Boy On Life Support Stirs Debate On Faith, End-Of-Life Care
MICHEL MARTIN, host:
I'm Michel Martin, and this is Tell Me More from NPR News. Coming up, our Friday BackTalk segment, where we hear what's on your minds. But first, each week at this time, we try to explore issues of spirituality and faith in our segment Faith Matters. Today, we're talking about the intersection of faith, medicine and the law - in this case, the very definition of death. At the Children's National Medical Center in Washington, D.C., 12-year-old Motl Brody lies in a coma, the result of a malignant brain tumor.
He became ill just a few months ago, received treatment, but never awakened from surgery. Last week, doctors pronounced him dead, saying there is no activity in any portion of his brain. But Motl's heart is still beating, and his family, who are observant Orthodox Jews, say that according to their faith, that means he's still alive. They want the hospital to keep their son on life support, and they are making plans to take the hospital to court to ensure that they do so. Helping us to explore this dilemma between faith and the law, we've invited Dr. Edward Reichman to joins us. Dr. Reichman is a rabbi and a physician. He joins us from the emergency room at Montefiore Medical Center, where he is an attending physician. Dr. Reichman, thank you so much for taking time out of your busy schedule to join us.
Dr. EDWARD REICHMAN (Rabbi and Physician, Montefiore Medical Center): Pleasure to be here with you today, Michel.
MARTIN: Now, Dr. Reichman, you also teach emergency medicine at Yeshiva University's Albert Einstein College of Medicine. It serves the Orthodox Jewish community as well as many others. I'd just like to ask, just how is the Orthodox community responding to this dilemma? Is it a big issue, this dilemma involving Motl Brody in this terrible situation?
Dr. REICHMAN: It's no question that there is a lot of discussion within the Jewish community about how the response will be to this particular case. It's really an issue of respecting religious sensitivities, which our wonderful country has generally been very accepting of religious observance, in particular observance in the Jewish community. And this really pushes the issue to the fore. You have a circumstance where the physicians maintain that this patient is indeed dead, but at least some rabbis within the Orthodox Jewish tradition maintain that this child is indeed alive and merits the care as any other patient would.
MARTIN: Now, this isn't the first debate that's become public over the fate of a patient in a coma. How is Motl Brody's case different from Terri Schiavo's in 2005? That's a case a lot of people are familiar with.
Dr. REICHMAN: Very good. Excellent question. There's been a lot of misconception about that. The major distinction is that in the case of Terri Schiavo, her medical condition was a persistent vegetative state. She did not sustain brain death and she was able to breathe comfortably on her own, did not need the assistance of another device to assist her in breathing. She could have continued in that state for a prolonged time. There, the question was, should we withhold care from her? Should we withhold, in particular, the feeding tube? And then, the debate ensued.
However, this case of Motl Brody, he has a unique diagnosis of brain death, which means that as the doctors determined, he has cessation of entire brain function, including the brain stem, and is connected to a respirator to sustain his breathing and sustain his heartbeat. So here, the difference is that general society accepts this as legal death. But in the eyes of Jewish law, at least according to some rabbinic opinion - and I should hasten to add, it is a matter of rabbinic debate - this child is considered legally alive as long as the heart is still beating. So therein lies the dilemma.
MARTIN: Is it under any circumstances if the heart is beating, even if there is assistance, then the person is still considered to be alive?
Dr. REICHMAN: The answer to that is yes. Even if the heart is beating only by virtue of the connection of the body to a respirator, which is providing oxygen to the body, there is a rabbinic opinion that maintains that this child is indeed still alive.
MARTIN: Can I ask what's the basis for that rabbinic opinion?
Dr. REICHMAN: It's based on precedence. It's based on, in our case, a very ancient theological tradition dating back to the times of the Bible through the times of the Talmud, which was compiled in the 5th century of the common era, to this very day.
MARTIN: Can you help me understand the difference in rabbinic opinion? Is there a difference within the traditions, within - is there, say, for example, a difference in Orthodox opinion versus Conservative rabbinic opinion? Or is there a debate within the Orthodox rabbinate about this issue?
Dr. REICHMAN: In this particular case, there is a debate even within the Orthodox Jewish community. So the rabbis are all looking at the same source material, but their interpretation of that source material differs, not dissimilar to two Supreme Court justices that are looking at the Constitution and interpreting it differently. The difference is that Judaism is a theological system and we believe that the law is divinely ordained, but we also believe that competent, well-trained Orthodox rabbis are able to deduce the law. And even if they come to different conclusions, both of those conclusions are respected within the tradition.
MARTIN: If you're just joining us, you're listening to Tell Me More from NPR News. I'm Michel Martin. I'm speaking with Dr. Edward Reichman. He is a physician; he's the associate professor of emergency medicine at Albert Einstein College of Medicine of Yeshiva University. He's also a rabbi, and we're talking about the case of 12-year-old Motl Brody. He is a young boy who was suffering from a malignant brain tumor. He is currently in a coma, and there's a debate over whether life-sustaining support should still be continued. Dr. Reichman, if the Orthodox rabbis have differing opinions, how can a final decision be reached?
