrition and hydration like medication and extend the application of the principal of allowing one to refuse medication to one in a persistent vegetative state.  The second approach would be to “define brain death as the irreversible cessation of the functions of the neocortex…rather than of the whole brain.”  Rabbi Dorff rejects this approach, but affirms the first one as a basis for withholding food and water from a patient in a persistent vegetative state, but only after it is virtually certain that their condition has been properly diagnosed.

Therefore, while Orthodox authorities would require artificial nutrition and hydration, non-Orthodox authorities would permit their being withheld from a patient if the patient has clearly indicated that this is their will.

We hope and pray that we will never have to face such circumstances, but we should be prepared if, God forbid, something happens.  We should have a living will and a durable power of attorney for health care.  We should be certain that our physicians and family members have a copy of these documents and that the person who is entrusted with following these directives is comfortable with that role. 

Jewish tradition supports a range of options with regard to these end-of-life issues.  I would be glad to help you, not by making these decisions for you, but by helping you determine your position.  May the memory of Terri Schiavo motivate us to address these important issues so that when our time comes we will be able to die in peace.

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