I was discussing the principle this morning with a talmid chachom - that an innocent person is not sacrificed for the good of others. This is a major principle in halacha which is obviously relevant to the issue of child abuse.
The talmid chachom I was discussing this asked the following. He said that major poskim had said that brain death is actually death. Therefore doing a heart transplant by removing the heart of a brain dead person was permitted according to these poskim. However he had heard that even though these poskim held this way - they would not give a general heter to allow heart transplants with brain dead indiviuals because they didn't trust non-Jewish or non-religious doctors to decide whether a person was in fact brain dead. His question was, "So isn't this in effect sacrificing the individual who needs a heart transplant for the sake of maintaining the religious standards of the community - i.e., the welfare of others?" A possible answer is that we are not simply sacrificing a possible recipient by denying him a heart transplant but rather we are not sacrificing the donor - whom we have a sofek about whether they are dead for the sake of the possible recipient - even if the possible recipient will definitely die if he doesn't have a transplant.
Rema(Y.D. 157:1): ... If a non-Jew tells Jews that one Jew should be handed over to them to be killed, the Jews should not give one over unless they specify who they want (Mishna Terumos Chapter 8 and Rambam Hilchos Yesodei HaTorah Chapter 5). Others say that even if they specify a particular Jews he is not to be given over except if he is liable to the death penalty such as Shiva ben Bichri (Beis Yosef citing Rashi and the Ran). Similarly in the case of a group of women. If non-Jews say to give over one woman to be raped, they should all be raped rather than give over a single Jewish soul (Rambam).
The talmid chachom I was discussing this asked the following. He said that major poskim had said that brain death is actually death. Therefore doing a heart transplant by removing the heart of a brain dead person was permitted according to these poskim. However he had heard that even though these poskim held this way - they would not give a general heter to allow heart transplants with brain dead indiviuals because they didn't trust non-Jewish or non-religious doctors to decide whether a person was in fact brain dead. His question was, "So isn't this in effect sacrificing the individual who needs a heart transplant for the sake of maintaining the religious standards of the community - i.e., the welfare of others?" A possible answer is that we are not simply sacrificing a possible recipient by denying him a heart transplant but rather we are not sacrificing the donor - whom we have a sofek about whether they are dead for the sake of the possible recipient - even if the possible recipient will definitely die if he doesn't have a transplant.
who are the major poskim who permit ?
ReplyDeleteyou are right, it's pashut
ReplyDeleteWho permits? Almost everyone holds that R' Moshe Feinstein says it's assur. Rav Elyashiv - assur. Doesn't Rav SZ Auerbach saty assur? Rav Bleich in NYC - assur. Even if someone holds muttar, l'chorah one should be machmir [after all it's a safek on one of the big 3!] and NOT pull the plug.
ReplyDelete1/2
ReplyDeleteBrain death is as irreversible as death as we understand it. Brain death means a condition in which fluid pressure is such that necrosis of the brain (not just the cerebral cortex), has initiated and can not be reversed. This person will never again be capable of living without life support i.e. be able to breathe (humans need the brain stem to breathe, differently from other mammals for whom the spinal reflexes, or the spine and cerebellum, are enough) have autonomous blood pressure control (again in humans, in contrast with other mammals, the brain stem functions are required) and of course will never regain consciousness (the cerebral cortex will go into necrosis, along with the rest of the brain). This is of course the textbook; for clinical patients, each one has small variations (e.g. partially autonomous BP control exists in some patients, and the like). But, contemporary science tells us that this state entails necrosis and thus is as irreversible as death itself. This is the case even though we may keep ventilating artificially this person and keep the cardiocirculatory functions going, along with the rest of life support, medications for BP, etc, and if we do, it is or it may be possible (not easy to predict in advance) to keep the person in that state for hours, days, or in the case of a person in good general conditions, even longer. Diagnosis of brain death and brain stem death are of course made by human and fallible doctors and you can ask neurologists (does not matter if they are nonjewish, or atheists, they are likely to agree on this point, which further stresses the absolute importance of trying our best to get one or more very reliable and trustworthy doctors with specific experience to be involved, before accepting a diagnosis of brain death, brain stem death, legal death etc).
