WITHDRAWING OR WITHHOLDING NUTRITION
death." Some Orthodox posgim have accepted"brain stem death” as an appropriate criterion for defining death. Others have adhered to the traditional definition of death as cessation of respiration and heart beat.’ Both Liberal and Orthodox posgim have rejected the use of active euthanasia.’
Neither Liberal nor Orthodox posgim have written on the treatment of those in a persistent vegetative state. The Tzitz Eliezer does discuss the issue of withholding or withdrawing nutrition or hydration from patients who are terminally ill. He argues that even with respect to a goses one cannot withhold nutrition or hydration. How much the more so with one who is terminal, but not expected to die within three days. The published respons2 of the CCAR, Rabbi Walter Jacob or Rabbi Solomon B. Freehof do not deal with those in a persistent vegetative state. As the condition of the persistent vegetative state is among the hardest for families, and presents new and difficult issues for Liberal Judaism as it attempts to understand the end stages of life, we ought to address this issue. What must one provide for those in a persistent vegetative state? What is the theological basis for this understanding?
A persistent vegetative state is, for this paper, defined as a state in which the individual has only brain stem function. Brain stem function controls only the autonomic reflexes, but not cognition nor the five senses. Those in a persistent vegetative state have no possibility of ever again regaining cognition or the five senses. Those in a persistent vegetative state cannot eat, drink, respond to pain, sound or other stimuli, or have the possibility of ever responding to these stimuli. Those in a persistent vegetative state receive nutrition and hydration through intravenous or indwelling"feeding" tubes. An individual in a persistent vegetative state is not a goses. A goses is one who is expected to die within 72 hours. This person in a persistent vegetative state could continue to breath for months or years.
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