Sunday, June 19, 2016

Stan Larkin Had No Heart

The most extraordinary story was in the news recently. Stan Larkin of Michigan, age 25, has led a fairly normal life - except that for nearly two years, he didn't have a heart in his body. Last month, he finally received a heart from a donor. But for over a year and half before that, he had no human heart at all! Instead, he had a pump, connected to a machine that he carried around in a backpack, which circulated his blood.

The entire story is amazing. It also powerfully illustrates why brain death should be rated as death - with the consequence that the organs of people who are brain dead should be used to save the lives of other people.

Stan Larkin's story shows that the heart, as incredible an organ as it is, has nothing to do with housing our identity or our soul. It's just a sophisticated blood pump - nothing more, nothing less. When Stan didn't have a heart, just a machine in a backpack, he was no less of a person. And when he received the donor's heart, he didn't "become" the donor.

Due to the wonders of modern technology, enabling scenarios that never occurred before in history (and are thus not addressed in halachic sources), the same thing could happen with pretty much any of the body's organs. You can switch them out for artificial replacements, or you can transplant them from other people. It's amazing medical technology, but it has absolutely no consequences for their identity or their soul.

Except for the brain! You can't replace the brain with a machine. And you can't currently transplant one from someone else - but when technology eventually makes this possible (as it presumably will), there will most certainly be crucial consequences for the person's identity and soul. If, a hundred years from now, Stan Larkin Junior loses his brain, and has it replaced by that of a donor, then Stan Larkin Junior has ceased to exist, and the donor has taken over his body. The only way that Stan Larkin Junior can remain existing without a brain is if by then it is somehow possible to download the "software" of the brain onto a computer (which seems highly unlikely).

It's clear that a person's identity and soul is fundamentally rooted in his brain, not in his heart or any other organ. The heart is no more significant than any other organ. It can be replaced by a machine in a backpack. It's only the brain that is crucial to personhood. When the brain is no longer present, the person has passed on. And this gives us a unique opportunity to use their organs to save the lives of several people.

If you haven't yet signed up to be an organ donor, please do so today, at www.hods.org.

148 comments:

  1. Not sure how to make an halachic jump that brain dead should be the criteria. I understand that it seems obvious that the brain is the place of the thoughts and such, but there have been cases, true few but, where declared brain dead people have woken up.

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    1. There have been mistake diagnoses of brain death (just as there have been mistaken diagnoses of cardiac death, e.g. from hypothermia) but there have been NO correctly diagnosed cases in which the person woke up. Not a single one.

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    2. But that is a tautology. Obviously not, because had it been correctly diagnosed, the person would not wake up. The essential point is that misdiagnoses do occur, and a recent study in France indicated that they are not rare (perhaps as many as one in five). As a practical matter, until the techniques for diagnoses are improved greatly, I don't see how someone can support brain death as death.

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    3. You are confusing a few points. The American Academy of Neurology(AAN) has published guidelines for declaration of brain death and these are the most commonly accepted. When they are followed with precision, there has NEVER been anyone who has recovered any neurological function. So the techniques and protocols to determine brain death are beyond reproach. Unfortunately there are instances where the protocol being followed is insufficient, and there are people who dont follow the protocols exactly. So there are people reported as regaining function. But when you look carefully at those reports, they never would have been declared brain dead to start with if the appropriate steps had been followed. The vast majority of brain death determinations(at least in the US) are done with no problems. I would note that there are studies showing multiple people regaining function after being declared dead based on cessation of breathing/heart function. So you could say that there are problems with that as well if you want. I am not aware of the study you referenced from France. please provide a citation. To address your final point, the fact that people make mistakes in declaring brain death doesnt invalidate the underlying concept or the validity of the criteria/testing. It is just like saying that strawberries aren't kosher because people aren't checking them properly. that makes no sense.

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    4. Dr Stadlan: I think that your penultimate argument is much better than your last one. Obviously, if it were the case that brain death criteria were really a 100% accurate criteria, but the expertise needed to apply the criteria was so rare that the criteria were being misapplied in most cases, then it would be foolish to rely on them in practice. Thus your explanation that this is not the case in the US combined with the observation that cessation of breathing/heart function is also susceptible to error is the more compelling argument, IMO.

      In fact, it appears that this kind of argument (difficulty in applying otherwise reliable criteria) is used by some poskim to avoid traibering of the hindquarters.

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    5. I am not confusing anything. The fact that if the guidelines are followed to a T no one recovers does not discount the fact that in many cases the guidelines are not followed to a T. The study had to do with using a fMRI scanner and asking the subjects to imagine themselves performing certain activities, then comparing the responses to those of healthy people. I didn't say that it invalidates the concept, I said that as a practical manner it should not be followed until the criteria are followed in virtually all cases. To use your strawberry example, I am saying that until someone finds an effective way to get rid of the bugs, people should not eat strawberries.

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    6. I am sorry but you are confusing brain death with persistent vegetative state. they are completely different. The study you mention had to do with people in a coma but still had some brain function. No one claimed they were brain dead. And what I said is that in the vast majority of cases the guidelines are followed, and in a lot of cases where they are not followed, the deviations are not significant. I acknowledge sadly that there are rare occasions where the guidelines have not been followed with unacceptable results. I would add that the respiratory brain death law in Israel makes the Israeli guidelines legally binding. As far as the US(or even the world), the Jewish community it would be very easy to make sure that the guidelines are followed. Set up a hotline staffed by neurosurgeons and neurologists who can look after every brain death declaration involving Jews(that we are asked to get involved with). In fact I offered to do this many years ago to the RCA. Unfortunately they did not take me up on the offer. The offer still stands if any rabbinical organization wants to take me up on it.

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    7. I don't mind giving you the last word, but let me clarify: Many of the "hamon am" are not sufficiently aware of that distinction. It is my understanding that hospitals will encourage guardians of those in a persistent vegetative state to allow respirators to be shut off, and will use that claim that the organs can be donated in their efforts to convince them. This type of behavior on the part of the hospitals is possible only so long as brain death is accepted as death.

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    8. This type of behavior on the part of the hospitals is possible only so long as brain death is accepted as death.

      What has that got to do with what Poskim should say? What Rabbis say has no effect at all on the behavior of medical professionals. The family can call a sufficient trained Rabbi or doctor and ask whether it is appropriate to turn of the respirator based on halachic brain death criteria. Dr. Stadlan has already offered his services.

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    9. Yehoshua Duker- Please read some information on donation after brain death and donation after cardiac death(DCD). What you are referring to is donation after cardiac death, which has absolutely nothing to do with brain death. I have never heard of some one in persistent vegetative state being removed from a ventillator in order to harvest organs. I am sorry but you are confusing a number of different situations. Please dont blame brain death(which is support by many eminent poskim) with other issues.

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  2. Please clarify: is it current psak Halacha among Charedim that heart stoppage is considered death? If so, what do we do with basic CPR or other techniques which revive people routinely?

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    1. Chareidi psak is.. lets say confused and based on premodern concepts that dont account for modern medicine. It used to be that when the heart stopped, two assumptions could be relied upon- all functions in the body would soon stop as well and also, the heart and circulation would never restart. So it wasn't necessary to decide what function or anatomy in the body was the key to life, since it all stopped pretty much at the same time, and the cessation of heartbeat/circulation was a good marker for that time. Both of these assumptions are now false. So cessation of heartbeat/circulation can be reversed with machines(such as above) or transplants. you can support parts of the body with machines and so different functions of the body can potentially fail at different times. Most MO poskim acknowledge this and seem to have moved to R. Bleich's concept of vital motion(See my article in Hakirah 18 for a critique and why that makes only a little better sense). Most Chareidi poskim, at least of the last generation didn't acknowledge the modern medicine and hold that death is the cessation of circulation/respiration. Bottom line is that they have avoided declaring any particular part or function as key to life, hand the coherence of their definition depends on false premodern assumptions. They have yet to acknowledge that. Sad thing is that a lot of MO poskim also fail to fully acknowledge the change.

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    2. Both Rav Moshe Feinstein and Rav Shlomo Zalman Aurbach paskened brain death as halachic death, although there has been a movement to claim they never said that.

      As an aside Rav Moshe paskened there is a chiyuv assei doraisa to donate one relatives organs to save a Jew's life. If it will cause extreme pain to you to do so, then you are not mechuyav.

      In an extremely odd Teshuva the tsits eliezer paskened all organ donations - even kidneys - are forbidden.

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    3. There is an article in Hakirah(I think) by Dr. Alan Jotkowitz which discusses the Tzietz Eliezer's approach to medical issues. in the context of his general derech, his opinion actually fits.

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    4. The idea that lack of blood circulation is halachic death is an example of what happens when you lack understanding of science and history. The lack of understanding of science is demonstrated by the facts of this essay. The lack of understanding of history is demonstrated by the fact that blood circulation was only discovered in 17th century by William Harvey. It was unknown to Chazal and Rishonim. Basically those who are paskening that way are going completely against mesorah!

      Another problems is when you pasken that way you absolutely cannot permit heart transplants as the donor, who is brain dead but alive according to that psak, is actually murdered by the transplant team according to that psak. However, some rabbis who paskin lack of circulation as halachic death permit heart transplants and by doing so they are matiring murder according to their own definition.

      Not to mention that forbidding organ donation while allowing Jews to receive organs generates anti-Semitism. It is probably the only situation for which anti-Semitism is justified. We need to call out this incorrect application of halachah before it causes us more damage than it already has!

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  3. While I agree 100% with your conclusion, I don't think that this kind of argument will convince the other side. Their argument is simply that as long as the person's body remains alive, albeit with the help of a respirator, then the halacha will recognize that person as alive. They will remain agnostic as to when exactly "the soul leaves the body".

    I believe that Dr. Noam Stadlan counters this argument with a line drawing excercise: what if you kept only the arm alive or even a few brain cells? However, the fact that a halachic line is blurry doesn't mean that it is invalid. Lots of legal lines are blurry. [My apologies for possibly caricaturing his argument instead of reproducing it, as I am not a physician.]

    Also, a question: would you say the same about someone in a Persistent Vegetative State. Let's assume there are no questions about the possibility of recovery. Would you draw the same conclusion?

    Finally, the brain question can be made even more complex. What if we ever reached the stage where scan every individual neuron in all or part of a brain and replace part or all of it with a simulator? Then even the brain may lose its special place in defining the person.

