Monday, March 12, 2012

Irresponsible Fear Mongering in the WSJ

The Wall Street Journal published an incredibly stupid article against acknowledging brain death as death. Written by someone who is not a physician, it is riddled with inaccuracies and misleading information. Unfortunately, a number of Orthodox Jews seem to be taking this article seriously.

The article writes about how brain-dead people have "more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you'll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections." It talks about how they "react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates."

This is all entirely true. It is also entirely irrelevant.

Physiological processes do not always denote life, and reactions are not the same as feelings. The detached tail of a gecko can move around with complicated motion and respond to an external stimulus, but clearly the gecko does not feel anything. Even a properly anesthetized patient can respond to the surgeon's scalpel and have their blood pressure go up, but that does not mean that they are feeling anything.

Most significantly of all, especially from a halachic perspective, is that most, if not all, of the functions described as occurring with a brain dead person - to which one can add carrying a pregnancy - would also be entirely true for a person whose head would be severed and the bodily functions maintained via a ventilator (as per the famous sheep experiment performed for Rav Shlomo Zalman Auerbach). And yet halachah would certainly not recognize such a person as being alive!

This is why the article's sensationalist talk about how a dead person should be "cold, stiff, gray and not breathing," rather than "warm, pink and breathing" is entirely irrelevant - the same would be true of a person with a severed head!

The second point to be made is that the article amplified the oft-heard concern that allegedly brain-dead people might not actually be brain dead and might come back to full brain function. Again, this is true, but irrelevant. To be sure, in rare cases, there can be misdiagnosis, due to physicians not checking carefully enough. But exactly the same can be true with diagnoses of regular death! There have been cases of people who were mistakenly diagnosed as dead due to their heart function being so slow as to be virtually undetectable. People make mistakes. It doesn't mean that cardiac death is not death; it doesn't mean that brain death is not death.

Here are Dr. Noam Stadlan's comments:
There are many misstatements and half truths in this article. No physician is going to harvest organs without consent of the family, regardless of what box was checked on the driver's license. Dead people by definition don't have a right or ability to consent, whether it is regarding organ donation, what sort of casket will be used at the funeral, or whether to be cremated or not. The family, next of kin, or power of attorney decide all these things, and indeed can have input into the testing to determine brain death.

The vast majority of people would agree that what makes a person that particular person is his functioning brain. I am the person I am because of my brain. If you amputate my leg, take out a kidney, or any other piece of tissue except for my brain, I remain the person that I am. If my kidney or heart is transplanted to another person, that other person doesn't become me just because my organs are functioning in that body. The identity of the person goes along with the functioning brain. When the brain has irreversibly ceased to function, the person no longer exists, even if a lot of organs or limbs are still receiving circulation.

There certainly is an ongoing discussion as to how much of the brain needs to be destroyed or non-functioning in order for the person to be considered dead. But the first step in deciding whether a person is brain dead or not is that there has to be overwhelming evidence by history and imaging scans that there has been overwhelming and irreversible damage to the brain. Doctors are not trolling the ICU performing exams on random people looking for someone who may fit the criteria.

How much of the brain needs to be dead for the person to be dead? We now know that even when a person is declared dead by the traditional criteria, cessation of circulation, functional brain cells can be found more than 8 hours after the declaration of death (indeed Dr. Devita has done important research on how much function is still possible after variable times without circulation). Perhaps the author wants to issue another article calling for people not to be declared dead for at least eight hours after the heart has stopped?

It certainly is necessary for physicians to follow the criteria with precision, and there have been a very small number of cases where the criteria have not been followed with predictable results. However, when the criteria have been followed precisely, there has NEVER been an adult who regained any neurological function. In addition, there has been documentation of over 30 cases where a person has been declared dead by medical personnel using traditional criteria-cessation of circulation, but they have regained function. Where is the outrage there?

Those who fulfill criteria for brain death are not capable of reacting to pain. There is no brain mediated response to stimulation.There were initial studies which showed that pulse and blood pressure went up with a skin incision, and the obvious conclusion was drawn. Later studies showed that narcotics (pain medication) did not change this response. However, medications which dampened the autonomic system, which runs through the spinal cord, eliminated these responses. What was observed was a spinal reflex, no different from tapping the knees and watching the leg move. It has nothing to do with the brain or with pain, and implying that it does is irresponsible and untrue.

The topic of defining death and ascertaining whether a person is alive or dead is complex enough. There certainly are legitimate points to consider (whether an EEG is necessary or not) and philosophical issues to discuss. Whether donors should be compensated is one of them. Unfortunately this article does little to further the discussion and only presents a very jaundiced view based on half truths and misinformation.

Noam Stadlan, MD
Neurosurgeon

69 comments:

  1. This article and post remind me that Chazal were not precise on when death occurs.

    Just as the length of an Amah or a Tephach will change depending on who the person is, most of halacha is defined by the situation and the people involved in that situation.

    It seems to me here, that the definition of death is going to depend on the person and on the family. (At least legally, if not halachicaly)

    Perhaps we *should* be waiting 8 hours after the heart stops to be declaring people dead.

    Both the article and the response, make it clear that this is not a straight forward science issue. It is a legal issue, and a societal issue, and a "rules" issue.

    Maybe Dr. Stadlan wants to define his life by his brain, but I would not consider a brain in a jar to be alive, or a person. A person is the gestalt, or the sum of their parts, not any particular part.

    Just as the start of life is not defined on the physiological level, neither should death be.

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  2. "Written by someone who is not a physician"

    Is this a joke? Need I remind you how many times this accusation has been leveled at you?

    The WSJ is a respected publication, much more so than this blog, and using terms like "incredibly stupid" to describe an article with which you disagree does very little to foster the impression that you are desirous of serious conversation about a serious topic.

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  3. I don't write things that the vast majority of physicians would disagree with!

    The article hardly presents a serious conversation.

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  4. The WSJ is not a scientific journal. The general media is guilty of propagating sensationalised medical half-truths usually stemming from the editors/reporters personal bias. If someone wants to make scientific claims regarding brain death, let them quote reputable, peer reviewed scientific journals and other such publications, not the general media.

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  5. Just as the start of life is not defined on the physiological level, neither should death be.

    What are the alternatives to physiological criteria?

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  6. Stories like these send everyone running like a chicken without a head.

    It's funny how no chareidi would dispute that shechita is a humane way of killing the animal despite the signs of life exhibited for up to a minute afterward with fervent claims that death is "instantaneous" and the animal feel no pain, etc, because brain death sets in.

    It should come as no surprise that signs of life in the body that continue in spite of brain death are not the equivalent of actual life.

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  7. The US currently has what is described as an "opt in" system, for organ donation, in which a person must deliberately choose to allow to have his or her organs "harvested" after death. Other countries have "opt out" systems, in which one is presumed to be consenting to organ harvesting unless he or she has specifically said otherwise. And sometimes, as the saying goes, mistakes have been made.

    Consider the news story excerpted below. It's from the UK, whose National Health Service is a shining example for many in the USA:

    Computer errors affecting the National Health Service's organ-donor registry led to the removal of organs from 21 people who had not given consent, and the UK health secretary has ordered "a review to find out why this has happened."

