Monday, October 18, 2010

Medical Basis of Cardiorespiratory Death According to Chazal

We are now ready to take on the topic of halachic determination of death according to the unique approach of our blog.  I will try to analyze it using each one of the five basic principles, which can be found in our first post here.  The first principle was called the medical basis of halacha principle.  According to this principle, we need to understand the medical basis behind the halachic decisions of the Rabbis, and this includes the Chazal in the Talmud itself.

Let us recall the two primary Talmudic sources that we mentioned, the gemara in Yoma and the Mishna in Oholot.  Two basic issues need to be understood. Number one, what was the medical understanding of Chazal that influenced these decisions, and  number two, how much of the decision in the gemara is based on Torah and tradition - as opposed to based on science.  I must admit at the outset that it may be impossible to prove beyond any doubt what chazal were saying as a mesorah (tradition from Sinai) and what was being said as a result of their scientific thinking.  However, I do believe that I can convince you that there is overwhelming evidence that will point to one direction or another.

Please refer to Dr. Reichman's article for a review of the state of "scientific" understanding and Greco-Roman Physiology at the time of chazal.  I do not have the space here to repeat the work that he has already done.  If you don't have the time to read it, you can still understand this post, but you may not fully appreciate the power of my argument.

Let me call your attention to several famous debates that were raging in the philosophical world at the time of chazal.  One important argument was the argument over which organ developed first in the development of the fetus.  It was assumed that this organ would be the source from which all other organs are formed.  Aristotle maintained that the heart formed first, Lactatius of Nicomedia believed that it was the head, Alcomaeon believed that it was the navel, and Galen felt that it was the liver.

It is also very important to bear in mind the principle of innate heat and the function of respiration and the heart.  The Greeks, Romans, and indeed until William Harvey's discovery of the circulatory system in the 17th century, the educated world believed that the heart was the source of the primary life-giving force that they called the "innate heat".  The innate heat resided within the heart, and was mixed with air to become the vital force pumped from the heart throughout the body, and this was the life giving force to the body.  According to Greco-Roman thinking, the function of respiration was to keep the innate heat cooled and in check so that it didn't consume the entire body.  It also provided the "pneuma" (air) which mixed with the innate heat to become the vital heat, the ultimate life source for the body. Without the pumping of the heart, it is assumed that the life force emanating from the heart would not be pumped through the body, hence the heart was considered the place where the source of life resided.  So respiration together with the innate heat was the source of life.  Interestingly, the famous Roman physician, Galen, whose thought dominated medical thinking until the renaissance, did experiments that demonstrated that the brain actually controlled movements and breathing (in contrast to Aristotle and virtually all thinking before Galen's time), but even he still agreed with the principle that the heart was the source of life for the entire body.

With this basic background in mind, we can use our first principle to reanalyze the gemara in Yoma, and also compare it to a corresponding gemara in the Talmud Yerushalmi Yoma 8:5.

Here is the Babylonian version:


If debris falls on someone (on the sabbath), and it is doubtful whether or not he is there, or whether he is alive or dead ...One should open the debris for his sake. If one finds him alive one should remove the debris, and if he be dead one should leave him there (until the Sabbath day is over)


Our rabbis taught: How far does one search? until one reaches his nose. Some say: up to his heart. If one searches and finds those above to be dead, one must not assume that those below him are surely dead. Once it happened that those above were dead and those below were found to be alive.  Are we to say that these tannaim dispute the same as the following tannaim? For it was taught: From where does the formation of the embryo commence? From its head, as it is said "Thou are he that took me (gozi) out of my mother's womb" and it is also said "cut off (gozi) thy hair and cast it away"  Abba Shaul said: From the navel which sends its roots into every direction.  You may even say that [the first view is in agreement with] Abba Shaul, inasmuch as Abba Shaul holds his view regarding the first formation [of the fetus] as "everything develops from its' core (middle)" but regarding the saving of life he would agree that life manifests itself through the nose especially, as it is written "In whose nostrils was the breath of  the spirit of life"  Rav Papa said: The dispute only arises from below upwards, but from above downwards, once one has searched up to the nose, one need not search any farther, as it is said, "In whose nostrils was the breath of  the spirit of life"

Here is the Jerusalem Version:

How far can one dig [to determine the death  of a victim]? There are two opinions. One says until the nostrils because these are the source of life and Hurna says until the navel because from here the body grows.

It should be obvious to the reader that Chazal and the philosophers of the contemporaneous non Jewish culture had very similar ideas about the source of life in the body and the development of the fetus.  The argument over what body part serves as the building block of the fetus, and the discussion of the breath as the source of life correspond strikingly to the thoughts and ideas that were believed by the general Greco Roman philosophical community.  Indeed, the idea that one should assume that the body part from which the fetus develops is the source of life, is one that also appears in the philosophical literature of the time (see Aristotle "Generation of Animals Book 2:1).

