Rabbi's Message

Rabbi Elyse Wechterman
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April 2005

Terry Schiavo and End-of-Life Issues

The recent publicity and controversy over the fate of Terry Schiavo, the Florida woman who was left brain-dead after a terrible accident, raises many questions about life, death, compassion, care and decision-making for all of us. Although I have no desire to offer an opinion on the particulars of the Schiavo case itself, I do think the issues of end-of-life care in the Jewish tradition and community warrant a closer look.

Who decides?

At the heart of the Schiavo controversy is the question “who decides?” That is, who decides when extraordinary measures (a respirator, perhaps) or even un-extraordinary measures (like a feeding tube) should be pursued or stopped on someone’s behalf?

Jewish tradition weighs heavily on the ability of an individual to make autonomous decisions regarding his or her own health care. Although life is highly valued and recognized as precious, Judaism also carries with it a concern for quality of life, mental health and the diminishment of suffering. Our tradition asks us to walk the balance between the two Jewish values of pikuach nefesh (saving a life at any cost) and rachamim (compassion).

In a case where a patient is cognizant of his or her own situation and the possible outcomes and side effects of any treatments, those patient’s wishes are to be followed. Even treatment that is likely to lead to cure, for instance, can be refused if the patient deems the process to be too difficult or painful to bear.

Yet we all know that the majority of situations in which such heart-wrenching decisions have to be made often involve individuals who are not in a position to decide for themselves: they may be suffering dementia or brain damage; be in a coma or another unconscious state. In those situations, the nearest living relatives or designated parties have the gut-wrenching task of trying to figure out what the person might wish or what is the appropriate course of action.

This is why talking about these issues with your loved ones before such a need arises is so important. Almost all the Jewish movements support the notion of living wills, health care proxies and DPAHC (Durable Power of Attorney for Health Care). Having meaningful conversations is important, but unfortunately, as we see in the Schiavo case, they may not be enough. Taking the time now to clarify your wishes in a written document may prevent indecision and familial strife later on.

There are a number of helpful books and websites that can help you and your family work through these issues. A very helpful site I found that provides a cogent and comprehensive explanation of the various legal documents and options can be found at http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=401

In addition, the Reform Movement has published a workbook called A Time to Prepare, which contains explanations and forms to work through on your own or as a family. The Jewish ethical and spiritual perspectives provided can be very helpful and comforting to those thinking about these issues. It also contains sections on ethical wills, personal papers, funeral wishes and can be purchased through the URJ Press.

Can you remove a feeding tube?

The other primary point of controversy in the Schiavo case is the nature of the feeding tube that had kept her alive and in a vegetative state for so long.

Again, Jewish tradition sees the preservation of life as paramount, but does not condone unnecessarily prolonging life or preventing death when it is inevitable. “There is a time to live and a time to die,” says Kohelet (Ecclesiastes). We are taught to understand death as a part of and final stage of life – not to fear it and run from it. Most medical ethicists, Jewish and non-Jewish, agree that when no recovery is possible and death inevitable, it is permissible – and maybe even compassionate – to cease medical treatment designed to fight illness and focus instead on palliative (comfort) care. Therefore, we might agree to cease administering antibiotics or forego another surgery and maybe even disconnect a respirator or breathing apparatus.

But is a feeding tube medical care? Or is it providing food and water – meeting the basic needs of a living human being – certainly something that in most cases, we are obligated to provide?

Here, there are differences of opinion, even within the same Jewish movements. Some prominent rabbis of the conservative and reform movements see the feeding tube as providing the basic sustenance of life, which all humans require. Therefore, they conclude, once administered, a feeding tube cannot be disconnected.

Yet others, including other prominent conservative rabbis and the Reconstructionist movement’s resident ethicist, Dr. Rabbi David Teutsch, argue that the feeding tube is in fact medicinal – it would not be provided to any one in a healthy state and doesn’t constitute eating per se. Therefore, these rabbis conclude, a feeding tube can be removed as a medical device unnecessarily delaying an inevitable death.

This difference of opinion is neither a flippant nor a minute one. It is a sincere debate that holds the two values of pikuach nefesh and rachamim in tension and can be understood as a makhloket l’shem shamayim (an argument for the sake of heaven) and helps me to appreciate the seriousness with which we should approach all questions regarding life and death. For each family and each person that has to make these decisions, we can only offer our prayers that the decision reached is grounded in integrity, holiness and love of God’s creatures. From that perspective, it is almost safe to say that there can be no wrong decisions.

What is more important is to know those who struggle with the immanent ending of life in their community and family are supported, comforted, cared for and loved by a community that shares their struggle and is committed to the integrity of the process no matter where it leads.

My heart breaks in reflecting that for the Terry Schiavo case, that commitment seems to be missing in those who would use the struggle of one stricken family for political gain.

Rabbi Elyse

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