Sunday, August 31, 2008

Life support on a timer?

Bartley Kulp suggested Rabbis:New Life support tech 'murder' in JPost

To Rabbi Eidenson, this is a an article that is rife with halachic, hashgafic and political issues.
A technology soon to be introduced in local hospitals that automatically turns off life-support systems at the request of terminally ill patients has been denounced by a prominent group of rabbis as a desecration of God's name. 'Timer ventilator' allows patients the choice to have their life support cut off automatically. The technology is "tantamount to murder," according to the rabbis, who are aligned with the Ashkenazi haredi community's most respected living halachic authority, Rabbi Yosef Shalom Elyashiv.

"If the Health Ministry goes ahead with its plans to implement a technology that shortens the lives of terminally ill patients, the nations of the world will say that Judaism condones transgressing one of the Ten Commandments - Thou Shalt not Kill," Rabbi Ya'acov Weiner said last week. "That would be a terrible desecration of God's name."

Weiner, who heads the Jerusalem Center for Research, Medicine and Halacha, made the comments at a conference on Jewish medical ethics, organized by the center for the past 11 years, that brings together religious doctors and Halacha experts. Weiner and other rabbis who spoke at the conference, including a senior representative of Elyashiv, said the Terminally Ill Patient Law, approved by the Knesset in 2006, contradicted Jewish law.

They specifically targeted a technology condoned in the new law that allows a terminally ill patient to choose to be connected to a ventilator that is automatically turned off by a timer at a future date. The timer ventilator, which is in its last stages of development, will be introduced in hospitals in coming months. Meanwhile, proponents of the "timer ventilator," including many Orthodox rabbis and doctors, argue that while Jewish law prohibits pulling the plug, it permits refraining from reactivating the ventilator once it has automatically been turned off by the timer.

However, organizers of the conference said that "greatest rabbis of the generation" reject the use of the "timer ventilator." They said that in addition to Elyashiv, other prominent halachic authorities also opposed it, including Rabbi Moshe Sternbach of the Edah Haredit and Rabbi Zalman Nechemia Goldberg of the High Rabbinic Court. Rabbi Yehoshua Neuwirth, an author of a definitive book on the laws of Shabbat called Shmirat Shabbat K'hilchata (Observing Shabbat's Laws), told a contingent from the conference who visited his home on Tuesday that use of the "timer ventilator" was "murder," organizers said. [...]

Conspicuously absent from the conference, which took place in Jerusalem's Bayit Vagan neighborhood, were rabbis and religious doctors who support the use of the timer ventilator and had backed the Terminally Ill Patient Law.

Dr. Rabbi Mordechai Halperin, who was a member of the Steinberg Multi-Disciplinary Health Ministry committee that helped prepare the legislation, said many prominent rabbis supported the use of such ventilators. The committee was headed by Prof. Avraham Steinberg, a neurologist and halachic expert. "Many halachic authorities permit the use of the timer on condition that it is activated before the terminally ill patient is initially connected," Halperin said. "Once the patient is hooked up to a ventilator without a timer it is forbidden to activate a timer. In the legislation it is specifically stated that doing so would be a punishable offense. "The other conditions for allowing the use of the timer are that the patient is in severe pain and that he expressly asks for the option of using the timer," he said. The spring issue of Asia, a journal of Jewish medical ethics, features letters from two prominent rabbis supporting the use of the timer ventilator. One of the letters is from Rabbi Avigdor Nebenzahl, former rabbi of the Old City of Jerusalem. The other letter is from the same Neuwirth whom the conference organizers had claimed was adamantly opposed to the use of the timer ventilator. [...]


  1. This conference was completely misadvertised as one on medical halachah. Really it appears it was one on what only certain people think medical halachah could be.
    Imagine holding a conference on physics 100 years ago and not inviting Einstein or Bohr. How does one have a conference on such an important topic as the end of life without inviting Dr. Steinberg and Rav Halperin?
    Well the answer is easy: when you've already pre-determined what your position will be and wish to present it as THE halachah, you don't want people there who will inconveniently point out that the issue is quite complex and that there a poskim on the other side of the argument that cannot be ignored or pushed aside.
    This has been the case in Chareidi debates for the last while: announce THE position, ignore all those sources that contradict it and then shout loudly when someone tries to point the limitations of this approach out.

