I am really sorry that I have not posted in the last few weeks, but I want the readers of the blog to know that I have been working hard on this next topic. This is a subject that has been bothering me for quite some time. Let me share with you my personal history of my quest for an understanding of the halachos of treating non-Jews on shabbos. I am sharing this with you only because I believe that it will help you appreciate the full force of my arguments that I intend to put forth.
As a yeshiva graduate, newly armed with semicha and a few years of kollel behind me, I decided to go to medical school. I knew that treating patients on shabbos was going to be an important halachic issue so I made it my business to study the topic thoroughly so I would be ready to handle whatever situations I would encounter.
So I started by reading some articles and teshuvos, mostly in the Tzitz Eliezer and Igros Moshe to familiarize myself with some of the basics. I threw in a little bit of Nishmas Avrohom, Shemiras Shabbos Kehilchasah, and other seforim, and reviewed a few contemporary halacha books that were available then. This was the beginning. I also had some long conversations with some contemporary poskim, who shall remain nameless only because I don't want it to sound like I am claiming that any of them would endorse my ideas that I will be expressing in this blog.
In my final year of medical school I had the opportunity to take off a few months to do some "electives", so i chose to learn in kollel (under the guise of studying "Jewish medical ethics") for a few months to study the relevant sugyos in shas, the rishonim, acharonim, and ultimately the shulchan aruch and acharonei haposkim on the topic of treating gentiles on shabbos. So I thought that I at least had a handle on the relevant issues, i had poskim to call if I needed help, and I was ready to go.
However, I wasn't really prepared at all for what eventually became the real issue for me. Stepping out into the "real world" forced me to think seriously about what moral and ethical messages the Torah had to teach me, my colleagues, my patients and indeed the entire world about what it means to be responsible to take care of people's lives.
There is SO much in the Torah to draw strength from, and starting with Verapo yerapey, veahavta lereiachah kamocha and on down, there was so much in the Torah for me to draw strength from and teach others. But I kept on hitting a big bump, nay, a big brick wall. Everywhere I turned, I hit a brick wall. what I believed in my heart, and what I learned in shulchan aruch kept on crashing into each other like a game of chicken where both contestants "win".
In my heart I knew that treating and saving a human life is the highest calling. In my heart I knew that Hashem wants me to do everything I can to take care of all human beings with equal compassion, equal concern, and treat everyone appropriately no matter who they may be. I knew it in my bones, I knew it in my heart. So why then does halacha distinguish between caring for a Jew and a non-Jew on Shabbos?
The more I spent my life caring for others, doing what i know Hashem wants from me, the less I was able to reconcile these two seemingly contradictory lessons that the Torah was teaching me.
Let me now be really honest. I have went through many stages before I came to the conclusions that i will be arguing in this series of blog posts.
Stage One) Not willing to God forbid throw out the Torah, I first thought that maybe my priorities were messed up. If the Torah teaches me something, then my set of values must be wrong! Maybe I am just absorbing foreign non_Torah values, and I need to learn the Torah-true values and accept them as the word of God. But I couldn't accept it. Sure, on many levels I know that we cannot accept every whim of modern society as a proper value system. Things like premarital sex, abortion on demand, and other issues shouldn't become acceptable to me just because modern society says so! But this issue was different. Something deep down inside of me told me that this value system was right. God would not want me to treat a goy or jew differently on shabbos.
Stage two) So maybe the Torah is wrong? Maybe i should get with the program and join the modern world! As scary as this thought was to me, I would be dishonest if I claimed that such thoughts never entered my mind. If God were to ask me why I rejected the Torah, my answer would be, because I believed that all of your children were created equal! If I burn in hell for that conviction, then go ahead and let me burn! As such thoughts percolated in my head, I was disgusted. It can't possibly be that the Torah really believes this way! It is too beautiful, too wonderful, too peaceful, too loving, and I just KNOW that what Hashem wants from me is to treat everyone with the same respect.
Stage three) So I spoke with people to whom I could trust my inner thoughts, and I studied numerous seforim which entertained these types of doubts. I turned to thinkers that I knew had grappled with these issues honestly, and remained faithful to the Torah. Thinkers like the Rambam in the sefer Moreh Nevuchim. Thinkers like Rav Kook and Rav SR Hirsch. Poskim like the Seridei Aish. I spoke with people who dealt with these issues openly and honestly, and eventually I realized that with study, discussion, honesty, and openness, the true beauty of the Torah will always shine forth.
Armed with this new approach, I learned something both wonderful and scary. I learned that what shines forth from the Torah may be something new and refreshing to me, but others often seem to find it difficult to accept. The famous "Slifkin Affair" was a watershed event for me. That is because R' Slifkin was a person who also was grappling with the same difficulties that I was, and he seemed to find a path that both satisfied his rationalistic personality , and remained faithful to the Torah. His area may have been zoology, the age of the universe and so on, while my area was medical halacha, but the issues were the same to me. When he got "shot down" by the chareidi establishment, I was "shot down" as well.
