CARR 298-300


Contemporary American Reform Responsa

202. Parental Obligation to a Severely Retarded


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.