Saturday, January 29, 2011

Missing the Obvious

Did it ever happen to you that something suddenly occurs which is so obvious, you wonder how you ever missed it? Then you wonder how everyone else is missing it! And then you start to worry and think, well, it can't be that everyone missed it, so I must still be missing something!

I had this feeling on Friday night, going over the Gemara which Poskim use as the primary source for determining death. The Gemara discusses a building which has collapsed on Shabbos, trapping people in the rubble. Rubble is muktzeh, but it can be cleared away in order to save lives. Upon discovering a person trapped in the rubble, a determination must be made as to whether the person is still alive; if he is, then all the rubble can be cleared off him, but if has died, then one may not clear any more rubble off him. The Gemara establishes that if one is uncovering him from the top down, then one may only proceed as far as his nose. If breath is detected at his nose, one may continue extracting him. But if no breath is detected at the nose, then he is certainly dead and one may not clear any more rubble.

The Gemara relates this to the passuk which says, "Everyone that had the breath of life in his nose." It is the formal halachah brought down in the Shulchan Aruch. And Chassam Sofer famously stated regarding this that "Once his breathing ceases, one may no longer violate Shabbos. This is the general principle for all who die, and this has been the accepted criterion in our hands ever since God’s congregation became a holy nation, and even if all the winds in the world were to blow, they would not budge us from the position of our holy Torah."

Now, for a while it has been known that even if respiration has ceased, it is often possible to restart it via cardiopulmonary resuscitation - CPR. It is therefore commonly stated that the Gemara was not referring to a person whose breathing has merely stopped, but rather to a person whose breathing has irreversibly stopped. Of course, Chazal did not know about CPR, but, it is claimed, their words did not rule it out.

On Friday night, I realized that this is not true. Furthermore, I realized that everyone is very clearly overruling Chazal in this.

Why? Because in order to do CPR, you need access to the person's chest. Which means that you are clearing more rubble away! But the Gemara is completely unambiguous that if there is no respiration at the nostrils, it is forbidden to clear away any more rubble. The Gemara forbids clearing away any more rubble, and yet every single Posek would say that this is mandatory!

This is significant on several fronts. First of all, it refutes those who say that Chazal never erred in science. Second, it refutes those who say that even if they did err in science, it is forbidden to change the halachah. Rabbi Yosef Gavriel Bechhoffer claimed that "we are accustomed to assume that Chazal are the final arbiters of Halachah regardless of whatever thought process under-girded their rulings," and approvingly cited Rav Aharon Soloveitchik that he would have put Rav Yitzchok Lampronti in cherem (!) for saying that halachos based on belief in spontaneous generation should be changed. There are others who take a less aggressive line, but still maintain that, following the Chazon Ish's concept of "law being established in the Talmudic Era," any halachos established by Chazal cannot be changed. But the fact that we clear away the rubble to do CPR shows otherwise.

At this point I was wondering not only why this hadn't occurred to me beforehand, but also whether it had occurred to anyone else - and if not, then perhaps I was missing something! Fortunately I eventually came across a reference to this exact point in R. Nuriyeh Gutel's Hishtanut HaTevi'im, p. 77. He quotes Rav Shlomo Zalman Auerbach as saying that Talmudic prohibitions against violating Shabbos in an attempt to save someone who is not breathing, no longer apply now that we know how to save such people via CPR. And he notes that this specifically means that the Gemara's ruling about not clearing any more rubble does not apply.

Furthermore, this case arguably shows that Poskim today - even those who rely on respiratory death - are not following Chazal's exegesis. Chazal understood the passuk to mean that respiration equals life, and lack of respiration equals death. But these Poskim are understanding the passuk to mean instead that permanent lack of respiration means death. (This point can, however, be debated. But I think it's valid.) R. Gutel quotes Rav Shaul Yisraeli as pointing out that this means that our determination of the moment of death itself has changed since Chazal, with various other potential halachic ramifications. Chazal ruled that as soon as a person has stopped breathing, he has died. All Poskim today, on the other hand, rule that a person has not yet died until the period in which CPR is possible has elapsed.

Now, of course you can say that if Chazal would have known that pushing the chest can restart respiration, they would have interpreted the passuk differently and certainly they would have ruled differently. But, once you are going down that path, then you have to wonder what Chazal would have said differently had they understood the role of the brain and lived in a world where brain-dead people can have their heart and lungs maintained in operation for a while. Likewise, you have to wonder what we should infer from Chazal's words in light of their not having known those facts and not having lived in such a world.

So there's a can of worms which has, by virtue of the rubble-case, already been opened.

(On a different note - next Sunday I will be in New York, and I currently have no plans for that day. If anyone is interested in hosting a Rationalist Judaism get-together, and can arrange transportation for me - I'll be in Woodmere - please be in touch!)

71 comments:

  1. Rav Slifkin,

    An interesting post, however, I am unsure it solves the problem of brain death (as opposed to Brain stem death). Respiratory function is dependent entirely on activity in the brain stem, as long as the brain stem in viable, respiration should and can continue, at least for a short time. I am not a medical doctor, but my understanding is that in order to harvest organs for transplant (particularly the heart), a "live" heart needs to be extracted. A "live" heart is dependent on a lack of ischemia (and necrosis) on cardiac muscle, which means intact respiration.