I have made it clear in this blog that I have set out to revisit the entire field of medical halacha in a rationalist way, and I have determined to do this unapologetically, and rely on the research that I have conducted. I will do this because I am a frum Jew, and i will always love the Torah. For the sake of God, for the sake of my children, and for the sake of every Jew and every human being who uses his or her own head when they think about these issues, I will offer a way to deal with these very difficult subjects. I would love to hear your thoughts in the comments.
In the upcoming posts i will attack the following fundamental question. Despite the fact that all contemporary poskim DO allow chillul shabbos to save ANY life, we know that this is generally considered a heter due to fear of reprisal, mishum ayvah or some other heter. If the halacha is an ethical guide to life in addition to just being a book of rules, how could it be that the fundamental principles that underlie the halacha are so contrary to what most of us would consider to be basic ethics? How could it be that the halacha only allows chillul shabbos to save the life of a Jew but not a gentile? Does this not run counter to our basic ethical instincts?
If you are not bothered by this ethical problem, then you probably should not be reading this blog. If it doesn't bother you, then our perspectives are so different from each other, that further dialogue will probably not be very productive. However, if this problem bothers you, then please read it, listen, and tell me what you think.
Thursday, November 25, 2010
Sunday, October 31, 2010
The Halacha is Moral Principal and a Wrap-up of the Time of Death Issue
The fifth principle of rationalist medical halacha is the Moral principle. Similar to the fourth principle of Common-sense, this principle is not meant to prove anything. However, it does challenge us to view Halacha as moral guide that is meant to teach us how to properly act in the complicated situations that confront us in our daily lives. Certainly, the idea of what is moral and what is not is something which changes over time in different societies. Clearly, a Jew who claims to adhere to halacha should be looking to halacha to decide right and wrong, and not to the whims of society and what the general public thinks is moral. However, when the two conflict, it certainly warrants a clear review if the halacha to decide if indeed there is a conflict, or maybe the understanding derived from halacha may not have been correct.
The moral arguments in favor of brain death have been made by others, and I will not go into too much detail. But I owe it to the readers of this blog to review the basics.
1) Using brain death as a criteria for death allows us to harvest organs from a dead body to save lives
2) Halachic Jews generally allow the receipt of organs from brain dead donors, therefore, to prohibit the converse, i.e. Jews can get organs but not donate, leads to a situation that causes understandable animosity from people outside halachic circles.
3) Is it moral to use very considerable and very limited resources to maintain the “life” of a person who is completely brain dead, with no chance of ever regaining any consciousness or functioning?
I know that this topic has been discussed and debated in so many forums over the past 20-30 years, and that the “lines in the sand” have already been drawn on this issue. I don’t pretend to think that I will be changing any minds with this blog, nor will I delude myself into thinking that I have anything to say that will change the fundamental nature of this argument.
However, what I DO claim is as follows. That if you are willing to concede that a good moral case could be made for using brain death as a criteria for death, then at least can we review the halachic literature to make sure that we got it right when we declare this person to be halachically alive when his/her brain is completely dead?
That is all the fifth principle of rationalist medical halacha demands. That if something seems to be morally right, that we seriously examine the halacha to make sure we are learning the right lessons.
Let me take the opportunity to thank all of you who bothered to read and think about this first topic in our new blog. I do believe that we are beginning a new adventure together, a new way to look at medical/halachic topics. In our first discussion regarding the halachic time of death we used the five principles to suggest the following:
1. The Historical Principle when applied to this topic leads us to the conclusion that the gemara only declared that cardio respiratory death was halachic death because of the understanding that chazal had of physiology. This would lead us to conclude that with a new understanding of physiology that we should develop a new understanding of when death occurs
2. By applying the historical corruption principle we found that even the brain death advocates were guilty of trying to inject into the gemara modern ideas that could not have been the true intent of the gemara
3. Applying the mixed up principle taught us that trying to consistently apply the gemara’s understanding of death which is based on an understanding of physiology dramatically different from what we know today leads us to conclusions that are not logical. This forces us to try to amend and change and reinvent what the gemara meant in order to avoid decisions that are uncomfortable or clearly wrong.
4. The Common Sense principle forces us to reconsider the halachic time of death as common sense would have us conclude that brain death is death
5. The Halacha is Moral principle forces us to reconsider the halachic time of death as using cardiovascular death as the criteria for death can lead us to conclusions that seem to be immoral.
I am looking forward to hearing what you have to say, and I am getting material ready for my next topic, “Treating a non-Jew on Shabbos”
The moral arguments in favor of brain death have been made by others, and I will not go into too much detail. But I owe it to the readers of this blog to review the basics.
1) Using brain death as a criteria for death allows us to harvest organs from a dead body to save lives
2) Halachic Jews generally allow the receipt of organs from brain dead donors, therefore, to prohibit the converse, i.e. Jews can get organs but not donate, leads to a situation that causes understandable animosity from people outside halachic circles.
3) Is it moral to use very considerable and very limited resources to maintain the “life” of a person who is completely brain dead, with no chance of ever regaining any consciousness or functioning?
I know that this topic has been discussed and debated in so many forums over the past 20-30 years, and that the “lines in the sand” have already been drawn on this issue. I don’t pretend to think that I will be changing any minds with this blog, nor will I delude myself into thinking that I have anything to say that will change the fundamental nature of this argument.
