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Jewish scholars split on end-of-life issues

JERUSALEM - Like nearly everything in Israel, Ariel Sharon's condition touches both the hard-edged logic of the secular world and the vagaries of faith.

For doctors, the next medical challenge could come today when they start bringing Sharon out of his drug-induced coma. After that - should he need life support or fail to awaken - his case could become drawn into the thorny disagreements among Jewish scholars about the boundaries of life and what measures should be taken to sustain it.

The prime minister and his family hold the ultimate sway over vital medical decisions that may come. But the power of Sharon's legacy could exert itself even in those critical moments - becoming a possible example for others at a time when Israeli leaders and rabbis increasingly confront issues such as the right to refuse life-prolonging measures, when to declare death and how it fits with halacha, or Jewish law.

Doctors have kept Sharon in a medically induced coma and on a respirator since Thursday to give him time to heal after his massive stroke. Sharon remained in critical but stable condition, and a new brain scan Sunday showed that his vital signs, including the pressure inside his skull, were normal, said Dr. Shlomo Mor-Yosef, the director of Jerusalem's Hadassah Hospital.

It's likely all available medical measures would be taken for Sharon, who led a secular lifestyle that paid little heed to Orthodox Jewish views. Yet a need for life-sustaining equipment could open the kind of religious showdowns in Israel that gripped the United States over Terri Schiavo, the brain-damaged woman who died in Pinellas Park last year after her feeding tube was removed.

In Israel, physicians typically defer to families or patients about whether the treatment should follow secular or religious codes. Many rabbis follow a 1986 decision by Israel's chief rabbinate that defines death as irreversible inactivity of major parts of the brain stem, which controls breathing, swallowing and other basic bodily functions. The opinion is based on Jewish texts including the Mishnah, an early source of rabbinical tradition, which establishes decapitation as an irrefutable sign of death. In the modern sense, the rabbis interpret a nonfunctioning brain stem as the same thing.

Others see the core of life in the heartbeat, which can occur even with a severely damaged brain stem and continue with artificial respiration. Some rabbis cite ancient texts that say death occurs only when there is no respiration and no "movement" in the body. They consider a heartbeat a life-signifying movement even if maintained through life-support and may counsel followers not to remove it.

It took six years for Israel's top rabbinical scholars, physicians and other experts to hammer out legislation to allow the terminally ill to refuse life support. It passed last month with one unique provision: The equipment could only be turned off by an automatic timer to avoid having a health care worker do it.

As a concession to Orthodox Jewish lawmakers, the law extends the right only to patients diagnosed with six months or less to live - and not to those in a coma or in a vegetative state.

[Last modified January 9, 2006, 00:57:08]