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    1. Persistent Vegetative State is completely different from brain death. Brain death is not based on cessation of consciousness. My point is that a definition, by definition, establishes a line between two categories. We have a lot of different combinations of organs and machines that we can make. and we have to determine which are alive and which are dead. A definition needs to be able to determine between them. If it cant, then it isn't a definition- just a vague concept(which is what R. Bleich's 'vital motion' is). We have Halachic shiurim for everything under the sun. To say that a definition which cant distinguish between dead and alive people is a real definition, when there is a perfectly usable alternative, makes no sense, logically or Halachically. Halachic opinions are thrown out when they cannot explain cases. It is difficult to next to impossible to connect central nervous neurons(brain cells). the last paragraph is science fiction. we can imagine lots of different scenarios, but I dont think that a definition is disallowed because it fails to explain a situation that may never be real.

      As to the first paragraph. you write that 'the person's body remains alive'. the crux of the question is- what parts have to be present/functioning, for a collection of tissue to be called a human body, and not 'parts'? Those who oppose brain death cannot come up with an answer for that.

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    2. Persistent Vegetative State is completely different from brain death. Brain death is not based on cessation of consciousness.

      Dr. Stadlan: I agree 100% that they are different and I was not making a reductio ad absurdum argument. Quite the opposite.

      My point was simply that based on the logic of "brain = soul" (which I agree with), then it should be permissible, if we could truly establish irreversabilty, to consider someone in a persistent vegetative state to be halachically dead (or at least worthy of removing a feeding tube).

      Certainly, if I was in the same state as Terry Shiavo, I would prefer my wife and family to be released than to have them continue to maintain me in that state.

      My point is that a definition, by definition, establishes a line between two categories. [...] To say that a definition which cant distinguish between dead and alive people is a real definition, when there is a perfectly usable alternative, makes no sense, logically or Halachically. [...] As to the first paragraph. you write that 'the person's body remains alive'. the crux of the question is- what parts have to be present/functioning, for a collection of tissue to be called a human body, and not 'parts'? Those who oppose brain death cannot come up with an answer for that.

      And my point is that this is the weakest part of your argument. Legal definitions simply don't work that way. To take a simple example, the first amendment protect "freedom of speech, or of the press", and it is effective despite (or because of) the fact that it does not attempt to draw a line between that which is protected and that which is not. Yet the protections provided therein are almost as important as the protections against murder.

      So it's entirely possible to say that one is alive as long as his body is alive even though the precise definition of "body is alive" if fuzzy. In other words a fuzzy, but correct definition, is better than a sharp but incorrect one. Therefore, it is completely feasible to say, for example, "If all the major organs are functioning with the help of a respirator, that the brain dead person is alive. If only his left finger was functioning, then he is dead. In between, I'm not sure."

      Again, I agree that the right answer is brain death, but the best argument is unfortunately not one that will convince everyone.

      It is difficult to next to impossible to connect central nervous neurons(brain cells). the last paragraph is science fiction. we can imagine lots of different scenarios, but I don't think that a definition is disallowed because it fails to explain a situation that may never be real.

      I wasn't attempting to argue here for any definition. I was just questioning the certainty of the statement that the brain is the person. Perhaps some later technology will upend that. I agree that this is completely theoretical and has little practical import at this time.

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    3. Certainly, if I was in the same state as Terry Shiavo, I would prefer my wife and family to be released than to have them continue to maintain me in that state.

      Inserting this comment muddles the discussion. One's personal feelings don't enter into this particular part of the debate. If someone who's been badly disfigured decided that he'd rather not continue on, halacha would not consider that a valid position. So, too, from the standpoint of halacha, personal wishes do not trump halacha unless, as a corollary, the halacha takes personal wishes into account.

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  4. Just FYI, the point you make is exactly the same point R Yonasan Eybeshitz made in Kreiti U'Pleiti Yoreh De'ah 40:4 where he argues on the Chacham Tzvi (who is one of the main sources for the poskim who advocate that cardiac death is halachic death at least in part because the soul resides in the heart). The Kreiti U'Pleiti wrote a letter to the medical school in the University of Halle asking what the function of the heart is, and if it would be possible in theory to live without a heart. They answered according to the latest medical science (in 1709) that now that William Harvey identified the function of the heart and the circulatory system, that the heart is just a pump, and at least in theory, if one were to design a pump that pumped blood, that a person could live without a heart. The Kreiti U'Pleiti therefore paskened in the famous controversial case of the "heartless chicken" that it was kosher.

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    1. I never looked at the sources, but I think that you may have this backward. The Chacham Tvi (correctly) assessed as unreliable the testimony of young girl that of the existence of a chicken with no heart. It was clear to him that the heart was obviously there and then lost (possibly eaten by a housecat). Otherwise the chicken could not have lived to begin with. Therefore the chicken was kosher.

      Rav Eybeschutz disagreed that we could be sure that such a thing was impossible. Thus he ruled the chicken to be unkosher as a chicken with no heart would be a Tereifah.

      I did not look inside, so I could be getting this wrong.

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    2. you msystem be right about the peak regarding the Kashrut of the chicken. however, I am certain that it was R Eybeshitz that asked the University about the function of the heart, and how he strongly disagreed with the Chacham Tzvi who quoted from Galen at length regarding the heart being the source of the life of the body. R Eybeshitz said very clearly that the Chacham Tzvi was basing his words on old science which was no longer valid, and that modern science had proven Galen wrong.

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    3. I read the first Teshuvah and it basically says that anyone with a brain in his head knows that the chicken could not live without a heart. He brings a bit of evidence from sources, but that is not where his certainty comes from. I haven't looked at the second one yet where he goes back to provide more ammo. But the point is that is was Chacham Zvi who was willing to go back and read the sources in line with a correct understanding of the facts, even if he was a bit confused on the theory.

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  5. An interesting book discussing questions of the brain, the soul, consciousness, etc is "The Minds I".

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  6. Very similar to an Aryeh Kaplan piece, "If You Were God" (NCSY-OU). Aish Hatorah reprinted the piece here http://www.aish.com/sp/k/48955126.html

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  7. It is important to keep in mind that the Chacham Tzvi was the last major posek involved in this discussion NOT to take into account circulation. His opinions are based on the medical theories of Galen, where the heart is an organ of respiration

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    1. The irony is that the Chacham Tzvi seems to have gotten it right in that case, even if his reasoning was faulty. The chicken in question did have a heart! (now I need to read the sources :)...

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  8. The following is the text of a letter signed by R' Shlomo Zalman Auerbach and R' Yosef Shalom Elyashiv in 1991, cited by Rabbi J. David Bleich in Time of Death in Jewish Law (pg. 177), in which they clearly assert that transplanting the heart of a "brain-dead" patient is MURDER:
    נתבקשנו לגלות דעתינו דעת תורה בענין השתלת הלב או שאר איברים לצורך חולה מסוכן בזמן שלב התורם פועם ומוחו כולל גזע המוח אינו מתפקד כלל הנקרא "מיתת מוח" – דעתינו שאין שום היתר להוציא אף אחד מן איבריו ויש בזה משום שפיכת דמים
    R' David Holzer (The Rav Thinking Aloud) recalls:
    "I once asked the Rav about why halachah insists on preserving life under all circumstances, even if the patient is in a persistent vegetative state and will never regain consciousness. Why are we so intent on keeping a person alive, when he can no longer do or feel anything?
    The Rav responded that we cannot comprehend the neshamah, cannot appreciate what kind of life this person may still be experiencing. Man exists at many levels, and we do not fully understand them all."
    This incredibly brazen post assumes that:
    (1) Chazal did not know when the soul departs from the body (though they claimed they did).
    (2) Science does know when the soul leaves the body (though it doesn't acknowledge the existence of a soul).
    (3) Dr. Slifkin's awareness of medical advances and knowledge of Chazal's limitations exceeds that of great contemporary poskim, who dealt with shailos in these areas on a regular basis.
    I think that Jews who consider themselves Torah-observant should take note of what Dr. Slifkin – a persuasive writer, by all accounts - has revealed about himself here, and carefully consider how much of a role he ought to have in shaping their opinions.

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    1. Just Pointing OutJune 20, 2016 at 6:16 AM

      Shai, I don't think that you would speak that way about R. Slifkin if you knew that he could literally be mechaye meisim. And according to you, he can! After all, Chazal said that if you find a person under a collapsed building and he is not breathing, then his soul has departed. But R. Slifkin would be able to do CPR and bring him back to life!

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    2. You say the letter is about "transplanting the heart of a "brain-dead" patient", but then quote the letter as saying "even if the patient is in a persistent vegetative state and will never regain consciousness".
      Brain dead and persistent vegetative state are NOT the same. The whole point of brain dead is that there is no life being experienced since experience involves brain activity and there is none.

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    3. Why are you and Dr. Slifkin and Dr. Stadlan so sure that the experience of the soul in its body involves brain activity?
      That is the crucial question which Rabbi J.B. Soloveitchik raised.
      The moment that a soul departs from the body would seem to be a clear metaphysical question and not a medical one.

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    4. To Gillian

      The LETTER of R' Auerbach and R' Elyashiv specifically refers to brain-death - "מיתת מוח"

      The REPORTED STATEMENT of Rav Soloveitchik implies that the precise definition of death cannot, in principle, be determined scientifically because it relates to the soul, which we don't fully understand.

      The reason I cited this statement was to point out the fallacy of following scientific criteria to define death, not to demonstrate his position on brain-death per se. Nonetheless, although he was asked about a persistent vegetative state, his reasoning applies to brain-death as well. R' Bleich cites a number of sources who reported that R' Soloveitchik did indeed oppose treating "brain-death" as death.

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    5. As Gillian points out, that anecdote is talking about "persistent vegetative state", not brain death. In addition, that book is a book of informal conversations with the Rav, not a book of P'sak, nor of fully developed positions. Most importantly, there is a halachic dispute here with great Poskim on both sides (and at least one whose opinion is argued over). If the Rav was not on the brain death side (and I don't know if we was or wasn't) that would be just one more name on that side. Finally, there is no way to be "Machmir" since the delaying the declaration of death costs the lives of potential organ recipients every day.

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    6. Also, the problem with the letter cited is that it contains no reasoning. Thus, while it is significant, it it hard to bind anyone to it or to learn anything from it.

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    7. Also, Rabbi Kornreich, to go into "lackey" mode, you undermine your own credibility when you write "Dr. Slifkin", IMO. If you can't bring yourself to write Rabbi Slifkin, you can write an ambiguous R. Slifkin. It can't be any worse than making ambiguous statements in response to religious persecution, which is permitted.