However, what I DO claim is as follows. That if you are willing to concede that a good moral case could be made for using brain death as a criteria for death, then at least can we review the halachic literature to make sure that we got it right when we declare this person to be halachically alive when his/her brain is completely dead?
That is all the fifth principle of rationalist medical halacha demands. That if something seems to be morally right, that we seriously examine the halacha to make sure we are learning the right lessons.
Let me take the opportunity to thank all of you who bothered to read and think about this first topic in our new blog. I do believe that we are beginning a new adventure together, a new way to look at medical/halachic topics. In our first discussion regarding the halachic time of death we used the five principles to suggest the following:
1. The Historical Principle when applied to this topic leads us to the conclusion that the gemara only declared that cardio respiratory death was halachic death because of the understanding that chazal had of physiology. This would lead us to conclude that with a new understanding of physiology that we should develop a new understanding of when death occurs
2. By applying the historical corruption principle we found that even the brain death advocates were guilty of trying to inject into the gemara modern ideas that could not have been the true intent of the gemara
3. Applying the mixed up principle taught us that trying to consistently apply the gemara’s understanding of death which is based on an understanding of physiology dramatically different from what we know today leads us to conclusions that are not logical. This forces us to try to amend and change and reinvent what the gemara meant in order to avoid decisions that are uncomfortable or clearly wrong.
4. The Common Sense principle forces us to reconsider the halachic time of death as common sense would have us conclude that brain death is death
5. The Halacha is Moral principle forces us to reconsider the halachic time of death as using cardiovascular death as the criteria for death can lead us to conclusions that seem to be immoral.
I am looking forward to hearing what you have to say, and I am getting material ready for my next topic, “Treating a non-Jew on Shabbos”
Saturday, October 30, 2010
The Common Sense Principle and the Determination of the Time of Death
Our fourth principle is the common sense principle. According to this principle, if a contemporary halachic analysis of a particular medical issue leads to a conclusion that seems to defy common sense, one should seriously consider the possibility that his/her halachic analysis may have been flawed. Let me reiterate that this by no means proves that the analysis is wrong. Sometimes halacha may defy what a contemporary person thinks is common sense, because the halacha may be promoting a different value system. Nonetheless, it clearly warrants a deeper look into the issues to make sure some important factors were not missed when the halachic analysis was originally done.
So it should come as no surprise to anyone reading this blog, that common sense would dictate that irreversible brain death should be a reasonable criteria for death. If this is not obvious to you, let me present the following arguments for this. Remember, these are non-halachic, common sense arguments.
1) All thoughts and feelings occur in the brain
2) A person's personality, sensations, emotions etc... are all in the brain
3) All voluntary movements of the body originate in the brain
4) Once the brain is irreversibly dead, it is impossible to resuscitate a brain
5) Once the brain dies, ALL body functions cease, unless otherwise supported by artificial devices
6) Almost any organ can be transplanted from one person to another, but brain transplantation is impossible, and most likely always will be impossible
7) Even if # 6 was proven wrong, i.e. brain transplantation was possible, most of us would agree that if person A's brain were transplanted into person B's body, that the body that was formerly of person B would really now be person A with new organs, and not person B with a new brain. This is different than the transplantation of any other organ, which simply becomes the new heart, lung etc... of the recipient body.
8) There is no such thing as an artificial device which can keep a dead brain alive, nor is it conceivable that there ever will be such an invention
9) Even if # 8 were proven wrong, i.e a machine were invented that was equivalent to a respirator for the brain, this would simpy, be considered a machine that keeps people alive, as their consciousness and identity abnd awareness would be preserved by this machine. This is different from a respirator for the lungs which simply keeps the lungs and other organs alive while the person is actually dead. 10) Consciousness is reflected by electrical activity in the brain, this is demonstrated all the time with many medical imaging studies and tests, if we assume that consciousness is at least in part a function of our soul, then it would make sense that the irreversible cessation of electrical activity in the brain is probably a good indicator of the departure of the soul
Now I know that none of these prove anything about the halachic criteria for brain death, but tell me honestly, based on what we all know to be true about human anatomy today, if you had to pick one organ that was the central organ of life, one organ which defined whether you were alive or dead, one organ which was the seat of your soul, which organ would you choose? That is what I mean by common sense.
The common sense principle dictates that if common sense leads to one conclusion, and a halachic interpretation leads to an opposite conclusion, that this warrants a serious review of your halachic conclusion to determine if indeed halacha is trying to teach you something above and beyond common sense, or maybe your halachic conclusion was wrong in the first place. It also dictates that if you conclude against what almost all physicians, scientists and health care practitioners today believe to be true, that you should seriously consider if your halachic conclusion might be wrong.
I have considered whether or not the CDA are wrong, and I do believe that their halachic conclusion is just plain wrong. Brain death not only makes common sense, it is halachically correct as well, for reasons which we have already described in previous posts.
So it should come as no surprise to anyone reading this blog, that common sense would dictate that irreversible brain death should be a reasonable criteria for death. If this is not obvious to you, let me present the following arguments for this. Remember, these are non-halachic, common sense arguments.
