Halachic Perspectives on Feeding Tube Removal: The Nancy Cruzan Case
Rabbi Yehuda Finchas
In 1983, 25-year-old Nancy Cruzan was involved in a car accident that left her in a persistent vegetative state, requiring a feeding tube to survive. Her parents requested the removal of her feeding tube, arguing that their daughter would not have wanted to live in such a severely disabled state. However, the hospital refused to remove the feeding tube without court approval.
The case eventually went to the Missouri Supreme Court, which ruled that Nancy’s parents could not have the feeding tube removed. In 1991, the U.S. Supreme Court, in a landmark decision, authorized the removal of Nancy Cruzan’s feeding tube, and she passed away shortly afterward.
Without delving into the legal technicalities, what does halacha say about the removal of a feeding tube?
Halachic Perspective on Self-Starvation
Rabbi Yosef Karo, author of the Shulchan Aruch and Bet Yosef, explains that to starve oneself to death is included in the Biblical prohibition against suicide. This is evidenced by the fact that an oath to abstain from eating for seven days is considered invalid. The Rambam (MishnehTorah, Shavu’ot 1:7) writes that anyone who swears to abstain from food for seven days is guilty of taking a false oath, receiving lashes, and may eat immediately. The reason for this is that such an oath constitutes an intent to transgress a Torah prohibition -essentially, an oath to kill oneself. Therefore, the oath is invalid (Bet Yosef, Y.D., 236).
Fasting and Endangerment of Life
If a person endangers his life by fasting, it is considered an act of possible suicide, even on Yom Kippur. Hacham Ovadia, zt”l, (Yechaveh Daat 1:61) writes: “If there is concern that fasting may endanger someone’s life, one must listen to the doctor and eat on Yom Kippur, as pikuach nefesh (saving a life) overrides the mitzvah of fasting. If the sick person insists on fasting, far from being pious, they will be punished for it.” Since eating is a matter of life and death, they should be forced to eat (Radbaz, quoted by Sheyarei Kneset Hagedolah, O.C., 618).
Autonomy in Halacha and Medical Treatment
While Judaism values autonomy and recognizes free will, this does not extend to the right to take one’s life or violate Torah laws. A person must live according to halacha, which limits autonomy and free choice in certain circumstances. Therefore, patients cannot autonomously refuse potentially beneficial or life-saving treatment. These principles shape the halachic position on tube feeding – Judaism prioritizes the preservation of life, considering patient autonomy only in exceptional circumstances.
The Obligation to Provide Nutrition to a Goses
Even a goses (a dying person) must be provided with nutrition and hydration, as long as it does not pose a choking hazard: “One should not feed a goses since they cannot swallow, but one can place liquid in their mouth, such as extracted broth from salvia, from the sage plant, to enable them to speak” (Sefer Hasidim, 234). This applies equally to tube feeding (Igrot Moshe, CM 2:74:3, Nishmat Avraham, Vol. 5, p.155).
Conclusion on Removing a Feeding Tube
In conclusion, the removal of the feeding tube actively shortened Nancy Cruzan’s life and is therefore halachically forbidden. Hacham Yitzhak Yosef (ResponsaRishon Lezion, EH 25) writes that it is forbidden to shorten the life of a patient, even if they are in a persistent vegetative state. Regarding the precise extent of the liability, see Rambam (Rotzeach, 3:10), who classifies various forms of causing death by restricting access to food and drink. Halacha does not differentiate between withholding milk from a baby, withholding nutrition from someone in a persistent vegetative state, or withholding tube feeding from an advanced dementia patient who cannot take food orally. In fact, the first practical application of Kibud Av Va’em (honoring parents), as stated in Shulchan Aruch Y.D. 240:4, is to feed one’s parents. One may certainly not shorten a person’s life by withholding nutrition and hydration from them.