Events in a Washington D.C. hospital prove that the divisive controversy over the question of when human life begins is matched by equally complex issues over the determination of when it ends. As a father, I can not fathom the pain of parents watching their child die. And the case of Motl Brody, a 12-year-old Hasidic boy from Brooklyn, NY being treated for brain cancer at Children’s National Medical Center is just such a case.
It is not surprising to me that the family may not be handling things so well. How could they? But the behavior of both the hospital and the religious organizations that claim to support the Brody’s is pretty darn lousy too. And the only reason seems to be that in each case, they put their own ideologies before the needs of this family. In each case, they are battling in court instead of coming together to find a solution that works for the Motl, his family, and the hospital.
To be sure, there are real differences of opinion here about when death occurs, so this is no simple matter. For the medical establishment, and for most Americans, death happens with either the irreversible cessation of breathing or the irreversible end of brain function. But for some within the Orthodox Jewish community, only the cessation of breathing counts as death.
That means patients like Motl Brody, who is intubated and on a “breathing machine”, are still considered alive and that withdrawal of life support would be considered murder by his parents.
Given their beliefs, it is not hard to understand why they object to the hospital’s desire to end life support and allow him to “complete the process of dying”.
It does not explain the hospital’s claiming that keeping Motl on life support “is offensive to good medical ethics”, as they insist in court papers being reviewed this morning. Does that that mean that anyone who differs with them is unethical and or offensive? While I, and many other Orthodox Jews, agree that Motl is already dead, the only thing offensive here is the arrogant use of that kind of language by the hospital.
On the other hand, the behavior of Orthodox advocacy group, Agudath Israel is not much better. Rather than work with the hospital or focus attention on this one case, they have a team of lobbyists and lawyers who have jumped to the precedent and principle involved. Rather than address the issue of one little boy, they are using his tragedy as a platform in their ongoing political battle about when death is considered to have occurred.
It seems to me that each side needs to ask, how it can help this one family and not how to use their experience to “prove” a particular point. This is not about all of medical ethics, it’s about Motl. And the hospital could work with the family to support their decision instead of hiding behind grand philosophical statements.
Agudath Israel likewise, should be figuring out how to keep Motl on life support without taxing the hospital’s resources – medical or financial. The truth is that most people think that Motl is already dead. If they want to continue treatment, it is incumbent upon them to make that happen without diverting resources from other patients, who are deemed more worthy. The sad truth is, that medical care is not an infinite resource and those kinds of decision are made every day.
I know that the hospital can not bear to admit that there might be more than one appropriate definition of when death occurs because it’s to ethically disquieting – how orthodox of them! And I know that Orthodox rabbinic authorities are likewise no fans of multiple possibilities when it comes to these tough issues. But we have more medical capacity right now than we have ethical capacity. It’s not surprising. It takes time for our ethical systems to catch up to the new realities that are created by new technology.
The answer? Take each situation as it comes. Admit that working on an ad hoc basis, taking into account the particular experience of each patient and family will get us better results that politicking this issue. If we open our hearts to the experience of people instead of invoking the rules of some medical code or religious text, we can develop an ethic for the end of life that is as sophisticated as the medical capacity which has brought us to this dilemma and all be the better for both.



Author, radio and TV talk show host, and President of CLAL-The National Jewish Center for Learning and Leadership, Brad Hirschfield is the author of 



posted November 10, 2008 at 1:41 pm
In relation to the issue of when life begins that came up not long ago in Windows and Doors, I opined that on our planet life began on once in the distant eons, in that epoch when the non-living chemical soup spawned rudimentary life. Since then all living things/beings share in that same life. Life does not begin at any point for the individual. Sperm and egg are already alive with the life that flows from time immemorial.
The other side of that is that life does not end with any individual death. We trim our toenails and slough off dead skin cells, but our individual life does not end. Likewise, our individual lives are sloughed off but the greater life of which we are a part continues. As long as our planet is not made totally inhospitable to life, as long as some living thing survives, death has not occurred and the shared life of us all continues.
This grand schema does not answer the medical-ethical questions like those surrounding Motl Brody. But it gives us a sound basis for thinking about those issues. Life and death are much bigger than we generally admit. The result is that we make broad pronouncements based on things we don’t understand at all.
L’Shalom,
Chaim
posted November 10, 2008 at 4:15 pm
“The answer? Take each situation as it comes. Admit that working on an ad hoc basis, taking into account the particular experience of each patient and family will get us better results that politicking this issue. If we open our hearts to the experience of people instead of invoking the rules of some medical code or religious text, we can develop an ethic for the end of life that is as sophisticated as the medical capacity which has brought us to this dilemma and all be the better for both.”