1) All thoughts and feelings occur in the brain
2) A person's personality, sensations, emotions etc... are all in the brain
3) All voluntary movements of the body originate in the brain
4) Once the brain is irreversibly dead, it is impossible to resuscitate a brain
5) Once the brain dies, ALL body functions cease, unless otherwise supported by artificial devices
6) Almost any organ can be transplanted from one person to another, but brain transplantation is impossible, and most likely always will be impossible
7) Even if # 6 was proven wrong, i.e. brain transplantation was possible, most of us would agree that if person A's brain were transplanted into person B's body, that the body that was formerly of person B would really now be person A with new organs, and not person B with a new brain. This is different than the transplantation of any other organ, which simply becomes the new heart, lung etc... of the recipient body.
8) There is no such thing as an artificial device which can keep a dead brain alive, nor is it conceivable that there ever will be such an invention
9) Even if # 8 were proven wrong, i.e a machine were invented that was equivalent to a respirator for the brain, this would simpy, be considered a machine that keeps people alive, as their consciousness and identity abnd awareness would be preserved by this machine. This is different from a respirator for the lungs which simply keeps the lungs and other organs alive while the person is actually dead. 10) Consciousness is reflected by electrical activity in the brain, this is demonstrated all the time with many medical imaging studies and tests, if we assume that consciousness is at least in part a function of our soul, then it would make sense that the irreversible cessation of electrical activity in the brain is probably a good indicator of the departure of the soul
Now I know that none of these prove anything about the halachic criteria for brain death, but tell me honestly, based on what we all know to be true about human anatomy today, if you had to pick one organ that was the central organ of life, one organ which defined whether you were alive or dead, one organ which was the seat of your soul, which organ would you choose? That is what I mean by common sense.
The common sense principle dictates that if common sense leads to one conclusion, and a halachic interpretation leads to an opposite conclusion, that this warrants a serious review of your halachic conclusion to determine if indeed halacha is trying to teach you something above and beyond common sense, or maybe your halachic conclusion was wrong in the first place. It also dictates that if you conclude against what almost all physicians, scientists and health care practitioners today believe to be true, that you should seriously consider if your halachic conclusion might be wrong.
I have considered whether or not the CDA are wrong, and I do believe that their halachic conclusion is just plain wrong. Brain death not only makes common sense, it is halachically correct as well, for reasons which we have already described in previous posts.
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.
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.
Tuesday, October 26, 2010
The Mixed Up Medical Principle and the Time of Death
The third Rationalist principle of Medical Halacha is the Mixed Up Medical Principle. The importance and relevance of any legal system can be measured by how the system can be applied to rapidly changing situations. However, the difference between the halacha and the various secular legal codes is that, at least in theory, the halacha was meant to last forever, i.e. the ground rules were never meant to change. However, in a secular system, there is usually some mechanism by which the rules can change. So if the people of the United States for example decide that they don't like certain rules, there is a mechanism to change the rules. If a new situation arises, new rules can be devised to apply to the new situations.
However, in halacha, the rules are divinely directed. Therefore, the rules cannot change, and in general, we cannot make up new sets of rules. So the interesting part of the halachic process is figuring out how to apply the same old rules to new situations that arise throughout history. This makes it extremely important to figure out what the original rules actually were, so that we can apply them correctly to new situations.
Let us now analyze some modern situations according to the major group of poskim, the cardiovascular death advocates (CDA). According to the CDA, the chazal defined the time of death as the cessation of spontaneous respiration. In actuality, what the gemara said was that you can declare death based on the fact that the victim buried in the rubble was not breathing on his own. The CDA believe that we can derive from here that anyone who has stopped breathing on his own (and since according to the gemara breathing and the heartbeat are connected - he also has no heartbeat - see the Chacham Tzvi as mentioned in previous posts) is halachically dead, and the converse as well, that anyone who still has a heart beat or is breathing is halachically alive.
When we try to apply this rule to modern situations, this way of learning the gemara leads to several absurdities. Anyone involved in modern day search and rescue knows that when you discover a victim at the scene of an accident, even if he is not breathing and/or his heart is not beating the first thing you need to try is CPR. Only after this fails can you declare him/her dead. In applying the rules of the gemara according to the CDA, there would be no obligation to perform CPR!
Another similar scenario would be the person on a "heart-lung" machine (usually used in cardiac surgery - the blood is diverted from the heart and lungs during surgery and it acts as a temporary heart and lung while the heart is surgically repaired). In these cases it would seem that the patient is halachically dead!
The CDA poskim (see Rabbi Bleich here - bottom of page 90) do recognize this problem with their interpretation, and they therefore add the condition of "irreversible cessation of spontaneous respiration" i.e. that the gemara only meant to say that he/she is dead IF there is no chance of getting the person to breathe again. But this is clearly something they are reading into the gemara, the gemara could not possibly have meant this.