  2. Hey Garnel, I agree with you that there is a general lack communication on both sides of many halachic issues I disagree with your Einstein, and Bohr analogy. Dr. Rabbi Mordechai Halperin and Proffessor Steinberg are not Einsteins in their respective fields. Who is today I cannot answer that question. Though I will not deny that both are very knowledgeably in medical halacha, they are not the only one nor are they the final authorities in it.

    Now I do not know a lot about the research insitute that held the conference. I wanted to know under what capacity are they capable of discussing medical topics. It is not enough to have poskim, you need doctors on board or the ship cannot begin to sail. So here are the names and titles on their medical advisory boards.;

    Professor Arthur Edleman
    Director, Neonatal Care Unit
    Shaare Tzedek Medical Center, Jerusalem

    Professor Karl Skorecki(also on the board of directors)
    Director, Nephrology and Molecular Medicine
    Rambam Medical Center, Haifa

    Professor Rafael Walden
    Chief of Surgery
    Sheba Medical Center, Tel Hashomer

    Professor Yehuda Schoenfeld
    Director, Internal Medicine, Autoimmunology Unit
    Sheba Medical Center, Tel Hashomer

    Professor Meir Gottessman
    Head of Cardiology
    Hadassah Medical Center, Jerusalem

    Professor Shlomo Moshiach
    Director of Gynecology and Obstetrics
    Sheba Medical Center, Tel Hashomer

    Professor Rafael Katan
    Director, Oncology
    Shaare Tzedek Medical Center, Jerusalem

    Professor Eran Dolev
    Director, Internal Medicine
    Ichilov Medical Center, Tel Aviv
    Chairperson, Ethics Committee of the Israel Medical Association

    Professor Charles Sprung, MD, JD
    Director, Pulmonary Intensive care Unit
    Hadassah Medical Center, Jerusalem

    Professor Arnold Rosen
    Director, Geriatrics
    Shaare Tzedek Medical Center, Jerusalem

    Now besides the medical advisory board. The board of directors include;

    Fishel Goldman, MD
    Internal medicine and Oncology
    Private Practice, Jerusalem

    Dr. D. Weissman
    Former Director, Surgeon
    Weissman Hospital
    Beverly Hills, California

    Professor L. Layfer
    Administrative Director
    Rush Presbyterian Hospital
    Chicago, Illinois

    Dr. A. Solomon Eaglstein
    Director, Research Division
    Ministry of Labor and Social Affairs

    This is hardly a Luddite organization and they have their own so-called Einsteins.

    Now in terms of the new technology being discussed, putting a timer on life support systems is not a new scientific or technological innovation that warrents a Nobel prize. Nor does it need careful study to understand how it works. Nothing has been invented here. timers have been around for a long time and are used in everything from cooking to military applications. I do not think that to many poskim today need to play catch up in order to understand this technology. The question though remains, is it halachikly permissible to deploy this technology for euthanasia purposes?

    The article from the Jerusalem post is unclear regarding both sides and may be misquoting people on the issues.

  3. The relevance of mentioning Dr. Steinberg, for example, is because the breadth of his knowledge. Having published an encyclopedic work (literally) on Medical Halachah, he's the kind of person you'd want to invite to a conference to get the most comprehensive views on a subject. Also, was Dr. Avraham Avraham, the author of Nishmas Avraham there? How can one have an important conference on a subject that is so complex and not invite the author of the definite guide to medical halachah?

    I'm not, chas v'shalom casting aspersions on those who attended but if you only invite the experts who are going to agree with you, you can't expect your conclusions to be taken seriously.

  4. Didn't R'MF have a tshuva about not having to change an oxygen tank?
    Joel RIch

  5. Again this is not a complex issue on the definition of death. This would requires an extensive briefing on neurology and so forth. Not to mention having a holistic understanding of the technology being used to determine brain death much less ascertaining its reliability. There is no need for a symposium of medical experts to describe this.