I don’t doubt this is the better path. It can be enormously difficult when family members of different minds, however. All the issues are not moral or medical.
posted November 10, 2008 at 9:09 pm
It’s funny that this comes up. Basically, if you have the money, you can be alive for a much longer period of time than not. If you are poor, things like Texas Advance Directives Act are imposed on you and get unplugged showing signs of no life, a little life or a lot of life but just not enough money to keep it going. So I guess the answer is that death comes when you can’t afford to live. Right now I am having enough trouble paying attention.
posted November 11, 2008 at 1:22 am
Dear Rabbi Hirschfield,
You wrote “While I, and many other Orthodox Jews, agree that Motl is already dead”
1) What makes a person (you (or anybody)) be considerd a Orthodox Jew???
2) From where in Jewish law do you base your opinion???
Thanks for your time in answering me,
Yosef
posted November 11, 2008 at 9:45 am
Dear Yosef,
Much ink has been spilled and little agreement reached about the definition of what constitutes and Orthodox Jew, I offer you two brief approaches to answering your first question. The first is purely sociological. It understands anyone to be Orthodox, who is accepted as such by a critical mass of other people who are themselves seen as Orthodox.
The second definition of Orthodoxy would probably include a life that is based on the authority of Torah and the performance of mitzvot (commandments, not just “good deeds” as the word is often translated), both of which are expressions of divine will for the Jewish people.
The brain death controversy hinges, in large measure, on the p’sak (ruling) of Rabbi Moshe David Tendler and his understanding of like rulings by his late father-in-law, Rabbi Moshe Feinstein of blessed memory. By no means do all Orthodox Jews agree with his conclusions, but many do. My interst lies in respecting the understanding of each side in this ongoing debate. Thanks for you questions.
posted November 11, 2008 at 11:41 am
Interesting comments and responses–thanks.
What is….or IS there a position that the Jewish faith takes with regards to abortion and is there an agreement as to when life actually begins? In my simple and humble opinion death occurs when the brain no longer functions and the breathing process is merely stimulated by equipment; after all once the machine is detached the body usually dies. So, I ponder–is that not answer enough?
posted November 11, 2008 at 11:45 am
When is one considered dead. It is my conclusion that when the brain is dead or brain wave gone, that person has ceased to be.
Think of the brain as like a computer tower and the heart like electricity. When he the tower ceases to function, all the electricity going into will not make it work any longer. One might as well toss it. However there might be parts of that computer that one might be able to harvest. The memory section might be able to be used in a like machine.
Likewise there are parts of the human body that might be harvested for the use in someone else.
About forty years ago my mother was strickened with what we now call an aneurysm in her brain. She never regained conscienceness, nor did the doctors expect her to. She lived (breathed) for 11 days before pneumonia set in and evenually killed her. No attempt was made to revive her as the doctor just said, she would never be the same. They ran an object across her feet and hands and got no respond. When she did open her eyes briefly, they looked like road kill staring out blankly and expressioness. I saw that same look in pictures I saw of Terri (Schervo)? the Florida woman a few years back. And the only thing we as a family could do was wait for the inevitable. My mother’s heartbeat was strong and up until the pneumonia set in so was her breathing. But for all intents and purposes she was gone. She was only 37 years old when this happened.
Let’s face it, we will all have to leave this world someday, and for the most part we will not have any say in the when and in most cases neither the how. When death taps one on the shoulder, it is already to late to protest. And in cases like my mom, even if we had been millionaires and lived in today’s society with all the fancy equipment, it wouldn’t have made much difference. It would have delayed us saying that final goodbye, but still……
posted November 11, 2008 at 11:49 am
i agree with you that the focus of all parties is for the long range outlook and motl is just a pawn in this fight bet the medical establishment/insurance companies and religious orthodox halacha
hence many states have the DNR form be filled out by patient/family in order to avoid the above senario
posted November 11, 2008 at 11:55 am
rabbi brad
you quote rabbi tendler who’s psak is based on “His understanding of his father inlaw’s psak” most other poskim disagree on rabbi tendlers
understanding og hagoan reb moshe ztl’s tshuva on the issue
todays accepted orthodox gedolim are all in agreement “pulling the plug” is tantamount to murder
though their are allowances to sign the DNR
posted November 11, 2008 at 3:29 pm
wow what a tough thing to have to go thru. It is up to the family and their religon and the hospital and the gov and that is emnough to drive everyone involved up the wall.
Everyone else needs to keep out of it and not have tons of people stating their cases.
Sorry but it this case like any of its kind everyone just needs to let those involved take care of it.
hugs
Laura
posted November 11, 2008 at 10:51 pm
As a nurse, I feel for the family in this situation. But I can also see where the hospital is coming from. There is no electrical activity in this child’s brain stem whatsoever; this is not a debate about whether or not he’s a vegetable. He’s far beyond that at this point. Legally, he is dead. His heart and lungs aren’t “working”; his heart is “beating” thanks to a cocktail of strong drugs, and his lungs are being inflated by a ventilator. His heart isn’t beating any more now than it would if I stuck my hand in his chest and squeezed it to circulate blood myself. His brain tissue is even beginning to decompose; Marriea alluded to organ donation, but at this point he’s been dead for so long that his organs wouldn’t be suitable anymore.
