Saturday, November 8, 2008

Pikuach nefesh & mental health I

One of the crucial issues in reporting child abuse is whether abuse constitutes pikuach nefesh and calling the police to save a child from abuse would be permitted. It seems to be widely assumed that it is - but where are the sources?

One source is the fact that when Rav Yochanon became psychotic [Rashi] after causing his beloved student Reish Lakish to die - the Rabbis prayed that he die and he did. This indicates that a state of insanity is worse than death.

Bava Metzia (84a): One day R. Johanan was bathing in the Jordan, when Resh Lakish saw him and leapt into the Jordan after him. Said he [R. Johanan] to him, ‘Your strength should be for the Torah.’ — ‘Your beauty,’ he replied, ‘should be for women.’ ‘If you will repent,’ said he, ‘I will give you my sister [in marriage], who is more beautiful than I.’ He undertook [to repent]; then he wished to return and collect his weapons, but could not. Subsequently, [R. Johanan] taught him Bible and Mishnah, and made him into a great man. Now, one day there was a dispute in the schoolhouse [with respect to the following. Viz.,] a sword, knife, dagger, spear, hand-saw and a scythe — at what stage [of their manufacture] can they become unclean? When their manufacture is finished. And when is their manufacture finished? — R. Johanan ruled: When they are tempered in a furnace. Resh Lakish maintained: When they have been furbished in water. Said he to him: ‘A robber understands his trade.’ Said he to him, ‘And wherewith have you benefited me: there [as a robber] I was called Master, and here I am called Master.’ ‘By bringing you under the wings of the Shechinah,’ he retorted. R. Johanan therefore felt himself deeply hurt, [as a result of which] Resh Lakish fell ill. His sister [sc. R. Johanan's, the wife of Resh Lakish] came and wept before him: ‘Forgive him for the sake of my son,’ she pleaded. He replied: ‘Leave thy fatherless children. I will preserve them alive.’ ‘For the sake of my widowhood then!’ ‘And let thy widows trust in me,’ he assured her. Resh Lakish died, and R. Johanan was plunged into deep grief. Said the Rabbis, ‘Who shall go to ease his mind? Let R. Eleazar b. Pedath go, whose disquisitions are very subtle.’ So he went and sat before him; and on every dictum uttered by R. Johanan he observed: ‘There is a Baraitha which Supports you.’ ‘Are you as the son of Lakisha?’ he complained: ‘when I stated a law, the son of Lakisha used to raise twenty-four objections, to which I gave twenty-four answers, which consequently led to a fuller comprehension of the law; whilst you say, "A Baraitha has been taught which supports you:" do I not know myself that my dicta are right?’ Thus he went on rending his garments and weeping, ‘Where are you, O son of Lakisha, where are you, O son of Lakisha;’ and he cried thus until his mind was turned. Thereupon the Rabbis prayed for him, and he died.

ר"ן (נדרים מ.) אין מבקש עליו רחמים לא שיחיה ולא שימות - נראה בעיני דה"ק פעמים שצריך לבקש רחמים על החולה שימות כגון שמצטער החולה בחליו הרבה ואי אפשר לו שיחיה כדאמרינן בפרק הנושא (כתובות קד) דכיון דחזאי אמתיה דרבי דעל כמה זימנין לבית הכסא ואנח תפילין וקא מצטער אמרה יהי רצון שיכופו העליונים את התחתונים כלומר דלימות רבי ומש"ה קאמר דהמבקר חולה מועילו בתפלתו אפי' לחיות מפני שהיא תפלה יותר מועלת ומי שאינו מבקרו אין צריך לומר שאינו מועילו לחיות אלא אפי' היכא דאיכא ליה הנאה במיתה אפי' אותה זוטרתי אינו מהנהו.

3 comments :

  1. One should start from a scientific position. Is there fatality associated with child abuse? If the answer is yes, then pikuach nefesh becomes relevant. If not, then it doesn't.

    For example, someone having a heart attack is in a pikuach nefesh situation. Most people who have heart attacks don't die from them but because heart attacks have an established potential for causing death, we treat it as sakanos nefashos.

    Similarly, it is well established that children have died from child abuse. Yes the majority don't but that is also not relevant. Therefore one could suggest that any case of child abuse is a potential sakanos nefashos.

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  2. Garnel Ironheart said...

    One should start from a scientific position. Is there fatality associated with child abuse? If the answer is yes, then pikuach nefesh becomes relevant. If not, then it doesn't.
    ================
    science would have you be clearer in your definition of abuse and fatality.

    1) Does the specific abuse involved ever cause direct fatality from the action itself?

    2) If there is never a direct fatality from the abuse itself - does it develop later. For example is it likely to induce depression which 10 years later might result increased likelihood of suicide?

    3) Does it increase the likelihood of psychosis which exempts the person from mitzvos - but doesn't increase the likelihood of physical death?

    4) Does it produce stress and inability to form proper human relations which indirectly increases the likelihood of early death?
    ===============
    Anything other than a possibility of death directly resulting from the abuse itself is problematic in describing it as pikuach nefesh.

    For example an autopsy might provide knowledge that in 10 years results in someone's life being saved. Most poskim do not view this as pikuach nefesh that would enable an autopsy to be done.

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  3. >1) Does the specific abuse involved ever cause direct fatality from the action itself?

    Yes.

    2) If there is never a direct fatality from the abuse itself -

    I would say: if fatality does not occur from the abuse itself, since as I just noted, it definitely can.

    > does it develop later.

    Yes. Quite often post-traumatic stress disorder with severe depression develops along with elevated risks of suicidality.

    3) Does it increase the likelihood of psychosis which exempts the person from mitzvos -

    Not that I'm aware of. People are miserable, their judgement may be impaired due to overwhelming depression but they rarely lose contact with reality which is the clinical definition of psychosis.

    4) Does it produce stress and inability to form proper human relations which indirectly increases the likelihood of early death?

    Yes.

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