This is clearly a product of poskim reading into the gemara conditions that are simply not there. There is no question in my mind, that the gemara meant exactly what it said. According to the gemara, if a person is not breathing, you can assume that he is dead. But the CDA have some more difficulties trying to apply this to more modern scenarios. What about the polio patient who can't breathe on his own, but requires an Iron lung? Is he halachically dead? What about the person under anesthesia who requires a respirator to breathe because the medications of anesthesia do not allow him/her to breathe?
Since the CDA take the gemara at face value, they have to make all sorts of twists and turns in order to explain how to apply the principle of cardiorespiratory death to situations that the gemara simply could not have possibly conceived of. So many of the conditions that they make up may sound logical, but they are clearly not what the gemara intended.
So how then are we supposed to apply the halacha to modern situations? Is it impossible? Should we simply throw out the halacha and say that it is irrelevant to modern medicine?
Of course not! We need to do the obvious! The gemara applied its understanding of physiology to teach people in those days how to determine death. The gemara did not know about respirators, iron lungs, and CPR! The gemara thought that life resided in the breath of the nostrils which then gave life to the beating heart. So the gemara said that you have to listen to his breathing, and or feel for the heartbeat to determine if the person is dead.
We on the other hand, should learn from the gemara exactly that same principle! Since we know that the brain directs all of the body's actions including breathing, and we know that consciousness resides in the brain, also know that in order to determine death we need to make sure that brain is no longer functioning in order to determine death! In this way we can be very consistent in the application of halacha. Just as chazal determined death by searching for signs in life where they thought the source of life resided, so should we! If life can be restored by CPR, the we are obligated by halachabecause the brain is where the source of life for the body resides.
In fact, the CDA all agree that CPR would be required if there is a chance to resuscitate someone. They explain this usually by using the irreversible cessation of respiration criteria that we mentioned above. However, they are usually unwilling to use this same criteria the other way around, i.e. if the person's heart and lungs are still breathing/beating they still consider the person alive despite the fact that he will never be able to breathe on his own due to brain death! This, to me, is mixed up.
However, in halacha, the rules are divinely directed. Therefore, the rules cannot change, and in general, we cannot make up new sets of rules. So the interesting part of the halachic process is figuring out how to apply the same old rules to new situations that arise throughout history. This makes it extremely important to figure out what the original rules actually were, so that we can apply them correctly to new situations.
Let us now analyze some modern situations according to the major group of poskim, the cardiovascular death advocates (CDA). According to the CDA, the chazal defined the time of death as the cessation of spontaneous respiration. In actuality, what the gemara said was that you can declare death based on the fact that the victim buried in the rubble was not breathing on his own. The CDA believe that we can derive from here that anyone who has stopped breathing on his own (and since according to the gemara breathing and the heartbeat are connected - he also has no heartbeat - see the Chacham Tzvi as mentioned in previous posts) is halachically dead, and the converse as well, that anyone who still has a heart beat or is breathing is halachically alive.
When we try to apply this rule to modern situations, this way of learning the gemara leads to several absurdities. Anyone involved in modern day search and rescue knows that when you discover a victim at the scene of an accident, even if he is not breathing and/or his heart is not beating the first thing you need to try is CPR. Only after this fails can you declare him/her dead. In applying the rules of the gemara according to the CDA, there would be no obligation to perform CPR!
Another similar scenario would be the person on a "heart-lung" machine (usually used in cardiac surgery - the blood is diverted from the heart and lungs during surgery and it acts as a temporary heart and lung while the heart is surgically repaired). In these cases it would seem that the patient is halachically dead!
The CDA poskim (see Rabbi Bleich here - bottom of page 90) do recognize this problem with their interpretation, and they therefore add the condition of "irreversible cessation of spontaneous respiration" i.e. that the gemara only meant to say that he/she is dead IF there is no chance of getting the person to breathe again. But this is clearly something they are reading into the gemara, the gemara could not possibly have meant this.
This is clearly a product of poskim reading into the gemara conditions that are simply not there. There is no question in my mind, that the gemara meant exactly what it said. According to the gemara, if a person is not breathing, you can assume that he is dead. But the CDA have some more difficulties trying to apply this to more modern scenarios. What about the polio patient who can't breathe on his own, but requires an Iron lung? Is he halachically dead? What about the person under anesthesia who requires a respirator to breathe because the medications of anesthesia do not allow him/her to breathe?
Since the CDA take the gemara at face value, they have to make all sorts of twists and turns in order to explain how to apply the principle of cardiorespiratory death to situations that the gemara simply could not have possibly conceived of. So many of the conditions that they make up may sound logical, but they are clearly not what the gemara intended.
So how then are we supposed to apply the halacha to modern situations? Is it impossible? Should we simply throw out the halacha and say that it is irrelevant to modern medicine?
Of course not! We need to do the obvious! The gemara applied its understanding of physiology to teach people in those days how to determine death. The gemara did not know about respirators, iron lungs, and CPR! The gemara thought that life resided in the breath of the nostrils which then gave life to the beating heart. So the gemara said that you have to listen to his breathing, and or feel for the heartbeat to determine if the person is dead.
