What does Jewish law say about the Terri Schiavo case? Most Jewish organizations have given straightforward answers, and at first glance the halachic response seems clear.
Even though Schiavo is in a chronic vegetative state, unable to interact with her surroundings and with no hope of recovery, Jewish law forbids us to remove her feeding tube. She is clearly alive and to disconnect her medical equipment is to kill her and may not be done, regardless of what she or her husband may desire.
But this determination raises an important question that mostly has not been discussed.
If the tube can’t be removed, who is required to keep feeding her? Who is obligated to pay for her continuing medical care?
In Schiavo’s case, this had not been a problem. Fifteen years ago, she was awarded a $700,000 medical malpractice claim and that money has paid her bills.
But as of earlier this week, there is only $50,000 left and Terri is only 42 years old. If her life had been preserved, what would have happened when her money ran out?
In a high profile case like this a donor might come forward, or Terri’s parents or other family members might have the means. But what if that didn’t happen? Or what if this was an ordinary, non-publicized case involving a family without extraordinary financial resources?
Should the government be required to pay? If Congress had meant to affect responsibly health care for brain-damaged individuals (rather than just make a political point), it should have added an appropriation to the “Terri Schiavo Relief Act.” Instead of just granting her parents the right to sue in federal court, it should have also passed funding for lifetime medical care for patients in chronic vegetative states.
Path to bankruptcy
Having just spent the better part of a nice spring weekend filling out my income tax return, I feel entitled to voice an opinion about federal spending. I’m not so sure full funding for chronic vegetative patients is a good idea.
It might give us ethical superiority, but also will lead us down a path toward financial bankruptcy. High ethics won’t pay for the government programs we all need.
Since paying the bills for someone like Schiavo for possibly decades is a problem, there is no alternative to considering the prospect of rationing medical care. There are two ways to do this.
We can ration actively by making conscious decisions as to which patients should and should not receive care. Or, we can make a policy of passive refusal to remove medical equipment and allow rationing to be done for us.
But if someone like Terri is kept in hospital and hospice beds for the next 30 years, while other patients receive inferior care due to the resources devoted to such a person, that is our choice.
If funds are spent on people like Terri rather than on medical research or on equipment that could benefit other patients, that is also our choice and responsibility.
I admit I have no answer as to where to draw the line for rationing care. Who wants to decide which people are too old, too ill or too unimportant to receive treatment?
But in reality, even the wealthiest country in the world cannot afford to provide everyone complete, unlimited access to all the medical resources invented by science. While I don’t know where the line should be drawn, I have a sad feeling that Terri Schiavo might be on its wrong side.
Halacha needs to take a serious look at this possibility. How can it be moral to devote medical resources to one patient in a vegetative state with no hope of recovery when doing so means denying these resources to others?
As religious people it is tempting to hide behind the halachic maxim that all life is of equal value and that we are forbidden to “play God” by removing medical equipment from one patient to conserve it for another.
But what if an ambulance standing-by to take Terri Schiavo from her hospice to the hospital was needed to care for victims of a car crash? Would we insist with a clear conscience that since the Schiavo call came first it must be God’s will that she be cared for while critically injured children lay unattended at the side of a road?
Throwing up our arms when the going gets tough and “letting God decide” is moral laziness, not piety.
Decisions to ration medical care are inevitable when medicine depends on high cost, high-tech drugs and equipment. If we stick with leaving these choices to God, then the decisions will be made by other people, ethicists that most likely have core values very different than ours.
The Terri Schiavo case represents a challenge to Jewish legal thinkers to address the grueling dilemmas of rationing medical care. Not to do so condemns us to an irrelevant ivory tower and invites secular and non-Jewish ethicists to determine our fate.
Rabbi Shlomo Levin is spiritual leader of Lake Park Synagogue in Milwaukee.
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