    But that's talking about clerical errors. There are influential people in the US who have bigger ideas which, even if defeated once are not going to go away:

    [A] proposal [which] could move the federal government closer into alignment with what has been proposed by longtime Barack Obama adviser Cass Sunstein.

    Obama’s “regulatory czar” was revealed in 2009 to have pushed strongly for the removal of organs from those who did not give their consent to becoming an organ donor.

    In his book, “Nudge: Improving Decisions about Health, Wealth and Happiness,” Sunstein and co-author Richard Thaler presented the possibility of the “routine removal” of organs because “the state owns the rights to body parts of people who are dead or in certain hopeless conditions, and it can remove their organs without asking anyone’s permission.”


    So Dr. Stadlan's statement No physician is going to harvest organs without consent of the family, regardless of what box was checked on the driver's license may describe the current norm in the United States, but that norm is under pressure.

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  8. Ameteur- Since we cant identify exactly what it is that makes a human being alive, it is difficult to precisely define exactly when a person is dead. Of necessity, definitions of death dont identify the moment of death, but when there is certainty that death has occured.
    While an anatomical measurement of a fist or arm will be different person to person, there needs to be some societal uniformity. Otherwise, for example, the eruv or the sukkah might be halachically acceptable for some but not for others, as their length measurements will be different. In addition, different religions may have different conceptions of marriage, but by US law you are married when you have a marriage license.

    With modern technology we are capable of providing any organ or limb with circulation. It can be an isolated big toe, ear, arm, heart, brain or most anything with arteries and veins. I suggest that you would not think that a big toe all by itself, even with circulation, is a human being. It is obvious that there is a difference between a human being, and human tissue with circulation. Not all functioning tissue with circulation is a human being. My point is that the difference between a tissue with circulation and a human being is that the human being has a brain. Any collection of tissue without a brain, no matter how much function or circulation, is not a human being. That is why the person whose brain has irreversibly ceased to function is dead(and we can certainly argue about how much function etc., but this is the basic premise).
    It is interesting that you want to consider isolated brain cells as human life(the only reason to wait 8 hours), but a fully functioning brain, even when not connected to anything, is not human life. Yet the person whose brain that is in the jar is fully conscious, thinking thoughts, perhaps reviewing memories, evoking feelings, and otherwise functioning just like your brain, with the exception that there is very limited to no input or output to the environment(we could attach electrodes and use the person's EEG to control things- this has already been done). A person is his functioning brain, and without it he is dead.
    Regarding your final point: physiological criteria are actually all we have to go by. we dont have a soul-o-meter or anything else to measure metaphysical ideas of life. All we have to go on are the results of physical examination and testing of the body.

    By the way, having done a google search, the author of this article has written a number of books and science articles, and is set to launch a book on this topic.

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  9. Yitz Waxman asked, perhaps rhetorically: "What are the alternatives to physiological criteria?"

    First-person empirically, i.e., withholding the universal quantifier, the alternative appears to me to be: "have faith in the faith of human X."

    So I must choose between the epistemology-in-practice of people like Dr. Stadlan [1][2], and the faith of the relevant Xs.

    I would be very interested in first-person empirical reports which indicate other alternatives.

    -----
    [1] Which is both weaker and categorically different w.r.t. 'personhood' than with respect to, say, cortical perfusion.
    [2] Many thanks to Dr. Stadlan and Rabbi Slifkin on this one, from a WSJ reader.

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  10. This is a consequence of the extreme deontological approach under which a tiny difference in the world (such as between someone who has a certain number of neurons firing per second and someone else with one less neuron firing per second) is the sole criteria for morality. Who doctors define as "really dead" is a matter of nearly arbitrary definition.

    Maybe the question of who is "really dead" is the wrong one. Some people have amount of brain activity X, others amount Y, others amount Z, with some such amounts very close to zero, some levels are unsustainable for more than 10 minutes, others for more than 10 seconds, etc.

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  11. Anyone who reads this article to say brain death is not death is foolish and misses the point of the article. The article is trying to push for more tests to be certain that people who have brain death actually have brain death. Eeg's should be performed because we want to perform all teats possible to make sure the brain is actually dead. Anyone reading the idea that a brain dead person has more in common with a live person to mean the person is still alive is not very good at reading comprehension.

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  12. James said...
    "Written by someone who is not a physician"

    Is this a joke? Need I remind you how many times this accusation has been leveled at you?

    The WSJ is a respected publication, much more so than this blog, and using terms like "incredibly stupid" to describe an article with which you disagree does very little to foster the impression that you are desirous of serious conversation about a serious topic.


    Natan Slifkin said...
    I don't write things that the vast majority of physicians would disagree with!

    The article hardly presents a serious conversation.

    The problem with your response R' Slifkin, is that many would also not consider you an expert on Jewish Philosophy and you DO argue with the majority of accepted experts in that field!

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  13. Um, no I don't. Actually my views on Jewish philosophy are exactly the same as the majority of accepted experts in that field.

    Unless you are somehow under the impression that charedi Talmudists are experts in Jewish philosophy?

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  14. "Irresponsible Fear Mongering in the WSJ "

    Oh well, I had this strange hope this was going to be an anti-war post.

    "The article writes about how brain-dead people have "more in common biologically with a living person than with a person whose heart has stopped. Your vital organs will function, you'll maintain your body temperature, and your wounds will continue to heal. You can still get bedsores, have heart attacks and get fever from infections.""

    In my Brisk days we decided, for these very reasons, that a brain dead person doesn't have a din dead person but rather a din live mouse.

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  15. "The WSJ is a respected publication"

    Not anymore. The Danforth family sold to Rupert Murdoch a few years ago, and Murdoch has transformed it into yet another propaganda vehicle. This article is one of many such examples.

    "The article is trying to push for more tests to be certain that people who have brain death actually have brain death. "

    New York State requires two independent neurological exams to declare someone brain dead. An article in *Neurology* last year reviewed 1300 cases and the number of cases in which the second neurological exam did not agree with the brain death diagnosis of the first exam was zero.

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  16. " In 1981, the Uniform Determination of Death Act made brain death a legal form of death in all 50 states."

    This is a false statement. The majority of states have enacted the Model Uniform Determination of Death Act, but not all. And that is after 30 years!

    The old WSJ would never have published such a poorly researched article. But truth is optional in the reality of Rupert Murdoch.

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  17. Bancroft not Danforth. I regret the error.

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  18. The author of the article has recently written a book entitled, *The Undead: Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers--How Medicine Is Blurring the Line Between Life and Death*. It gets published TOMORROW. This poorly researched essay is clearly an attempt to publicize the book and I'm not optimistic that the book is any better.

    The real question is how even an experienced writer like Teresi can get a paper like the WSJ to give him what is essentially a free full page ad.

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  19. The person who wrote the WSJ article has written a number of books and articles on scientific topics, and has edited some popular scientific magazines. He has a book on this topic set to be released this week. While he castigates the medical establishment about benefiting financially from organ transplantation, he apparently has no problem using a sensational article to help boost his book sales.