Dr. REICHMAN: That's an excellent question. And to answer that, allow me to clarify how the legal system works. We don't have a central court, for example, that requires consensus. The law is adjudicated on a case-by-case basis. So, in this particular case, the Brody family went to their rabbinic authority, who rendered a decision on this case that, in his opinion, the child is legally alive. So it is not an ambiguous decision. It is a definitive decision. That is the decision which the family is bound by. It's quite possible that another family in another part of the country or another part of the world would ask their rabbinic authority, who could have rendered a different decision. So it is not an argument about the nature of the decision for this family. For this family, there is one decision, one decision only, and that's the one rendered by their rabbi.
MARTIN: I see. And in addition to your many hats - you are not a lawyer, so I'm not asking for a legal opinion in addition to all the other responsibilities you have. But as I mentioned, the family has considered going to secular, legal authorities to advance their case. They have not yet done so because I think both sides have made it clear, both the hospital and the family have made it clear they would like to settle this outside of those proceedings. But do you know, as a doctor, what the precedent is if one, as a matter of religious conviction, believes that a certain action is, particularly in a matter of end-of-life care, needs to be maintained and the secular, legal standard is different? Do you know what the precedent is for addressing this?
Dr. REICHMAN: For example, in the state of New York, there is a religious exemption to the definition of death exactly similar to this case. So while the state acknowledges that brain death is legal death, if a family has a religious exemption, which in this case, the Brody family does, that family would be allowed to have their wishes respected and have care continued.
MARTIN: I don't think the District of Columbia has the same legal requirement to respect different religious interpretations of end of life, as New York and New Jersey do. The hospital says in their court filing that they, that there's no - ethically, there's no appropriate treatment except removable of the ventilator and the drugs. There's no known treatment being withheld, and that there's no medical necessity for the treatment. But they say that they need the space for other patients who need this care, and that they cannot ethically continue to press the insurance company to pay for this treatment when in fact, this is not treatment being offered. What is to be done here?
Dr. REICHMAN: The insurance issue is admittedly an issue which requires further analysis. But with respect to the treatment issue, indeed, brain death is an irreversible process, at least as we understand it today. But that doesn't mean that this particular individual, at least in the eyes of the family, is not alive currently. Currently, this child is alive and has rights within the law, at least from the eye - perspective of Judaism, to be treated as such. And Judaism believes that his life has no less sanctity than any other life. And the issue here, more subtly - perhaps not so subtly - is that the removal of the respirator, at least from the perspective of this rabbinic position, could potentially constitute homicide because once that respirator is removed, the child will die, or his heart will stop, within a few moments.
MARTIN: Could he not be maintained on a respirator at home?
Dr. REICHMAN: To be honest, he could be maintained on a respirator anywhere. It doesn't have to be in that hospital. It could be at another facility, could theoretically be at home with nursing care. Those particulars I'm not privy to within the hospital's complaint nor the family's contention.
MARTIN: There are those who will listen to our conversation who will understand completely what you're saying. They're just saying, look, if the medical definition is X and this is Y, then that should be the end of it, particularly given, you know, scarcity of resources and so forth. Is there something you could - is there something you could say to them to help them understand why this is such a difficult dilemma for this family?
Dr. REICHMAN: The thrust of our society, and I happen to practice emergency medicine, is we're in a phase now over the last few decades of being aggressive in our withholding care. And there's been a focus, for example, on quality of life. And as a result, our notion or perceptions of quality of life in the society that we live in have led us to consider life as being of much less value and withhold care on a frequent basis. And it's a relative value that's evolved in our society. And one of the greatnesses of Judaism in the religious tradition is consistency.
The tradition has been the tradition for thousands of years, places tremendous value on human life from the beginning of life to the very end of life, even after life, even the way we treat the deceased. And it's that aspect which I think is being lost here, and it's not a question of a family wanting to do something against the hospital here. It's a family looking to a child and realizing that in our tradition, this child is a human life. Let's respect that human life and treat it with the respect that it deserves.
MARTIN: If the secular law does permit the ventilator to be removed, what guidance would you offer the parents spiritually to accept this?
Dr. REICHMAN: The general teaching in Judaism is that everything - there is a cause and reason for everything that occurs. Some things are within our control, some things are not. Here, the family has clearly done everything they can do. There clearly is a greater design, a greater plan, and they have obviously become a part of a major analysis of this particular issue. And perhaps this case will bring to the fore a discussion of this issue, which will bring good to other people in the world.
MARTIN: Those of us who are perhaps not bound by this particular religious tradition - I mean, anytime one is facing the loss of a child, this is just a terrible, terrible thing to experience. You know, every parent wants to protect his or her child, and to be unable to do so must just be an awful feeling. But I wondered if there's something that you would wish the rest of us to learn from this dilemma, however it is resolved.
Dr. REICHMAN: There's a rabbinic expression that you cannot judge an individual until you are in the exact same circumstance as that individual. There's no question that it is an immensely emotional, heart-wrenching situation that the family now finds themselves in. Our focus has been on the theology. Our focus has been on the legal aspects, on the theory. Our focus really should turn to the family themselves and give them the greatest support that they need, the prayers that they need to get through this very difficult situation.
MARTIN: Dr. Edward Reichman is a rabbi. He's a physician. He's an associate professor of emergency medicine at the Albert Einstein College of Medicine at Yeshiva University. And he was kind enough to join us from the emergency room at Montefiore Medical Center in New York. Dr. Reichman, I thank you so much - Rabbi Reichman, I thank you so much for speaking with us.
Dr. REICHMAN: Thank you so much, Michel.
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