    Modern concepts of Brain Death, if I understand things correctly, mean cortical brain death, but intact, or at least functional brain stem, supporting respiration and other autonomic function.

    However, In the articles that I have read (on JLaws) the issue of gosses seems to be very important. Is a person who is coritically brain dead, a gosses. Even in a persistent vegetative state such a person would not be able to feed and drink on their own, and their death would be imminent and inevitable. If the person was unconscious then heroic medical intervention would be needed to maintain respiration and heart function. What would be the halachic implications of being a gosses be?

    It has been mentioned several times the debate and discussion here the ANENCEPHALIC BABIES (http://highschoolbioethics.georgetown.edu/units/unit1_3.html) are very classically a gosses. What would the implications of this state be with regard to harvesting organs from this neonate be vis a vis definition of life, death and gosses?

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  2. By get-together, I presume you mean social? Private home/restaurant/...?

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  3. I think your reasoning is flawed. I would take a different approach. In the time of chazal, there was obviously an overwhelming chazaka that a buried person who is not breathing will not survive. Today, that chazaka is not so overwhelming. Does that mean that chazal abandoned living people back then? Probably yes.
    Did chazal think that the victim could still be alive? That's not so clear. Probably they felt, based on chazaka, that there was no chance of saving them. They had to know that a person who holds his breath for 1 minute is not dead. Thus, they obviously knew there is a time lag from the cessation of breathing to "death." But they also knew, based on *empirical evidence* that if a buried person is not breathing, that there was no hope of saving him.
    Therefore this case, by itself, brings no support for the notion that chazal felt that the simple absence of respiration equals "death." The only thing this case proves is that in the days of chazal, there was no essentially hope of saving the buried victim, if he was not breathing.
    The fact that rishonim and later posekim ruled similarly, and inferred definitions of death from this case, only proves that medicine had not improved since the days of chazal. The case says nothing about the onset of "death," and its fuzzy correlation with spontaneous respiration.
    However, this gemara can be used to derive a different halacha: We are not mechalel shabbos for a person who, based on experience, has no chance of surviving. I'm not so sure that anything else can be inferred or derived from this case. Later posekim would not have made those inferences if they had access to modern medical knowledge.
    This line of reasoning says nothing about the use of brain death as a definition of "death." It only argues that chazal did not dogmatically define death as "absence of respiration." This was a pragmatic decision for determining when there was no hope, such that one should not even handle muktzah on shabbos. I would also argue, that chazal *intentionally* did not define the moment of death, and they almost certainly felt that death was a process that happened over some unknown period of time.

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  4. Kol hakvod. Very good point. Essentially your argument is (I think): If we're already not paskening by that gemara, how could everyone use it to say brain death isn't death?

    This is not an easy question to answer.

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  5. "At this point I was wondering not only why this hadn't occurred to me beforehand, but also whether it had occurred to anyone else - and if not, then perhaps I was missing something!"

    Yes. In fact, I think I've pointed this out in your comments.

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  6. Pashut
    I do not think you need a whole post to say that there are new methods and technology now which can affect the final halacha. Even the most extreme anti-"rationalist" would recognize that. It is not hard to think of many cases where phones and automobiles, for example, will affect the halacha. Obviously, what chazal said about saving someone can change if there is new technology. For example, no one in the time of chazal would violate shabbos to save someone whose hearts and lungs stopped, but nowadays there can be attempts to resuscitate him.

    What error?
    When people say chazal would mean irreversible cessation of breathing(ICB), they obviously recognize more rubble would have to be cleared to perform it. The effect of modern methods on a specific psak halacha in a case does not mean that their claimed definition of death has to be rejected too. You can save the person under the rubble, but still define death as ICB. Before the 20th century, ICB occurred when breathing stopped. Chazal ruled correctly for their time.


    Definition?
    Of course, its likely that chazal weren't really focussed on the definition of death, but just on the criteria to check to determine if undisputable death occurred. Before the 20th centruy there was never really a question over the defintiion of death since everything stopped functioning at once. If that is the case, these gemaros can not really be quoted to prove either side, since they're discussing a different issue. Though it wouldn't have to do with any error in science on chazal's part, just changes in technology.

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  7. Found the post for you:

    "Nobody, as far as I know, ever says that you aren't allowed to do CPR on shabbat for example, even though we would not force someone to do CPR if they did not want to. "

    I could be mistaken but as I recall this is _exactly_ the point of the pivotal gemarah. Chazal would have forbidden removing a beam from on top of a person who was not breathing. Today we, presumably unanimously, would.

