The Terri Schiavo case has sharply divided bioethicists from 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 as immoral as leaving a helpless infant to starve. But those who regard it as medicine say that, given the Florida woman's condition, it is as ethical to withdraw the feeding tube as it would be to shut down a respirator.
The question, fraught with emotions over the nature of human life and obligations to safeguard it, has riven people within the same religion.
Rabbi Elliot Dorff, rector of the University of Judaism in Los Angeles, argued that artificial nutrition was not food but medical treatment and was appropriate to withdraw given the hopelessness of Schiavo's persistent vegetative state. He also said people had to accept their mortality, as the Bible made clear.
But Rabbi Avram Reisner, a member along with Dorff of a Jewish law committee in the Conservative Movement, said the feeding tube was removed prematurely. If Schiavo could be trained to swallow, a capacity he said had not been adequately explored, then feeding her with a spoon would be morally obligated. Until that issue was resolved, he said, artificial nutrition should have been maintained.
"Feeding is part of the natural process of life," Reisner said.
Orthodox Jews voiced even stronger views. Withholding food and drink was "cruel and unusual punishment," said 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 ethics professor Daniel C. Maguire at Marquette University, a Catholic school in Milwaukee, 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 also exist among evangelical Christians, many of whom have sided with court appeals by Schiavo's parents to continue feeding the severely brain-damaged woman.
Focus on the Family, a conservative evangelical broadcast ministry in Colorado Springs, Colo., said it was "appalled and opposed" to removing Schiavo's feeding tube.
"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 evangelical Scott Rae, a professor of Christian ethics at Biola University in La Mirada, argued that withdrawing the feeding tube would be appropriate if it could be determined that it coincided with 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 would not want to be sustained as Schiavo had been. "As a Christian, I don't want anybody to delay my homecoming" in heaven, he said.
But Rae said he was not convinced that Schiavo would have willed this outcome, and questioned whether her husband, Michael Schiavo, 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 case has triggered discussion and soul searching in other religious communities as well.
Southern California physician Hassan Hathout said Islamic ethics asserted a right to food and drink and that withdrawing Schiavo's feeding tube was "tantamount to euthanasia by hunger and thirst, which is a very cruel kind of euthanasia."
Tibetan Buddhists believe that prolonging someone in a vegetative state could harm the chances of a good rebirth, and they would support ending artificial feeding if recovery were hopeless, said 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 offer clear guidance for such modern ethical dilemmas, their practitioners said.