MARK N. STAITMAN

Infants, who cannot yet perform mitzvot, the profoundly retarded, anencephalic newborns, comatose patients, and patients in a persistent vegetative state are all in a state where it is impossible to perform mitzvot and thus, to participate in the covenant. There is, however, a difference among categories. Some have the potential of performing mitzvor. Others of these categories have no possibility of ever being able to perform mitzvot. The new born will grow and learn. Prayer, study, tzedagah and travel to Israel may all become a part of life. The profoundly retarded may at some time have some self consciousness and express, even silently, a prayer. The comatose patient may hear the shema and internally respond. Not so the patient in a persistent vegetative state. This patient lacks all brain function other than brain stem function. There can be no cognition nor any experience of the five senses. Not only can this patient not perform mitzvot, there is no potential for ever performing mitzvor. In a sense we can say that this patient no longer has a soul. Like the decapitated or the one with the broken neck bone, this one cannot, and never will again perform mitzvot. The very basis for the relationship with God through the covenant, the very source of meaning in life is now gone.

This new category of existence, a breathing body which has no potential for the performance of mirzvot, is disturbing. How ought we behave toward such a patient? We have clear obligations toward this patient, as we do to all human beings, dead or alive. Recognizing the basic dignity(kavod) of the individual, we must treat this new category of person with honor and care. We cannot mutilate it nor can we derive benefit from it,(with the possible exception of piquah nefesh). While clearly this category is different from a corpse, it is also different from a goses or a terefah. While there may be an obligation to provide hydration and nutrition to a goses, there is no obligation to provide ventilation to such a patient. Ventilation would not prolong life, but rather, prevent the dying process from proceeding. The need for artificial ventilation defines a point at which the dying process has reached an irreversible point for the goses. For the patient in a persistent vegetative state theological death has already occurred. The

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