    Basically what he has done is cobble together one side of discussions that have been ongoing in the medical literature for over 50 years. There are a lot of articles debating whether an EEG should be used in brain death testing(for example, see Chris Pallis, ABC's of brain death). There are literally hundreds of philosophical articles discussing how to define human life, and in its absence, determine death. Every point he brought up has been discussed and dissected,and there are counter points(as I hope I demonstrated) which he has totally ignored. There is a serious ongoing discussion in the medical/ethical/legal literature. The WSJ article, in my opinion, does not bring anything new, presents half truths in a sensational manner, and is clearly better suited to the National Enquirer than the WSJ(and that is an insult to the National Enquirer). It is not that the issues should not be discussed. They absolutely should be discussed, and if there is one good thing about the article is that it has spurred discussion. However, it has set the tone for the discussion stacked deliberately to one side and done so just for sensationalism. It is neither journalism nor science.

    In response to E-man: The article presents an opinion by Dr. Devita that he prefers his dead bodies not to be pink and have a pulse(or something like that). The cadaver of a patient who has been determined to be dead by neurological criteria is pink and has a pulse. Therefore, to my mind, at least part of the article is an attach on brain death.

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  20. "Unless you are somehow under the impression that charedi Talmudists are experts in Jewish philosophy?"

    Off topic, but interesting that you should say this. R' Yaakov Weinberg ZT"L, the late R"Y of NIRC, said of R' Elchonon Wasserman ZT"L that, with all his greatness in learning, he was not an expert in Hashkafah.

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  21. "What are the alternatives to physiological criteria?"

    Less precise ones.

    We do not define a baby as alive when it's brain can start to respond to stimuli within the womb. The baby is alive after it has come out of the mother. Even if it needs machines to be kept alive and to continue to grow so it can live on it's own. But ofcourse, the talmud says you don't sit shiva until after 30 days.

    A person is dead, when the people close to said person feels they are dead. It doesn't have to be such a precise thing which suffers from Xeno's paradox.

    "It is interesting that you want to consider isolated brain cells as human life(the only reason to wait 8 hours), but a fully functioning brain, even when not connected to anything, is not human life."

    This is a complete distortion of what I said.

    A half dead body, which is complete and looks like a human being, and evokes emotional responses from people around them are not "isolated brain cells"

    While zombie cyborgs might be possible, and poets with no bodies might create grand masterpieces, neither are going to be treated as human beings.

    When people decide they want to remove brains from people and hook them up to computers to study how the brain functions, you will find 1001 reasons why that brain is not a person, just as we find 1001 reasons to say that embryos are not people.

    Pretending that there is some precise moment or collection of cells which you can triumphantly declare as alive or dead is inhuman. Thousands of words by sci-fi authors and Cyborg ethicists have already been written on the subject, with no line agreed upon by anybody.

    So you don't find my Sukkah Kosher.. We will manage.

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  22. " An article in *Neurology* last year reviewed 1300 cases and the number of cases in which the second neurological exam did not agree with the brain death diagnosis of the first exam was zero."

    So basically, what you are saying is that the pressure is so strong to harvest organs and declare people dead, that there wasn't even a single case of dissent.

    In the Talmud, this is a good reason to prevent an execution. If everybody agrees, something must be wrong.

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  23. Noam- Please explain how this is an attack on brain death? Brain death is where the body is pink and the heart is still beating. Did you think otherwise before you read this article?

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  24. Charlie Hall: " The Wall Street Journal is no longer a respected publication." (paraphrase)

    Right. It's only the most prestigious paper in the country, with the biggest paid circulation in the country. Hall, you never disapoint.

    Someone should do a study on these lefties, like the failed study the academic tried to do in Kansas. WSJ has the highest circulation, Fox News the highest cable viewership, and Rush the largest radio audience. That's all three mediums, print, TV, and radio. And yet the fringe left wing like Hall, and others who get their thinking orders from the New York Times editorial page, tell themselves that all the millions of people who share these views must all be nuts. The gall is fascinating. I would love to see an anthropological study of such people.

    Fascinated Observer in West Virginia

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  25. E-man already pointed out that you all missed the point of the article. In addition to wanting more tests, the important point is made that once one has signed off on donation, the deceased and family have no say in how that will be carried out - including whether or not death has been established to the moral or religious satisfaction of the family. This is no small issue, even if you accept brain death. I can personally attest (as an ER nurse, among my other hats) that outside places like NY, Donor Services are sometimes unaware that Jews may have concerns over determination of death and that there may even be variant practices among observant Jews. When I started working in the hospital here, Donor Services was completely unaware of this and largely still are.

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  26. While I agree that the cited article is a biased presentation of a complex and critical issue, it does, however, point out some real concerns. I gather from the article and some responses that doctors need not conduct definitive tests to establish 'brain death'. The absence of certain reflexes and the lack of spontaneous breathing is, apparently, sufficient to begin harvesting organs for transplant. Why should that be considered an adequate indicator of death, when more definitive tests are available such as PET and EEG brain scans? If the PET scan shows no glucose uptake by the brain (at least, the brain stem) and the EEG registers no electrical brain activity, then the confirming absence of spontaneous breathing should satisfy both the talmudic and modern defitions of death. The additional expense of the brain scans should not add unreasonably to the cost of a transplant and should not be considered an optional procedure.

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  27. N Slifkin said...
    "Unless you are somehow under the impression that charedi Talmudists are experts in Jewish philosophy?"

    Uh...yeah, it is ACCEPTED that the Talmudists are the experts in Jewish philosophy, thus they are the accepted experts!

    P.S. I've noticed that you occasionally quote R' Hershel Schachter's opinions on Jewish philosophy, correct me if I'm wrong but I believe he is "nothing more" than a "Talmudist"....

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  28. It is accepted by many charedim. Not by others.

    Rav Schachter is somewhat more widely learned than regular chareidi roshei yeshivah. But I still wouldn't consider him an expert in Jewish philosophy, and I don't think that he would consider himself one, either.

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  29. then why do you quote him, simply because he agrees with your viewpoint? And no, he is NOT more learned in Jewish philosophy than the Chareidim gedolim, (perhaps equal).

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  30. When have I ever quoted him on Jewish philosophy?

    I'm not sure that you know what the term means.

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  31. I am referring primarily to your posts on March 2, and December 6,. It is interesting that you compare Rav Schachter to Rav Meiselman because whether you agree with the latter or not, anyone who knows the two of them even slightly would be aware of the fact that Rav Meiselman knows FAR more about Jewish philosophy than Rav Schachter. (I have heard them both discuss these matters and where Rav Schachter quotes well-known maharshals, rambams, and r' Hirschs, Rav Meiselman discusses the multiple manuscripts of rishonim he personally examined, the handwritten letters of various gedolim to each other, and exotic maareh mekomos. To put it simply, I know the basics of this discussion and almost nothing Rav Schachter said was new to me, while Rav Meiselman quoted MANY items I had never heard of.)

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  32. Could well be that R. Meiselman knows more sources. But that doesn't make much of a difference, because he is passionately committed to proving himself charedi, and to trashing me, rather than being honest with his analyses.

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  33. Rabbi Meiselman knows so much, he even knows things that aren't true, such as his pathetic assertion that the quote from R. Avraham ben Harambam is not authentic or that all of the rishonim interpreted Bereishis literally.