The care that this child is receiving is incredibly expensive. Insurance won’t pay for it. And the most important thing to consider, in my opinion, is the fact that this child is taking up a bed and other resources (doctors, nurses, equipment, etc.) that a living child could be using to receive life-saving treatment. THAT is why continuing to provide care to a legally dead child is medically unethical.
What should have happened here is for the hospital staff to sit down with the family…preferably with an Orthodox Jewish doctor, nurse, and/or administrator (there have to be some somewhere!)…who could compassionately but honestly lay out the situation and come up with a way to withdraw care that would be acceptable to the parents’ religious beliefs. But now that lawyers and lobbyists are involved, the tone has changed completely; it may be too late to change it. I’ll be praying for this little boy and his family.
posted November 12, 2008 at 1:12 pm
“But for some within the Orthodox Jewish community, only the cessation of breathing counts as death.” This means to me that, even within the Orthodox community, there is disagreement re: when death occurs. As a rabbi, maybe you could discuss the different ideas within Judaism re: when death occurs.
posted November 12, 2008 at 2:01 pm
Selfish doesn’t even begin to describe this circus. Enough already. Our pets can die with dignity and decisiveness, but not humans. Prolonging this kind of no-quality-of-life accomplishes nothing but postponing grieving & denying the family’s long overdue ability to move on. These parents must have $ to burn. They are also increasing costs for everyone else in their health care plan, the hospital, other patients, etc. Selfishness strikes again! Maybe they are related to Terry Schiavo’s parents?!?! Same mentality….clinging to hope when there ain’t none.
posted November 13, 2008 at 10:22 am
“As a nurse, I feel for the family. . .I can also see where the hospital is coming from. There is no electrical activity in this child’s brain stem whatsoever; . . .Legally, he is dead. His heart and lungs aren’t “working”; his heart is “beating” thanks to a cocktail of strong drugs, and his lungs are being inflated by a ventilator. . . at this point he’s been dead for so long that his organs wouldn’t be suitable anymore.”
So this boy is already dead and is being kept alive artificially. Sounds to me suspiciously like a modern-day golem, and all that remains is to inscribe his forehead. It should be recalled that the golem turned on the community that depended on it for salvation. In like fashion, I am concerned that this symbolic golem will turn on the ultra-Orthodox community that is trying to keep it alive to validate its beliefs. The non-Jewish community usually doesn’t make distinctions in the wide range of Jewish philosophy and thought. Whether we agree or not, we are just seen as Jews who are making trouble again.
Gavriella
posted November 13, 2008 at 1:22 pm
IMO, and considering the Jewish definition of death, If the child can’t breath on his own, after an attempt to help him if need be, he has fallen asleep in death. I personally believe he continues to exist, just not here under the sun. King David, gives us a good example of letting go, when his first child with Bathsheba died.
2 Samuel 12:21-23 KJV Then said his servants unto him, What thing is this that thou hast done? thou didst fast and weep for the child, while it was alive; but when the child was dead, thou didst rise and eat bread. 22 And he said, While the child was yet alive, I fasted and wept: for I said, Who can tell whether GOD will be gracious to me, that the child may live? 23 But now he is dead, wherefore should I fast? can I bring him back again? I shall go to him, but he shall not return to me.
posted November 13, 2008 at 2:01 pm
Modern medicine is wonderful…and horrible. Obviously, we now have the ability to cure (and sometimes even prevent) diseases that once killed countless people every year. We have ways to manage disorders (such as diabetes) so that people who once would have died can now live near-normal lives. Unfortunately, the technology which allows doctors to keep hearts and lungs working temporarily while accident victims recover from injuries or heart patients recover from surgery, also allows for a sort of psuedo-life. The machines make a heart beat and cause the lungs to move while the essence of the person is gone. It may look like life, but it is not.____ Certainly, when one ceases to breath, one is dead. Unfortunately, that simple test cannot be the only one when machines can breathe for us. If our soul survives our body and in some way continues, what happens when we force this psuedo-life upon someone? I find it frightening. ____ I feel terrible for the boy and his family. I know they are suffering. But the rabbis who insist on re-animating this dead body are doing harm. The child is dead. His family must mourn and move on. It is terrible that this will end up in the courts when it should have been handled compassionately by those involved.____Lucy G.
posted November 13, 2008 at 2:29 pm
Read the Bible about Euthanasia.
posted November 13, 2008 at 9:12 pm
IMO Motl’s energy has already left and returned to the Universe. Unfortunately his family disagrees due to their beliefs. Guess it is a good thing that Motl is already dead and has no idea the conflict that his occuring.
I sincerely hope the situation gets worked out soon for the good of all involved.
posted November 16, 2008 at 8:06 am
The family and their rabbi should consider what effect this has on a hospital’s acceptance of a seriously ill person who holds extreme religious end of life beleifs.