We on the other hand, should learn from the gemara exactly that same principle! Since we know that the brain directs all of the body's actions including breathing, and we know that consciousness resides in the brain, also know that in order to determine death we need to make sure that brain is no longer functioning in order to determine death! In this way we can be very consistent in the application of halacha. Just as chazal determined death by searching for signs in life where they thought the source of life resided, so should we! If life can be restored by CPR, the we are obligated by halachabecause the brain is where the source of life for the body resides.
In fact, the CDA all agree that CPR would be required if there is a chance to resuscitate someone. They explain this usually by using the irreversible cessation of respiration criteria that we mentioned above. However, they are usually unwilling to use this same criteria the other way around, i.e. if the person's heart and lungs are still breathing/beating they still consider the person alive despite the fact that he will never be able to breathe on his own due to brain death! This, to me, is mixed up.
Thursday, October 21, 2010
Decapitation, Brain Death and the Historical Corruption Principle
The second principle of Rationalist Medical Halacha is the Historical Corruption Principle. It is not uncommon that when a posek ignores this principle, that he may either ignore the fact that the halachic precedents were based on a different scientific understanding than his own, or worse, he may project his own understanding of science onto the earlier poskim and onto Chazal and assume that they meant something other than their true intention. Often it is the more scientifically inclined poskim who seem to make this particular blunder.
We mentioned in previous posts the two major current opinions, one held by the the brain death advocates, and the other by the cardiorespiratory death advocates. In the last post, we demonstrated how to apply the first Rationalist Principle to the primary Talmudic source for the cardiorespiratory death advocates.
Now I will focus my attention on the brain death advocates, and demonstrate the second principle of rationalist medical halacha at work.
The primary source for the brain death advocates is the Mishna in Oholot 1:6, which reads as follows:
A person does not impart impurity (the impurity imparted by a dead body) until his soul leaves him....If their heads are removed, even though there are movements - they are impure, similar to the tail of the lizard that it moves
The argument simply goes as follows: If the Mishna supports physical decapitation as death, even if there is still movement (and presumably this would be any movement - even heart motion) then clearly physiologic decapitation is also death halachically. Although this argument makes a lot of sense, I don't think this approach stands up well to the scrutiny of the Rationalist approach. In short, I don't think it is possible to claim that the gemara equates physical and physiologic decapitation. I still believe that the Chazal believed in cardiorespiratory death, as indicated in Yoma, but that they believed that physical decapitation should be considered death anyway, for other reasons which I will explain. In fact, the entire concept of physiolgic decapitation would have been so foreign to Chazal's understanding of anatomy and physiology that they probably would have thought that such a suggestion would be absurd. Let me explain why.
When the brain death advocates bring the Mishna in Oholot, they are forced to explain how they know for certain that physiologic brain death would be considered death according to chazal. It is well known that the chief proponent of the physiologic decapitation idea (PDI) is Rabbi Dr. Moshe Tendler Shlita. In an article published in 1990, Rabbi Tendler describes how he derives the PDI from this mishna. The Rambam explains the mishna in Oholot (why the movement of a lizard's tail is not real movement): "This occurs in some living animals because the source of motion does not spread to all its limbs from its' source and one place rather it is spread throughout the body". In Rabbi Tendler's words, the Rambam holds (and explains the Mishna this way) that there is a difference between organismic death and organ death i.e. although the organ may be "alive" the organism (the entire animal) may be dead. This happens when the movement is not directed by its source, which is of course, according to Rabbi Tendler, is the brain which controls movement.
Now this is a classic example of the Historical Corruption Principle in action. The Rambam did not believe that the brain was the source of motion! The Rambam (see Dr. Reichman's article, note 67). The Rambam believed that the source of motion was the heart! This can be found in numerous places in his medical writings, and in the Moreh 1:38,72. If you think this sounds strange, let us review for a moment a brief history of the ancient understanding of the function of the brain.
According to Aristotle, the function of the brain was to cool the innate heat of the heart. Thoughts, feelings, and decisions were all made in the heart. (see Aristotle, On Sleep and Sleeplessness, Part Three, trans. J. I. Beare. [Online here, scroll to second-to-last paragraph.]. Only after Aristotle did the Greek thinker Herophilus identify the brain as the source of intellect. It wasn't until the time of the Roman philosopher Galen (CE 129-199) that it was discovered that the brain wills and controls motion. The Rambam (see Max Meyerhoff "Maimonides Criticizes Galen Medical Leaves 3:1 1940) actually sided with Aristotle and believed that although the brain had a function in controlling movement, the actual origin of movement was the heart. So how strange indeed it is that Rabbi Tendler tried to use the Rambam's explanation of the Mishna in Oholot to prove that brain death is indeed death. According to the historical principle, we must understand the Rambam according to HIS OWN understanding of physiology, not by imposing modern ideas and imputing them to him. The Rambam clearly did not mean to explain the mishna that the reason why decapitation is death is because the central source of motion is dead if he didn't believe that the source of motion was the brain!