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  34. Y. Aharon- Those who fulfill criteria for brain death have irreversibly lost CLINICAL brain function. The criteria were designed to identify those people who have no observable brain function and will never regain any. In this regard they have functioned perfectly. There are definitive tests: imaging to show massive brain damage, and detailed examination to show lack of function.
    The issues you are raising are seperate but important: does a person who has no observable function but has some function identified by EEG alive or dead? Does a squiggly line on an EEG machine mean life? The consensus in England and the growing consensus in the US is that EEG function, in the context of absent observable function, is not life. It is considered the same as a few neurons functioning(as I pointed out in my comment). The Chief Rabbinate Criteria are also in agreement with this and as a matter of halacha they do not require EEG. Furthermore, having EEG activity does not predict any return of function. In other words, patients who fulfill brain death criteria and have some function measured by EEG still never regained any other function, and even when supported maximally, suffered from cessation of heart function within days-at most a week.(Just to be clear, I am not making the argument that these patients were 'close' to death and that they ultimately were going to 'die' when their heart stopped so it doesn't matter. The point is that having some activity on EEG is not a predictor of recovery).
    Regarding the use of PET scans. The question is: does some blood flow or function on PET scan, in the absence of any other clinical sign of brain activity, qualify as life, or a sign that human life is still present? again, there is a consensus that it does not. I personally think blood flow studies are useful because it provides additional certainty that the loss of function is permanent. However, if the criteria are applied with precision, even those without blood flow studies have never regained function. And, there are some who had blood flow studies done, had some blood flow, but still didn't regain function.

    The focus of the definitions of death has been on observable function.

    With any test, the question is: does this test indicate function? does this test tell me something about irreversibility? Then you can decide if it is useful or not or if it should be done.

    It is reasonable to posit that some EEG activity is a sign of life, and in my personal opinion a normal EEG is a sign of life(if the criteria are applied correctly, it would be impossible for a person with a normal EEG to be identified as dead). Some poskim feel it is necessary and/or useful.
    by the way, feel free to email me with further questions: noamstadlan at gmail dot com

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  35. @E-man. I firmly believe that the irreversible cessation of neurological function(brain death) is the death of the human being. When I declare someone dead on those criteria(and I have many times unfortunately), the body is pink and has a pulse. The article quoted someone as saying that they prefer their dead bodies cold, and not having a pulse. I interpret that as an attack on brain death. Feel free to interpret it differently.

    Mordechai Sher- as a practicing physician who has dealt with this issue many times, I can assure you that the box on the license means NOTHING if the family or the power of attorney object. I dont know if filling out the box is actually legally binding, but as a practical matter, physicians DO NOT go against the wishes of the family in these matters. What is important isn't what box to fill out, but to talk to your loved ones or power of attorney as to what you want done. If there are questions regarding whether a declaration is appropriate or not, you can contact the Halachic Organ Donation Society (HODS.org there is an emergency number listed) and we can provide guidance and assurance.

    @ Ameteur- there is a difference between observed results and opinion. There was no pressure and it wasn't a matter of opinion, just a matter of measurable fact. If you drop an apple 1300 times and it falls to the ground each time are you know going to say there is a problem with the law of gravity because there weren't any deviations? The report is just stating results. please read it before you baselessly criticize further.

    Regarding measurements. If you believe in halacha, your life is surrounded by precise halachically defined measurements. There may be debate over what the measurement is, but no one as far as I know doubts the precision. In fact many this Pesach will carefully measure out their matzo, wine and marror. However, in a matter that is literally life and death, you want to claim that measurements dont matter? That what matters is how the people near them feel? What if they feel that the person with horrible Altzheimers is dead? What if a murderer feels that the victim is still alive so he isn't actually a murderer? I dont think this approach is neither legally nor halachically viable.

    I dont claim that I know the precise amount of cellular function or exactly what constitutes human life. I agree in that it is impossible for us to know. But that doesn't mean that we dont know the boundaries within which the dividing line exists. The boundary line between life and death exists in the amount of neurological function you have. when you have it all, you are alive. when you have none, you are dead. A nice pink kidney with circulation, A nice pink kidney attached to a heart, a nice pink kidney attached to a heart and a torso, and a leg and an arm, no matter how nice and pink, is not a human being. It isn't a human being unless there is a brain.

    You stated: A half dead body, which is complete and looks like a human being, and evokes emotional responses from people around them are not "isolated brain cells"

    By this criteria, Lenin, embalmed for years, is alive(and if you want to dispute the claim, you only have ‘half-dead’ to go by, and so you need to define exactly what you mean by ‘dead’ or ‘half-dead’). :-)

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  36. Mr. J, I honestly wish I could have the same attitude as you, so could you please share with me your answer as to why Rabbeinu Avraham ben Harambam would quote (in the questionable piece) a gemara according to the nusach ashkenaz NOT the nusach sforad, and also why he argues with an interpretation of the Rambam when he writes elsewhere explicitly that he only diasgrees with his father in a specified number of places (which he identifies)? I am writing this shorthand because since you disregard Rabbi Meiselman's claim so out of hand I assume you are intimately familiar with his proofs. Please help me, because I find them very convincing!

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  37. "Written by someone who is not a physician"

    Isn't it possible that someone can be a respected expert without specific credentials? If they do not have certification in a specific field, does that automatically negate the validity of their expertise?

    Example: Rabbi Avraham Elimelech Firer is not a doctor, yet he is certainly a medical expert and his opinions have saved countless lives.

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  38. "In the Talmud, this is a good reason to prevent an execution. If everybody agrees, something must be wrong."

    In other words, you want to stop all transplants because the system works. Beautiful.

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  39. " It's only the most prestigious paper in the country, with the biggest paid circulation in the country. Hall, you never disapoint."

    Have you actually READ the WSJ prior to and after the Murdoch takeover? Popularity isn't a measure of quality.

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  40. " his pathetic assertion that the quote from R. Avraham ben Harambam"

    Whether the introduction to Ein Yaakov was written by R'Avraham is as relevant as whether the Zohar was written by R'Shimon. Both are accepted in our mesorah and nobody can change that.

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  41. Was the WSJ article a sales pitch for the author’s new book? Sure. (Not exactly a practice unique to Murdoch owned media; it’s pretty common on NPR to have guests on shows be there when by a strange coincidence they’re launching a new book.)

    Scaremongering? Maybe. Wrong about important details? Yes. Irresponsible scaremongering? I don’t think so. Here’s why:

    According to a recent Canadian Medical Association Journal article, euthanasia without consent is a commonplace in Belgium .
    Around 25% of the heart transplants in Belgium come from euthanized donors. (The argument made is that the mere fact of a patient being alive should not stand in the way of their strong desire to donate their organs if the patient is a suitable candidate for euthanasia.)

    The CMAJ article also tells us that the current application of “euthanasia without consent” probably means that most of the subjects of that procedure aren’t then the source for transplanted organs; indeed, there seems to be a “wall of separation” between the euthanasia and the transplant.

    When the discussion of euthanasia began in Belgium and The Netherlands, part of the argument for it was that there would be no euthanasia at all without consent. But as more physicians had experience with killing their patients, consent came to be considered unnecessary in some cases as euthanasia was considered to be in the patient’s best interest. No doubt the patient would have consented in time if he had been as wise as the physicians.

