The Terri Schiavo case has sharply divided bioethicists from both secular and religious traditions over what they say is the key ethical dilemma: Should artificial nutrition be considered food or medicine?
Those who view it as food argue that withholding it from Schiavo would be just as immoral as leaving a helpless infant to starve. But those who regard it as medicine say that, given her condition, it is just as ethical to withdraw the feeding tube as shutting down a respirator would be.
The question, fraught with emotions over the nature of human life and obligations to safeguard it, has riven even people within the same religion.
Rabbi Elliot Dorff, rector of the University of Judaism in Los Angeles, for instance, argued that artificial nutrition is not food but medical treatment, and was appropriate to withdraw given the hopelessness of recovery in Schiavo's diagnosed "persistent vegetative state." He also said people must accept their mortality, as the Bible makes clear.
But Rabbi Avram Reisner, a fellow member on the Conservative Movement's Jewish law committee, argued that the feeding tube was removed prematurely. If Schiavo could be trained to swallow, a capacity he asserts has not been adequately explored, then feeding her with a spoon would be morally obligated. Until that issue is resolved, artificial nutrition should have been kept. "Feeding is part of the natural process of life," he said.
Orthodox Jews voice even stronger views: Withholding food and drink is "cruel and unusual punishment," according to Rabbi Yitzchok Adlerstein, chairman of Jewish Law and Ethics at Loyola Law School in Los Angeles.
Similar divisions are evident among Roman Catholics. The Vatican and U.S. bishops have said that giving food and drink, even artificially, was morally required in the case of Schiavo, who is Catholic.
But at Marquette University, a Roman Catholic school in Milwaukee, ethics professor Daniel C. Maguire took issue with that position. Saying the Vatican and U.S. bishops were out of step with "mainstream" Catholic theology against extraordinary measures to sustain life, Maguire called the Schiavo case a "15-year atrocity" that represented a tendency to idealize physical life and forget the natural process of death.
"We live in a culture where death is the witch or warlock to be driven out of town by technical means if possible," Maguire said.
Conflicting opinions exist even among evangelical Christians many of whom have sided with court appeals by Schiavo's parents to continue feeding the severely brain-damaged woman, who lapsed into her current state 15 years ago.
Focus on the Family, a conservative evangelical broadcast ministry in Colorado Springs, said it was "appalled and opposed" to ending her feedings. "This is a woman who was not dying until they removed that feeding tube," said Carrie Gordon Earll, the ministry's senior analyst for bioethics. She maintained that Schiavo was not brain dead or in a "persistent vegetative state."
But fellow evangelical Scott Rae, a professor of Christian ethics at Biola University in La Mirada, Calif., argued that withdrawing the feeding tube would be appropriate if it could be clearly determined that were Schiavo's wishes. He said he agreed with a 1990 U.S. Supreme Court decision that "feeding tubes constituted medical treatment analogous to ventilation, and removing them was no more starving someone than removing ventilation was suffocating someone."
He said he himself would not want to be sustained as Schiavo had been until her feeding tube was removed Friday. "As a Christian, I don't want anybody to delay my homecoming" to heaven, he said.
But Rae said he was not convinced that Schiavo would actually have willed this outcome, and questioned whether her husband was acting in her best interests. So long as her parents were willing and able to care for her, what was the harm in allowing them to do so? he asked.
"If in doubt, you always offer life," Rae said.
The Schiavo situation has triggered discussion and soul-searching in other religious communities as well.
Among Muslims, Southern California physician Hassan Hathout said that Islamic ethics asserts a right to food and drink and that withdrawing Schiavo's feeding tubes were "tantamount to euthanasia by hunger and thirst, which is a very cruel kind of euthanasia."
Tibetan Buddhists, by contrast, believe that prolonging someone in a vegetative state could harm the chances of a good rebirth, and would support ending artificial feeding if recovery were hopeless, according to Robert Thurman, a Columbia University professor of Indo-Tibetan Buddhist Studies.
"Natural death is very natural and healthy, which means no lifeline like that," said Bishop Koshin Ogui of the San Francisco-based Buddhist Churches of America.
Other traditions, such as Hindu and Bahai, do not yet offer clear guidance for such modern ethical dilemmas, according to their practitioners. Lina Gupta, professor and philosophy department chair at Glendale Community College in Glendale, Calif., said the Hindu response would depend on individual circumstances. While not specifically addressing the Schiavo case, she said her tradition offered both absolute moral dictates and flexible ones for instance, eschewing killing in general but recognizing warriors who do so to protect others.
Saradeshaprana, a nun of the Vedanta Society in Los Angeles, said that the Hindu response would depend largely on the motivation for taking out the tube and whether it would prolong or terminate Schiavo's suffering. Without knowing that, there is no clear-cut answer, she said.
Legally, both the California Legislature and the courts have defined artificial feeding tubes as medical treatment that can be withdrawn by wishes of the patient or designated decisionmaker, according to Vicki Michel, a Loyola Law School adjunct professor who coordinates a consortium of hospital ethics committees in Southern California.
"On a gut emotional level, feeding someone is considered to be basic care," she said. "But people have to realize that when you put in a tube to artificially feed, it is a medical treatment unlike giving a spoon or baby bottle."