1. It is prohibited to actively shorten any human’s life¹, including someone in a persistent vegetative state (PVS) or in a state of minimal consciousness².

2. It is obligatory to provide a PVS patient with routine treatments such as nourishment³, respiration and administration of routine medications. With regard to these treatments he is no different from a patient in a state of full consciousness, in line with the principles outlined in the previous chapters⁴.

3. Concerning non-routine treatments that are intended to lower risks, when the doctors maintain that the patient should be treated, and sufficient time has passed since the onset of his condition until he has been medically characterized as a PVS patient⁵, one should distinguish (in the absence of any preliminary instructions from the patient) between two types of treatment: If it is an effective treatment that a conscious patient would most likely choose to undergo, it must be done. If it is a high-risk procedure, which it can be assumed that many patients would refuse to accept, it should not be done⁶.

1. See footnote 54, above
2. In the case of a patient in a Persistent Vegetative State (PVS), the non-conscious systems that are essential for life, such as the respiratory, cardiovascular, and digestive systems, as well as sleeping patterns, are operative. However, due to irreversible damage to the cerebral cortex, the patient loses the ability to think, to be aware of his surroundings, and to experience emotion and consciousness. The prevailing opinion among doctors is that patients in this condition do not feel pain or suffer, although this is not known with absolute certainty, and very rare cases have also been documented in which such patients have recovered. There are other conditions involving damage to the cognitive system; see Encyclopedia of Medicine and Halakha, vol. 5, “A Terminally Ill Patient (a),” pp. 113–17.
3. That is, unless the medical team is of the opinion that feeding the patient is harming his quality of life, endangering him and providing little benefit.
4. In chapter VIII, above, we discussed in detail the question of medical treatment for a patient whose chances of recovery are low. A PVS patient is in this category, and virtually all of the poskim agree that such a patient should not be treated any differently from others. This can be inferred from the comments of the Beiur Halakha, 329, s.v. Ela lefi sha’a, and the same is stated in Iggerot Moshe, Ḥoshen Mishpat, II:74, 1; Tzitz Eliezer, XVIII:19. This is also the opinion of Rabbi S. Z. Auerbach, as cited in Nishmat Avraham, Yoreh De’a, 339:2; see Encyclopedia of Medicine and Halakha, vol. 5, “A Terminally Ill Patient (a),” pp. 159–60. Accordingly, the halakha treats a patient of this kind the same as a patient who has full consciousness.
5. According to medical definitions, the length of time required to define a person as a PVS patient varies depending on the cause of his vegetative condition, such as unsuccessful resuscitation and lack of oxygen supply to the brain, traumatic physical injury, and irreversible degenerative disease. Each case should be considered on its own merits. Another aspect to take into account is the patient’s age. The various medical considerations require sober and careful decisions to be made which are tailored to each patient individually.
6. On the question of risk-taking in medical treatment, see chapter V, subsection iii and footnote 47, above. In the specific case of a PVS patient, the question of informed consent comes to the fore, as well as the issue of who is authorized to determine the patient’s wishes and how he should be treated. For more on this, see ibid., subsections vii-x.