NUTRITION AND INCURABLE CANCER Walter Jacob

QUESTION: Should nutrition in contrast to medicine be continued for a comatose patient who is suffering from incurable cancer?(Stanley Landman, San Antonio TX )*

ANSWER: We need to make some distinctions immediately between a terminal cancer patient and a victim of stroke or an accident. In the latter cases, the prognosis is not at all certain and death may not be indicated in the foreseeable future. In the case of the incurable cancer patient, a time is reached when medicine can no longer be considered as healing and when the suffering patient is being kept alive artificially with no potential of improvement. When we have reached this point and nothing more can be done, then we may justifiably state that we are dealing with a goses and should remove obstacles which may lead to an easier death (Ket. 104a; Ned. 40a; Sefer Hassidim#723; Isserles to Shulhan Arukh Yoreh Deah 339.1; Even Haezer 121.7; Hoshen Mishpat 221.2 and commentaries). We are willing to utilize modern medical criteria determine when this stage has been reached(W. Jacob ed., American Reform Responsa#79 etc). We realize that these criteria will be refined as medicine is making rapid strides. Medical and technical means need not be continued when the patient is dying and is only being kept alive through these means.

Now let us look at nutrition specifically. We should not think of it in terms of the meals which we normally eat but rather of nutrition provided intravenously or through a stomach tube. Both of these methods are certainly appropriate when they are part of the healing process and help the patient toward a cure. They should, however, be discontinued, Just as medication when only they and medicine are artificially keeping the patient who is dying(goses) alive. Such feeding does not help the Patient and at best must be debilitating and uncomfortable, if not painful. We should also realize that diminished interest by those patients normally capable of eating is another sign that life is ebbing and that the last stages have been reached. Our main goal should be the patient's comfort.