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  8. Okay, hang on.
    First of all, respiratory cessation is not a monolithic, there's only one type, kind of event.
    Secord of all, CPR does not restart respiration. In addition, its reputed ability to push blood around that has been oxygenated through mouth-to-mouth breathing is overrated. All CPR does is prime the heart so that the application of electricity will be more succussful when someone shows up with the defibrillator. That's it. Other than some limited cases in drowning, CPR is useless unless you're have epi and a defib machine.
    Third, even when CPR does work it's only really effective for a few minutes. If one doesn't get a defibrillator and/or epinephrine into the patient at that point the chance of return of spontaneous circulation quickly drops to near zero. A few minutes, that's it.
    A person who is drowning can suffer from respiratory failure. A child who aspirates a marble can also have respiratory failure.
    An elderly person going into irreversible heart failure will also stop breathing at some point.
    In all these cases, there is no spontaneous movement of air but the underlying causes and treatments are different. In the first two cases, it's likely that taking the correct measures will quickly restore breathing. In the third case, chances are nothing we do will turn the lungs back on. Each case of respiratory failure is unique and is treated differently based on its circumstances.
    So let's look at the case in Yoma. The person was in a building when it collapsed. It will take time to clear the rubble until he's found. When his nose is exposed, there is no spontaneous breathing. What does this mean? Odds are he had a traumatic head and neck injury which has resulted in the destruction of the respiratory centres in his brainstem. No amount of CPR is going to restore his breathing. He's dead. If his heart is still beating, that's only because it hasn't run out of his last bit of oxygen yet but odds are it won't be anyway.
    Therefore, in Chazal's scenario it is likely that rescuers nowadays would come to the same conclusion. We might check the guy's pupils but again, they'll be fixed and dilated. He's dead. No point to CPR. No point to assisted breathing. This specific case stands.
    Chazal never did discuss the issue of a sudden cardiac arrest where CPR might make a difference nowadays, did they?

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  9. Before the 20th centruy there was never really a question over the defintiion of death since everything stopped functioning at once. If that is the case, these gemaros can not really be quoted to prove either side, since they're discussing a different issue. Though it wouldn't have to do with any error in science on chazal's part, just changes in technology.

    You've hit the nail on the head. These gemaros can not really be quoted to prove either side, since they're discussing a different reality.

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  10. Avi said...

    "At this point I was wondering not only why this hadn't occurred to me beforehand, but also whether it had occurred to anyone else - and if not, then perhaps I was missing something!"

    Yes. In fact, I think I've pointed this out in your comments.


    Whoops! Avi, you're right, you did beat me to it. Sorry for not reading your comment carefully the first time around!

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  11. But once again, the issues are different. In the Gemara's case we are talking about breaking shabbos, somthing that can be done to save a life. In organ transplant brain-death issues, we are talking about a safek in killing a live person to save another, something one cannot do. So even though we do CPR on shabbos, we still might not do organ transplants.

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  12. Reuven Meir, I fail to see who you are addressing. Nobody is claiming that you can kill someone who is safek alive in order to take their organs.

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  13. I am honored to have a school of thought associated with my name! But if so, can we please spell it correctly? Two h's, but one f.

    I'm sorry if I'm being repetitive, but I did not "approve" of RAS's position, just reported it. It is important to remember that the Rabbis Soloveitchik are of the opinion that Chazal never erred in science (the first school of thought in RNS's hierarchy).

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  14. Did chazal think that the victim could still be alive? That's not so clear. Probably they felt, based on chazaka, that there was no chance of saving them. They had to know that a person who holds his breath for 1 minute is not dead. Thus, they obviously knew there is a time lag from the cessation of breathing to "death."

    I don't think that consciously holding your breath would have been classified by Chazal as "cessation of breathing." I think that it's pretty clear from the Gemara that Chazal held that someone who has ceased breathing IS dead.

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  15. I'm sorry if I'm being repetitive, but I did not "approve" of RAS's position, just reported it.

    Please do not be disingenuous. You reported it as one possible, viable response to a claim that I made. In other words, you approved of it.

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  16. Possible, viable, yes. Approved, not necessarily.

    Very similar to the opinion I had concerning the ban issued against your works. Possible, viable, yes. But not an approach I would have taken or wanted to see taken.

    Which is why even though I had my own disagreements with you and rejected your approach, I expressed my solidarity and empathy with you at the time.

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  17. RYGB - you had claimed that "we are accustomed to assume that Chazal are the final arbiters of Halachah regardless of whatever thought process under-girded their rulings." In response, I asked: "then what do you say about the various Acharonim and Poskim who say otherwise, such as in the case of lice?" You responded as follows:

    They were/are wrong. R' Aharon Soloveitchik told me that had he been around in 18th century Italy he would have put the Pachad Yitzchak in cherem.

    Now you claim that you only meant that this is a viable approach, but not one that you approved of? You are either being dishonest now, in claiming that you don't approve of it, or you were being dishonest then, by citing such a view in support of your position without saying that you disapprove of it.

    By the way, in light of the case discussed in this post, do you still maintain that "we are accustomed to assume that Chazal are the final arbiters of Halachah regardless of whatever thought process under-girded their rulings"?

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  18. And if you found someone who was not breathing through his nose, you would no longer be mechallel Shabbos to attempt to save his life?

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  19. RNS: "I don't think that consciously holding your breath would have been classified by Chazal as "cessation of breathing." I think that it's pretty clear from the Gemara that Chazal held that someone who has ceased breathing IS dead."

    No, I think that is a common, but unsupported inference. Q: According to chazal, how many seconds of breathing cessation makes a person dead? Answer: The issue is not addressed.

    Death is associated with lack of spontaneous respiration. However, lack of spontaneous respiration is not necessarily or immediately associated with death. Therefore, you can't claim that chazal held that death = "lack of spont. resp."

    Therefore, IMO, you can't use this gemara to argue that lack of spont. resp. defines death.

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  20. Rabbi Slifkin,

    While I agree with many of your overall points, there are some particulars I would like to note.

