I chose as my first topic of discussion the Halachic Definition of Death. My reason for choosing this, is because it was while reading an article by Dr. Reichman in the Torah U-Maddah journal that I was inspired to think about medical halacha in a new rationalistic and historically accurate way. I don't claim at all to be the first person to think of this approach, but I hope to try to apply it to many areas where halacha and medicine intersect.
There has been much written about the subject, and I do not want to bore you with a review of the entire subject in detail. However, I must give a basic review of the topic, and explain the various sources and halachic opinions in order to set up how we can apply our Five Principles to see if a Rational Halachist might come up with a unique conclusion that could affect practical halacha.
Defining the time of death is halachically crucial for many reasons. However, one of the most contentious topics that are heavily affected by the timing of death is the issue of organ transplantation. As a general rule, as long as a person is halachically alive, one may not harvest his/her organs even in order to save another life. One can not kill one person to save another. However, once a person is dead, it then would become a mitzvah to harvest his/her organs in order to save someone else's life. The majority of poskim would agree with the above statement.
It is also generally true that in order to harvest a fresh organ, it generally needs to be removed before it begins to degenerate. Since this process begins virtually instantaneously upon the cessation of the flow of fresh oxygenated blood to that organ, doctors will try to harvest the organ while the patient's heart is still pumping oxygenated blood into the circulation.
This leads to the big problem, with which most readers of this blog are probably familiar. If a person is declared dead by modern medicine because his/her brain has ceased functioning, but his/her heart is still beating, is he/she dead or alive according to halacha. If he/she is dead, the organ can be harvested. If he/she is still alive, we cannot remove the organ as this would be tantamount to murder. With this introduction behind us, let's get to work.
All halachic discussions of the time of death start with the following basic sources.
The Mishna in Oholot 1:6 teaches us that physical decapitation is considered death, despite the fact that there may still be some movement of the body. This is the source for the poskim who support brain death as an appropriate criteria for halakhic death. The argument is basically that if physical decapitation is death, than physiologic decapitation must be death as well, and that is indeed what happens when a person is brain dead. This is the conclusion of Rabbi Dr. Moshe Tendler and his interpretation of Rabbi Moshe Feinstein's responsa.
The gemara in Yoma 85a is the primary source for the heart death advocates. This gemara is referring to the determination of death in a person who is stuck under a collapsed building on Shabbat. The conclusion most draw from this gemara is that once we determine that the person is no longer breathing and/or that the heart is no longer beating that he/she is considered dead. The ultimate source of this idea is the pasuk in Bereishit 7:22 "all in whose nostrils was the breath of life..."
I admit that I am oversimplifying, but if you want to learn more about this debate in detail, see this great list of articles on this topic here on the HOD society website.
From these sources, we can trace the issue throughout halachic history. The Rambam codifies the criteria of respiratory death in Hilchot Shabbat 2:19, and the Shulchan Aruch follows his lead in Orach Chaim 329:4. Although there are hundreds of responsa that reference this topic, two key responsa need to be mentioned here. One is the teshuva of the Chacham Tzvi # 77. In this teshuva, the Chacham Tzvi gives a lengthy and erudite explanation of his view on the function of the heart and lungs and what the halachic definition of death is. He says that although the cessation of respiration is the Talmud's criteria for death, this is because the cessation of respiration is an indication that the heart has stopped beating. The beating heart however, according to the Chacham tzvi is the true indicator of life.
The second is the teshuva of the Chatam Sofer Yoreh Deah # 338 where he follows the lead of the Chacham Tzvi and states that since the heart is the source of life, that any indication of a heart beat or pulsation means that the person is still halachically considered to be alive.
Let us conclude this basic review of the sources with the statement that the majority of contemporary Poskim seem to agree that as long as the heart is beating, the person is halachically alive. Some Poskim though still support the concept of brain death based on the decapitation argument. I hope in my next post to subject this topic to our Five principles and see how it stands up to the rationalist approach. I invite any of you to try your hand at applying the principles in the comments section, and we can see if we agree. Take care, and shavua tov!