    Looking at future prospects for the supply side of this $20 billion industry, “presumed consent” legislation for organ harvesting has been proposed in at least two US states and in the UK, among other places.

    Of course, if you can’t wait for an organ in the US or don’t want to, maybe you could go to China! If you procure your organ in China, it frees up an organ in the US, so it’s really a humanitarian act, right?

    But according to an article in the Weekly Standard, political prisoners in the laogais have been murdered for their organs, in some cases probably to order after they prove to be a tissue match for a particular recipient. Chinese physicians participate in the organ procurement murders.

    Returning to the USA, part of the current climate is the explosion of government by administrative fiat. (No, it’s not all Obama’s fault, though he and his party are masterful practitioners of the art.) Imprecise laws are passed calling for sweeping change, to be figured out later. Couple that with the “presumed consent” organ donor laws being proposed in many places.

    Consider this: the President of the United States has appointed a “Regulatory Czar” who thinks that a human being’s internal organs are the property of the State. Even the Chinese government doesn’t like to be seen harvesting the organs from someone who’s not a convict, even if the conviction wouldn’t bear scrutiny. Our Czar doesn’t even see the need of such a procedural figleaf.

    Now move from fact to supposition. Suppose that the Progressive agenda succeeds. Obamacare is upheld, and then single payer government provided healthcare follows. Dr. Stadlan’s and his colleagues’ main, or even sole source of income would be the the State. Physicians who practice according to government guidelines will be immune from malpractice suits.

    Should that happen, how long will Dr. Stadlan be able to reassure us that “No physician is going to harvest organs without consent of the family, regardless of what box was checked on the driver's license?”

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  42. "In fact many this Pesach will carefully measure out their matzo, wine and marror."

    True, and many of those same people say that brain death isn't a valid form of death in halacha. But I won't be measuring my matzo, and I think brain death is the same as decapitation. It's a lovely system we have.

    " However, in a matter that is literally life and death, you want to claim that measurements dont matter? "

    Correct, because it can't be measured and was never intended to be.

    "That what matters is how the people near them feel? What if they feel that the person with horrible Altzheimers is dead?"

    Then such a person will likely be left to die, and won't be given treatments to prolong their life. It is my understanding that amongst many halacha observant people, that is the practice today.

    " What if a murderer feels that the victim is still alive so he isn't actually a murderer?"

    What if a person thinks they are killing the next hitler? That will be for the judges and courts to decide.

    "I dont think this approach is neither legally nor halachically viable."

    Well this becomes the cruxt of the issue doesn't it? What is legally viable will be what people feel comfortable with their laws saying. If they don't want someone to be declared dead without 6 different tests being done, then thats what will be legally viable. If they want doctors to have complete freedom to declare anybody they like dead, then that will be legally viable.

    As for halacha, I think it is suffienctly vague to be comfortable with the fact that Dayanim and Poskim have a range of opinions and judgements on the matter. I won't be measuring my Matzah, and I have no problem with the guy at my Seder who wants to measure his.


    "By this criteria, Lenin, embalmed for years, is alive(and if you want to dispute the claim, you only have ‘half-dead’ to go by, and so you need to define exactly what you mean by ‘dead’ or ‘half-dead’). :-)"

    I'm not sure what criteria you mean. Using your example, I stated that the embalmed Lenin, is not a "collection of brain cells", and I still believe that to be correct. An embalmed Lenin is dead however, and any and all poskim would agree that a Kohen can not enter that room. Would Russians treat a person who attacked the body as a murderer? I doubt it, but maybe some would?

    The line between life and death can not be measured like the distance between two stars, or the number of chromosomes in a cell.

    You have live people, and you have dead people, and the border between them is fuzzy and large.

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  43. "Of course, if you can’t wait for an organ in the US or don’t want to, maybe you could go to China! If you procure your organ in China, it frees up an organ in the US, so it’s really a humanitarian act, right?"

    Gd willing the whole debate will become moot soon, and we will be able to replace someone's organs without taking them from other people's bodies.

    I never understood why people are so against allowing people to buy and sell their own organs. Isn't that part of the premise of allowing abortions?

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  44. WSJ has the highest circulation, Fox News the highest cable viewership, and Rush the largest radio audience. That's all three mediums, print, TV, and radio. And yet the fringe left wing like Hall, and others who get their thinking orders from the New York Times editorial page, tell themselves that all the millions of people who share these views must all be nuts.

    Yeah, sorry, if you get your news from FOX, you are nuts. If you think Bill O'Reilly is a consistent "traditionalist" who isn't by any means a conservative, Gretchen Carlson is the "independent" panelist on the "fair and balanced" FOX and Friends show, and Megyn Kelly runs a fair show...you're off your rocker.

    Are other media outlets bad with bias? Sure. MSNBC's clearly "the network on the Left." David Gregory, Chris Jansing, Mika Brzezinski, Andrea Mitchell, and Alex Wagner are clearly on the left. But even MSNBC has (popular!) pundit-hosts who aren't "toeing the line:" Scarborough and Ratigan are clear examples. Steele's also a forceful personality at the network. Who's FOX's big liberal personality that gets brought out almost daily to talk about his liberal perspective? Colmes of Hannity & Colmes? Oh yeah, it's just Hannity now.

    For the record, the NYT (which I'm no fan of, actually) is the most popular newspaper site. And by the way, there is at least one cable show on the news which beat out the FOX lineup in 2011 (and IIRC every single show which doesn't rhyme with "The O'Lielly Factor") Welcome to The Daily Show. :)

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  45. YoelB. thanks for the link. It is an interesting paper and somewhat disburbing. However, your claim that euthanasia without consent is commonplace is a bit exaggerated. The cases of euthanasia were a small percentage of all deaths, most were with consent, and of those without consent, the paper documents that in many of them the family(but not the patient) were consulted. The fact that it happens at all is concerning, but persepective is necessary.

    I understand your concern that such a practice could become common in the US, but I think that social pressures are significantly different here than in Europe. The same emphasis on personal autonomy that fuels the drive for legalization of euthanasia also strongly opposes letting a physician kill a patient without patient and/or family consent. Our society is very much against physician paternalism. That is why informed consent rules are so rigorous. In addition, our legal climate allows families to sue for most any sort of real or perceived physician misconduct, and I cant see how a physician performing a 'mercy killing' against patient or family wishes can escape civil(if not criminal) consequences.
    So, I think that the vast majority of physicians in the US are trustworthy enough not to do such a thing, and our social and legal climate is such that even if a physician was tempted to act in this way, our social and legal system are powerful deterrents.

    Ametour- thank you for your responses. I am not sure that we have enough of a shared basis of assumptions to have a meaningful discussion. I suggest that your approach to defining death is unique in the halachic literature.

    Just to clarify you had stated: "A half dead body, which is complete and looks like a human being, and evokes emotional responses from people around them are not "isolated brain cells"". This implies that aside from the isolated brain cells, there is something about such a body that makes it alive. I only pointed out that the body of Lenin fulfills the rest of that sentence- it looks like a human being and evokes emotional responses from the people around it. Therefore you would have to think about why you consider Lenin dead but not the body under discussion.

    Regarding the person we discussed with Altzheimers- there is a huge difference between dead, and going to die soon or inevitably. One is dead and the other is alive. My point is that by your criteria I could consider someone with end stage altzheimer's dead. Your response did not address that situation.

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  46. Dr. Stadlan, thank you for your thoughtful response. I'd like to point out that I didn't say that euthanasia without consent was common, but rather that euthanized patients were common donors for heart transplants in Belgium.

    We share a concern that the ethical wall between involuntary euthanasia and organ donation will become permeable. One factor that might contribute to this would be medical education favorable to euthanasia, which I believe may already be in place in Belgium, etc.

    The presence of the State or its agents as sole payors would be another. We have seen this foreshadowed in the legal and administrative apparatus set up around vaccine production and product liability.

    This was in part pushback against the effects of the decision in the Cutter polio vaccine case. (I grew up near Cutter and carried a Cutter snakebite kit when I was in the Boy Scouts --speaking of obsolete medical doctrines, how about incision and suction as standard first aid for envenomation-- so I read Paul Offit's excellent book The Cutter Incident with interest.) Given that I mentioned government standards and malpractice immunity, I think it's relevant here.

    I drew a somewhat different conclusion than did Dr. Offit from the facts he lays out: I think that despite the problems for the vaccine industry caused by the Cutter verdict, (and despite my visceral distaste for the plaintiff's bar) the verdict was correct and socially useful in that it maintained the surveillance which you mentioned.

    The verdict held that despite Cutter's having followed government approved procedures in vaccine production, they were still liable for damages due to the fact that many people contracted polio from the version of the Salk (killed virus) vaccine Cutter produced whereas those vaccinated using one of Cutter's competitors' vaccines were safe.

    Unfortunately, one of the testing methods that the government approved to detect polio virus contamination of the vaccine turned out to be flawed. It was wrongly believed by some experts to be equivalent to another more complex and expensive procedure. That meant that the only thing protecting the public from getting polio from the vaccine was the filtration process.

    If the filtered liquid stayed crystal clear after standing for a while, it was safe. If turbidity developed, it wasn’t. While the vaccine experts of the time didn’t know that their test for live virus was flawed, they knew filtration to be critical. And even by the flawed test, Cutter couldn’t consistently make virus free vaccine.

    In addition, despite the flawed safety test, Cutter’s polio vaccine competitors were still able able to make virus–free vaccines. This was probably because they were conscientious, due to their corporate culture and a sort of aesthetic preference for filtrates that were absolutely clear, about making sure their filtration methods cleaned up the cellular debris from their vaccines. Fatally, Cutter Labs wasn't.

    While Cutter used procedures that were in compliance with the federal regulations, Cutter’s corporate culture was not compatible with the attitudes needed to safely make biologicals for large scale human use. (Cutter was basically a startup, moving from the much less regulated veterinary biological and vaccine market to the the human market.) Cutter’s senior management knew about the contamination problems, but didn’t seek help in solving them. They apparently believed that since they were following the government’s guidelines, it wasn’t a problem.

    That attitude had fatal consequences for people given Cutter’s vaccine.

    The government and rent seeking government tied corporations are much more involved in medical practice than was the case 50 or 60 years ago. That leads me to be less sanguine than you are that the medical profession will be able to hold the line against the abuses I fear are coming, though I really hope I am wrong.

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  47. " This implies that aside from the isolated brain cells, there is something about such a body that makes it alive. "

    No such implication exists, it just means it deserves the respect of a human body, and not "a collection of brain cells" which do not deserve any reverence or respect, anymore than a collection of hair or skin cells do.


    "Regarding the person we discussed with Altzheimers- there is a huge difference between dead, and going to die soon or inevitably. One is dead and the other is alive. My point is that by your criteria I could consider someone with end stage altzheimer's dead. Your response did not address that situation."

    "Ametour- thank you for your responses. I am not sure that we have enough of a shared basis of assumptions to have a meaningful discussion. I suggest that your approach to defining death is unique in the halachic literature."

    I'm curious what assumptions you believe I am lacking.

    And I am sure that my approach is unique. Rarely does somebody argue that their interpretation of halacha is correct, but so b'metzius is their detractors. However, when it comes to reality, we have conflicting arguments about the status of some case, and both sides of the argument have their supporters and their detractors.

    The fact that lawsuits, and societal norms, are part of the conversation, proves to me that this is more about what people feel and their gut reactions to situations, than it is about anything concrete or scientific. Nobody consults a lawyer about the definition of a virus, or the need to quarantine an infectious disease.


    Why would you consider them dead if they aren't? I don't understand. Do you have any cases to point to where humans have actually thought that a person was in reality dead, and had all the emotional trauma of believing a love one died, when they merely suffered from a mental disease?

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  48. Baruch Pelta,

    The notion that Fox News is more biased than the mainstream media is absurd. I have no idea why people aspiring to be intellectual have this knee-jerk desire to bash Fox.

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  49. I saw this comment in Hirhurim about another topic, but I felt it relayed my opinions here very well.

    Mica wrote,
    "But is the role of halakhah to fix abstract data about the world, or the people living in it?

    No matter now much someone knows about centripital force, when they climb into a “Cyclone” or “Tilt-a-Whirl” at the amusement park and the floor falls out, there is a thrill of excitement. Scientific knowledge isn’t what operates at the gut level. And if the Torah’s mission is to make us more refined and more capable of moral choices, it cannot do so by being paired off with something that we embrace “only” intellectually.

    Thus, I think it is actually less contrived to assume that the Torah works with intuitions rather than empirical facts. If we don’t intuit microscopic eggs or larvae, then their existence or non-existence doesn’t change how I relate to the resulting maggot or worm. Notice Chazal don’t actually speak about things existing or not existing. They speak of “metzius” — that which can be found, and “mamashus” — tangibility. It’s all how we directly experience the world, not how we understand it to be. In a healthy human psyche, those microscopic maggot eggs have no mamashus, we don’t feel them. And halakhah based on them would actually have less leverage in changing the practitioner."

    I think this same approach is use and should be used with regards to the death and life.

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  50. But lice eggs are NOT microscopic.