What then is the pshat in the Rambam? Why is physical decapitation considered death if the body is still moving? For that we need to understand the significance of the brain according to the Rambam. Although this is not the place for a detailed analysis of the Rambam's pshat in the Mishna, the bottom line is that the brain is an "eiver shehaneshama teluyah bo" and the Rambam goes out of his way to say that even if the head is attached by skin and soft tissue, but the spine is severed (like what would happen in a hanging) that the person is dead. If anything, this could prove that the Rambam would not hold of PDI, or he would have went even farther than that and said that even if it is totally attached, but not functioning, the person is dead, but if I said that, I may be guilty of violating the historical principle myself. If one looks carefully at Rabbi Kapakh's translation of the Rambam Peirush hamishnayot (my English translation of the Rambam Peirush on the mishna in oholot is based on the R' Kapakh version), one will see that the Rambam explained that in certain simple LIVE creatures, such as the Leta'ah (some sort of lizard presumably) the motion is not centrally directed, and thus there is a lot of movement even after the tail is severed. This movement proves that there is such a thing as movement that does not derive from the central life giving source i.e. the heart. In the same way, the mishna teaches us, that after death there could be movement that does not constituite life at all. That is all the rambam meant IMHO.
Let's look at one more area where the brain death advocates make the same blunder. In that same article, Rabbi Tendler brings another important source, the Shulchan Arukh, Yoreh Deah Chapter 370, based on a gemara in Chullin. The title of the chapter is "Who is considered dead even though he is alive". The Shulkhan Arukh (SA) lists two such people,one whose neck is broken, and the other who has a severe injury to his back which is split open. The SA explains that they are considered halachically dead, even though they may still be moving. However, a gosses (someone in the throes of death) is still considered alive, even with multiple wounds or a slit throat. Rabbi Tendler asks, "Why would the first cases be regarded unequivocally as instantaneous deaths, and the others not so regarded?" and he explains, "The answer is that such individuals experience a condition in which their blood pressure drops instantly due to a massive wound. Blood flow to the brain is interrupted, and they die because their brain dies within seconds or minutes of that interruption ..." So brain death is once again being injected into the SA, even though it is obvious that this was not the intent of the SA or the gemara upon which the SA was based.
It is important to mention that there is another group of authorities who advocate brain death as a possible criteria for halachic death, but from a completely different angle than the PDI of Rabbi Tendler and his supporters. This is most clearly articulated by Rabbi Dr. Avraham Steinberg in several articles. See this link here for one article easily accessible online. The bottom line of this opinion is that cardiorespiratoy death is the halachic definition of death as the gemara in yoma indicates. However, since the brain stem controls respiration, it should be obvious that if you can prove that the brain stem is totally dead, than by definition spontaneous respiration has ceased. In other words, brain death is only considered death because that causes breathing to stop.
This approach makes a lot of sense but it should be obvious that the gemara never intended to teach us that the death of the brain is the proximate cause of the cessation of respiration. However, at least it gets around the problem of the Historical Corruption Principle, as no claim is made that the gemara intended to teach us about concepts which would have been foreign to chazal. This is really another version of the opinion of the cardiorespiratory death advocates, with the understanding that the brain controls the action of breathing.
There is obviously much more to be said, but I think I would like to move on next time to the third principle and describe some of the strange and confusing consequences of trying to apply Halachic death criteria to modern medical situations. Looking forward to your comments.
We mentioned in previous posts the two major current opinions, one held by the the brain death advocates, and the other by the cardiorespiratory death advocates. In the last post, we demonstrated how to apply the first Rationalist Principle to the primary Talmudic source for the cardiorespiratory death advocates.
Now I will focus my attention on the brain death advocates, and demonstrate the second principle of rationalist medical halacha at work.
The primary source for the brain death advocates is the Mishna in Oholot 1:6, which reads as follows:
A person does not impart impurity (the impurity imparted by a dead body) until his soul leaves him....If their heads are removed, even though there are movements - they are impure, similar to the tail of the lizard that it moves
The argument simply goes as follows: If the Mishna supports physical decapitation as death, even if there is still movement (and presumably this would be any movement - even heart motion) then clearly physiologic decapitation is also death halachically. Although this argument makes a lot of sense, I don't think this approach stands up well to the scrutiny of the Rationalist approach. In short, I don't think it is possible to claim that the gemara equates physical and physiologic decapitation. I still believe that the Chazal believed in cardiorespiratory death, as indicated in Yoma, but that they believed that physical decapitation should be considered death anyway, for other reasons which I will explain. In fact, the entire concept of physiolgic decapitation would have been so foreign to Chazal's understanding of anatomy and physiology that they probably would have thought that such a suggestion would be absurd. Let me explain why.
When the brain death advocates bring the Mishna in Oholot, they are forced to explain how they know for certain that physiologic brain death would be considered death according to chazal. It is well known that the chief proponent of the physiologic decapitation idea (PDI) is Rabbi Dr. Moshe Tendler Shlita. In an article published in 1990, Rabbi Tendler describes how he derives the PDI from this mishna. The Rambam explains the mishna in Oholot (why the movement of a lizard's tail is not real movement): "This occurs in some living animals because the source of motion does not spread to all its limbs from its' source and one place rather it is spread throughout the body". In Rabbi Tendler's words, the Rambam holds (and explains the Mishna this way) that there is a difference between organismic death and organ death i.e. although the organ may be "alive" the organism (the entire animal) may be dead. This happens when the movement is not directed by its source, which is of course, according to Rabbi Tendler, is the brain which controls movement.