    1. RYGB actually made the point you are now making in his shiur (the one given in response to your first post). However, as he pointed out, being mechalel shabbos for someone because of a CPR possibility is clearly l'chumrah. However, to harvest organs from someone who is brain dead is a major kula regarding the possibility that brain death may not be death. Many poskim have explained that the reason they are against harvesting organs from brain dead people is because - absent solid evidence - we need to be machmir and assume the person is still alive. You seem to assume that pikuach nefashos should allow us to harvest the organs... but this ignores the possible pikuach nefesh of the brain dead person.

    2. Another point - there is a difference between saying that Chazal did not know about CPR and saying that the halacha regarding brain death did not take into account the function of the brain. In the first case, Chazal's understanding was absolutely correct in their times. Since there was no CPR at that time, the person was dead. Now, circumstances have changed, so the halacha reflects that.

    In the second case, however, one is arguing not that the circumstances changed, but simply that Chazal's understanding was wrong. The fact that the two arguments are distinct should be noted.

    The above distinction favors the argument that you made that brain death did not ever occur in Chazal's time more than the argument that they did not understand the function of the brain. In the former argument, one contends that circumstances have changed, as there was no brain death back then. The latter argument, on the other hand, argues that the halacha was based on misunderstanding. Clearly, the former argument is therefore less controversial.

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  21. Q: According to chazal, how many seconds of breathing cessation makes a person dead? Answer: The issue is not addressed.

    I have to disagree - I think that the whole point of this Gemara is to equate the two. Furthermore, this is clearly how the Chasam Sofer understood it - that was why he invoked this Gemara against those who argued for holding off burial.

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  22. However, to harvest organs from someone who is brain dead is a major kula regarding the possibility that brain death may not be death. Many poskim have explained that the reason they are against harvesting organs from brain dead people is because - absent solid evidence - we need to be machmir and assume the person is still alive. You seem to assume that pikuach nefashos should allow us to harvest the organs... but this ignores the possible pikuach nefesh of the brain dead person.

    I've already responded to this several times. Obviously, if there is a safek as to whether the person is still alive, pikuach nefesh does not allow us to take his organs.

    With regard to your second point - yes, there is a difference, but not a significant one. Once you're saying that "Chazal's statement was correct for their times, given the medical knowledge and capabilities that they had," then you have neutralized the ability to draw inferences from this Gemara for modern situations.

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  23. Chazal were only discussing the simanim of life, not its sibbah. This gives poskim the ability to over-rule the original psak since a sibah can still exist without its siman which is clearly the case of being alive without breathing, prior to CPR.

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  24. Great lomdishe chilluk. But I don't see how it helps. True, they saw the nostrils as the siman, and the respiration as the sibah. But the bottom line is that they ruled that when respiration stops at the nostrils (=the siman), it's terminal.

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  25. I understood respirartion as the simman and brain function as the sibah. Chazal could not have known the sibah of life (brain function) hence they were only able to pasken based on the simanim (respiration).

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  26. Garel Ironhart's assumptions about the case in the gemora are flawed. The scenario was clearly set up in order to illustrate how "mechalel shabbos" one can be to attempt to save a life. From the fact that Chazal didn't mention pupil reflex we can deduce that they were unaware of it. The fact that they even entertained a possibility that the victim could be alive nullifies your assumption about the severity and type of injury.

    Remember we're not necessarily talking about the collapse of 110 story skyscraper. More likely it's the collapse of 1 or 2 story structure where someone could easily have been buried under some light rubble for a very short period of time before being accessed. This scenario invalidates your assumptions about how it would be handled today.

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  27. Chazal could not have known the sibah of life

    In those few words (assuming RNS agrees with them), "Meir" captures the quintessence of the objectionableness of this approach.

    How do you "know" that Chazal could not have known the "sibah of life"?!

    Perhaps they has a mesorah from Har Sinai?

    Perhaps Eliyahu HaNavi revealed it to them?

    Perhaps the Malach HaMaves himself revealed it to them?

    Perhaps R' Yishmael Kohen Gadol in an aliyas neshama discovered it?

    Perhaps when R' Yochanan resurrected R' Kahana the latter informed them of it?

    Perhaps not.

    Perhaps they only knew it "scientifically".

    But how do you know?...

    ואידך פירושא, זיל גמור

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  28. ゴリラ ゴリラJanuary 30, 2011 at 5:54 PM

    Of course, Chazal did not know about CPR, but, it is claimed, their words did not rule it out.

    If you are refering to the CPR of today, that would be correct. CPR as we know has been around since the 1960's and 1970's. But the concept of using breath or air to resuscitate someone is much older. There are Mayan and Incan hieroglyphics from 5,000 years ago depicting the idea. Or consider this excerpt from מלכים ב. It's around 3,000 years old. 

