Sermon delivered March 25, 2005, by Rabbi Barry H. Block
When I was a young child, when an older person would die, I recall my parents’ telling me that the person had “died of old age.” Indeed, such would seem to be the malady that carries away most of the significant figures in the Bible. Yes, Rachel dies in childbirth; Saul and Jonathan are killed in battle; and Elijah doesn’t die, but is instead carried into the heavens in a fiery chariot. Those, though, are the exception. Abraham and Sarah; Jacob and Joseph; Miriam, Aaron and Moses; King David and King Solomon; all die at a ripe old age. God is explicitly involved in some of those deaths, but these great figures die quickly, and mostly painlessly, quite advanced in years.
Our own time is very different from the biblical period. We should be surprised that the deaths of young people are the exception, rather than the rule, in the Bible, for life expectancy was actually quite short in those days. As one who sees death up close quite often, I find that most people do die rather advanced in years. With medicine as it is today, however, the cause of death is never ascribed simply to “old age.” One illness or another, or a tragic accident, will take each of us out of this world, at the will of God.
Today, our nation is riveted by the case of Terri Schiavo, the young Florida woman who has languished in a persistent vegetative state for some fifteen years. Tragically, when she was only in her twenties, Ms. Schiavo’s heart unexpectedly stopped, and her brain was deprived of oxygen for a period of time. The result, reputable physicians report, is that her cerebral cortex died, putting her in a persistent vegetative state.
As our member, and Express-News columnist, Jonathan Gurwitz, correctly noted, earlier this week, Terri Schiavo is not brain dead. Her brain stem functions, keeping her heart beating and her lungs breathing on their own. However, as a person in a persistent vegetative state, Ms. Schiavo lacks human life, as we know it. She breathes, but cannot think. She awakens, but is not aware. She may see, but does not perceive. She may hear, but she cannot interpret the sounds.
The only artificial mechanism that has been used to keep Terri Schiavo alive is artificial nutrition and hydration. She is unable to eat. She would not know what food was, if it were placed in her mouth. If she were fed the bread and water that some fanatics are bringing to the hospice this week, she would choke, or aspirate the food, develop pneumonia and die. A surgically-inserted tube has delivered her nourishment for many years.
As a Jewish congregation, we may be interested in knowing what Judaism teaches about the permissibility of removing artificial nutrition and hydration from a patient in a persistent vegetative state. The truth be told, our Jewish legal sources are mixed on this specific question.
Judaism is clear that nothing may be done to kill a person; euthanasia is strictly prohibited. On the other hand, we may remove artificial impediments to a natural death. Many regard nutrition and hydration as so basic to life that removing a feeding tube is viewed as tantamount to euthanasia. We would all agree that withholding food and water from a patient who is able to eat or drink would be wrong. However, some Jewish authorities view artificial nutrition and hydration as equivalents of ventilators and other artificial life supports. For them, tube feeding may be stopped, removing an unnatural impediment to death.
Having seen death up close on many occasions, I tend strongly toward the latter view. People who are dieing, in natural processes, stop eating, and then stop drinking, in the days and hours leading up to death. My observations square with what I’m told to be ample medical evidence: People do not suffer from hunger or thirst in these situations. A dry mouth can be, and is, swabbed with moisture, often several times an hour.
On more than one occasion, I have been with families, making the difficult decision to end life supports, such as medicines that are keeping a dead heart beating and ventilators that are breathing for a person who has no reasonable hope for recovery. I have also helped families make the difficult decision not to insert a feeding tube. In each of these cases, I would be deeply offended to hear the cause of death described as “removal of life supports.” Instead, death was caused by the massive stroke, the devastating head injury, the overwhelming heart attack.
Terri Schiavo’s cause of death will not be starvation and/or dehydration. Instead, she will, after all this time, die of the cardiac event that deprived her brain of oxygen, fifteen years ago.
Of course, Jewish views on end-of-life issues do not bear on Terri Schiavo’s case. She is Catholic. The positions of that faith, and the laws of the State of Florida, are at issue.
Though some right-wing Catholics have allied themselves with others on the religious right to make a cause celebre of poor Ms. Schiavo’s case, the Catholic Church and its American hierarchy are divided on the permissibility of removing artificial nutrition and hydration from a person in a persistent vegetative state.
The legal question surrounds the question of who should make decisions on Terri Schiavo’s behalf. As Jonathan Gurwitz has argued, Michael Schiavo, her husband, has, quite understandably, moved on with his life, violating the sanctity of his marriage and therefore arguably forfeiting his right to make this decision. On the other hand, I would add that Ms. Schiavo’s parents, who cannot be blamed for having their judgment clouded by their distress at their daughter’s death, are not the best ones to make the decision for their daughter. They apparently do not understand her devastating condition.
The matter appears to have been settled, because a guardian ad litem, appointed by the court to represent Terri Schiavo, concluded that evidence supports her husband’s claim that she would not have wanted to have been maintained on feeding tubes.
The circus in Washington last weekend was just that: a circus. Our President and congressional leaders expended untold sums of taxpayer money to gather in emergency session, in a failed attempt to impose the values of a passionate religious group upon one poor woman and a nation. Cynically, they wrote this supposed emergency law in such a way that even jurists of their own party took no action on its basis. These Washington politicians are beneath contempt, having immorally spent millions on politics alone, to pander to their base, millions more that will have to be borrowed, millions less to spend on health care, to benefit the homeless, to aid tsunami victims, or to armor our own troops in Iraq.
We must acknowledge that none of this would ever have happened, we would never have heard of poor Terri Schiavo, if she had declared her wishes, in writing, by executing what most people call a “living will,” but what is more properly called a “directive to physicians” and/or a “medical power of attorney.” Terri Schiavo is not to be blamed either. She was a young woman. How many young people imagine they could end up in her position? How many folks are adequately informed about such documents?
I have both a directive to physicians and a medical power of attorney. Among other things, my directive to physicians orders the removal of artificial nutrition and hydration, if I am in a persistent vegetative state for more than six months. My medical power of attorney makes clear that Toni is to make decisions on my behalf, if I’m unable to do so, and names successors if she should be unavailable. In this way, I am assuring that Jewish teachings, as I understand them, will be applied to any medical decisions that must be made on my behalf.
Tonight, I want to urge each and every adult in our midst to do the same. A lawyer prepared my directive to physicians and my medical power of attorney for me. I do recommend that you see a lawyer for this purpose. In the meantime, though, properly executed and witnessed forms, available on the Internet, provide essentially the same protection. Tonight, we have copies of these forms available, from a web site recommended in an Express-News editorial earlier this week. You will note that the directive we are offering was prepared by an arm of the Catholic Church, not by any wild-eyed liberal group or euthanasia advocate. Moreover, this directive offers choices: You may note your preference to receive artificial nutrition and hydration indefinitely, if that is your wish, just as easily as you may request that no heroic measures be taken.
God willing, each of us will die, like Moses, of old age, the accomplishment of our life’s goals in sight, at the age of 120, quickly and quietly, in the presence of the Lord. More likely, we will die a bit sooner than that. As our Yom Kippur liturgy reminds us, only God knows who will die by fire, and who by water; who by illness and who by accident. In impoverished regions of this world, and even of our city, people do die of hunger and of thirst. Terri Schiavo, though, shall not be a victim of either of these. Some kind of cardiac anomaly took her away from this world. Let her be in our prayers tonight, together with her family who loves her, even her husband who has violated his vows, even her parents, who do not comprehend her condition. May God grant peace to Terri Schiavo and to all who love her. May each of us find peace, too, when our own time comes, at the beckoning of the Lord.