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    8. "The moment that a soul departs from the body would seem to be a clear metaphysical question and not a medical one."

      It's a metaphysical question but it requires a clear understanding of the medical reality, and it can potentially be resolved without recourse to metaphysical reasoning, by isolating the part of the person in which the neshamah resides. For example, kidney transplants show us that the neshamah does not reside in the kidneys.

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    9. I think you'll find some of Rav Moshe Tendler's works informative. For example:
      Responsa of Rav Moshe Feinstein: Translation and Commentary KTAV, 1996. ISBN 0-88125-444-4.

      In it he explains the positions of both Rav Moshe Feinstein and Rav Shlomo Zalman Aurbach.

      It seems that Rav shlomo Zalman Aurbach was chozer from his original position.

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    10. For example, kidney transplants show us that the neshamah does not reside in the kidneys.

      This is a repetition of the search for Aristotelian essence. Suppose I have a round table with 10 legs. If I cut off of a leg, the table still works. I then conclude that the legs are not essential to the table which is obviously wrong. Similarly the fact that I can remove a kidney and still live as "myself" via a kidney replacement doesn't prove that the kidney was not a partial contributor to my "essence".

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    11. How do I know that the soul* leaves upon brain death, not cardiac arrest? Simple.

      1. The "soul" was created by God.
      2. God is omniscient.
      3. God created the "soul" to stay in people while they are alive, and to leave when they are dead.
      4. God knows--and unlike Hazal, always knew**--that a man with an artificial heart is a live person, and that a man with an artificial brain is a dead flesh puppet.
      5. Ergo, God created the "soul" to leave when people actually die, i.e., upon brain death.

      * Shai's remarks about the soul seem to make assumptions about the nature of the soul: that it is a metaphysical or perhaps quasiphysical object, that it is the source of the body's vitalism, and that it operates according to mechanistic rules in a metaphysical universe that is as mechanistic as the physical world. These are the opinions of the mystics. As a rationalist I reject them all.

      **If you find it troubling to suggest that Hazal could have been wrong about scientific matters, consider this. Assume Hazal magically knew about brain death. What would they have done differently? They didn't have EEGs to measure brain function. They had no means of artificial respiration and circulation. All they could do was check for a heartbeat or breathing. If these were absent, there was no way to prevent cardiac death from turning to brain death.

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    12. "4. God knows--and unlike Hazal, always knew**--that a man with an artificial heart is a live person, and that a man with an artificial brain is a dead flesh puppet."

      You are assuming your conclusion without even giving an argument.

      "As a rationalist I reject them all."

      So that's how you're certain that brain death is halachic death. No arguments, no evidence, just an ideological commitment to what you mislabel rationalism.

      The truth is that metaphysics is a field where classical rationalists like the Greek philosophers and the Rambam posit the existence of unchanging beings who influence the physical world and who operate according to mechanistic rules in a metaphysical realm.

      So what you meant to say was, as a materialist, you reject them all.

      This is why people are so sure that the experience of the soul in its body exclusively involves brain activity.

      It is because they are materialists, not rationalists.

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    13. David,

      If you believe in an afterlife where the soul can still experience pleasure and/or pain, then it is perfectly rational to believe that the soul is metaphysical; it is probably irrational to believe that it's physical.

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    14. There were Rishonim that emphatically rejected the Rambam's position that Olam Habah is a non-physical soul existence. They identified it as an (elevated) physical existence of the body after the resurrection of the dead. And that is the plain meaning of the Gemara in Perek Chelek, as the Rambam himself seems to acknowledge.

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    15. Fair enough, if that's the kind of Olam Habah that David believes in. However, it seems to be a pretty common belief amongst rationalists, including R' Slifkin, that Olam Habah is indeed a metaphysical existence, in which case it is perfectly rational to believe in a metaphysical soul. It's surprising to rule out all of these people as mystics.

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    16. "They identified it as an (elevated) physical existence of the body after the resurrection of the dead."

      I think David Ohsie is confusing Olam Habba with the soul's experience immediately after death.
      Everyone agrees there is an non-physical soul existence at some point. Some call it "Gan Eden" and some call it more generically "Olam Habba"

      See how the Ramban in Shaar Hagemul addresses the Rambam's view and how he contrasts it with his own:
      http://www.daat.ac.il/daat/mahshevt/hagmul/6-4.htm

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    17. "You are assuming your conclusion without even giving an argument.

      "As a rationalist I reject them all." [This is out of context. I referred to Shai's beliefs about the soul, not to brain death.

      "So that's how you're certain that brain death is halachic death. No arguments, no evidence, just an ideological commitment... "

      So you're against ideological commitments without evidence? Good to know. But the evidence is in Rabbi Slifkin's original post.

      Stan Larkin is a walking, talking, conscious man with a dead heart. There are no walking, talking, conscious people with dead brains. (Aside from presidential nominees.)

      "... to what you mislabel rationalism. ... So what you meant to say was, as a materialist, you reject them all. This is why people are so sure that the experience of the soul in its body exclusively involves brain activity."

      "The truth is that metaphysics is a field where classical rationalists like the Greek philosophers and the Rambam posit the existence of unchanging beings who influence the physical world and who operate according to mechanistic rules in a metaphysical realm. So what you meant to say was, as a materialist, you reject them all."

      I think you are seeing things very much from your own frame of reference. You assume that just as kabbalist haredim adopt Neoplatonism as revealed theology, rationalists do the same, only for classical Aristotelianism. Well, ancient and medieval philosophers believed lots of things that thinking people dismiss today. For example, they thought the planets were sentient, spiritual, perfect beings.

      I don't really care what label you put on my beliefs. I do care that they are being misstated, though that's partly my own fault: I see now that I wasn't clear.

      I denied that the soul is a "metaphysical or quasiphysical object." The part that I deny isn't "metaphysical" but "OBJECT." By which I mean that, as the soul is PURELY metaphysical, it has no direct interaction with physical being. It is not locatable in the body, subject to examination by science, or controlled by biological processes. The soul leaves by its own internal imperative when the body is dead, not because a biological process, be it brain death or cessation of heartbeat, mechanistically expels it.

      We are told by Hazal that (1) the soul leaves the body when the body is dead, and [allegedly] that (2) the body dies when the heart stops beating. The former is a metaphysical claim, not subject to revision in the light of fact. The latter is a physical claim, which science and experience can and do refute.

      [Of course, according to most poskim who allow organ donation from a brain-dead donor, Hazal did not exclude brain death at all.]

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    18. "But the evidence is in Rabbi Slifkin's original post.
      Stan Larkin is a walking, talking, conscious man with a dead heart. There are no walking, talking, conscious people with dead brains."


      You slipped in "walking, talking" in your argument, which only serves to cloud the question at hand.

      The question (minus the straw man) remains: how do you know there are no conscious people with dead brains?
      (Really the term "conscious" is also inappropriate. People in comas also aren't conscious, but no-one thinks their dead. The better term to use is "experience of the soul in its body".)

      When you arbitrarily choose define the soul at the outset as 1) located in one place in the body, 2) subject to examination by science, 3) leaves the body mechanistically because of a biological process, then of course you can draw your conclusions.
      But what evidence do you have to support all those assumptions?

      (I do think the last assumption has merit, but only because this is what the halacha has indicated. Not because of some a priori intuition.)

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    19. I think David Ohsie is confusing Olam Habba with the soul's experience immediately after death. Everyone agrees there is an non-physical soul existence at some point. Some call it "Gan Eden" and some call it more generically "Olam Habba"

      Incorrect in two aspects. One is that not all maintain the soul is non-physical. From Saadiah Gaon:

      As for the quality of its substance, it is comparable in purity to that of the heavenly spheres. Like the latter, it attains luminosity as result of the light which it receives from God, except that its substance becomes, in consequence hereof, finer that that of the spheres. That is how it came to be endowed with the power of speech.

      [...]

      Now if someone were to remark, "But we never see the soul depart from the body," our reply would be, "That is due to its transparency and to its resemblance to the air in its fineness ...

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    20. Dovid Kornreich: you seem to have misread David's comment. To quote David
      "It is not locatable in the body, subject to examination by science, or controlled by biological processes. The soul leaves by its own internal imperative when the body is dead, not because a biological process, be it brain death or cessation of heartbeat, mechanistically expels it."

      I think David is saying that when a body dies the soul departs. But the departure of the soul does not define death, it is a consequence of death. Thus in a discussion as to when halachik death occurs there is absolutely no need to consider when the soul departs the body.

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    21. "As for the quality of its substance, it is comparable in purity to that of the heavenly spheres. Like the latter, it attains luminosity as result of the light which it receives from God..."

      You have this backwards.

      Saadya Gaon and other medieval thinkers believed that the celestial spheres were spiritual beings. By comparing the soul to the spheres he is calling it spiritual, not material.

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    22. "The question ... remains: how do you know there are no conscious people with dead brains?"

      Because the brain is where the nervous system is controlled, where memories are stored, and where thought happens. We know these things because we can see them happen on a PET scan. You can cause and alter thought by stimulating neurons. You can destroy memories and abilities by killing neurons.

      "(Really the term "conscious" is also inappropriate. People in comas also aren't conscious, but no-one thinks their dead." [sic]

      The same could be said of sleep. But this is just more proof: the difference between sleep, coma, and death is the extent and permanence of the cessation of brain activity.

      "The better term to use is "experience of the soul in its body".)"

      At last we have your vitalist assumption, albeit in the guise of a thesaurus suggestion. So far, the opponents of vitalism are batting 1.000.

      I deny that "the experience of the soul in the body" is synonymous with consciousness [or if you prefer, the experience of the body on earth]. So no, that is not a better term.

      "When you arbitrarily choose define the soul at the outset as 1) located in one place in the body, 2) subject to examination by science, 3) leaves the body mechanistically because of a biological process, then of course you can draw your conclusions.
      But what evidence do you have to support all those assumptions?"

      None whatsoever, which is why I have have explicitly denied these things.

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    23. "David is saying that when a body dies the soul departs. But the departure of the soul does not define death, it is a consequence of death."

      Pretty much, but I would qualify the word "consequence." If I ask you to go to the store when the clock strikes five, is your going to the store a consequence of what the clock does?

      The body and its life and death are physical phenomena, while the soul is metaphysical. And the physical and metaphysical are not directly inter-relatable.

      Location is a quality of the (non-quantum) physical world; its applicability to metaphysical phenomena is metaphorical at best. So the soul is not "in" the body in a physical sense, and it is not driven "in" or "out" of the body by a physical process.

      Unidirectional time as we experience it is also a quality of the physical universe. It is not at all clear what it means to say that a metaphysical event happens at a given time.

      The bottom line is, the soul is driven to do what it does by metaphysical imperatives. These "coincide" with birth, life and death because the Creator "timed" them that way, but there is no physical causal relationship between them.

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    24. @David: I didn't say that the Saadia Gaon says that the soul is not spiritual. (Although that sounds like a tautology. Can a spirit not be spiritual?). I said that he maintains that it is a physical entity. (As opposed to Rambam who thinks it is pure form). Contra R Kornreich who said that "Everyone agrees there is an non-physical soul existence at some point."

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    25. "The body and its life and death are physical phenomena, while the soul is metaphysical. And the physical and metaphysical are not directly inter-relatable.
      Location is a quality of the (non-quantum) physical world; its applicability to metaphysical phenomena is metaphorical at best. So the soul is not "in" the body in a physical sense, and it is not driven "in" or "out" of the body by a physical process."


      The Rishonim I've read all seem to hold of a very direct correspondence between body and soul. Not incidental at all.

      See the Rambam in Moreh Book II chapter one:
      אני אוסיף כאן ביאור. והוא: האדם, דרך משל, אם הניעתו נפשו שהיא צורתו, 18 עד שעלה מן הבית אל העליה, הרי גופו הוא אשר נע באופן עצמי, והנפש היא המניע הראשון באופן עצמי, אלא שהיא נעה במקרה. כי בהעתק הגוף מן הבית לעליה, נעתקה הנפש אשר הייתה בבית ונעשית בעליה. ואם נחה תנועת הנפש, נח אשר נע מחמתה והוא הגוף. ובנוח הגוף, מסתלקת 19 התנועה המקרית שנעשית 20 לנפש.

      And see the Ramban's discussion of the Rambam and other philosophers about the soul/body correspondence here:
      http://www.daat.ac.il/daat/mahshevt/hagmul/4-4.htm
      Specifically paragraphs 37 and 38

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  9. Maybe I'm not logical, but since the soul is non tangible, we may think it resides in the brain, but it IMHO is spiritual. Memories may exist and exit the body in a way we cannot measure or see. Are all of our memories existent after death? If the brain is no longer functioning, how does that work?

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  10. Do you know that you know these things to be true? Or do you just believe that you know these things to be true?
    Do you truly know he doesn't have any traits of the donors heart ??
    aRe you just making some assumptions ??

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  11. http://www.medicaldaily.com/can-organ-transplant-change-recipients-personality-cell-memory-theory-affirms-yes-247498

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    1. That article is a collection of unreliable anecdote.

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    2. The cell memory phenomenon, while still not considered 100 percent scientifically-validated, is still supported by several scientists and physicians.

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    3. This is a perfect example of what happens when web aggregators attempt to write science. Look at the staff on that site. Nobody's a doctor, and the only person with even a background in science is their social media coordinator, for crying out loud.

      The link they provided about cell memory doesn't mean what you think. Cell memory does not mean "my heart cells remember what my heart donor ate for dinner." And it certainly doesn't mean personality traits. It just means that transplanted cells learn how to react to molecules, and they might share that knowledge with their neighbours. Even that is just a hypothesis.

      The rest is, as David Ohsie says, anecdotal baloney. In one study transplant patients were asked to self-report whether they felt different afterward. No serious study would do that because, (a) of course you feel different, you now have a working heart; and (b) no rigorous study operates by suggesting to subjects what it hopes to find.

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    4. Since when anecdotal evidence not good enough for religious people

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    5. Since the scientific revolution :).

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  12. I am not sure the original argument about the personality and soul being in the brain is a good one for "brain death." Mostly because the part of the brain where personality and cognition lie can be dead without the patient being brain dead--the latter depends primarily on the brain stem that controls respiration. Further, if it is cognition and personality that count, you will start finding at least some serious people considering harvesting the organs of people who are walking around with sufficiently advanced Alzheimer's. Someone alluded to the difference between brain death and persistent vegetative state above. Your original argument encourages the confusion by focusing on the cognitive function of the brain, rather than the functions that control respiration and homeostasis.

    While the situation seems very unclear to me, some things are quite clear. One is that no one seriously advocates using, unmodified, talmudic or other premodern standards for declaring death. Anyone who did would have to face the fact that, by those standards, anyone who needs CPR is dead, and an awful lot of EMT's, firemen and others have resurrected the dead. Whether someone today is advocating a circulatory criterion or a respiratory criterion (which is how brain death is usually approached in the halachic literature) words like "irreversible (cessation)" and/or "spontaneous( function)" that would have made no sense before the modern era, have to come in to any modern definition or criterion.

    Another is one really has to be careful not to offer definitions that can be overtaken rapidly by medical progress, so that people dead by your definition are plainly doing things (like playing basketball or giving lectures) that we would all say are clear evidence of being alive. Mr. Larkin is an example; so is Christopher Reeve who walked around for many years with machinery to make it possible for him to breathe.

    I understand the sense, both in halacha and secular ethics, of a more flexible criterion, which is what I think R. Bleich means by his "vital motion", although I can't for the life of me figure out how to define it in a precise way that isn't circular.

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    1. Mike S., you asked the question better than I did. If it is higher brain function, the we shouldn't need to wait for brainstem death (except for the fact that establishing permanent lack of higher brain function seems to be not so simple).

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  13. In the Talmud opinions get thrown out all the time for being inconsistent. Let's imagine that you define life as he presence of a heart. Rav Slifkin's post shows that doesn't work. So maybe it is circulation. You can attach a pump to a body that all agree is dead and still have circulation. So that doesn't work. So maybe it is R Bleich's vital motion. So you take a head off a body and keep both parts functioning. He says that the head is nothing, the body is the human being. But he head talks, thinks, can daven, etc. does that make sense? And now let's take a different body and attach it to the head. According to R Bleich, the head by itself wasn't life, but the combo now is. But who is it? Let's assume the body you attached is a baboon. So there is a human head and a baboon body. Is it s human being? Is it alive? The problem, isn't just being fuzzy, it is that you wind up with results that make no sense.

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    1. Sounds more hairy than fuzzy to me. Or is it a shaved baboon?

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    2. Let's imagine that you define life as he presence of a heart. Rav Slifkin's post shows that doesn't work. So maybe it is circulation. You can attach a pump to a body that all agree is dead and still have circulation.

      Dr Stadlan, you seem to be attempting to define an Aristotelian essence. Again, this is an exercise in line drawing which I've shown (I think) is not essential, inasmuch as some of the most important legal concepts in the world are also fuzzy.

      I'm not defending vital motion (which I don't understand and is probably ill-defined as you suggest). I'm simply saying that it isn't inconsistent to say that an intact body with brain death kept alive on a respirator is still a live person, as hard as it is to draw a line between that and a similar decapitated person. The fact that other criteria can draw a clearer line is not evidence that it is a better line.

      Finally, if we are going into the world of hypotheticals, it is not at all clear why we can exclude the possibility of an artificial brainstem at some point in the future. If we had that, then the line drawing question applies to your position as well.

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    3. I am not insisting on Aristotlian essence. But I doubt that you can come up with a Hakachically justifiable alternative theory of life, identity and species that works. If you can, I will certainly acknowledge. Everything I wrote about has been done either in humans or primates. dr Robert White detached and reattached heads and bodies of monkeys back in the '70's.

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    4. Thank you for the reference to Dr White's experiments. I don't think that anyone has an sharply defined theory of life, identity, and species. But I think that I understand your argument a little better and will respond.

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  14. Although I am not an adherent of 'reincarnation' which is an incorrect translation of גלגולי נשמות you statement above
    "there will most certainly be crucial consequences for the person's identity and soul. If, a hundred years from now, Stan Larkin Junior loses his brain, and has it replaced by that of a donor, then Stan Larkin Junior has ceased to exist"-- opens a window for a critique of the almost global acceptance of so-called 'reincarnation' in Judaism which even though in some Rishonim it is totally denied no one would dare touch this subject.

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  15. The brain can be rewired. For example if memories can be changed or implanted your Identity may be changed. They may implant in your mind that you are somebody else. Then if there is amnesia (induced or otherwise) you don't have an Identity. Regarding the soul - there is no evidence such a thing exists let alone where it resides. It is like asking how many angels reside on the top of a needle.

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    1. It seems to me that the Hebrew words נפש, נשמה, and רוח are used in the תורה to refer to the physical processes that a living being engages in (namely moving and breathing) rather than some sort of mystical external soul. The closest word to soul there is is כבדי, but that is used to refer to the same sort of soul as Dennet and Hofstaedter do, namely a word for the conscious being that you are as opposed to referencing your body. It does not have to be mystical. The mystical soul is I believe a later addition to Judaism.

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    2. @Yavoy - I basically agree with you, and support is found in comparative ancient near east literature. Yet most Orthodox Jews think there is a soul surviving after you die.Some even believe this soul can interact with the living, giving new meaning to the term "SPOOKY ACTION"

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    3. "The mystical soul is I believe a later addition to Judaism."
      If one of the Pharisee-Sadducee points of debate was about the resurrection of the dead, this "later addition" must have been prior to the time of the Mishnah.
      --YehudaP

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    4. Resurrection of the dead doesn't require the sort of soul posited by the Rishonim.

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    5. @David Ohsie: I don't understand your comment. The concept of a soul that remains after one's passing predates the Rishonim. It's clear from the Gemara in Sanhedrin 91 that Hashem restores the soul with the body at resurrection and judges them both. The Sadducees differed with resurrection being derived from the Torah, and whether there is an עולם הבא at all.

      They instituted answering in the Second Temple ברוך ה' מן העולם ועד העולם so as to counter the opinion of the Sadducees (or whoever the מינים are referred to there) who said that there is only one world.

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    6. @Yehudah P.: I don't claim to have great knowledge of what Neshamah meant at Chazal's time. My point is simply that the soul of many of the Rishonim (such as Rambam) that continues a full existence after death in Olam Habah is not described by the Gemara plainly. Rather it describes the body and Neshama separating in some way and then Olam Habah starting at the re-uniting of the body and soul at the Resurrection. Sanhedrin 94a describe the soul floating in the air like a bird after death. Also, not all describe the soul as completely non-physical, like the Rambam. Rabbeinu Bachya (IIRC) describes it as made of a very fine substance.

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  16. The post is confused. The major arguments in favour of cardiac death are not due to the heart being the repository of the soul. Rav Bleich is not concerned with this in all his arguments. So that's just a straw man. The arguments in favour of brain death are also not based on the brain being the seat of the soul, they're based on formal halachic considerations. R Slifkin should perhaps take note of that rather than spew a opinion free of any hint of the relevant sources in Chazal.
    This is a big subject well beyond blog soundbites. Just to point out that even the Rabanut who hold with brain death rarely permit heart transplant since their criteria are not often met. In fact it is reported that R Dr Halperin who was their expert shaliach to certify brain death in a number of cases disagreed with the medical team's diagnosis and considered that the criteria had been inadequately met.
    So it's just not as simple as brain death = death = go harvest the organs, for a collection of reasons.

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    1. Ben, first of all, when you use words like "spew," it doesn't make you look good.
      This is indeed a big subject, and it's one that I covered extensively in the past. And, as I demonstrated at length, there simply aren't any particularly relevant sources in Chazal. The poskim (on both sides) who make inferences from topics such as the sugya in Yoma about a collapsed building are, regrettably, making a mistake. Rav Shlomo Zalman Auerbach explicitly acknowledged his own mistake in this area - see http://www.rationalistjudaism.com/2011/02/rav-shlomo-zalmans-mistake.html. You can't derive the halachos of brain death from Chazal, because in their time, the functioning of different human organs and systems, was indivisible; if one system or basic organ failed, all other systems would fail at approximately the same time. Inasmuch as Hazal were unaware of the possiblity of one system functioning in the absence of other systems functioning, no statements in the Gemara could reveal what they would have regarded as indicating death in such a situation. See http://www.rationalistjudaism.com/2011/02/analogy-vs-inference.html.

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    2. The Chief Rabbinate of Israel paskened that someone who has irreversibly ceased to breathe in the context of devastating brain damage is dead. This definition of death overlaps with brain death. It is a solid and compelling Halachic argument aside from making by far the most sense.

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    3. Can you tell us the halachic basis of the Chief Rabbinate's pesak or where to find it?

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    4. You seem to be saying that Judaism has nothing to say on determination of death since all our sources are outdated. So we need to decide from scratch based on independant reasoning. That approach may be considered 'rational' by many but clearly has nothing to do with Judaism. Since Judaism has nothing useful to contribute here, as you state. You are prepared to suggest, nay encourage, what may halachically well be murder based on explicitly non-halachic reasoning. I think 'spew' remains a reasonable depiction of such a view from a Torah standpoint.
      And no, R Shlomo Zalman's retracting of an opinion does not justify your stance. Did you you think that meant he just ditched halachic reasoning entirely in this issue? Really? Talk about projecting your own opinions.

      Moshe - The Rabbanut in 1986 decided unanimously in favour of brainstem death I believe based on Rav Moshe plus their own deliberations. For R Moshe's opinions see Igros Moshe YD 2, 146 and YD 3 132. Essentially based on the sugya in Yoma 85a and resultant psak of Rambam and SA

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    5. There is an excellent book by Rav Avraham Steinberg - Respiratory Brain Death. Tradition also published the original psak of the chief rabbinate in 1989 I think. Contact me and I can send you lots of references

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    6. "You seem to be saying that Judaism has nothing to say on determination of death since all our sources are outdated."

      That would not be some novel heretical position. Rav Nachman Cohen, former head of the AOJS, once told me that he asked Rav Shlomo Zalman Auerbach about cloning, and Rav Shlomo Zalman said that Torah doesn't say anything about it.

      But in any case, I am not saying that Torah has nothing to say that would help us resolve it. I am saying that you cannot deduce the halachah from a sugya describing a different situation. (There are other Torah principles than can be utilized.)

      The same situation is discussed by Rabbi Ezra Bick regarding cases of donor IVF, with regard to the question of whether it is the egg donor or the birth mother who is halachically considered to be the parent. There is no way to infer it from the Gemara. But there are other Torah principles that can be used to resolve it.

      But if you don't like any of this "spewing," perhaps you can present an argument as how to resolve brain death from the Gemara?

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    7. 'perhaps you can present an argument as how to resolve brain death from the Gemara?'


      I am not a bar hachi. Are you? However R. Moshe Feinstein does precisely that. I heartily recommend reading his responsa.

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  17. OK, so I have a question for the physicians on this thread. Is it possible for the brain stem to be permanently damaged such a way that it can no longer support respiration, but the higher brain function other parts of the brain remains working?

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    1. It's called locked in syndrome. Totally conscious but the only voluntary movement is eye movement.

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    2. Thank you. But doesn't that undermine one of your arguments? For example you wrote:

      Let's imagine that you define life as the presence of a heart. Rav Slifkin's post shows that doesn't work.

      The locked-in syndrome sufferer does not have a working brainstem and must be supported by respirator which acts a (partial) substitute for the brainstem. As as result, they are alive. Thus (by your reasoning above) life cannot be defined by the presence of a working brainstem. However, I believe that the brain death criteria would define that person as alive.

      That would seem to argue for a definition of death whenever the higher brain function ceases (if this could be determined) regardless of the state of brainstem.

      Where I am going wrong?

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    3. You need a working reticular activating system which is part of the brain stem in order to be conscious. So being conscious by definition means that part of the brainstorm is working. You have identified a possible conceptual problem with the identification of death as the irreversible cessation of respiration. How do we Halachically get the brain part in? In fact R Bleich raised these objections against R Moshe Feinstein(which illustrates that R Moshe held cessation of respiration to be the definition of death ). R Steinberg uses a gloss by the Vilna Gaon(I forgot the exact quote but can find it if you wish). I take a much simpler approach which is that consciousness by definition is life. The Gemara in gittin noted that a person whose throat is cut and motions that he is giving his wife a get, it is accepted. So it seems that death is the cessation of brain based spontaneous respiration and brain function ie consciousness. I wrote about it in my chapter in the Koren book in brain death.

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    4. Dr. Stadlan, thank you for the expert explanations. Setting aside the various Gemaras for a moment, I think that this is where the line drawing becomes difficult and perhaps arbitrary. The criteria for brain death leaves an irreversibly unconscious and non-sentient person with spontaneous respiration alive. However, if the brain stem is not functioning to product spontaneous respiration, the person is dead. But this is something that can be replaced with a artificial respirator, just as a heart can be replaced with an artificial one. So if the permanently unconscious person with spontaneous respiration is alive, it becomes unclear why the person on a respirator is not also alive. (I understand that the brain stem does other things that would also have to be compensated for in order to keep the body alive as the length of time increases.)

      Furthermore if the brain stem cannot produce respiration, but the person is conscious (locked-in syndrome), then again the person is alive. So the brain stem's involvement in artificial respiration is shown directly not to be essential to life (if you take the "essence" approach).

      Bottom line is that if someone accepts that an irreversibly unconscious and non-sentient person with spontaneous respiration is alive, then it is unclear why we must say that the same person on an artificial respirator is dead if you use only the "line drawing" or "essence" approach. More later on the other arguments.

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    5. As Rav Tendler says, the issue isn't whether air is going in and out of the lungs, the issue is why the air is going in and out of the lungs. The point being that the brain function responsible for the breathing is the crux of the matter. If that part isn't working, the ventillator, working or not, is irrelevant. The breathing permanently unconscious person is alive because part of his brain is alive and working.
      Winston Chiong wrote a paper on how life can be present of one of a few properties is present. I think he was wrong with the ones he chose, but right on the concept. If any of a certain set of brain functions are present, the person is alive- the set includes any brainstem function and also consciousness.
      Ultimately we come to the question of what quality of the brain is so significant that we attach life and death to it? The answer is that it isn't clear(I suggest that all definitions of life/death reach a point of uncertainty, it is just that brain death is much more precise and accurate than waving your arms and saying it is something about the body- which is what 'vital motion' and integrated function' are.) My own thoughts are that there is something about enough neurons working together that at some point we give it the label of life. If there are enough to produce consciousness, or enough to produce a brainstem reflex or breathing, something observable, then it is enough for life. Obviously that is arbitrary, but I think it is the best we can do and explains pretty much what most of us inherently think. Most people would consider an anencephalic baby alive. most of us would think that a petri dish of neurons is not alive. however, if the petri dish of neurons was capable of some sort of human thought, we might think otherwise. by the way, I also think that there is and should be a sort of chazakah. To prove that someone who started alive is dead, you have to show that pretty much nothing works. To prove that a petri dish of neurons is human life, you have to show that it has a whole lot of function. As noted above, brain centered definitions of life and death are the only ones that provide coherent results of identity etc. Once we accept that, we can have a lot of arguments about what exactly it is about the brain that gives it that status.

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    6. As Rav Tendler says, the issue isn't whether air is going in and out of the lungs, the issue is why the air is going in and out of the lungs.

      I would say that a big part of the issue is not why, but what function is being accomplished. You say that if it is supporting a part of a brain, then it is important. Others say that it if it is supporting everything but a brain, it is still important. I prefer the brain theory, but others can disagree.

      My own thoughts are that there is something about enough neurons working together that at some point we give it the label of life. If there are enough to produce consciousness, or enough to produce a brainstem reflex or breathing, something observable, then it is enough for life. Obviously that is arbitrary, but I think it is the best we can do and explains pretty much what most of us inherently think.

      I agree, but since it is somewhat arbitrary, it is possible to disagree and not really possible to refute those who take a different view.

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    7. Your other argument seems to be as follows:

      1) A person has a singular unsplittable identity.

      2) With today's technology it appears (based on experiments with monkeys and other species) that we can cut person in "half" at the head where the brainstem and above go one direction and the rest goes the other direction and both parts can be kept "alive" (by splicing the head into a new body/blood source) and using an artificial source of respiration.

      3) Since the head by itself would be able to "think", the head/brain must be the person and other part is mere living tissue like a leg that is being kept alive on a machine.

      My counter would be that perhaps a person is not a single unsplittable entity:

      1) Certainly it was assumed in the past that a person was, but just like new technology shows that a failing heart is insufficient to kill a person, so too new technology shows that a person is not unsplittable.

      2) In reality the brain is "splittable" in the sense that it composed of a bunch of working parts that give the "illusion" of a unified self. And if you have a person with split brain syndrome or loses half the brain due to stroke, they can still function. albeit not as well. This suggests, at least, that even the human brain is splittable to some degree.

