QUESTION: A couple with two healthy, normal children has a thirdchild who is severely malformed and retarded. The child is not aware of people around him, and his intelligence is limited to a few reflexes. His face will occasionally form what appears to be a smile, and if food is placed in his mouth he will swallow by reflex. There is no hope for a future beyond this, however. The child has, for several years, simply lain in a fetal position in a crib in a nursing home. Do the parents have a continued obligation to visit this child or is it sufficient that they see to it that he is cared for in the institution where he now resides? Does the tradition provide some guidelines for determining the degree of medical care to be given to this child in a crisis? Physicians are generally surprised that the child has lived this long. If the reflex by which the child eats stops functioning, how far should the medical staff intervene to preserve life? Is there the obligation to feed him through a stomach tube, for example? (Rabbi M. Remson, Naperville, IL)
ANSWER: Let us begin by dealing individually with each questionwhich you have asked. Traditional Judaism places an obligation for the maintenance of children upon the father; it is his duty to provide for all of his children's needs in accordance with his ability (Yad Ishut 13.6; Shulhan Arukh Even Haezer 73.6 ff). This includes formal education, learning a trade or anything else which will enable a child to take her place in the adult world (Kid. 29a ff; Shulhan Arukh Yoreh Deah 245.1, 4). There is some discussion about the number of years for which this obligation exists. Originally tradition limited it to six years (Ket. 49b, 65b; Shulhan Arukh Even Haezer 71.1) and indicated that after that time, the father was duty-bound to maintain the child as an act of tzedaqah (Yad Hil. Ishut 12.14, 15, 21.17; Shulhan Arukh Yoreh Deah 251.4). However, the demands of tzedaqah were to be enforced rigidly according to the actual needs of the child (Yad Hil. Ishut 13.6; Shulhan Arukh Even Haezer 73.6). This obligation then continues until age thirteen or in modern times until the child reaches an independent adult status.
Little has been said in our legal tradition about the emotional needs of thechild, but such thoughts have been conveyed through the aggadic literature.
Nothing in the traditional literature limits such care to normal children. Inother words, the obligation is universal and applies to every child regardless of her mental or physical abilities.
Tradition, therefore, indicates that this child, despite its very limitedabilities, deserves both the maintenance and affection which the parents can provide. As I view this problem through my personal experience with a severely handicapped daughter and that of others who have dealt with parents of handicapped children, it is clear that unless ongoing relationships of some kind are established with such a handicapped child, the parents and other children will always feel guilty. Obviously this child can not be made part of the normal family life, but ongoing visits and continued concern with his welfare rests as any obligation upon all the members of the family. Practically speaking, such visits also assure a higher standard of care for such an individual, as those institutionalized children who receive no visits are frequently neglected.
Now, let me turn to the second portion of your question which asks aboutmedical procedures in case this child's normal reflexes stop. We should follow the advice of the Mishnah, which states that no positive action which will hasten death may be instituted (M. Shab 23.5, 151b; Shulhan Arukh Yoreh Deah 339). On the other hand, the same sources indicate that we need not impede the individual's death when no recovery is possible. This matter has been discussed at some length by Solomon B. Freehof (W. Jacob, American Reform Responsa, # 77). Nothing unusual needs be done by the attending physician; there would be no obligation to feed this individual through a stomach tube, etc. We followed the decision with our own child.
In summary, as long as this handicappedchild remains alive, he should be given all care and affection possible. If his reflexes stop and no recovery is possible, he should be permitted to die peacefully.