    לב וַיָּבֹא אֱלִישָׁע, הַבָּיְתָה; וְהִנֵּה הַנַּעַר מֵת, מֻשְׁכָּב עַל-מִטָּתוֹ.  לג וַיָּבֹא, וַיִּסְגֹּר הַדֶּלֶת בְּעַד שְׁנֵיהֶם; וַיִּתְפַּלֵּל, אֶל-יְהוָה.  לד וַיַּעַל וַיִּשְׁכַּב עַל-הַיֶּלֶד, וַיָּשֶׂם פִּיו עַל-פִּיו וְעֵינָיו עַל-עֵינָיו וְכַפָּיו עַל-כַּפָּו, וַיִּגְהַר, עָלָיו; וַיָּחָם, בְּשַׂר הַיָּלֶד.  לה וַיָּשָׁב וַיֵּלֶךְ בַּבַּיִת, אַחַת הֵנָּה וְאַחַת הֵנָּה, וַיַּעַל, וַיִּגְהַר עָלָיו; וַיְזוֹרֵר הַנַּעַר עַד-שֶׁבַע פְּעָמִים, וַיִּפְקַח הַנַּעַר אֶת-עֵינָיו.  לו וַיִּקְרָא אֶל-גֵּיחֲזִי, וַיֹּאמֶר קְרָא אֶל-הַשֻּׁנַמִּית הַזֹּאת, וַיִּקְרָאֶהָ, וַתָּבֹא אֵלָיו; וַיֹּאמֶר, שְׂאִי בְנֵךְ.  לז וַתָּבֹא וַתִּפֹּל עַל-רַגְלָיו, וַתִּשְׁתַּחוּ אָרְצָה; וַתִּשָּׂא אֶת-בְּנָהּ, וַתֵּצֵא

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  29. RYGB, it sounds like you're having fun, and that's good, and it's also good that you dont take these debates or yourself too seriously. Kol Hakovod. I sometimes think RNS should adopt the same approach, although perhaps, since he is not on the side of the establishment as you are, and also appears more interested in the truth than mere status quo, he cant afford to be so casually nonchalant . . . I dont know.

    In any event, your last comment doesnt make a whole lot of sense. You say that we cant know if chazal - by which I guess you mean all 2000 + men named in shas, over 500 years, across two continents - were privy to revelations from Elijah the prophet or the Angel Of Death about the cause of life. Some might question the sobriety of someone making such a statement. Myself, I would be content to observe that by the same logic, perhaps all of the Slifkinites in this forum also have such revelations. After all, you cant know that they dont.

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  30. YGB: I was not talking about 'the spiritual source of life'... what i mean is Chazal could not have known that body function, including respiration, is controlled by the brain. You have to put the Gemarah in context: a person is burried under rubble on Shabbat. The question the Gemarah is asking is 'What siman of life is sufficiant to allow me to mechalel Shabbat for safek pikuach nefesh?' and not 'what is the biological source of life?' hence we cannot necessarily infer from this Gemarah that respiration is the source of life.

    Oh, and please don't quote me out of context!

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  31. Seems like quoting out of context is common place amongst the anti-rationalists!

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  32. Too true, Meir. And by the way, RYGB not only also suggested (entirely without basis) that I agree with this strawman, but he also made a post out of this on his blog!

    RYGB - I have a suggestion for you. Retract your latest post and admit your misunderstanding. Then respond to all those who pointed out your distortions of Rabbeinu Bachya etc. on your kidney post.

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  33. "
    Modern concepts of Brain Death, if I understand things correctly, mean cortical brain death, but intact, or at least functional brain stem, supporting respiration and other autonomic function."

    No; brain death includes the brainstem.

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  34. "In those few words (assuming RNS agrees with them), "Meir" captures the quintessence of the objectionableness of this approach."

    Because in thousands of years of writings, chazal and their successors haven't managed to teach us one scientific fact we didn't already know. And they've taught us plenty we now know to be incorrect.

    ואידך פירושא, זיל גמור

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  35. Meir,

    I'm not clear on your understanding of the gemara, perhaps because your ideas are fragmented across several comments of מסא ומתן. Could you synthesize them into a single comment (or e-mail me)?

    Many thanks.

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  36. There is nothing novel about the observation that we no longer rely on simple cessation of breathing in determining death, despite that apparent conclusion in Yoma 85a. Obviously, resuscitation methods have advanced greatly from what was available in talmudic times. The issue, it seems to me, is the acceptance of a new criterion of death, i.e. the absence of any signs of a functioning brain-stem vs. the absence of blood circulation. If the tested symptoms include the absence of spontaneous breathing, then the brain-stem criterion becomes consistent with the talmudic one. Then the insistence on absence of a heartbeat or blood circulation becomes the problematic halachic innovation rather than the Harvard protocol.

    I should also add that a simple test for a functioning brain-stem is much older than the Harvard protocol. I recall that, nearly 50 years ago, a coroner would check for lack of pupilary response to a light shone in the eyes as part of the procedure for death certification.

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  37. I have to apologize, I was feeling formidable earlier and my previous comment was a bit too caustic. Sincere regrets.

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  38. [Sigh!]

    Let's try this again "in context":

    Meir:

    what i mean is Chazal could not have known that body function, including respiration, is controlled by the brain.


    In those few words (assuming RNS agrees with them), "Meir" captures the quintessence of the objectionableness of this approach.

    How do you "know" that Chazal could not have known that "that body function, including respiration, is controlled by the brain"?!

    Perhaps they has a mesorah from Har Sinai?

    Perhaps Eliyahu HaNavi revealed it to them?

    Perhaps the Malach HaMaves himself revealed it to them?

    Perhaps R' Yishmael Kohen Gadol in an aliyas neshama discovered it?

    Perhaps when R' Yochanan resurrected R' Kahana the latter informed them of it?

    Perhaps not.

    Perhaps they only knew it "scientifically".

    But how do you know?...

    ואידך פירושא, זיל גמור

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  39. DF said...
    RYGB, it sounds like you're having fun, and that's good, and it's also good that you dont take these debates or yourself too seriously. Kol Hakovod.


    Thanks. I try. Don't always succeed, but try, try again...

    In any event, your last comment doesnt make a whole lot of sense. You say that we cant know if chazal - by which I guess you mean all 2000 + men named in shas, over 500 years, across two continents - were privy to revelations from Elijah the prophet or the Angel Of Death about the cause of life. Some might question the sobriety of someone making such a statement.

    If I had been drinking, I would phrased it far more dramatically!

    Not necessarily all of them - but some of them, and that is enough. That may need to be elaborated on, but I'm not in the mood to be ma'arich right now.


    Myself, I would be content to observe that by the same logic, perhaps all of the Slifkinites in this forum also have such revelations. After all, you cant know that they dont.

    Aderaba, if even some Slifkinites have has such revelations, I will have no choice but to concede the argument!

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  40. How do you "know" that Chazal could not have known that "that body function, including respiration, is controlled by the brain"?!
    Perhaps they has a mesorah from Har Sinai?


    "In my opinion, the first principle that every student of Chazal’s statements must keep before his eyes is the following: Chazal were the sages of God’s law – the receivers, transmit­ters, and teachers of His Toros, His mitzvos, and His interper­sonal laws. They did not especially master the natural sciences, geometry, astronomy, or medicine – except insofar as they needed them for knowing, observing, and fulfilling the Torah. We do not find that this knowledge was transmitted to them from Sinai… We find that Chazal themselves considered the wisdom of the gentile scholars equal to their own in the natural sciences. To determine who was right in areas where the gentile sages disagreed with their own knowledge, they did not rely on their tradition but on reason. Moreover they even respected the opinion of the gentile scholars, admitting when the opinion of the latter seemed more correct than their own." - Rabbi Samson Raphael Hirsch

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  41. Sure, it's always theoretically possible that Chazal knew something via supernatural means. But considering that

    (a) they did not know that you can compress someone's chest to restore respiration, which resulted in the loss of lives,

    (b) they thought that the kidneys give counsel and the heart receives counsel

    (c) they thought that the liver causes anger

    (d) they prescribed all kinds of refuos which medical science rates as completely ineffective

    (e) the medical statements of the Bavli accurately reflect ancient Akkadian medicine

    (f) we never find ANY case of Chazal knowing a scientific fact ahead of their time

    (g) the Gemara NEVER definitively states that ANY of Chazal knew a fact about the natural world via supernatural means

    (h) the Gemara frequently states that various members of Chazal did not various facts about the natural world

    ...then it seems unlikely that they knew that respiration is controlled by the brain.

    But in any case, it's irrelevant. Their rulings do not reflect any position on whether respiration is controlled by the brain.

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  42. It all depends what you decide to bold ;-)

    "In my opinion, the first principle that every student of Chazal’s statements must keep before his eyes is the following: Chazal were the sages of God’s law – the receivers, transmit­ters, and teachers of His Toros, His mitzvos, and His interper­sonal laws. They did not especially master the natural sciences, geometry, astronomy, or medicine – except insofar as they needed them for knowing, observing, and fulfilling the Torah. We do not find that this knowledge was transmitted to them from Sinai… We find that Chazal themselves considered the wisdom of the gentile scholars equal to their own in the natural sciences. To determine who was right in areas where the gentile sages disagreed with their own knowledge, they did not rely on their tradition but on reason. Moreover they even respected the opinion of the gentile scholars, admitting when the opinion of the latter seemed more correct than their own." - Rabbi Samson Raphael Hirsch

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  43. Rav Hirsch is saying that they mastered the science insofar as they needed them for halachah, but this knowledge was not transmitted from Sinai - i.e. they mastered it in the same way that everyone else back then mastered it.

    RYGB, with the kidney discussion, I started to wonder if you lack reading comprehension, and now I'm convinced of it. And by the way, your earlier acknowledgment about how you don't take these debates too seriously leave me wondering if I should even allow you to comment here. This is a serious forum; it's not for people who don't bother being careful with their reading of sources and their usage of words.

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  44. Hirschian: let's assume that scientific knowledge was not transmitted, as RSRH says; but we're concerned here with the halachic status of dead, which obviously (given the Gemara under discussion) does not depend solely on death as (modern) science understands it.

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  45. @yitznewton - that's correct. But I was just responding to RYGB's claim that Chazal had medical, scientific knowledge about respiration from Sinai.

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  46. 1) Your point about irreversibility and Chazal was raised by Rabbi Dr. RMH and he retracted due to the criticisms of his commentors.
    His retraction is found here:
    http://rationalistmedicalhalacha.blogspot.com/2010/10/irreversability-and-mixed-up-principle.html

    2) The very Chasam Sofer you cited for dramatic effect also quotes the Rambam who clearly raised the possibility of a temporary cessation of respiration.
    The Rambam says in the fourth perek of Hil. Avel:

    ה הגוסס, הרי הוא כחי לכל דבר: אין קושרין לחייו, ואין פוקקין נקביו, ואין מניחין כלי מתכות וכלי מקר על טבורו שלא יתפח, ולא סכין אותו, ולא מדיחין אותו, ולא מטילין אותו על החול ולא על המלח--עד שעה שימות; והנוגע בו, הרי זה שופך דמים. למה זה דומה: לנר שמטפטף--כיון שייגע בו אדם, יכבה. וכל המאמץ עם יציאת נפש, הרי זה שופך דמים, אלא ישהה מעט, שמא נתעלף. וכן אין קורעין עליו, ולא חולצין כתף, ולא מספידין, ולא מכניסין עימו ארון ותכריכין בבית--עד שימות.

