Thursday, October 28, 2010

Irreversability and the Mixed Up Principle.

There have been several comments regarding my previous post that I decided to devote an entire post in response.  See Michael's and Daniel Shain's comments.  They both really highlighted some issues that I believe really need further explanation.

First of all, I was impressed by their thoughts, and flattered that they took the time to read and understand my ideas.  This is why I started this blog, in order to have the opportunity to share my ideas and discuss them in public.  I especially enjoy disagreement, as this forces me to rethink my ideas and make sure I stay honest and true to Rationalist principles.  Thanks, and let's continue this discussion. I promise to try to remain open and even change my mind in the face of convincing arguments.

In my last post, I said that the gemara didn't say anything about the irreversibility principle, and that the reading of the CDA to deal with certain absurdities was not what the gemara meant.  I said that the gemara only said that someone who is not breathing is dead, and that it never said that only irreversible cessation of breathing was considered halachic death.  This creates a problem when dealing with modern situations such as an Iron lung, a heart lung machine, CPR and others.

Danial Shain pointed out the following: If we ever figured out a way to restart a dead brain, wouldn't that negate the concept of brain death?  In the same way, just because we figured out a way to restart a stopped heart, doesn't mean that heart death is not death!

This is a very good point, and it forces me to explain my ideas a little further.

The fact is, that irreversibility is not really being read into the gemara.  It is actually the most important criteria in the determination of death.  It is obvious that if some sort of resuscitation is possible, that it must be done.  However, the gemara thought that since the source of life is in the breath, then once a person stops breathing, it must be impossible to resuscitate him anymore, and therefore rescuscitative efforts are not necessary anymore.  This is a consequence of the gemara's view of physiology, as we previously discussed.  The gemara thought that cessation of breathing is by definition irreversible, and this is part of the reason why it was considered death halachically as well.

What modern medicine has shown, is that the act of breathing is not what controls life, but rather the brain is what controls all of the body, including the act of breathing itself.  One of the primary reasons why brain death is medically considered death is because it is considered irreversible by modern science.  In almost all protocols, the determination of irreversibility is the first and foremost criteria for determining brain death.  See here on page 4 for one example. Because of what we now know scientifically, a brain is not declared dead until it is irreversibly dead.  So in response to your question, if we can resuscitate the brain, than by definition it wasn't dead in the first place.

Now I concede that this would be true according to the CDA as well.  They can claim that they are not reading anything into the gemara, for if they knew that cardiorespiratory death was reversible, they never would consider the person dead.  So I retract that part of my previous argument.  Just to clarify, the gemara thought that cardiorespiratory death (CRD) waas irreversible and therefore said that one can determine death in the way that it did.  So the CDA are not reading into the gemara the criteria of irreversibility (which was what I said before and I am retracting).  However, they are also not willing to say based on modern eviednece that the gemara simply would no longer have said that CRD is death.  I would argue that had the gemara known that CRD is often reversible and that life can be sustained without the heart and lungs that they never would have defined CRD as death.

This is not simply a result of modern discoveries that the gemara didn't know about, this is because the gemara fundamentally believed that breathing was the source of life.  This view of physiology makes it impossible to even imagine the feasibility of life without lungs and a heart.  Knowing what we now know about physiology would have made the gemara change its' entire definition of the source of life, and hence the definition of death as well.

As far as the pesukim are concerned that indicate that breath is the source of life, I don't believe that the pesukim are any more than an qasmkhta. for example, the pasuk brought by the gemara itself, "all in whose nostrils is the breath of life", when read in context was siomply diferrentiating between land animals that breathe that were killed by the mabul, and water animals that do not breath that survived the mabul.  here is the entire pasuk (JPS translation): "21 And all flesh perished that moved upon the earth, both fowl, and cattle, and beast, and every swarming thing that swarmeth upon the earth, and every man; 22 all in whose nostrils was the breath of the spirit of life, whatsoever was in the dry land, died."

The gemara was clearly only using this as an asmakhta to support what it thouhgt to be scientifically obvious, that the breath was the source of life.  According to current understanding, the pasuk still makes perfect sense.  When the pasuk calls breathing "the breath of life" is certainly not the same as saying that the lungs are the central organ of life in the body and determine halachic life and death.  Breathing, no matter how you twist it, in some form or other, is necessary for life to be sustained, and can appropriately be called by the Torah "the breath of life".

I think that ultimately my primary argument is now even stronger.  If the gemara claimed that cardiorespiratory death was death when it was felt to be irreversible, then irreversible brain death should certainly be considered death, once we determine that it is irreversible, since we now know that the brain is what controls the entire body.

As for Michael's comment regarding holding one's breath, I assume that there was some "tongue-in-cheek" sentiments in that statement and that I answered your primary concerns in this post.  Obviously the gemara knew that breathing is not constant and that people aren't dead between breaths.

I plan on moving on to the fourth principle, the Common Sense Principal in my next post.

1 comment:

  1. Interestingly, according to R. Shabtai Rapoport (R. Moshe's grandson-in-law), R. Moshe learned that brain death accords with the gemara in yoma,as described by his grandson-in-law:
    "My father’s position was very simply that the stopping of breathing is the point of death. It doesn’t matter if the heart functions or doesn’t
    function. That is the way he explained the Gemara in Yoma. . . . If the breathing has stopped, then he is considered dead. . . . Anything else is not a criterion."
    See here for the quote: