Sunday, October 17, 2010

Halachic Definition of Death

I chose as my first topic of discussion the Halachic Definition of Death. My reason for choosing this, is because it was while reading an article by Dr. Reichman in the Torah U-Maddah journal that I was inspired to think about medical halacha in a new rationalistic and historically accurate way.  I don't claim at all to be the first person to think of this approach, but I hope to try to apply it to many areas where halacha and medicine intersect.

There has been much written about the subject, and I do not want to bore you with a review of the entire subject in detail.  However, I must give a basic review of the topic, and explain the various sources and halachic opinions in order to set up how we can apply our Five Principles to see if a Rational Halachist might come up with a unique conclusion that could affect practical halacha.

Defining the time of death is halachically crucial for many reasons.  However, one of the most contentious topics that are heavily affected by the timing of death is the issue of organ transplantation.  As a general rule, as long as a person is halachically alive, one may not harvest his/her organs even in order to save another life.  One can not kill one person to save another.  However, once a person is dead, it then would become a mitzvah to harvest his/her organs in order to save someone else's life.  The majority of poskim would agree with the above statement.

It is also generally true that in order to harvest a fresh organ, it generally needs to be removed before it begins to degenerate. Since this process begins virtually instantaneously upon the cessation of the flow of fresh oxygenated blood  to that organ, doctors will try to harvest the organ while the patient's heart is still pumping oxygenated blood into the circulation.

This leads to the big problem, with which most readers of this blog are probably familiar.  If a person is declared dead by modern medicine because his/her brain has ceased functioning, but his/her heart is still beating, is he/she dead or alive according to halacha.  If he/she is dead, the organ can be harvested.  If he/she is still alive, we cannot remove the organ as this would be tantamount to murder. With this introduction behind us, let's get to work.

All halachic discussions of the time of death start with the following basic sources. 

The Mishna in Oholot 1:6 teaches us that physical decapitation is considered death, despite the fact that there may still be some movement of the body.  This is the source for the poskim who support brain death as an appropriate criteria for halakhic death.  The argument is basically that if physical decapitation is death, than physiologic decapitation must be death as well, and that is indeed what happens when a person is brain dead.  This is the conclusion of Rabbi Dr. Moshe Tendler and his interpretation of Rabbi Moshe Feinstein's responsa.

The gemara in Yoma 85a is the primary source for the heart death advocates.  This gemara is referring to the determination of death in a person who is stuck under a collapsed building on Shabbat.  The conclusion most draw from this gemara is that once we determine that the person is no longer breathing and/or that the heart is no longer beating that he/she is considered dead. The ultimate source of this idea is the pasuk in Bereishit 7:22 "all in whose nostrils was the breath of life..."

I admit that I am oversimplifying, but if you want to learn more about this debate in detail, see this great list of articles on this topic here on the HOD society website.

From these sources, we can trace the issue throughout halachic history.  The Rambam codifies the criteria of respiratory death in Hilchot Shabbat 2:19, and the Shulchan Aruch follows his lead in Orach Chaim 329:4.  Although there are hundreds of responsa that reference this topic, two key responsa need to be mentioned here.  One is the teshuva of the Chacham Tzvi # 77.  In this teshuva, the Chacham Tzvi gives a lengthy and erudite explanation of his view on the function of the heart and lungs and what the halachic definition of death is.  He says that although the cessation of respiration is the Talmud's criteria for death, this is because the cessation of respiration is an indication that the heart has stopped beating. The beating heart however, according to the Chacham tzvi is the true indicator of life.

The second is the teshuva of the Chatam Sofer Yoreh Deah # 338 where he follows the lead of the Chacham Tzvi and states that since the heart is the source of life, that any indication of a heart beat or pulsation means that the person is still halachically considered to be alive.

Let us conclude this basic review of the sources with the statement that the majority of contemporary Poskim seem to agree that as long as the heart is beating, the person is halachically alive.  Some Poskim though still support the concept of brain death based on the decapitation argument.  I hope in my next post to subject this topic to our Five principles and see how it stands up to the rationalist approach. I invite any of you to try your hand at applying the principles in the comments section, and we can see if we agree. Take care, and shavua tov!


  1. I don't know enough about the medical reality, but would it make sense for the doctors to use a machine to artificially pump the heart to get blood to the organs?

    I would imagine that this would not count as the heart still beating since it is not doing so on its own, and the person could not survive with their chest open and some person or machine keeping the heart pumping.

  2. Ameteur beat me to it. I was about to comment on the following sentence, "the majority of contemporary Poskim seem to agree that as long as the heart is beating, the person is halachically alive" -- with the question, "does that mean only /without/ machine assistance?

    I suspect that you already had this question on your mind, and will address it soon.

  3. On a slightly similar topic what is this blog opinion on the soul with respect to death? Does death imply the loss of the soul or are the events orthogonal?
    More over, what is a soul halachically?

  4. The anatomic/physiologic relationship between the heart and lungs bears a mention. As you know, the brain stem controls the automatic respirations and its viability is maintained by oxygenated blood from the heart. A pumping heart provides oxygenated blood, the brain stem keeps the lungs breathing. Hypoxia would lead to a cessation of brain stem function followed by loss of heart function due to global ischaemia. Seen in this light, the gemara in Yoma as well as the mishna in Oholos make much more sense. Decapitation means loss of brainstem and brain, hence no automatic lung function. Finding someone who is not spontaneously breathing means he is essentially decaptitated so residual cardiac activity becomes meaningless.

  5. This is very true.We know from isolated heart experiments in petri dishes that beating of the heart can continue for a good while.Thus, it is highly reasonable to view the cessation of respiration, from physical (decapitation) and/or physiologic reasons as end of life.