    He says to wait long enough before pronouncing death because perhaps there was a momentary lapse of respiration which will resume.

    SO you cannot claim that death is traditionally defined as the moment a person stops breathing. It obviously means irreversible cessation of breathing.
    The only thing which has changed is the practical limits of irreversibility. Nothing conceptual has changed whatsoever.

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  47. On Avodah, I think we succeeded in dividing the topic in two:

    1- Do Chazal mean the same thing as medicine does when they speak of "chayim"? What are piqu'ach nefesh or dinei nefashos about the potential loss of? Is it something empirical altogether that medicine /could/ have an opinion on? (E.g. maybe it is defined by the soul's connection to the body in ways that don't involve the brain as the seat of the mind.) And if it is something empirical, how do we know the set of medical states the AMA or some country's legal system call "alive" matches the set halakhah recognizes?

    2- How do we get from chai vs meis to measurement? Measurement technology does change over time.Of chayim isn't an empirical thing, than all we can measure is something that would provide a chazaqah that the person is alive. And even if it is empirical, we might lack the technology, yet. Or, perhaps chazal did but we don't.

    But those are two discrete questions. And I think people skip over the first one.

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  48. Thanks for the link to RMH. But I don't think that he's saying what you claim him to be saying. In fact he expresses my point even more sharply. The Gemara thought that the cessation of breathing is by definition irreversible - and Rabbi Dr. RMH points out that this is because they believed breath to actually be the source of life.

    As for Rambam - I think that he is diverging from the Gemara. But I have to check into this further, because Chasam Sofer cites him.

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  49. DF,
    How is RGBY having fun if he meant his comment seriously? I am quite sure he meant what he said about what is the "quintessence of objectableness." He really thinks that we cannot say chazal didn't know something. Even though neuroscience didn't exist until the 1900's, he would have us believe that chazal knew about the brain and to say otherwise is denying the possibility that angels came and spoke it to them and they kept it secret... etc. Not even worth comment. He is wasting his time here.

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  50. YGB: had they known then it would have been passed down in the messorah along with the rest of torah shabaal peh! At least mentioned some where in the talmud. But regarding this particular gemarah it is imaterial whether they new out not since they were only discussing the simmanim of death required to establis wheter one can be mechalel Shanbat for safek pikuach nefesh.

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  51. Maimonidean - in any case, the point of this post was that nobody follows the standard established by the Gemara.

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  52. I don't understand the diyuk. In the Gemara's time, cessation of respiration *was* irreversible because there was no CPR. That is why you didn't clear away any more rubble. The Gemara was saying, at least according to Rashi as understood by Rav Moshe, that irreversible cessation of respiration is the definition of death and once that has happened, as in the case of rubble (absent CPR, which didn't exist then), you must stop efforts. And the passuk is brought (post facto) to show that *irreversible* cessation of breathing is death.

    This whole post is incomprehensible to me.

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  53. In the Gemara's time, cessation of respiration *was* irreversible because there was no CPR.

    This is exactly the point of the Gemara's ruling - that cessation is irreversible. And we now rule otherwise. You are incorporating the science as a premise of the halachah. But it wasn't a premise - it was the point of it.

    You might as well say that the premise was that the brain cannot function separately from the heart, etc. Once you start incorporating their worldview as a premise to their halachah, you have completely undone the possibility of deriving rules for modern brain-death scenarios. Which I am fine with!

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  54. RGS: You blur two concepts by saying that because cessation of breath was irreversible in Chazal's day, it was the definition of death.

    Death has to do with some kind of disconnect between body and soul. What made Adam a human being? "Vayipach be'apav nishmas chayim". What's the end of being a human being? When the neshamah and the "afar min ha'adamah" no longer have that linkage. (Now, go define that linkage in a way that distinguishes between sleep on the one hand, and chibut haqever on the other. This topic is non-trivial!)

    Breathing is something measurable that allows us to assume the intangible did occur. This is step 2: relying on a chazaqah in order to deal with the unmeasurability of the actual definitions of life and death. And so, with changes in metzi'us we might justify changes in what we rely upon.

    But first, doesn't someone have to show that the measure they're suggesting is a plausible way of knowing whether the soul has disconnected from the body?

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  55. No, the change in whether cessation of breath is reversible is a change in technology, not science. We don't rule differently because we understand the same situation differently. But rather because the situation changed -- we can now do things we couldn't then.

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  56. This is exactly the point of the Gemara's ruling - that cessation is irreversible.

    I must be missing that. All I see is the Gemara saying that irreversible cessation of respiration is death (according to Rashi/Rav Moshe) or a sign of death (according to others). I don't see it saying that cessation is reversible. That just happened to be the case in those times.