2/2
ReplyDeleteI wish the Rabbi would comment further. I used to think we don't usually have a heter with transplants and organ donation because of benefitting from a body. The sofek if a brain dead patient may not be actually dead, I understand it's from the big 3 but it seems to me it has little practical relevance. These patients are in a high intensive care unit, hooked to machines. At a point the hospital thinks that they may be brain dead and initiates the procedures of monitoring and if they are in good general conditions, the hospital looks up the organ donors' database or notifies the family asking them if they would agree to organ / tissue transplant and giving them a few hours to think it over. Once the legal observation period has elapsed, if there was no declaration of the patient and if the family decline organ transplant, the machines are disconnected immediately. In all major countries, the law is that brain death or brain stem death or some variant of it (and please notice my remark above about diagnosis reliability) is legal death. That is, unless there is a reason to keep the person hooked to machines for another patient's sake (the transplant recipient if transplant is going to take place, i.e. waiting for the surgical equipe that explants organs and the other one which transplants them to be flown in their respective hospitals, the organ shipping logistic be ready and in stand-by, the transplant patient confirmed to have reached the hospital and being prepped for surgery and all that; the only other possibility is the case the patient is pregnant and we seek to buy time for the immature foetus before delivery), no one, not the family and not the patient through living will /advance health care directives and not the doctors and not even the hospital management, is in any position to make decisions or choices. The person is disconnected from vital support and clinical death occurs. Additionally, even in the case a person were to be a multimillionnaire and in a position to pay / bribe enough that the law is overlooked and no diagnosis is made and the patient is quietly left hooked to the machines to die a few hours later - even for a few hours, this is a huge load of money that would be required to silence (the very existance of the hospital ICU and perhaps as well the rest of the hospital is at stake, plus the lawsuits by insurances and by the country health ministry, plus the people are actually and seriously risking being destroyed i.e. being sentenced to pay astronomical amounts of damages from personal assets and to spend years behind bars - and all ICU workers, and there are many, would be in a position to blackmail), I think i recall the halacha is we are not obligated to spend a fortune for a medical treatment that is unlikely to change the outcome (how much more so when the situation, according to contemporary medical science, is hopeless). You may remember that some time ago a boy in NY was kept on life support after brain death, in according to his family's wishes (Orthodox Jews by the way), and allowing cardiocirculatory arrest to occur for other causes (he had a brain tumor). This was achieved by deliberately setting up red tape on both sides, thanks to a very sensitive hospital management; the law would eventually order the hospital to pull the plug, but the clinical situation of the boy brought him to cardiocirculatory arrest in about two weeks, which made the lawsuit moot. Does the Rabbi holds this is what we have an obligation to do in all legal death settings that involve a Jew? Or even a nonjew, can we pull the plug of a brain dead person on him, as science tells us very clearly that if we pull the plug the person dies, which they all do within minutes? Or explant their organs? Thank you a lot.
2/2
ReplyDeleteI wish the Rabbi would comment further. I used to think we don't usually have a heter with transplants and organ donation because of benefitting from a body. The sofek if a brain dead patient may not be actually dead, I understand it's from the big 3 but it seems to me it has little practical relevance. These patients are in a high intensive care unit, hooked to machines. At a point the hospital thinks that they may be brain dead and initiates the procedures of monitoring and if they are in good general conditions, the hospital looks up the organ donors' database or notifies the family asking them if they would agree to organ / tissue transplant and giving them a few hours to think it over. Once the legal observation period has elapsed, if there was no declaration of the patient and if the family decline organ transplant, the machines are disconnected immediately. In all major countries, the law is that brain death or brain stem death or some variant of it (and please notice my remark above about diagnosis reliability) is legal death. That is, unless there is a reason to keep the person hooked to machines for another patient's sake (the transplant recipient if transplant is going to take place, i.e. waiting for the surgical equipe that explants organs and the other one which transplants them to be flown in their respective hospitals, the organ shipping logistic be ready and in stand-by, the transplant patient confirmed to have reached the hospital and being prepped for surgery and all that; the only other possibility is the case the patient is pregnant and we seek to buy time for the immature foetus before delivery), no one, not the family and not the patient through living will /advance health care directives and not the doctors and not even the hospital management, is in any position to make decisions or choices. The person is disconnected from vital support and clinical death occurs. Additionally, even in the case a person were to be a multimillionnaire and in a position to pay / bribe enough that the law is overlooked and no diagnosis is made and the patient is quietly left hooked to the machines to die a few hours later - even for a few hours, this is a huge load of money that would be required to silence (the very existance of the hospital ICU and perhaps as well the rest of the hospital is at stake, plus the lawsuits by insurances and by the country health ministry, plus the people are actually and seriously risking being destroyed i.e. being sentenced to pay astronomical amounts of damages from personal assets and to spend years behind bars - and all ICU workers, and there are many, would be in a position to blackmail), I think i recall the halacha is we are not obligated to spend a fortune for a medical treatment that is unlikely to change the outcome (how much more so when the situation, according to contemporary medical science, is hopeless). You may remember that some time ago a boy in NY was kept on life support after brain death, in according to his family's wishes (Orthodox Jews by the way), and allowing cardiocirculatory arrest to occur for other causes (he had a brain tumor). This was achieved by deliberately setting up red tape on both sides, thanks to a very sensitive hospital management; the law would eventually order the hospital to pull the plug, but the clinical situation of the boy brought him to cardiocirculatory arrest in about two weeks, which made the lawsuit moot. Does the Rabbi holds this is what we have an obligation to do in all legal death settings that involve a Jew? Or even a nonjew, can we pull the plug of a brain dead person on him, as science tells us very clearly that if we pull the plug the person dies, which they all do within minutes? Or explant their organs? Thank you a lot.
