Dear Rabbi Fried,
I am very torn about a situation which has arisen with my mother. She is currently in advanced stages of terminal cancer, and presently in the hospital on intravenous feeding, as she’s not able to eat much by mouth. They’re talking about releasing her to hospice in three weeks. The doctors recommend discontinuing the feeding tube. They claim she no longer assimilates the liquids and electrolytes in her body, and it could cause her more trouble than gain to continue that mode of feeding. I feel like it’s starving her to death to discontinue the feeding; Mom’s not sure. I’ve always heard that Jewishly it’s wrong to withhold feeding. I’m not sure; what’s the right thing to advise her?
I’m very sorry about your mother’s situation, and what it’s putting you through.
The question of intravenous feeding, or Total Parenteral Nutrition (TPN), is truly a very complicated one. Back in the ‘70s, when it was first developed, it was felt that artificial feeding, when one could no longer eat on their own, was always a good thing. Dr. Robert Fine, of the medical ethics department of Baylor, told me that in those days they were shocked when many times the feeding had the opposite effect and no one dared challenge the notion that TPN is always a good thing. Since then, numerous studies have shown that TPN is quite a mixed bag and many times does more harm than good.
This is for multiple reasons. At times, the cells can no longer utilize the nutrients and liquid provided by the TPN. In those cases, rather than provide the body with nutrition, all the TPN does is fill the body with liquids it can’t expel, causing much pain and many side effects. In addition, it can cause infection, and sepsis, which is often a fatal infection of the blood. In these cases, the feeding actually hastens death.
Furthermore, in the above cases, the death process itself can be much more painful, as the person is not able to go into their final, peaceful sleep through which they can pass naturally and painlessly.
Jewishly, it’s a case-by-case question. It needs to be investigated thoroughly if, indeed, the body no longer is receiving nutrition by the TPN. If that were truly the case, to withhold TPN would not be considered starving her to death, since it’s not providing nutrition anyway. In such a case, it is no longer a mitzvah to attempt to provide her with something she doesn’t need and can’t use. Since there are physicians who are hasty to conclude this is so, you must be sure the situation was determined clearly and scientifically, without regard to the costs of continued feeding. If the body still needs and can use the nutrition, Jewish law forbids the cessation of TPN at all costs.
We need to recognize the God-given cognizance of the body to know when its end is near, and begins to shut down. At that time, the body rejects further sustenance. As difficult as it is, we need to allow the body to do what it needs to.
In Jewish law, every moment of life is precious and is above valuation. We do anything and everything in our power to preserve life. The preservation of life even goes above the observance of the most important laws of the Torah. This, however, only goes for preserving life, not prolonging death. There’s a fine line between the two, and every case needs the determination of a rabbi, well versed in these issues, in consultation with the doctors.
May God give you the strength to endure this difficult time, and to make the most of the final precious days and weeks, which are a gift, with your mother.
Dear Rabbi Fried,