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  57. R. Micha- regarding your earlier post. We obviously can't scientifically determine the presence of a soul, and we dont know actually if there is a connection between the soul and parts of the body that aren't the brain. However, when the status of a living person with regard to their neshama(ie life and death) doesn't change when they have had a limb removed, heart removed and replaced with a transplant, donated a kidney or other such manipulations of tissue, you have essentially come to the conclusion that that particular piece of tissue was not irreversibly linked to the neshama.

    The second part(which I am trying to write up in a coherent fashion), is that the problem of 'how can I know the person is really dead, and the neshama has left the body' applies to all definitions of death, not just the brain death definition. Consider the circulation definition. Why should someone who has lost circulation for 20 minutes be considered dead? Is that always the case? In fact, it is not. There are surgeries where the heart is stopped and the patient actually has no pulse for over 30 minutes.(the body is protected from the effects by being cooled and by the use of medications to slow the metabolism). The vast majority of these patients have normal function afterwards. Therefore, 20-30 minutes without circulation, respiration, or movement can't actually be applied in all circumstances. Therefore, from a logical point of view, it is necessary to posit that there is something that happens to the body over the course of 20-30 minutes without circulation(in the normal course of events, without efforts at preservation of function) that indicates the person is dead. The next step is to identify exactly what that is as precisely as possible. It can't be irreversible circulation, because pumps can always be used. It can't be loss of every brain cell, because live brain cells can be found for up to 8 hours after cessation of circulation. Perhaps it is the irreversible loss of function of the brain.

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  58. Gil Student's Close FriendJanuary 31, 2011 at 7:10 PM

    I agree with Gil on this. I think you are over-reading into the gemara. They didn't have CPR back then. Now that we do, the metziut has changed. Not the basic definition of death.

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  59. A reminder: The point of this post was not that the basic definition of death has changed. (For the record, I don't think that this Gemara shows anything about brain-death, in either direction.) The point was that it shows that we overrule Chazal.

    By the way, Micha - I wouldn't call CPR an advance in technology. You do it with your hands!

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  60. Assuming Gil's other friend's "you" refers to me:

    We [meaning: the people on this thread, from what I've seen in their comments] do not know the basic definition of "death" with any precision. Therefore, how can you know whether the change in metzi'us impacts the din, or not?

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  61. RNS: Technology doesn't mean electronics or even steam powered automation. A lever is also "technology".

    My point, though, was to distinguish between saying the pesaq should change because our understanding of what's behind the observable reality changed, and saying the pesaq changed because we can do different things in the parallel situation.

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  62. Noam: YOu are correct. I am not positing an answer. I'm reframing, and splitting, the question. I think the question as asked here, on Avodah, and elsewhere since the RCA study is not constructively posed, because it leads the person to answer step 2 without even considering that there is a step 1.

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  63. 'Kill and cure' surgery

    http://sciencefocus.com/feature/health/kill-and-cure-surgery

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  64. RYGB:

    You might be not serious, but you are playing with fire.

    If you say that Chazal could have made this ruling based on a mesorah from sinai, malach hamavet, etc. you have effectively falsified (or at least made unreliable) these sources of knowledge, as this ruling can be defeated by logic and science.

    I think that is good reason to say they didn't have a mesorah.

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  65. How much of my body could I live without?

    http://sciencefocus.com/qa/how-much-my-body-could-i-live-without

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  66. As an interested observer I must say that it appears to me that rabbi Student has not understood the point RNS has made and is arguing against something that was not said by RNS or simply a tangent not being addressed.

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  67. R. Micha: I believe you are suggesting that even according to Rav Moshe, irreversible cessation of respiration (ICR) is only a sign of death. OK, I'm fine with that, although I'm not 100% sure he meant it. But that doesn't really affect this discussion. Also, I think the self-identified close friend of mine meant that R. Natan Slifkin ("you") is overreading the Gemara.

    Student V: I certainly accept that possibility. Will you please restate it so I can understand it?

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  68. R. Micha: I believe you are suggesting that even according to Rav Moshe, irreversible cessation of respiration (ICR) is only a sign of death. OK, I'm fine with that, although I'm not 100% sure he meant it. But that doesn't really affect this discussion. Also, I think the self-identified close friend of mine meant that R. Natan Slifkin ("you") is overreading the Gemara.

    Student V: I certainly accept that possibility. Will you please restate it so I can understand it?

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  69. It affects the meta-issue that I found problematic in the original post. (As did RYGB, unsurprisingly; but I think he errs by going to the opposite extreme here.)

    If halakhah isn't a matter of science, then all this talk about Aristo biological theories is entirely irrelevant. The presumption underlying that half of the original thesis was that human life = conscious thought. That in itself was an unwarranted assumption.

    This whole notion that halakhah is a scientific endevor is one that is both wrong and dangerous. Halakhah isn't truth, it's law. (And personally I think the realia of halakhah are literally "metzi'us" and "mamashus" -- the world as we find it and feel it, not necessarily as we know it to be in the abstract.)

    One of the themes of The Lonely Man of Faith is that Adam I has run amok in this era of technological progress. Science isn't more rationalist than using a different close system, such as law or the world-as-experienced.

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  70. Well, really I think RMT conflicts himself about what RMF told him.

    Version 1: When someone is halachically dead, their body can never again breath on its own.

    Version 2: When someone is halachically dead, their body isn't supplying oxygen to the brain.

    Both are meant diagnostically, not definitionally.

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