Tzvi Hersh Weinrab and Richard Address are both New York City rabbis who firmly believe Judaism forbids the hastening of death. But the case of Terri Schiavo has nevertheless revealed in them two sets of moral outlooks, methods, and conclusions that are in practice worlds apart.
The sole consideration should be whether or not she's alive, according to Dr. Weinrab, executive vice president of the Union of Orthodox Jewish Congregations. Because Mrs. Schiavo has breathed on her own and demonstrated some measure of brain-stem activity, he says, removing her feeding tube amounts to "murder by starvation."
Rabbi Address, however, sees a moral dilemma complicated by a dismal prognosis, a poor quality of life and, most important, a real possibility that she never wanted to live in a persistent vegetative state. "Husband, mom, and dad - this isn't about you," says Address, director of the Department of Jewish Family Concerns for the Union of Reform Judaism. "It's about this woman, and what is in the best interest of this woman.... If [feeding tube removal] is what she would have wanted, then this is what you should do."
As Terri Schiavo enters what seem to be her final hours, issues raised by her extraordinary case are highlighting sharp differences in the way religious denominations approach the toughest of moral questions. Across and even within religious traditions, camps are lining up according to their theological views of human nature, religious institutions, and individual responsibility for one's own destiny.
On one side, leading thinkers in the United Church of Christ and Unitarian Universalist Association stand with other religious progressives in urging everyone to draft a living will. Where skepticism toward religious authorities is robust in these circles, ultimate decisionmaking responsibility has come to rest with the conscience-driven individual and his or her surrogates in times of duress.
On the other side are faiths that question whether human beings should have latitude for choosing the circumstances in which they or their loved ones die. This view is underpinned theologically by a view of human beings as deeply corrupted, down to the last individual. Notions of entrusting people with decisions about when to die appear naive at best, potentially catastrophic at worst.
"If she is allowed to die of dehydration and malnutrition, every American who is sick, elderly, infirm, ill, mentally or physically handicapped is significantly less safe in this culture than they were before Terri Schiavo was allowed to die," Richard Land, who heads the Southern Baptist Conference's ethics commission, said as Schiavo appeared to hover on the brink of death. "Once you move from a sanctity-of-life ethic, [that] there are some things that should never be done to a human being, to a quality-of-life ethic, where human beings are making decisions for other human beings about what is a sufficient quality of life that deserves the sustaining of life, you are on a very steep and slippery slope to a very dangerous place."
Faithful voices on both sides of the debate are quick to point out their reverence for all human life as a divine gift. Theological differences are instead playing out in varied interpretations of medical technology, its ultimate purpose, and what certain of its readings have to say in spiritual terms in cases where the physical body has undergone radical changes.
In the view of Unitarian minister and death-with-dignity activist Ralph Mero, for instance, Schiavo's feeding tube has become a form of "futile medical treatment" that can be justifiably discontinued. The Roman Catholic Church, by contrast, sees the tube as a vehicle of "basic care" and nutritional sustenance to which any ill person is entitled, according to Richard Doerflinger, deputy director of pro-life activities at the United States Conference of Catholic Bishops. In March 2004, Pope John Paul II clarified this understanding and its relevance to patients everywhere in a persistent vegetative state. While the Vatican has nuanced its position over the past 30 years, allowing for "extraordinary medical treatment" to be discontinued when such measures become overly burdensome to a patient, what's regarded as basic sustenance remains a necessity in all cases,regardless of prognosis or quality of life.
Across a range of traditions, such distinctions resonate more or less according to divergent opinions of whether human beings are capable of knowing what's best for themselves and their kin. "Traditional Judaism does not know of the concept of quality of life," Weinrab says. "If you're alive, you're alive. Even if you're unconscious and in a coma and your life seems to be meaningless, that's only in the eyes of men. But in God's eyes, as long as a person is living, breathing on his own [or showing an active brain], he's alive. And to take that away is something no human being has a right to do."
Islam affirms the same basic idea, albeit with exceptions reserved for select cases of brain damage to the point where there is "no improvement possible," according to Muzammil Siddiqi, president of the Islamic Law Council of North America. Still, he says Mrs. Schiavo should have continued on the feeding tube: "Because she is a living person, we should maintain the life [which is given from God].... If there is any doubt about life and death, we as Muslims believe it is better to err on the side of life."
For those with another theological understanding of human life, however, the opposite conclusion seems justified. Hindus who believe in reincarnation, for instance, can legitimately ask whether justice is served by spending hundreds or thousands of dollars per day to sustain Mrs. Schiavo indefinitely, according to Hindu American Foundation President Mihir Meghani. "Why not let her go into a form, a body, which she will be able to use much more efficiently to reach spiritual levels we are all trying to reach?," says Dr. Meghani, an emergency physician in Fremont, Calif. "In other words, her body has outlived its ability to function for the purpose for which she was born into it, so let her shed the old 'clothes' and put on new 'clothes' that will let her move much more freely."
In the end, the Schiavo case has provided a new stage for an old debate about whether human beings in times of trial need divine guidance to be mediated through religious texts, doctrines, or authorities. The answers seem certain to vary for years - or centuries - to come.