      3) Your argument depends on the current state of technology. If it ever became possible to split off parts of the brain and keep them alive, you might end up with a real situation where the person has been split into two.

      Again, I agree with the brain death criteria, but I don't think that you can "disprove" the other side.

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    8. The brain is not splittable. That is the key and the point. Without a brain stem the rest of the brain doesn't work and you can't split the brainstem

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    9. and my other point is that we are looking for the best definition of death, not THE definition of death. So unless you can come up with an alternative that makes more sense and works better, brain death wins. Holes can be poked in any definition of death.

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    10. and my other point is that we are looking for the best definition of death, not THE definition of death. So unless you can come up with an alternative that makes more sense and works better, brain death wins. Holes can be poked in any definition of death.

      I think that this is one of the meta-halachic arguments underlying the dispute. On one side you have those (like us) who think that the halacha is under-determined. There is a certain amount of choice in application to new situations. In addition certain Talmudic statements are "inapplicable" because they are based on "old science". So if you can provide a rule which is clear, doesn't contradict precedent, can account for the notion of the identity of the soul, and enables saving of many lives via transplant, then the Rabbanut can get together and decide that this is the proper definition of death.

      The other side believes that the halacha determines everything. In addition, every Talmudic statement is to be given a new application given the current understanding of science which we can assume that they had enough of to confidently make their statements. If there seems to be wiggle room, that just means that you haven't figured it out yet and there is doubt. Thus, if two possible interpretations of death, then we must be "Machmir" and choose the later of the two, since otherwise we may be committing murder as determined on Sinai.

      The other issue is that even if you agree to go with "best", "best" is in the eye of the beholder.

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    11. The brain is not splittable. That is the key and the point. Without a brain stem the rest of the brain doesn't work and you can't split the brainstem

      1) The brain as a whole may not not splittable with a horizontal cut. But the part that thinks (and that we call "identity") is splittable with a vertical cut (or by half of it dying). And the two parts and go on "thinking" independently. From the purely physical PoV, identity is an "illusion" of sorts.

      2) That fact seems to be a contingent reality. It doesn't at all have anything to do with the identity of the person which we equate with thought. It appears to be a fact of the way that plumbing of the brain works. It might be that the it is not technically feasible to split the brain that way and never will be, but basing fundamental notions of identity on that fact leaves room for doubt.

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  18. I hesitate to enter the fray this time since it's been years since I reviewed the primary sources - nor am I a medical professional. However, this emphasis on the brain vs. the heart in terms of defining death seems a bit misguided in terms of the Talmudic definition. The sages of the Talmud appear to have had little notion about the workings of either brain or heart. My reading had suggested that only breathing was the effective criterion. That's why uncovering a person buried on Shabbat in a collapsed building need only proceed until the face or nose was exposed. If breathing could not be detected then nothing further was done on Shabbat since that was considered proof that the person was dead. A biblical phrase "nishmat chayim" was used as a proof text that breathing defined life. In a modern context, that could support the idea that a complete cessation of brain function - including the breathing center was an adequate criterion to determine death notwithstanding the continued autonomous beating of the heart.

    Y. Aharon

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  19. Those who oppose transplanting organs from brain-dead patients on life support should at least consider donating their corneas. These can be removed from cadavers, rendering moot the halakhic definition of death.

    Organ donation would be greatly increased if only those who consented (while healthy) to donate their organs were eligible to receive transplants.

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    1. It would indeed. And forcing people to donate organs at gunpoint would as well, as would creating a free market for organs.

      Unfortunately morality is about more than what just works.

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    2. You're right. Morality is also about behaving consistently, and treating people fairly.

      Yes, ideally everyone who needed an organ would get one. But the reality is, there aren't enough organs to go around. People die every day on waiting lists. Choices must be made. Why shouldn't fairness be part of those choices?

      If you won't donate your organs because you believe it is tantamount to murder, you have no business taking the organs of "murdered" donors.

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    3. If the articles I read are correct, the willingness to donate organs is (officially at least) used in Israel as a tiebreaker after all other criteria are applied and found equal. But the reason is not so much fairness, as the incentive to sign the donor card which is supposed to increase the number of donations.

      I would add it that isn't clear why a free (or at least freer) market in organs might not improve the situation for everyone in certain cases.

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    4. A free market may encourage destitute people to sell their organs.

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    5. A free market may encourage destitute people to sell their organs.

      Correct. And it may also increase the number of available organs and save lives. Life is full of tradeoffs. (Besides the fact that people will sell their organs may or may not be so bad; it's hard to predict a hypothetical future).

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    6. To clarify my point. I was not trying to suggest David's idea was definitely immoral. I was trying to point out that whilst such ideas seem attractive at first sight, we must carefully consider the moral impacts of such ideas before pushing them, and we should carefully explain our reasoning.

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    7. "Organ donation would be greatly increased if only those who consented (while healthy) to donate their organs were eligible to receive transplants."

      Perhaps I'm just free associating, but I think they have a similar arrangement when donating blood--those who donate can ask for some sort of a special privilege if they should ever (G-d Forbid) need blood.

      When the "Knife Intifada" started last Tishrei, they had a blood drive here in Ramot, Jerusalem (which is mostly Charedi). The response was very positive. I don't think the donors were thinking about anything other than the fact that people were getting stabbed almost daily, and they need copious amounts of blood. If the halachah was unequivocal about donating organs after death, I don't think people would need some sort of "incentive" to agree to donate.

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    8. I think there is a great psychological difference between donating blood and donating organs.

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  20. A pop-sci article, but recent and connected to this topic:

    http://blogs.discovermagazine.com/crux/2016/05/10/lessons-from-living-cadavers/

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  21. The debate here seems very similar to the "immediate burial or three days" issue that arouse during the time of RY Emden and M. Mendelsohn. Only in that argument those advocating for change (ie, delayed burial) were basing it on considerations of pikuach nefesh, that someone declared dead might actually be alive. Here, it is exactly the opposite - those opposed to using the proposed brain death standard are concerned that someone declared dead on these standards might actually be alive. So it seems that whether or not that is viewed as a good argument is somewhat fluid. In other words, exactly like any other law in any legal system.

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  22. Although still rather a long way off, what makes you so sure that it wont be possible to replicate and download the information and workings of the brain way off in the future? Also, what's the source for the idea that your soul is linked to your brain?

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    1. I never said that it won't be possible!

      The source for the idea is the process of elimination. We see that it's not linked to any other part of the body, the brain is all that's left.

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    2. Are you willing to stake a life based on the process of elimination? Maybe the soul is not specifically linked to any part of the body? After all the soul is not something that can be measured of identified. Maybe we simply can't know the exact time that the should departs the body.

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    3. Are you willing to sacrifice the lives of all those who die from a lack of donor organs, based on vague speculations?

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    4. But again, the soul is most definitely linked to a specific part of the body. We know that from transplants. You can transplant all the parts of a person (even the brain, though it is not legal), and you can split them among different people. You could add the head as a second head to one person, the heart to another, etc. Where is the person's soul? Obviously it's with the head.
      Or, another way of looking at it: What if a person is born with extra body parts, as often happens? If they have two hearts, we don't say that they are two people. Only if they have two heads, even if there is only one heart.

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    5. But who says that the soul had to be connected to exactly one part. Maybe it connects to any sufficiently human-like composite? Or that a person, like a planarian flatworm, cannot be split into two?

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    6. Also, what's the source for the idea that your soul is linked to your brain?

      Eli - you are correct in saying that there is no way to identify how the soul connects to the body. And that's because there is no way to identify the soul. We don't know what a soul is and we don't really know anything about it. There is no true description of it anywhere.

      That's how Maimonides can all but (if not actually) equate the soul with the mind, while others can vehemently disagree with him -- because it's a big argument about something no one actually knows anything about. The same with the 3rd Temple and what will occur in the times of the Messiah -- there are snippets of information here and there, and layers and layers of midrashic commentary that to, some degree, conflicts with other midrashic commentary, and frankly, none of this debate really matters for how Judaism operates until we need to make these decisions, and we don't need to make these decisions until we are given further information as to how to make these decisions, so we're very safe from all the ramifications of this doubt.

      What constitutes life -- at the beginning and at the end -- we will never know. We can't know, because Moses and even Chazal were not able to be made privy to this information. It would have made no sense to them. Medieval times (and certainly hundreds and thousands of years before Medieval times) was no time to discuss microscopic things that could not be detected nor measured.

      What this really comes to, then, is the body of Judaic law and literature being ill equipped to deal with questions like this. On the one hand, much good can come from transplants. But on the other hand, just because the death of one person can help keep 12 other people alive doesn't give us the right to terminate that one person for the greater good. That's social justice, which is inherently unjust.

      Judaism isn't good at changing with the times. It's difficult because difficult decisions have to be made and no one is bound by the decisions of any one decisor or board of decisors. And Judaism largely remains ossified in the past because the Torah was given thousands of years ago when life was very different. Sure, there is great fluidity in many things, and where there is precedent, tremendous leeway can be derived in many cases. But to suggest that saving lives (the ends) justify the means (murder, according to the definitions which were, necessarily, to some great degree, fixed in time before we knew what we were talking about, is, in my mind, an inappropriate jump. One cannot say that saving lives outweighs murder. And since it appears to hinge upon somehow including the soul in the equation and we don't even know what it is or how it plugs into things, we end up in a big mess, which is where we are right now.

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    7. Only if you assume an independent soul exists, which is not necessary in Judaism, and leads to all sorts of contradictions. Otherwise the soul exists only when consciousness exists, which exists only when the brain is active. Thus the only sensible definition of death is brain death.

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    8. R Slifkin asked:
      "Are you willing to sacrifice the lives of all those who die from a lack of donor organs, based on vague speculations?"

      My answer is very simple, שב ואל תעשה עדיף. There are no clear sources as to when death occurs and the soul leaves the body. We can speculate all we want but the bottom line is that action in these cases may be murder. Therefore, even though the cost is great, it is better to do nothing.

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    9. 1) If you want to say שב ואל תעשה עדיף, fine. But don't pretend that it's only my approach that might lead to the wrongful loss of human life. Yours does, too.

      2) To my mind, the only people doing the vague speculating are those talking about the soul not being linked to a specific organ. I think that there is clear evidence and logical proofs that it is linked to the brain.

      3) It should also be noted that no less than Chasam Sofer suggested that the definition of death should be taken from physicians, even non-Jewish ones. The vast majority of physicians (including frum ones) believe that brain death as death.

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    10. Dr. Rosenbach - Nobody is saying that saving lives justifies murder!

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    11. bluke: If valid poskim look at this and say that it definitely isn't murder, then in following them, you are not committing murder, even if other valid poskim disagree. There isn't doubt. Maximal Shitah compliance can be a Midas Chasidus, but not in a situation where you are costing people their lives. There is no way to be Machmir here.

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    12. @Yavoy: "Only if you assume an independent soul exists, which is not necessary in Judaism, and leads to all sorts of contradictions."

      I asked this above--at what point in history was the idea of an independent soul "introduced" into Judaism? This was not introduced by 16th century Kabbalists, or the Rishonim, but is already explicit in the Gemara (unless I'm reading all the Gemaras incorrectly, which is possible).

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    13. Yehuda P: I imagine that you and I disagree quite strongly on hashkofoh, but there are plenty of orthodox Jewish rabbonim who would agree with me on this point.
      Namely the fact that the Tannaim and Amaroim held of a particular philosophy does not mean that such a belief is required for Judaism.
      Whilst that may sound extreme, there are plenty of examples which are not considered controversial. For example the Tannaim and Amaroim would all have assumed the world was 6000 years old, none of the stories in the Torah are purely allegorical, and that all (except for 8 pesukim) were written by Moshe. Yet in many circles these views are not even considered controversial. Two were also held by many rishonim.

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    14. @Yavoy: But I think there are examples from Tanach as well that Judaism believes in a soul that departs from the body, and continues as a separate entity. [The one that comes to mind first is the story of the witch of En-Dor communicating with Shmuel's spirit. I am sure I can find more examples.]

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    15. Natan Slifkin wrote:
      "2) To my mind, the only people doing the vague speculating are those talking about the soul not being linked to a specific organ. I think that there is clear evidence and logical proofs that it is linked to the brain."

      There are certainly sugyos in Shas indicating that the soul is not linked to any specific organ of the body. Phrases like דם שהנפש יוצא בו an נטילת נשמה when making a wound which draws blood would indicate a soul is linked in some way to blood--which circulates throughout the entire body.

      See also the Tosfos Rid to T.B.Shabbos 122b:
      אי קשיא מ"ש כיבוי הנר כדי לחוס על הפתילה דפטר ר"ש וקרי לי' מלאכה שא"צ לגופה משחיטת הבהמה שקורא אותה מלאכה שהיא צריכה לגופה והלא במקום אחד הוא שוחט לצורך כל הבשר. וה"נ במקום אחד הוא מכבה לצורך כל הפתילה

      תשובה השוחט את הבהמה אע"פ שבמקום הצוואר שחט הנשמה הוא נוטל מכל הגוף והילכך אם צריך לבשר או לעור או לדם הויא מלאכה הצריכה לגופא שלאותו מקום שהוא נוטל הנשמה משם הוא צריך שהנשמה מתפשטת בכל הבשר והעור והדם
      אבל הלהבה שבראש הפתילה אינה מתפשטת בכל הפתילה אלא במקום שהיא דולקת הילכך אם הוא צריך למקום שכיבה דהיינו במקום שהיא דולקת שהי' צריך להבהבה כדאמרן התם בפ' במה מדליקין שהוא עושה פחם הויא לה מלאכה שהיא צריכה לגופה

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    16. You can have an arm attached to a machine with blood circulating in it. Is that an alive human being? You can have a body where every single cell is dead, but have a machine pumping blood in it. is that body alive? these things were not possible prior to modern technology. Circulating blood is linked to life. It just happens to be blood circulating to a functioning brain. blood going anywhere else has no meaning with regard to human life.
      If you want to talk about organs in shas, lets go directly to the sources. R. Schachter brings the concept of 'ever sh'haneshama tiluya ba" in the Arachin. So if you go by that sugya, a liver, all by itself, is a human being- because the soul is bound to to it. If you seperated out a heart and liver, well now there are two neshamot- which means two people. I hope it is clear that in premodern times, losing a heart or a liver meant that everything in the body ceased to function. So that concept of ever sh'haneshama tiluya ba worked under the assumptions of premodern medicine. but they dont work when you dont even need a flesh and blood heart and when you can seperate out all these different organs and keep blood circulating to them and keep them functioning independent of each other.

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    17. The Rambam correctly warns that the words Nefesh and Neshama have multiple meanings. Animals and even plants have "Nefesh" but do not live on after death. Netilas Neshama means "taking a life", not "removing the soul from the body". דם שהנפש יוצא בו just means the blood loss that kills the animal. All Tosafos Rid is saying is that when you kill the animal it has an effect on the whole animal because the entire animal dies so the animal is Gufa of the Melacha, but when you put out a candle, it does not have an effect on the whole wick so it cannot be Gufa of the Melacha.

      In fact you can make good trivia question out of this.

      Q: Is there any traditional Jewish authority who says that the Neshama dies with the body of the person.

      A: The Rambam! (See below)


      ח. נפש כל בשר היא צורתו שנתן לו האל והדעת היתרה המצויה בנפשו של אדם היא צורת האדם השלם בדעתו ועל צורה זו נאמר בתורה נעשה אדם בצלמנו כדמותנו כלומר שתהיה לו צורה היודעת ומשגת הדעות שאין להם גולם כמו המלאכים שהם צורה בלא גולם עד שידמה להן ואינו אומר על צורה זו הניכרת לעינים שהיא הפה והחוטם והלסתות ושאר רושם הגוף שזו תואר שמה ואינה הנפש המצויה לכל נפש חיה שבה אוכל ושותה ומוליד ומרגיש ומהרהר אלא הדעה שהיא צורת הנפש ובצורת הנפש הכתוב מדבר בצלמנו כדמותנו ופעמים רבות תקרא זאת הצורה נפש ורוח ולפיכך צריך להזהר בשמותן שלא יטעה אדם בהן וכל שם ושם ילמד מענינו:

      ט. אין צורת הנפש הזאת מחוברת מן היסודות כדי שתפרד להם ואינה מכח הנשמה עד שתהא צריכה לנשמה כמו שהנשמה צריכה לגוף אלא מאת ה' מן השמים היא לפיכך כשיפרד הגולם שהוא מחובר מן היסודות ותאבד הנשמה מפני שאינה מצויה אלא עם הגוף וצריכה לגוף בכל מעשיה לא תכרת הצורה הזאת לפי שאינה צריכה לנשמה במעשיה אלא יודעת ומשגת הדעות הפרודות מן הגולמים ויודעת בורא הכל ועומדת לעולם ולעולמי עולמים הוא שאמר שלמה בחכמתו וישוב העפר על הארץ כשהיה והרוח תשוב אל האלהים אשר נתנה:

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    18. I don't think this comment got through the first time so I'm reposting. If it went through already, ignore.


      Pardon me Dr. Noam and David Ohsie, but Rabbi Slifkin posed a challenge, criticizing his opponents for merely speculating that the soul is not link to any specific organ.
      Someone then responds by showing this assertion is not based on speculation but what appears to be explicit sources and inferences.

      I think it behooves Rabbi Slifkin to either acknowledge that his criticism was unfounded or try to explain away the sources mentioned.

      But lackeys coming to the defense of Rabbi Slifkin by bringing up non-sequitirs, mentioning and critiquing other people's approaches, or eliding the very specific wording chosen by the Tosfos Rid seems to be an evasion the response that was given.

      Rabbi Slifkin has shown to be quite capable of responding directly to people's comments on this very thread.
      I'm sure he is capable of doing so again.

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    19. It looks like we have a new strategy for delegitimizing rationalists: referring to them disparagingly as being Rabbi Slifkin's "lackeys"!

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    20. This comment has been removed by the author.

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    21. I caught some typographical errors in my comment, so I'm resubmitting it:
      Rabbi Slifkin wrote:"Where is the person's soul? Obviously it's with the head."
      Even though I am usually reluctant to quote Chassidic sources here (since this is a Rationalist blog and what a non-rationalist says may not be considered significant): In Tanya, it states that there are two souls: the G-dly soul and the animalistic soul. (Other sources in Chabad philosophy posit a third soul, the נפש השכלית, that mediates between the other two souls.) Likkutei Amarim Chapter 9 says that the G-dly soul resides principally in the brain, whereas the animalistic soul resides principally in the left ventricle of the heart, which is "full of blood", and הדם הוא הנפש.

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    22. Yehudah P, not sure why you removed your comment, but I think it is fine to Chassidic sources.

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    23. Rabbi Kornreich, (setting aside your demands and ad hominem arguments), the Tosafos Rid's point is complete sensible even if he thought, like Saadia Gaon, that the heart is the seat of the soul. You cite the language:

      אע"פ שבמקום הצוואר שחט הנשמה הוא נוטל מכל הגוף והילכך אם צריך לבשר או לעור או לדם הויא מלאכה הצריכה לגופא שלאותו מקום שהוא נוטל הנשמה משם הוא צריך שהנשמה מתפשטת בכל הבשר והעור והדם

      Saadia Gaon could agree 100% with this. When he says "neshama" all that he has to mean is that the life (neshama) present in the blood/skin/flesh is extinguished when the animal is slaughtered. In addition, a cow doesn't have a "soul" that lives on after the body dies, so I don't see how this can possibly prove your point. Soul/Nefesh/Neshama are equivocal terms, as the Rambam and lots of Rishonim point out.

      Dr. Stadlan's argument also is applicable. If the soul is in the blood, that would imply that my blood donation must be treated as a person and not discarded which would result in the death of the cells contained inside. This would be an very odd result.

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    24. Here is Saadia Gaon, he actually supports the notion that the seat of the soul is the brain in a roundabout way:

      "So far as the human soul is concerned, it seat is in the heart, since it is definitely known that the nerves [he did not distinguish veins and nerves] which endow the body with the powers of sensation and motion, all have their roots in the heart. I do indeed find that the great ramification of nerves to not issue from the heart, but originate rather from the brain. However, these ramifications have no connection with the soul as such. They are merely sinews and ligaments of the body. That is why Scripture invariably mentions the heart and soul together."

      If you fix this up with modern biology, you get the brain as the seat of the soul.