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  51. Rabbi Slifkin,

    I just saw this article on another blog regarding a "brain dead" child who responded to commands etc. please comment.

    http://www.vosizneias.com/103011/2012/03/16/miami-beach-fl-family-remembers-young-near-drowning-victim

    Miami Beach, FL - Four and a half years after her near drowning made national news, eight year old Aliza Schwab, the North Miami Beach girl who was discovered unconscious at the bottom of the family pool four and a half years ago, died peacefully Thursday at her home at the age of 8.
    Paramedics who were called to the scene were able to restart the little girl’s heart, but approximately one month later doctors at Miami’s Jackson Memorial Hospital declared the girl brain dead and wanted to disconnect her from life support, a decision that was staunchly opposed by her parents, Esther and Moshe Schwab, who insisted that their daughter be given the opportunity to live. The story attracted national attention as Florida law allows doctors to remove brain dead patients from life support but the Schwabs fought for and won the chance to care for their daughter, who now bore the additional name, Ruchama, at home.
    Advertisement:

    Several weeks after bringing their daughter home, the Schwabs saw signs of improvement, as Aliza responded to commands, moving her arms and legs. A year later Aliza continued to progress as reported previously on VIN News.
    A sefer Torah was written as a zechus for Aliza’s recovery in 2008 and hundreds of people, including singer Mordechai Ben David and his son Yeedle, attended the Hachnasas Sefer Torah which was hosted by the Schwab family.
    Jews worldwide continued to pray for Aliza’s recovery throughout her ordeal.
    In an emotional interview with Florida TV station WSVN, Aliza’s mother says the last four and a half years were some of the happiest moments of her life. “I wouldn’t change anything for the world. The extra four and a half years I got with her, there aren’t enough words to describe it,” said Schwab.
    “There were many miracles over the four and a half years, and she had her ups and downs, but every second of every day was a treasure.”
    Her mother says this is a day when they pay tribute to a fighter. “I wouldn’t change it for anything in the world. She will be missed, but she’s in a better place now, and she’s looking down on us, and she’s resting peacefully, and she went in the right time,” Schwab said.

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  52. "But lice eggs are NOT microscopic."

    What does that have to do with ANYTHING!?!?

    This complete obliviousness to what people are saying is dumbfounding.

    Nits are 0.8 mm - 0.3 mm. A mustard seed is 1 - 2 mm. Nits are smaller than a mustard seed and are therefore irrelevant. It doesn't matter if you can actually see them if you try hard enough, or if they are truly microscopic and less than 0.0299999 mm. This fetish with exact measurements makes you completely unable to understand fellow human beings.

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  53. anonymous- It is very likely that when the newspaper uses the word 'brain dead' it doesn't mean 'the patient has fulfilled the criteria for irreversible loss of neurological function'. The meaning is probably 'horribly devastated with very poor likelihood of regaining any function.'

    It would be very unusual to the point of being unheard of, for a patient to be determined brain dead 1 month after an injury. If a person is actually brain dead, the determination is made very soon after the injury-within days to a week at most.
    There have not been any reported cases of people recovering function after being determined brain dead. if this child recovered some function, they doctors would probably have reported it in medical journals.

    for all the above reasons, I highly doubt that this was actually anything more than just lazy and imprecise use of language.

    Ameteur- I hold that there are halachic and legal rules to determine death. you do not seem to think so, depending on your reaction to the person, which by definition would be different from someone else's reaction. it is also necessary to identify what is a human being and what is just a body part. If you are willing to address these issues there is some common language. otherwise we are just speaking past each other.

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  54. "Ameteur- I hold that there are halachic and legal rules to determine death. you do not seem to think so, depending on your reaction to the person, which by definition would be different from someone else's reaction."

    That is not a correct assessment of my view. There are halachic and legal views of death, and if a person is talking, and playing some sport, even if they have made their parents very upset, you can't declare them dead. etc.

    However, when you have competing definitions of death, which are equally sourced and valid, there is no reason to say that one is correct and the other is wrong. And you allow consensus rather than some shifting line to define that moment.




    " it is also necessary to identify what is a human being and what is just a body part. If you are willing to address these issues there is some common language. otherwise we are just speaking past each other."

    I understand, you are correct that there is no common language here. I see no reason to define the difference between a body part and a person. Nor do I think any such dividing line can ever truly be made, as technology will always shift what that line is.

    If the brain is the essence of the person, does that mean that someone who has a stroke, or is lobotomized is a new person, and needs a new name and the old person needs a death certificate?

    Which part of the brain defines the person? The hippocumpus, the verbal center, the frontal lobe? Which parts of the brain can be removed and replaced by machines and still say that the person is the same person? Which parts of the brain can't? Is a robot controlled by a rat's brain which has been inserted into the robot, a robot or a rat? What if we start moving body parts of that rat onto the robotic shell? At what point does it switch from robot to rat? Does it ever? These questions are impossible to answer in such a way that every reasonable person will agree.

    As they say about porn, "You know it when you see it."

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  55. I suggest that not all the definitions of death are equally sourced nor equally valid. The fact that they are discussed doesn't give them validity.

    In addition, unless you distinguish between a person and human tissue, when parts of people are transplanted, you have no basis by which to identify which person is the donor and which is the recipient. How are you making the determination?

    I agree that it is impossible to specify exactly which piece of the brain is the 'seat of the soul'. However, I think that the position of 'life is related to neurological function' is closer to the actual truth than throwing up your hands and saying you have no idea. Just because you may not know something exactly, you can know the boundaries within which that something has to be, and which circumstances where you know that that something has a very high likelihood of being present or absent.

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  56. "In addition, unless you distinguish between a person and human tissue, when parts of people are transplanted, you have no basis by which to identify which person is the donor and which is the recipient. How are you making the determination?"

    Other than for bureaucratic reasons, why do you need to make a distinction?

    I'm sure many people who donate organs, do so with the sense that they will be "living on" with that other person. And people who receive transplants, get a sense that they share a life with another person.

    There is plenty of literature on that point.

    See here


    If these stories are fact or fiction, are really not the point.


    " However, I think that the position of 'life is related to neurological function' is closer to the actual truth than throwing up your hands and saying you have no idea. "

    I didn't say I have no idea. And I didn't throw up my hands. I said that no single criteria can tell you if someone is alive or dead. It is the gesalt of the human being that determines this. There is a state that is clearly dead, and there is a state that is clearly alive. There are also a few states in between, where it is more difficult to tell, and only somebody who is there and knows the people involved can determine which side of the line they are on.

    Judges do not generally rule on cases from a distance in any topic. You have to look at all the factors.

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  57. I guess this is the crux of the matter: "In addition, unless you distinguish between a person and human tissue, when parts of people are transplanted, you have no basis by which to identify which person is the donor and which is the recipient. How are you making the determination?"

    Other than for bureaucratic reasons, why do you need to make a distinction?

    Well, if the donor is still alive, then his wife is not a widow, his kids dont inherit and his life insurance policy doesn't pay. In addition, since the donor is still alive and joined with the recipient, there are yichud issues between the recipient and his wife,, issues related to yibbum(if they did not have kids), etc. etc.

    It is a huge issue.

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  58. "Well, if the donor is still alive, then his wife is not a widow, his kids dont inherit and his life insurance policy doesn't pay. In addition, since the donor is still alive and joined with the recipient, there are yichud issues between the recipient and his wife,, issues related to yibbum(if they did not have kids), etc. etc.

    It is a huge issue."

    Well that is fascinating.
    I see now that it is an important question, but your scenario is really more complicated.

    If the donor is still alive, then that means, that the recipient is now married to more people, has more assets, etc etc. Which has a whole host of other issues.

    Is there any actual discussion about this anywhere? Does the Talmud or midrashim give rules for what is a body part and what is not, and what happens when you transfer body parts between people?

    And further, when a brain transplant is done, do these questions come up again?

    It seems to me, that if you take the brain of one person, and transplant bits or all of it into another person, then you might raise the exact same questions. I would think, on the basic level, the person who donates the brain parts is now dead, and their family gets their inheritance.

