CCAR RESPONSA
Contemporary American Reform Responsa
202. Parental Obligation to a Severely Retarded
Child
QUESTION: A couple with two healthy, normal children has a third
child 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 question
which 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 the
child, but such thoughts have been conveyed through the aggadic
literature. Nothing in the traditional literature limits such care to normal children. In
other 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 limited
abilities, 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 about
medical 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 handicapped
child 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.February 1984
If needed, please consult Abbreviations used in CCAR Responsa.