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    25. Dear R. Kornreich. I am not sure why you feel the need to refer to me or anyone else as a 'lackey'. The fact is that we rebutted your statements. Rather than deal with them, the way discussions usually transpire, you resort to insults. Not very menchlich if you ask me. R. Slifkin is a busy person, and I would not blame him for not wasting further time on you. However, I would be remiss in not pointing out a fundamental flaw in your understanding of the sources you provide. They are based on a premodern assumptions. It used to be that when blood poured out of a wound and could not be stopped, the entire body also ceased to function. So it wasn't necessary to identify what exactly was the key to life- or the home of the soul, if you will. Every part of the body ceased to function(died) at the same time. With that assumption, a massive loss of blood meant that everything died, including whatever part was the home of the soul. Now, when everything can be preserved independently or combined with parts from other people, the assumption is wrong. massive blood loss means- massive blood loss. So the gemara is accurate only with the (now mistaken) assumption. So Rav Slifkin doesn't need to rebut anything. the assumption is false. We need to try to figure out what Chazal meant with that statement, but certainly at this point in time it doesn't mean what you claim it does.

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    26. Dr. Stadlan said, " So the gemara is accurate only with the (now mistaken) assumption."
      I'm not so sure "mistaken"--there is the דין of דם תבוסה--if a person bled a lot, until the point that he bled to death, the collected blood is מטמא מדרבנן, because there is an admixture of דם הנפש (at the point at which the person passed away) and the bleeding prior to his passing. They clearly distinguish between דם הנפש and other bleeding. (It's not as absurd as R. David Ohsie presents it, that every blood donation is like the original person.)

      I want to throw out this question: I learned with a fellow in yeshiva, who had a degree in medicine. He said that he studied forensics: there are ways of killing a person and disposing of the body that there is no way to trace the murder anymore. He gave an example of dissolving a body in a bathtub of nitric acid. Once the body has dissolved, you can destroy the evidence by emptying out the bathtub. If there is absolutely no trace of a body anymore--just individual molecules--does the rationalist approach obligate that there is no soul left either? (I'm just not sure what some people are arguing here anymore.)

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    27. Interesting. So how much blood does there have to be in order to qualify? What if he bleed a huge amount but was transfused and so is still alive? It seems that the blood is only metameh because the person is dead and not exactly due to the amount. I will have to look it up. With regard to the second question- it is clear that the body returns to the earth and soul returns to its Maker. Death is the seperation of the soul from the body. So when the body dissolves, the soul remains eternal and does what all other souls do when the body attached to them is no longer alive.

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    28. Oh well, I guess there is no way to avoid these diversions.

      David Ohsie:
      I did not quote Rav Saadia Gaon. I quoted the Tosfos Rid.
      You can speculate that the Tosfos Rid could accept Rav Saadia's idea or visa-versa when "all he has to mean is..."
      But this does not change the fact that the precise formulation of the Tosfos Rid reveals where he believed the is located and where it departs from. It certainly lends basis to the view that death should be defined as the soul's departure from the body as a whole and not merely from one organ or another.
      Rabbi Slifkin claimed there is no basis. The Tosfos Rid, as read plainly and without your added layers of conjecture and speculation, does provide basis.

      To Dr. Noam:
      I think that in general, there is some confusion going on here regarding the question of what causes the soul to depart from the body on the one hand, and where it departs from on the other-- which is causing people to talk past each other.

      I am NOT using this Tosfos Rid to deduce what causes the soul to depart from the body. I am not saying there must be a massive loss of "vital life-sustaining blood" in order to make the soul depart from the body. (It doesn't matter whose blood it is.)
      I am open to the possibility of deducing from various sugyos in Shas that the soul departs with brain death alone.

      I am only deducing one thing: Contra Rabbbi Slifkin, there are certainly sources which understand the soul to be ubiquitous throughout the body and not located in one specific organ. These sources would lend support to the conclusion that the loss of any isolated organ function --that doesn't fatally impact the entire body-- will NOT by definition mark the soul's departure.
      Nothing you wrote about what makes (or doesn't make) the soul depart has rebutted anything I said. You are interjecting your argument where it clearly doesn't belong --seemingly just because you saw someone who may have a source that upends Rabbi Slifkin's main assertion.
      That is not "menchlich".

      Again: Rabbi Slifkin's approach seems to be built on the assertion that the soul is located in one specific organ--namely the brain--and draws his conclusion that a cessation of brain function signals the departure of the soul.
      When Rabbi Slifkin was challenged that his assertion is mere speculation, he counter-charged that those who assert the soul is not linked to a specific organ are similarly speculating.

      The response is that this is not mere speculation. The wording of the Tosfos Rid reveals his understanding that the soul is present in the entire body. There are other sources in Chazal that also indicate this, but the Tosfos Rid is the sharpest in his formulation.

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    29. @Yehuda P.: I believe that you are correct. Dam Hanefesh just means that blood that leaves the body around the time of death (and presumably "caused" the death due to blood loss). But that also means that the soul doesn't inhere in the blood.

      My argument about donated blood being life was a reductio ad absurdum to Rabbi Kornreich's interpretation.

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    30. You can speculate that the Tosfos Rid could accept Rav Saadia's idea or visa-versa when "all he has to mean is..."
      But this does not change the fact that the precise formulation of the Tosfos Rid reveals where he believed the is located and where it departs from.


      R. Kornreich, you keep repeating yourself without actually addressing the objections. You are trying to prove that Tosafos Rid had a certain theory of body-soul and you do this by repeating your interpretation of his words. But you never deal with alternative interpretations, nor with the implications of what you are saying.

      1) Neshama in his statement can simply mean life. Especially as a cow does not in fact possess a human-like soul. Thus drawing blood from the neck kills the entire animal. And the Rambam actually interprets the word that way (not that Tosafos Rid has to agree with Rambam, but that is a completely plausible interpretation).

      2) He is stating a halachic interpretation. The importance of his emphasis that the Neshama is spread throughout the body is to explain why it is that killing an animal is not Melacha SheEinah Tzreichah LeGufa. It is sufficient to his point that Neshama mean life. Thus schechting in the neck kills the arm and now the arm can be eaten. There is no need to assume that he is making any non-halachic statements in this context.

      3) Along with #2, it seems doubtful that he would make his halachic interpretation depend on a non-halachic principle that many would argue with (and did argue with). This again makes it much more plausible that he simply meant "life".

      4) If you take your interpretation seriously, then you get the absurd result that a bag of refrigerated blood or a single organ kept alive via artificial means must be treated like a live person. No one seems to even consider this position.

      I didn't bring Saadiah Gaon to disprove your interpretation of Tosafos Rid. I brought him because it was relevant to the larger question. I also said that Saadiah Gaon could agree with everything Tosafos Rid wrote because the principle makes perfect sense even if the seat of the soul is the heard (or the brain).

      If you want to prove that the Tosafos Rid actually believe what you claim he believed, you need to show why other interpretations which leave him not making any claims about the seat of the soul are incorrect, and not just repeat that it clear that is what he held.

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    31. Nothing you wrote about what makes (or doesn't make) the soul depart has rebutted anything I said. You are interjecting your argument where it clearly doesn't belong --seemingly just because you saw someone who may have a source that upends Rabbi Slifkin's main assertion.
      That is not "menchlich".


      I shouldn't bother with this, but you've redefined "not menchlich" to be anyone who provides an argument that you don't like. This is quite odd.

      Also, I didn't argue with you because you try to argue with R. Slifkin. I argue because your proof is weak to non-existent. Scroll up to the fifth response in this thread for proof of that fact.

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    32. Dr. Stadlan said: "Interesting. So how much blood does there have to be in order to qualify?"
      Chazal gave the shiur of דם הנפש to be a revi'is--which is the amount of blood in a newborn, so it's the minimum to sustain human life. Less than a revi'is is not מטמא.

      Dr. Stadlan: "What if he bleed a huge amount but was transfused and so is still alive? It seems that the blood is only metameh because the person is dead and not exactly due to the amount. "

      I once heard that Keith Richards of the Rolling Stones had taken such a huge quantity of drugs that they had to give him enough transfusions to dilute the toxicity--to essentially recycle all his blood (I don't know the quantity, or even if the story is true.). Clearly a person undergoing such a procedure is the same person after this massive transfusion as before.

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    33. I also shouldn't bother with this, but..

      1) I wasn't referring to you response as not exhibiting menschlichkeit. I was referring specifically to Dr. Noam. Stop being his lackey too.

      2) In case you didn't read what I wrote, it lacked menschlichkeit because he inserted a complete non-sequitir to refute a point that I never even raised, let alone never raised with him.
      If he had figured a way to read the Tosfos Rid differently like you tried to, then it at least would have related to what I said. Instead, he just took off about how blood running through organs cannot be considered the definition of life, etc.

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    34. it lacked menschlichkeit because he inserted a complete non-sequitir to refute a point that I never even raised

      Exactly what I said: you've redefined "not menschlich" to be anyone who provides an argument that you don't like. This is quite odd.

      Anyhow, his argument is perfectly relevant for the reasons that I mentioned in my comment.

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  23. Some people are suggesting that if halochoh cannot clarify halachic death then we must be machmir.

    Can I have people's thoughts on the following alternate suggestion:

    Halacha is defined according only to how it is brought down in halochoh/mesorah. Thus if there are no sources for defining halachic death then halachic death doesn't exist. It is meaningless. It will only become defined once klal yisroel is noheg a specific way, creating a new mesora. Thus it would be most sensible to pasken lekulah as that will save lives and it is impossible to be over on murder since halachic death is undefined.

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  24. 1. Interestingly a new Rabbi Avigdor Miller version of Chovos Halevavos is entitled "Duties of the Mind"!
    (https://www.amazon.com/Ohr-Avigdor-Duties-Mind-1/dp/B002BA2HEY/189-5835663-4696528?ie=UTF8&*Version*=1&*entries*=0)
    2. Check out "Mind & Cosmos" by Thomas Nagel. It is a significant and best-selling book countering Science's materialist/reductionist explanation of the human soul and consciousness.

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    Replies
    1. Personally, I think that it makes much more sense to avoid changing the name and then includes notes about what Rabbeinu Bachya probably thought about the seat of thought.

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  25. It is worthwhile to read the official guidelines from the American Academy of Neurology regarding diagnosis of brain death.

    https://www.aan.com/Guidelines/home/GetGuidelineContent/433

    Note in particular the procedures to show the absence of a breathing drive. This is entirely consistent with the mainstream position in rabbinic Judaism that used lack of breathing as a definition of halachic death. If these procedures are followed we should have no problem accepting brain death as halachic death.

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