    I don't see how the brain here, is any different than any other body part. But please correct me if the Talmud or Midrashim state differently.

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  59. As far as I know the Talmud doesn't discuss transplants. However, it does discuss the related issue of a baby born with extra parts, and, when the baby has two heads with independent function, it is considered two people- proof that the functioning brain is what determines the person. (see discussion by Rav Azriel Rosenfeld here: http://www.hods.org/pdf/head%20heart%20halacha2.pdf ) as well as article in Tradition by Rav Bleich on conjoined twins. I discussed the topic as well in my article in Meorot here: http://www.hods.org/pdf/Problems-Defining-Life-and-Death-by-Circulation.pdf

    I also have references to head/brain transplants in my article. (Rav Rosenfeld discusses it as well and also in his articles in Tradition). If the person goes with the brain, then the the result of transferring the brain of A to the body of B is going to be person A. It actually is not a brain transplant, it is a body transplant.

    At this point, it is impossible to transplant parts of brains and have them continue to function(you can transplant a few cells- but we already have established that a few cells do not consitute enough function to qualify as a person). It is unclear if it ever will be possible to transplant parts of brains. If it becomes possible, it will be necessary to address the identify of the resulting person(it will probably depend on what fuction each part produces). On the other hand, perhaps God has designed brains so that moving significant parts is not possible, precisely so that identities would not become confused. I think that approaches to identity need to address all technologically possible situations, and do not problems that result from presently technologically impossible situations do not have to impugn the coherence of the approach. We could think of many science fiction scenarios that would challenge any definition of death. It is interesting to think about them, but I dont think that they should be used to challenge existing concepts of life and identity.

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  60. "At this point, it is impossible to transplant parts of brains and have them continue to function(you can transplant a few cells- but we already have established that a few cells do not consitute enough function to qualify as a person)."

    This may not be possible with Humans, but something which I believe is close enough is definitely possible with rats. If it was pure science fiction, I would not have brought it up, but to me, its not so much science fiction anymore.

    I'm sure people once thought that if you transplant a heart into another person, then their identity would go with them as well.

    Navigating with a Rat Brain

    There is also the case of the conjoined twins which they believe can see out of each other's eyes. This to me indicates, that the brain, just like every other organ, is interchangeable under the correct conditions.

    Could conjoined twins share a mind

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  61. Dr. Stadlan said… “anonymous- It is very likely that when the newspaper uses the word 'brain dead' it doesn't mean 'the patient has fulfilled the criteria for irreversible loss of neurological function'. The meaning is probably 'horribly devastated with very poor likelihood of regaining any function.”

    Fine but that also makes things much worse. They knew that the patient was brain-alive but encouraged the motion to remove life support and condemn the patient to death (!).


    Dr. Stadlan said… “thank you for your responses. I am not sure that we have enough of a shared basis of assumptions to have a meaningful discussion. I suggest that your approach… is unique in the halachic literature."

    Without becoming involved in the context, as a generAL rule, this comment is so on target and so elegantly and honorably expressed, that it should be canonized, IMHO.

    כל הכבוד!

    reject

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  62. Ameteur- the article you linked to regarding rats has nothing to do with transplanting rat brains. They created a computer MODEL of how the rat brain worked.

    The twins do not share a brain. They each have a brain. What is different is that there is a connection between the brain(not surprising given how their heads are connected). It is like having two seperate computers, with cable in between them which allows them to share information. There are still two seperate computers. Similarly the twins are two seperate people who happen to have a direct neural connection between their brains.

    You are correct that prior to heart transplants people thought that the the person goes with the heart. Unfortunately, those people dont realize that science has shown that to be an erroneous belief(unless you want to believe that the heart transplant recipient is dead and the donor is the one who is actually alive). I do not claim that my definition of life is THE unchanging one. It is the one that best fits present understanding. Future accomplishments and understanding may lead to different definitions. We do our best with what we know and think.

    Anonymous- thanks. Many physicians and in fact some halachic authorities believe that there is a point where the prognosis is so futile(the patient is not brain dead, but devastated)that is it a reasonable option to discontinue support. It is obviously wrong to tell families that they HAVE to discontinue support. It is reasonable to give them the option. It is accepted in the US that some people want to discontinue care in some circumstances. Many people have instructed their loved ones that they do not want to be on life support if they do not have a possibility of regaining a quality of life. (it is common for people to have it in their living will or medical power of attorney). You have the right to disagree(and decide for yourself and your loved ones). They have the right in the US to decide for themselves and their loved ones.

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  63. "Ameteur- the article you linked to regarding rats has nothing to do with transplanting rat brains. They created a computer MODEL of how the rat brain worked."

    I suggest you look this up online. They actually made a robot with real life rat brains, and hat those robots run mazes. Another article about the rat brain robots

    You can watch videos of these, and see how the project has changed over time.

    Regarding the girls, again it is not so certain. They do some behaviors that makes it seem as they are "three people", the two of them and the combined person. They never say "we", only "I".. but we don't know why that is yet.

    Regarding your comment to Anonymous about families having the right to stop life support... How is that any different from them having the right to continue life support or object to organ donations? This is clearly a subjective matter in many borderline cases.

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  64. Ameteur- I am sorry but I do not have the time or patience to continue this particular conversation after this response.

    I will address a few issues that you raised. In one article you referenced they are trying to grow neurons and have them function as a computer. This is very exciting but at present they are just a few neurons that aren't doing a whole lot together.(similar to the brain cells that are found in the brain hours after circulation has ceased). There certainly is some promise there, but we will see where it goes.
    The other articles are using essentially rat EEG to control machines, similar to what can be done with humans. These are not transplanted rat brains or 'rat robots.' Instead of the rat sending a signal to it's own foot to move, they use a machine to read the rat's brain impulses and trigger a machine to move. The rat is intact, they didn't take the brain out.

    I find it hard to see how these examples affect the points I have made.

    It is accepted in law and Halacha that under some circumstances a person has the right to choose whether to undergo medical treatment or not. This is very different than choosing whether to be defined as dead or not. I hold that death is a discoverable condition, and is not affected by the choice a person makes or does not make.

    I appreciate the conversation.

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  65. Well I'll be, I suddenly feel justified in my "daat yachid" on this issue.


    http://www.haaretz.com/opinion/a-voice-that-should-be-heard-1.421609

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  66. "The world of organ donation in Denmark is in turmoil. A documentary was aired earlier this month which showed family members reacting in anguish to the news that their 19-year-old daughter was brain dead after a car accident, agreeing to donate her organs and allowing doctors to turn off her respirator. About 1.7 million viewers tuned in to the heart-rending drama.

    But Carina Melchior did not die after her respirator was removed. She is now undergoing rehabilitation and may make a full recovery. About 500 people immediately removed their names from Denmark’s organ donor register." -- See the rest here:

    http://www.bioedge.org/index.php/bioethics/bioethics_article/10278

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  67. According to:
    http://www.medicaldaily.com/danish-teen-wakes-dead-just-doctors-prepare-harvest-her-organs-243163
    "doctors were about to declare her brain dead and harvest her organs."
    Obviously Carina Melchior wasn't brain dead, but isn't the issue that the doctors were prepared to declare her brain dead?

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