NEW YORK (Oct. 20)
Three rabbinical experts, one Orthodox, one Conservative and one Reform, have expressed separate conflicting opinions on whether Jewish Law would sanction the plea of the parents of a 21-year-old New Jersey women for removal of a respirator which has sustained her life processes for more than five months.
Karen Ann Quinlan has suffered irreversible brain damage, according to doctors at St. Clare’s Hospital in Denville; N.J., where she is in a coma. Her foster parents, Mr. and Mrs. Joseph Quinlan of Landing, N.J. filed a petition, asking a Superior Court to authorize removal of the respirator so that their daughter can die “with grace and dignity.” A hearing on the petition began today in Morristown before Judge Robert Muir. Jr.
The three rabbis asked by the Jewish Telegraphic Agency for comment on the issues in the situation from the standpoint of Jewish Law-and ethics are Rabbi Norman Lamm, spiritual leader of the Jewish Center in Manhattan and professor of Jewish Philosophy at Yeshiva University; Rabbi Seymour Siegel, chairman of the Committee on Jewish Law and Standards of the Rabbinical Assembly, the association of Conservative rabbis; and Rabbi Joseph Perman, spiritual leader of the Free Synagogue of Westchester in Mount Vernon, and chairman of the subcommittee on bio-ethics of the Central Conference of American Rabbis, the association of Reform rabbis.
CANNOT PULL THE PLUG
Rabbi Lamm said that the parents “simply are not a party to the case from the point of view of Jewish Law” and that “to bestow upon them the legal right to determine the life or death of their daughter would be a reversion to ancient Roman times when parents had the absolute authority over the life and death of their progeny.”
He declared that “the general principle of the Halacha with regard to the case itself is that we are not required to utilize heroic measures to prolong the life of hopelessly sick patients but we are forbidden to terminate the use of such measures once they have been begun.”
In other words, Rabbi Lamm added, “if we are asked whether or not to use such extraordinary measures to prolong biologically the life of a patient who has suffered irreversible brain damage, then there are grounds, always depending on the individual case, for responding negatively.” But, he asserted, “I cannot see how Jewish Law can sanction pulling the plug, which is tantamount to severing a vital organ of the patient, which is forbidden.”
CRITERIA FOR DETERMINING DEATH
Rabbi Siegel stressed, in his comment, that he was giving his personal opinion because the Committee on Jewish Law and Standards “has as yet not considered this matter, but will do so soon.”
The basic question, he said, is whether the woman is to be considered dead or still alive, though in a coma. In traditional Judaism, he said the criteria for determining death have been “the cessation of respiratory functions and at the cessation of heart beat.” These criteria represented “the best scientific knowledge of the day” and once those functions stopped, the person was judged to be dead he said.
Rabbi Siegel added that, in the judgement of Orthodox “decisors,” these criteria “should not be changed since they have been enshrined in the traditional texts.” But “in the judgement of more liberal decisors, such as those affiliated with Conservative and Reform Judaism, the criteria for death should reflect the best scientific knowledge of the time, not dogmatic principles.” At the present time, he said, “there is near consensus in the scientific community that ‘brain death’ does indeed indicate the cessation of human life” and that therefore, the “basis for decision in this vital area has been established.”
On the assumption that Miss Quinlan is not dead by current medical standards, the next question, Rabbi Siegel said, is the issue of euthanasia. He said there was a distinction between active and passive euthanasia. Active euthanasia is action to stop life or permitting a person to die.”
Removing the respirator would be a situation of passive euthanasia, which he said would be permitted if medical opinion is that the woman is dead. Since active euthanasia is forbidden, the respirator may not be removed if the person is held to be alive. He stressed also that when dealing with such “an infinitely precious thing as human life, the most stringent precautions be taken to protect the patient.”
ROLE OF ETHICAL SENSITIVITY
Rabbi Perman agreed that traditional Jewish Law does not speak of brain death because this was beyond the limits of medical knowledge at the time it was written. In any event, he added, “we do not need to go beyond the law; we need to get behind it and try to understand the ethical sensitivity and human compassion that has determined all Jewish bio-ethical decisions.”
Rabbi Perman said it was his understanding that there was no present hope for a cure for Miss Quinlan nor any possibility of returning her to a normal relatively healthy life. The question, he said, was “whether artificially to prolong her condition or not to prolong it. We ought not to do it.” He said it could not be “ethically justifiable to extend a vegetable state for weeks, let alone months” and that no patient “should have to suffer such indignity, regardless of state of consciousness.”
Rabbi Perman also contended that “no parents, whether natural or adoptive, should ever have to beg that their child’s life be taken. To my mind, there is no possible good to outweigh the anguish of these circumstances.” Quoting Ecclesiastes that “there is a time to live and a time to die,” Rabbi Perman declared “there is also a time to let live and, in this case, to let die.”
He noted that there is not at present any structure to make an effective decision in the Quinlan case. He said the National Institute of Health has a requirement in respect to bio-medical and behavioral research establishing review committees to examine all research involving human subjects, made up of physicians, non-medical scientists “and respected medical laymen,” Rabbi Perman, a member of the human subjects review committee of the Mount Sinai School of Medicine, said that ideally, every hospital “should have a formalized review procedure with appropriate means of appeal” for dealing with ethical questions in general, hospital practice or physician-patient relations.