I wish the Rabbi would comment further. I used to think we don't usually have a heter with transplants and organ donation because of benefitting from a body. The sofek if a brain dead patient may not be actually dead, I understand it's from the big 3 but it seems to me it has little practical relevance. These patients are in a high intensive care unit, hooked to machines. At a point the hospital thinks that they may be brain dead and initiates the procedures of monitoring and if they are in good general conditions, the hospital looks up the organ donors' database or notifies the family asking them if they would agree to organ / tissue transplant and giving them a few hours to think it over. Once the legal observation period has elapsed, if there was no declaration of the patient and if the family decline organ transplant, the machines are disconnected immediately. In all major countries, the law is that brain death or brain stem death or some variant of it (and please notice my remark above about diagnosis reliability) is legal death. That is, unless there is a reason to keep the person hooked to machines for another patient's sake (the transplant recipient if transplant is going to take place, i.e. waiting for the surgical equipe that explants organs and the other one which transplants them to be flown in their respective hospitals, the organ shipping logistic be ready and in stand-by, the transplant patient confirmed to have reached the hospital and being prepped for surgery and all that; the only other possibility is the case the patient is pregnant and we seek to buy time for the immature foetus before delivery), no one, not the family and not the patient through living will /advance health care directives and not the doctors and not even the hospital management, is in any position to make decisions or choices. The person is disconnected from vital support and clinical death occurs. Additionally, even in the case a person were to be a multimillionnaire and in a position to pay / bribe enough that the law is overlooked and no diagnosis is made and the patient is quietly left hooked to the machines to die a few hours later - even for a few hours, this is a huge load of money that would be required to silence (the very existance of the hospital ICU and perhaps as well the rest of the hospital is at stake, plus the lawsuits by insurances and by the country health ministry, plus the people are actually and seriously risking being destroyed i.e. being sentenced to pay astronomical amounts of damages from personal assets and to spend years behind bars - and all ICU workers, and there are many, would be in a position to blackmail), I think i recall the halacha is we are not obligated to spend a fortune for a medical treatment that is unlikely to change the outcome (how much more so when the situation, according to contemporary medical science, is hopeless). You may remember that some time ago a boy in NY was kept on life support after brain death, in according to his family's wishes (Orthodox Jews by the way), and allowing cardiocirculatory arrest to occur for other causes (he had a brain tumor). This was achieved by deliberately setting up red tape on both sides, thanks to a very sensitive hospital management; the law would eventually order the hospital to pull the plug, but the clinical situation of the boy brought him to cardiocirculatory arrest in about two weeks, which made the lawsuit moot. Does the Rabbi holds this is what we have an obligation to do in all legal death settings that involve a Jew? Or even a nonjew, can we pull the plug of a brain dead person on him, as science tells us very clearly that if we pull the plug the person dies, which they all do within minutes? Or explant their organs? Thank you a lot.
ReplyDeleteNot sure if both comments went through, I got an error message on the second one. They are labeled 1/2 and 2/2. Thank you.