    They are discussing timers. We are not talking about a new form of space age technology here. My grandmother knew how to operate a timer.

    However we are still lacking information from this article. In exactly what context are they talking about deploying this device. In the case of imminent death or not? These are important issues. It is hard to even comprehend this argument without knowing the parameters in which they are discussing this issue.

    One issue that was brought up by the ones who object to this device is what are the protocols of usage of it. Who is to prevent anybody from setting this timer? Even if you make laws over this, who can prove who did it?

    There is a lot of information that needs to be clarified in this article.

    Also whether or not the author of the Nishmas Avraham was there is something I do not know. Even whether or not there were previous discussions with Halprin or Steinberg is also not known. The only thing that the article did mention was that the changes will be implimented soon. This would not leave the rabbanim who were opposed to its implementation a lot of time for discussions.

  6. Joel RIch wrote:

    Didn't R'MF have a tshuva about not having to change an oxygen tank?

    שו"ת אגרות משה חושן משפט חלק ב סימן עג

    וחולה מסוכן שאינו יכול לנשום צריך ליתן לו חמצן (אקסידזשען) אף שהוא באופן שא"א לרפאותו, שהרי הוא להקל מיסוריו, דהיסורין ממה שא"א לנשום הם יסורים גדולים והחמצן מסלקן, אבל כיון שלא יהיה ניכר אם ימות צריך להניחו בחמצן קימעא קימעא שיהיה כל פעם לשעה אחת או שתים, וכשיכלה החמצן יראו אם חי הוא עדיין יתנו עוד חמצן לשעה או שתים, וכן כל הזמן עד כשיראו אחר שכלה החמצן איך שהוא מת, ובאופן זה לא יהיה שום מכשול לחשש איבוד נפשות ולא להתרשלות ברפואתו אפילו לחיי שעה הקצרה ביותר.

    See also Rav Moshe Tendler's book "Responsa of Rav Moshe Feinstein" page 34

  7. Ok, Garnel was right about them davka not inviting Rav Halprin and Rav Steinberg to the conferance. I did not no this, I just researched this now. Rav Halprin and Rav Steinberg respectively had input and supported the New "Terminally Ill Patient Law" which went into effect in 2006. This law was opposed at the time by Rav Elyashuv and Associates. This at least was echoed at the conference according to YNET.

    The basic gist of this law is that a patient who is terminally ill has the right to refuse having life saving medical procedures on him/her. Also the patient can refuse being put on life support from the outset. The definition of terminally ill as defined by the law is someone whose death has been declared imminent by the doctors within six months no matter what procedures are available. The issue of the timer is somehow an extension to this argument.

    Rabbi Eidensohn, could you or someone here bring more details as to the halachot involving this?

  8. Life is short, relatively speaking, and none of us knows how many days we have, even when we think we know.

    Doesn't that make all of us technically terminally ill? Don't some of us have miserable lives that others would feel are filled with pain and lack quality?

    Letting someone set a timer to end their life because a doctor has told them they would die soon is no different than a 95 year old lady opening up the gas in her apartment to do the same thing for the same reason (given the average life expectancy of a 95 year old). I don't see how it's different than someone intentionally starving themselves to death, or going scuba diving with a tank that you know will run out of air while you are too deep to do anything about it, or any other suicide machine booby trap you can think of.

    Many medical experts are certain they understand death, when it is hard to clearly understand exactly what life is. Brain function is so limitedly understood. What's not understood at all is the interaction between the soul and the body. Except for when the body completely stops functioning, how can anyone be sure what "dead" really is?

    I would be very interested to learn if there is any place in Halacha for suicide for health reasons.

  9. bright eyes said...

    "would be very interested to learn if there is any place in Halacha for suicide for health reasons."

    I don't know what halacha has to say about it but practically how does does suicide help one health wise?

  10. I would be very interested to learn if there is any place in Halacha for suicide for health reasons.
    See the article from JLaw
    dealing with physician assisted suicide in particular whether unbearable pain is justification for suicide


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