Sunday, October 17, 2010
Friday, October 15, 2010
My First Post - The Five Principles of Rationalist Medical Halacha
I am so happy to finally introduce my new blog to the world, and i hope to develop this into a major influence on the Orthodox Jewish world in terms of our approach to deciding medical halacha. I am sure you are all wondering what in the world I have in mind, aren't there numerous books, articles, journals etc... that deal with this topic already? What could this blogger possibly think he can do to change the way we think about medical shaalot? What does he mean by Rationalist Medical Halacha?
Indeed, there are many poskim that are genuinely expert in many areas of medical halacha, and faithful Orthodox Jews rely on these fine Rabbanim to guide them through the complicated details of thousands of shaalot that come up in our lives. The shaalot are related to so many areas, such as end of life issues, Shabbat issues, Pregnancy issues, and on and on. However, the purpose of this blog is to present a consistent and rationalist way to analyze ALL of these topics. I am warning you now though, that your local Orthodox rabbi may not endorse some of the conclusions we make here, even though I hope you will be convinced when you read my presentation of each topic. We will be treading on dangerous halachic ground, so if that scares you, read another blog.
As we develop each topic, you will come to understand how these principles are used by the rationalist system, and you will appreciate the value of each one and why they are important. Admittedly, these can be applied to many areas that are not related to medicine, and while you should feel free to apply them wherever you want, this blog will be devoted to medicine.
The basic assumptions and rules of rationalist medical halacha are as follows:
1) The Medical Basis of Halacha Principle - The Halachic decisions made by the rabbis throughout the ages, from the Talmud until this day are ALL based on their understanding of medical reality. As an Orthodox Jew, we do believe that the halachic PRINCIPLES used to make these decisions are of divine origin, as part of Torah Shebaal Peh. However, the medical understanding that led to the halachic decisions in specific cases is not of divine origin, but rather it was based on the medical knowledge of the person/people who are writing the decision.
2) The Historical Corruption Principle - As history took its course, many poskim used the precedents as found in the previous literature when they made their decisions. Sometimes, they took into account the changes in medical understanding when they made this decision, but in other instances the poskim did not understand how the medical understanding of their predecessors affected the decisions that they made. This created a situation where a precedent was set based on erroneous medical understanding, and then it became reinforced by the subsequent halachic literature, although it should have been overturned due to new knowledge.
3) The Mixed Up Medical Principle - Most contemporary poskim consult physicians or other experts when they render halachic decisions today. While this is clearly appropriate, this also creates a confusing mix of ancient and modern scientific knowledge when the halachic decision is rendered. clearly the ancient torah knowledge SHOULD be applied, but ancient medical knowledge is often confused with ancient Torah knowledge, which leads to some very hard to understand conclusions.
4) The Common Sense Principle - Some Halachic decisions seem to go against common sense. In many cases, this is simply a result of not appreciating true Torah values in contrast with the values of the rest of the modern world. In these cases we are clearly obligated to try and understand the Torah values, and implement them into our lives, in contrast with the whims of modern society. However, sometimes simple common sense should lead you to understand that the psak halachah you may have received is wrong. If an analysis of the sources based on our principles leads one to conclude that the Torah and common sense actually do agree, then one should live by common sense, and not according to what is obviously an erroneous psak halacha.
5) The Halacha is Moral Principle - Halacha is more than just a bunch of meaningless legal requirements. it is also a moral code that contains lessons for all of us, even non-Jews. If it seems to you that what the halacha is in conflict with what you understand to be basic morals, then you should seriously consider if your understanding of the halacha is correct.
