Igros Moshe (YD III #132)The definition of when a person is dead is stated explicitly in the gemora (Yoma 85a) in the case where a person is buried under a pile of rubble. It says he can be dug out even on Shabbos and then his nostrils are examined to determine if he is still breathing. Rambam and Shulchan Aruch rule that if breathing is not detected he is considered dead. Thus we determine death by the absence of breathing. Even if the breathing is very slight he is considered alive. This can readily be determined with the aid of a feather placed near the nostrils. If the feather or a small piece of paper doesn’t move at all, he is presumed dead. Nevertheless he should be examined a number of times as I have explained previously to ensure he hasn’t just fainted because it is impossible to live without breathing. This test is valid only if the person is under constant watching. However since this is not realistic and it is possible he regained his strength a bit and was able to briefly get a few weak breathes it is impossible to properly determine death except by repeated testing. If these tests reveal there is no breathing at all than that is a sign the person is dead. This is more fully discussed by the Chasam Sofer. This is also relevant with the typical sick person who is close to dying, but is not dependent on a respirator. However there are many sick people who can not breathe without a respirator. Thus it is possible with a respirator to continue breathing even after death and these people are not considered alive.
Before the invention of cardiac monitors and ventilators, the Talmud's approach was logical because cardiac and respiratory death usually happened within minutes of another. If one had a cardiac arrest, one stopped breathing within seconds. Respiratory failure led to eventually cessation of pulse within a few minutes. So using breathing as the marker for life made sense - if he's breathing, there's a heartbeat.
ReplyDeleteThe question regards the second part of that gemara, examining the belly. Are we looking for abdominal wall movement because of respiration or were they trying to feel for the aorta and see if there was still a pulse? I would guess it was the former because unless you're very thin, it takes a lot of pressure to feel the aorta and it's pretty much impossible in fat people. So again, it's all about respiration.
However, the ventilator has disturbed that connection. A person who can't breath can now be made to breath and be kept alive in a vegetative state for a long time since the ventilator will keep his heart oxygenated. But is he really alive if his breathing is 100% artificial? (Remember that some ventilors have "assist modes" where the person breathes and the ventilator is there to make sure it's a good enough breath and to assist if it isn't)
In this case we go up a level. Why do we breath automatically? Because of the respiratory center in the brain stem which is programmed to regulate how fast and hard we breath. If it's knocked out, then we don't breath. (Look up Ondyne's Curse) In this case, one could argue that even a person with a heart beat on a ventilator is dead because he's really not breathing since the mechanism that moves the lungs is gone. Hence the legitimate position of brainstm death in halakha,
Side note: There's one authority the cardiac death side always quotes when talking about how heart activity is the real guide to death except in his teshuvah, when he describes the heart he is actually talking about the lungs. Inadvertently through his lack of proper anatomy, he actually supports the respiratory position.