November 30, 2022

If Terri Schiavo were a New Yorker, would she have died?

In a New York rerun of the Terri Schiavo case, the quarrel of two generations over how to care for an elderly Jewish woman with advanced Alzheimer’s disease has produced a very different result. Mrs Lee Kahan, 86, is a observant Orthodox Jew who depends on artificial hydration and nutrition to stay alive. Her doctors wanted to remove her nasal tube and replace it with a stomach feeding tube. This brought about a dispute between her sister and her daughter, who was Mrs Kahan’s health care agent. The sister felt that the younger woman wanted to have all food and water withdrawn.

The outcome of subsequent litigation was a decision by a Supreme Court judge, Martin Ritholtz, which allowed the daughter to remain as the health care agent, but not giving her authority to remove the stomach tube because her mother had left no written instructions about what should be done if she became incompetent.

In his judgement, Judge Ritholtz was required to make an assessment of Orthodox attitudes towards feeding tubes. “Judaism views nutrition and hydration by feeding tubes or intravenous lines not as medical treatment but as supportive care, no different from washing, turning or grooming a dying patient,” he wrote. “The first halachic [Jewish law] principle of medical intervention is that whenever it is possible to increase the longevity of a patient, it should be done.

“On the other hand, halacha certainly takes pain and suffering into account. Under certain exceptional circumstances, only to be determined by a competent rabbi, it has been held by [the 20th century halachic authority] Rabbi Moshe Feinstein that for a patient with pain and suffering who cannot be cured and cannot live much longer, it is not obligatory for physicians to administer medications briefly to prolong his life of pain and suffering, but nature may be allowed to take its course.”

He said that from a halachic perspective, a persistent vegetative state and Alzheimer’s disease are not terminal conditions, per se, despite the fact that they are progressive, irreversible and inevitably result in death. “Patients with these illnesses,” Ritholtz wrote, “deserve the same full range of treatment that is made available to any other patient.”