The first topic we will discuss is the time of death in halacha. I will try to stick to a consistent format with every topic. First I will discuss the basic issue at hand, and will summarize the various contemporary halachic approaches on the issue. I will then give a brief explanation if how these opinions were rendered through the contemporary halachic process. We will then analyze the sources using the five principles of rationalist Medical halacha, and determine if our approach leads to the same conclusions as the mainstream contemporary poskim. As much as possible, i will give sources and references and links for you to do your own research. I love comments, both supportive one's and critical one's, and I will try my best to respond to comments whenever possible.
Indeed, there are many poskim that are genuinely expert in many areas of medical halacha, and faithful Orthodox Jews rely on these fine Rabbanim to guide them through the complicated details of thousands of shaalot that come up in our lives. The shaalot are related to so many areas, such as end of life issues, Shabbat issues, Pregnancy issues, and on and on. However, the purpose of this blog is to present a consistent and rationalist way to analyze ALL of these topics. I am warning you now though, that your local Orthodox rabbi may not endorse some of the conclusions we make here, even though I hope you will be convinced when you read my presentation of each topic. We will be treading on dangerous halachic ground, so if that scares you, read another blog.
As we develop each topic, you will come to understand how these principles are used by the rationalist system, and you will appreciate the value of each one and why they are important. Admittedly, these can be applied to many areas that are not related to medicine, and while you should feel free to apply them wherever you want, this blog will be devoted to medicine.
The basic assumptions and rules of rationalist medical halacha are as follows:
1) The Medical Basis of Halacha Principle - The Halachic decisions made by the rabbis throughout the ages, from the Talmud until this day are ALL based on their understanding of medical reality. As an Orthodox Jew, we do believe that the halachic PRINCIPLES used to make these decisions are of divine origin, as part of Torah Shebaal Peh. However, the medical understanding that led to the halachic decisions in specific cases is not of divine origin, but rather it was based on the medical knowledge of the person/people who are writing the decision.
2) The Historical Corruption Principle - As history took its course, many poskim used the precedents as found in the previous literature when they made their decisions. Sometimes, they took into account the changes in medical understanding when they made this decision, but in other instances the poskim did not understand how the medical understanding of their predecessors affected the decisions that they made. This created a situation where a precedent was set based on erroneous medical understanding, and then it became reinforced by the subsequent halachic literature, although it should have been overturned due to new knowledge.
3) The Mixed Up Medical Principle - Most contemporary poskim consult physicians or other experts when they render halachic decisions today. While this is clearly appropriate, this also creates a confusing mix of ancient and modern scientific knowledge when the halachic decision is rendered. clearly the ancient torah knowledge SHOULD be applied, but ancient medical knowledge is often confused with ancient Torah knowledge, which leads to some very hard to understand conclusions.
4) The Common Sense Principle - Some Halachic decisions seem to go against common sense. In many cases, this is simply a result of not appreciating true Torah values in contrast with the values of the rest of the modern world. In these cases we are clearly obligated to try and understand the Torah values, and implement them into our lives, in contrast with the whims of modern society. However, sometimes simple common sense should lead you to understand that the psak halachah you may have received is wrong. If an analysis of the sources based on our principles leads one to conclude that the Torah and common sense actually do agree, then one should live by common sense, and not according to what is obviously an erroneous psak halacha.
5) The Halacha is Moral Principle - Halacha is more than just a bunch of meaningless legal requirements. it is also a moral code that contains lessons for all of us, even non-Jews. If it seems to you that what the halacha is in conflict with what you understand to be basic morals, then you should seriously consider if your understanding of the halacha is correct.
The first topic we will discuss is the time of death in halacha. I will try to stick to a consistent format with every topic. First I will discuss the basic issue at hand, and will summarize the various contemporary halachic approaches on the issue. I will then give a brief explanation if how these opinions were rendered through the contemporary halachic process. We will then analyze the sources using the five principles of rationalist Medical halacha, and determine if our approach leads to the same conclusions as the mainstream contemporary poskim. As much as possible, i will give sources and references and links for you to do your own research. I love comments, both supportive one's and critical one's, and I will try my best to respond to comments whenever possible.
Subscribe to:
Posts (Atom)