This leads to the big question.  When Chazal stated that the breath is the determining factor as to whether a person is alive, and they brought the pasuk  "In whose nostrils was the breath of  the spirit of life", what exactly was going on?  Were Chazal taking what was an assumed belief by educated people at the time, and using the pasuk as an asmakhta of sorts, or were they learning the principle that breath is the source of life from the pasuk.  This is a crucial question. Because if the pasuk is the source for this knowledge, then we are dealing with a Torah concept of divine origin. However, if they believed in the breath as the origin of life based on the basic understanding of physiology that was current in their day, then one can argue that the only reason they determined that cardiorespiratory death was the definition of death was because of their scientific beliefs.  However, now that we know otherwise, death may be determined by other factors, such as brain death.

In fact, The Chacham Tzvi, in Teshuva # 77, which we mentioned in the last post, describes Galenic and Aristitelian medicine in excrutiating detail when he explains the opinion of chazal. this is an integral part of his opinion that cardiorespiratory death is halakhic death.  He basically assumes that the heart is the place where the life force resides, and uses that to explain Chazal.  R Yonasan Eibushitz, in the Kreisi U'Plasi Yoreh deah 40:4 attacks the Chacham Tzvi based on a consultation that he had with the University of Halle.  The theories of William Harvey were already known to them, and R Yonasan clearly states that the heart is nothing more than a pump, where no life force resides.  We will get to this argument in more detail later, but for now just keep in mind that they both assumed that Chazal's determination of the major organ of life depended on the scientific understanding, NOT based upon Chazal's Torah understanding.

Now this begins our rationalist analysis of the time of death according to Halkhah using our first principle.  In my next post, I plan on applying more of our principles to this topic to see where it goes.  Looking forward to your comments.


  1. While I find your argument highly coherent and I often find myself following a similar line of enquiry, the problem is that Chazal's contemporary understanding of science has permeated into halacha in so many ways that have been codified and cannot now be changed, whether or not they erred. To give an annoying example, the alleged threat to life of eating fish and meat together: as far as I know, only the Magen Avraham is happy to annul the gezeira on the basis of "hishtaneh ha-teva". This is a far cry from evaluating psuk according to "the medical basis of halachic principle".

  2. Leo: This is the big problem that I am setting out to deal with in this blog. There are no easy answers, but we can still try.

  3. Regarding the babylonian talmud...
    Based on what you have written here, I notice a couple of things.

    1. Clearly, the majority of the verses are brought down as asmachtas. Regarding the verse of breath in his nose, it seems to me like this is used as an asmachta to put words into Abba Shaul's mouth. If it was not being used as an asmachta, it would be be used as a proof/response to the rabanan.

    2. I think one can argue that since the gemora is willing to put words into Abba Shaul's mouth, that this is then a case of logic and deduction and not an issue of messorah or Deoraita halacha.

    However, I'm not sure why the historical debates regarding fetus development is relevant. Maybe I'm missing something. Was the movement of the belly used to determine the status of life?

  4. regardless of whether or not the chacham tzvi & r yonasan imply that chazals rulings were based solely on scientific knowledge, or wether chazal learned from the pasuk directly or used it as an asmachta, we still have a pasuk which is clearly telling us that breathing is the source of life ("In whose nostrils was the breath of the spirit of life"). We therefore cannot simply go about redefining that source of life (for halchik puurposes) as the brain or any other organ for that would directly contradict the pasuk.

  5. "we still have a pasuk which is clearly telling us that breathing is the source of life ("In whose nostrils was the breath of the spirit of life")."

    I disagree!

    The full pasuk is "Kol asher nishmat-ruach chayim be'apav mikol asher becharavah metu."

    It almost seems like it is a qualifier not a definition. For the pasuk to be a contradiction it would have needed to be written "Kol asher metu, ki nefesh chayim yitziah be'apavim" Or something similar.

  6. If the pasuk is an asmakhta, that means that the gemara does not learn from the pasuk that breath is physiologically the source of life. The pasuk is then just a text that hints at the theme that the gemara is trying to prove. However, the gemara would have understood that the pasuk was not meant to teach about when halachic death occurs. Rather it would be the same as numerous other pesukim which were simply written Kelashon bnai adam. For example, no mainstream Jewish thinker today would claim that "Uveruach Apaekhah Ne'ermu Mayim" (with the breath from your nose the waters piled up) in the shirat Hayam Shmot 15:8 means that God actually breathed through his nose to make the red sea split! rather it means that God is so powerful that with a simple "breath" He can make great seas split (or some variation of this explanation) In the same way, when the Torah says "Kol Asher Nishmas Ruach Chayim Be'apav Mikol Asher Bekharavah Meitu" (All in whose nostrils was the breath of the spirit of life, everything on dry land died) all it meant to say was "all living creatures on land (as opposed to water dwelling animals that do not breath air) died. One can hardly learn from here that cardiorespiratory death is halakhic death. Rather, it is simply an asmakhta, as explained above.