WITHDRAWING OR WITHHOLDING NUTRITION

Without any one of the three, life cannot be sustained. If then there is a moral reason for providing any one of these three, there is a moral basis for providing all three.

Liberal Judaism is uncomfortable with the theology which draws a distinction between respiration and nutrition or hydration, but is equally uncomfortable with the secular medical ethical position. This is clearly seen in the case of the frail elderly. Mrs. Ginsberg, a ninety-two year old nursing home patient is visited daily by her son and daughter. She talks weekly with her grandchildren by telephone. Most liberal Jews would be comfortable with a"Do Not Resuscitate” order for Mrs. Ginsburg. Mrs. Ginsburg does not want to be placed on a respirator. She does not wish to live with the limitations of no longer being able to communicate with her family. She is afraid that if she is placed on a respirator, she will lose all control over her care, and will lose the ability to communicate. On a respirator she will be in a"state of indignity." If she goes into respiratory failure, she wishes to be allowed to die. Death would be within a few hours. As Mrs. Ginsburg gets older, it is more and more difficult for her to eat and drink. She can no longer chew, and swallowing has become difficult. None the less, she is lucid and communicative. She might well be sustained on a feeding tube. Without a feeding tube, she would die within a few weeks. Some how nutrition and hydration seem different from respiration. Both the length of time between the withdrawal or withholding of therapy and death, and the nature of the death seem to make Jews uncomfortable. While Mrs. Ginsburg is not in a persistent vegetative state, her case does help us to see the difference in the way we experience and react to mechanical ventilation as opposed to mechanically administered nutrition and hydration.

Prior to the twentieth century there were no patients in persistent vegetative states. The various cerebral accidents which lead to this state were untreatable in earlier times. Before to the development of intravenous hydration and nutrition, patients died. Prior to the development of the ventilator patients died. Because there is no