Now this is a classic example of the Historical Corruption Principle in action. The Rambam did not believe that the brain was the source of motion! The Rambam (see Dr. Reichman's article, note 67). The Rambam believed that the source of motion was the heart! This can be found in numerous places in his medical writings, and in the Moreh 1:38,72. If you think this sounds strange, let us review for a moment a brief history of the ancient understanding of the function of the brain.
According to Aristotle, the function of the brain was to cool the innate heat of the heart. Thoughts, feelings, and decisions were all made in the heart. (see Aristotle, On Sleep and Sleeplessness, Part Three, trans. J. I. Beare. [Online here, scroll to second-to-last paragraph.]. Only after Aristotle did the Greek thinker Herophilus identify the brain as the source of intellect. It wasn't until the time of the Roman philosopher Galen (CE 129-199) that it was discovered that the brain wills and controls motion. The Rambam (see Max Meyerhoff "Maimonides Criticizes Galen Medical Leaves 3:1 1940) actually sided with Aristotle and believed that although the brain had a function in controlling movement, the actual origin of movement was the heart. So how strange indeed it is that Rabbi Tendler tried to use the Rambam's explanation of the Mishna in Oholot to prove that brain death is indeed death. According to the historical principle, we must understand the Rambam according to HIS OWN understanding of physiology, not by imposing modern ideas and imputing them to him. The Rambam clearly did not mean to explain the mishna that the reason why decapitation is death is because the central source of motion is dead if he didn't believe that the source of motion was the brain!
What then is the pshat in the Rambam? Why is physical decapitation considered death if the body is still moving? For that we need to understand the significance of the brain according to the Rambam. Although this is not the place for a detailed analysis of the Rambam's pshat in the Mishna, the bottom line is that the brain is an "eiver shehaneshama teluyah bo" and the Rambam goes out of his way to say that even if the head is attached by skin and soft tissue, but the spine is severed (like what would happen in a hanging) that the person is dead. If anything, this could prove that the Rambam would not hold of PDI, or he would have went even farther than that and said that even if it is totally attached, but not functioning, the person is dead, but if I said that, I may be guilty of violating the historical principle myself. If one looks carefully at Rabbi Kapakh's translation of the Rambam Peirush hamishnayot (my English translation of the Rambam Peirush on the mishna in oholot is based on the R' Kapakh version), one will see that the Rambam explained that in certain simple LIVE creatures, such as the Leta'ah (some sort of lizard presumably) the motion is not centrally directed, and thus there is a lot of movement even after the tail is severed. This movement proves that there is such a thing as movement that does not derive from the central life giving source i.e. the heart. In the same way, the mishna teaches us, that after death there could be movement that does not constituite life at all. That is all the rambam meant IMHO.
Let's look at one more area where the brain death advocates make the same blunder. In that same article, Rabbi Tendler brings another important source, the Shulchan Arukh, Yoreh Deah Chapter 370, based on a gemara in Chullin. The title of the chapter is "Who is considered dead even though he is alive". The Shulkhan Arukh (SA) lists two such people,one whose neck is broken, and the other who has a severe injury to his back which is split open. The SA explains that they are considered halachically dead, even though they may still be moving. However, a gosses (someone in the throes of death) is still considered alive, even with multiple wounds or a slit throat. Rabbi Tendler asks, "Why would the first cases be regarded unequivocally as instantaneous deaths, and the others not so regarded?" and he explains, "The answer is that such individuals experience a condition in which their blood pressure drops instantly due to a massive wound. Blood flow to the brain is interrupted, and they die because their brain dies within seconds or minutes of that interruption ..." So brain death is once again being injected into the SA, even though it is obvious that this was not the intent of the SA or the gemara upon which the SA was based.
It is important to mention that there is another group of authorities who advocate brain death as a possible criteria for halachic death, but from a completely different angle than the PDI of Rabbi Tendler and his supporters. This is most clearly articulated by Rabbi Dr. Avraham Steinberg in several articles. See this link here for one article easily accessible online. The bottom line of this opinion is that cardiorespiratoy death is the halachic definition of death as the gemara in yoma indicates. However, since the brain stem controls respiration, it should be obvious that if you can prove that the brain stem is totally dead, than by definition spontaneous respiration has ceased. In other words, brain death is only considered death because that causes breathing to stop.
This approach makes a lot of sense but it should be obvious that the gemara never intended to teach us that the death of the brain is the proximate cause of the cessation of respiration. However, at least it gets around the problem of the Historical Corruption Principle, as no claim is made that the gemara intended to teach us about concepts which would have been foreign to chazal. This is really another version of the opinion of the cardiorespiratory death advocates, with the understanding that the brain controls the action of breathing.
There is obviously much more to be said, but I think I would like to move on next time to the third principle and describe some of the strange and confusing consequences of trying to apply Halachic death criteria to modern medical situations. Looking forward to your comments.
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:
Mishna:
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)
Gemara:
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.
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:
Mishna:
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)
Gemara:
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.
Subscribe to:
Posts (Atom)