ReplyDeleteI wish the Rabbi would comment further. I used to think we don't usually have a heter with transplants and organ donation because of benefitting from a body. The sofek if a brain dead patient may not be actually dead, I understand it's from the big 3 but it seems to me it has little practical relevance. These patients are in a high intensive care unit, hooked to machines. At a point the hospital thinks that they may be brain dead and initiates the procedures of monitoring and if they are in good general conditions, the hospital looks up the organ donors' database or notifies the family asking them if they would agree to organ / tissue transplant and giving them a few hours to think it over. Once the legal observation period has elapsed, if there was no declaration of the patient and if the family decline organ transplant, the machines are disconnected immediately. In all major countries, the law is that brain death or brain stem death or some variant of it (and please notice my remark above about diagnosis reliability) is legal death. That is, unless there is a reason to keep the person hooked to machines for another patient's sake (the transplant recipient if transplant is going to take place, i.e. waiting for the surgical equipe that explants organs and the other one which transplants them to be flown in their respective hospitals, the organ shipping logistic be ready and in stand-by, the transplant patient confirmed to have reached the hospital and being prepped for surgery and all that; the only other possibility is the case the patient is pregnant and we seek to buy time for the immature foetus before delivery), no one, not the family and not the patient through living will /advance health care directives and not the doctors and not even the hospital management, is in any position to make decisions or choices. The person is disconnected from vital support and clinical death occurs. Additionally, even in the case a person were to be a multimillionnaire and in a position to pay / bribe enough that the law is overlooked and no diagnosis is made and the patient is quietly left hooked to the machines to die a few hours later - even for a few hours, this is a huge load of money that would be required to silence (the very existance of the hospital ICU and perhaps as well the rest of the hospital is at stake, plus the lawsuits by insurances and by the country health ministry, plus the people are actually and seriously risking being destroyed i.e. being sentenced to pay astronomical amounts of damages from personal assets and to spend years behind bars - and all ICU workers, and there are many, would be in a position to blackmail), I think i recall the halacha is we are not obligated to spend a fortune for a medical treatment that is unlikely to change the outcome (how much more so when the situation, according to contemporary medical science, is hopeless). You may remember that some time ago a boy in NY was kept on life support after brain death, in according to his family's wishes (Orthodox Jews by the way), and allowing cardiocirculatory arrest to occur for other causes (he had a brain tumor). This was achieved by deliberately setting up red tape on both sides, thanks to a very sensitive hospital management; the law would eventually order the hospital to pull the plug, but the clinical situation of the boy brought him to cardiocirculatory arrest in about two weeks, which made the lawsuit moot. Does the Rabbi holds this is what we have an obligation to do in all legal death settings that involve a Jew? Or even a nonjew, can we pull the plug of a brain dead person on him, as science tells us very clearly that if we pull the plug the person dies, which they all do within minutes? Or explant their organs? Thank you a lot.
ReplyDelete2/3 (I further split the comment)
ReplyDeleteI wish the Rabbi would comment further. I used to think we don't usually have a heter with transplants and organ donation because of benefitting from a body. The sofek if a brain dead patient may not be actually dead, I understand it's from the big 3 but it seems to me it has little practical relevance. These patients are in a high intensive care unit, hooked to machines. At a point the hospital thinks that they may be brain dead and initiates the procedures of monitoring and if they are in good general conditions, the hospital looks up the organ donors' database or notifies the family asking them if they would agree to organ / tissue transplant and giving them a few hours to think it over. Once the legal observation period has elapsed, if there was no declaration of the patient and if the family decline organ transplant, the machines are disconnected immediately. In all major countries, the law is that brain death or brain stem death or some variant of it (and please notice my remark above about diagnosis reliability) is legal death. That is, unless there is a reason to keep the person hooked to machines for another patient's sake (the transplant recipient if transplant is going to take place, i.e. waiting for the surgical equipe that explants organs and the other one which transplants them to be flown in their respective hospitals, the organ shipping logistic be ready and in stand-by, the transplant patient confirmed to have reached the hospital and being prepped for surgery and all that; the only other possibility is the case the patient is pregnant and we seek to buy time for the immature foetus before delivery), no one, not the family and not the patient through living will /advance health care directives and not the doctors and not even the hospital management, is in any position to make decisions or choices. The person is disconnected from vital support and clinical death occurs.
3/3
ReplyDeleteAdditionally, even in the case a person were to be a multimillionnaire and in a position to pay / bribe enough that the law is overlooked and no diagnosis is made and the patient is quietly left hooked to the machines to die a few hours later - even for a few hours, this is a huge load of money that would be required to silence (the very existance of the hospital ICU and perhaps as well the rest of the hospital is at stake, plus the lawsuits by insurances and by the country health ministry, plus the people are actually and seriously risking being destroyed i.e. being sentenced to pay astronomical amounts of damages from personal assets and to spend years behind bars - and all ICU workers, and there are many, would be in a position to blackmail), I think i recall the halacha is we are not obligated to spend a fortune for a medical treatment that is unlikely to change the outcome (how much more so when the situation, according to contemporary medical science, is hopeless). You may remember that some time ago a boy in NY was kept on life support after brain death, in according to his family's wishes (Orthodox Jews by the way), and allowing cardiocirculatory arrest to occur for other causes (he had a brain tumor). This was achieved by deliberately setting up red tape on both sides, thanks to a very sensitive hospital management; the law would eventually order the hospital to pull the plug, but the clinical situation of the boy brought him to cardiocirculatory arrest in about two weeks, which made the lawsuit moot. Does the Rabbi holds this is what we have an obligation to do in all legal death settings that involve a Jew? Or even a nonjew, can we pull the plug of a brain dead person on him, as science tells us very clearly that if we pull the plug the person dies, which they all do within minutes? Or explant their organs? Thank you a lot.