The Noble Sacrifice of Lesser Life

A completely different path to legitimizing organ donation

The following is extracted from my book Rationalism vs. Mysticism, available online here.

In general, discussions about organ donation rest upon whether brain death is rated halachically as death. But aside from the powerful arguments in favor of this, there there may also be a very different halachic mechanism which can be used either in conjunction with the aforementioned arguments, or as stand-alone approach for someone willing to become an organ donor in the eventuality of his becoming brain-dead. In such a case, even if brain-death is not considered to be death, and all the more so if it is of uncertain status, several contemporary rabbinic scholars have argued that there is a halachic option of “noble sacrifice.”[1]

Ordinarily, halachah absolutely prohibits saving one person’s life at the expense of the life of another person: “Who says that this person’s blood is redder?” We cannot judge whose life is more valuable. R. Yisrael Lipschitz, however, permits it if the person being sacrificed is already in the process of dying.[2] He argues that one can sacrifice a person’s chayey sha’ah, temporary life, for the chayey olam, full life, of another person. Similarly, there are authorities who state that one is permitted to hand over a terefah (someone with a mortal injury) to be killed, in order to save the lives of healthy people.[3]

Admittedly, this is a far-reaching view, not generally followed by mainstream halakhah. But even if we reject it regarding the cases mentioned above, we might accept this reasoning regarding the case of brain-death. First, the life of a brain-dead person, even if it is considered to be human life, is much less of a human life than that of a chayey sha’ah, a terefah, or even a goses. The reason usually advanced as to why even a few moments of a suffering or dying person’s life are precious is that “a single moment of repentance and good deeds in this world is worth more than all the life of the World-to-Come.”[4] But the brain-dead person is not even capable of a single moment of repentance and good deeds—he cannot take any actions, speak any words, or think any thoughts. His life is certainly worth less than the lives of those waiting for his organs, by any measure.

Even more pertinent is another difference with organ donation. There is a distinction drawn by many classical authorities between taking someone else’s life and volunteering one’s own life. This is based upon the Talmud itself, which records how the Roman authorities once threatened the entire Jewish community of Lod with annihilation if they did not hand over the murderers of the emperor’s daughter. Normally, halachah does not permit the community to choose someone to hand over; yet when Papus and Lulianus chose to sacrifice themselves in order to save the others, they were praised for their martyrdom.[5] This shows that we have more autonomy over our own lives than we do over the lives of others. A person voluntarily signing an organ donor card indicating his or her desire to donate organs upon brain death would be similarly praiseworthy.

A person is never obligated to sacrifice his own life in order to save that of another; as Rabbi Akiva famously ruled, if there are two travelers in the desert and only one of them has sufficient water to survive, he is not obligated to give it to the other person. But may a person choose to do so? May a person choose to sacrifice his life in order to save the life of another person? This is a matter of dispute between halachic authorities. Some, such as R. Moshe Feinstein,[6] forbid it; others, such as R. Chaim b. Moshe Attar (the Ohr HaChaim HaKadosh),[7] permit it; and some, such as R. Yechiel Yaakov Weinberg,[8] not only permit it but also consider it praiseworthy. Those in the latter two categories would surely also permit someone to donate his organs in order to save lives in the eventuality of his suffering brain-death.

Choosing to sacrifice oneself in order to save the lives of others is also encouraged by some authorities in cases where the other person’s life is more valuable. R. Yehudah HaChassid states that it is praiseworthy for an am ha’aretz to choose to sacrifice his life in order to save the life of a Torah scholar who is needed by the community.[9]

Thus, we have authorities who permit taking the life of a dying person in order to save the life of a healthy person, even against his will; and we have authorities who permit a healthy person to voluntarily sacrifice his life in order to save another. And so in a case where both factors are present—a dying person voluntarily sacrifices his quasi-life of no human consciousness—there are vastly more grounds for permitting and even encouraging it.[10]

Even with regard to those who forbid the traveler to give his water to the other person, the case of organ donation is vastly different. The traveler would be sacrificing a regular life of inestimable value. But in the case of organ donation, it is a matter of one person choosing to sacrifice a few days of a brain-dead state, during which he will not take any actions, speak any words, or think any thoughts, in order to save the lives of several people who will, as a result, lead full lives. Even if one were to consider this to be the sacrifice of a life, it is barely human life, and there is thus a firm basis to judge it to be an appropriate and praiseworthy act of self-sacrifice.

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[1] Rabbi Yehudah Dik, “Terumat Eivarim Mi-Goses LeHatzalat Chayey Adam,” Assia vol. 53-54 (Elul 5754/ August 1994) pp. 48-58; Rabbi Naftali Bar-Ilan, “BeInyan Mi SheTorem Lev O Kaveid LeHashtalah,” Assia 47-48 (Kislev 5750), pp. 131-141; “Terumat Lev HeHashtalah,” Assia 83-84 (5769) pp. 108-118; Rabbi Dr. Michoel Avraham, “Terumat Evarim,” in Techumin (5769) 29 pp. 329-339; Rabbi Shmuel Eliyahu, Chief Rabbi of Tzfat, at the HODS Rabbis & Physicians Seminar, Albert Einstein College of Medicine (video available at HODS.org). For an analysis of the philosophical framework behind such determinations, see Rabbi Dr. David Shatz, “As Thyself: The Limits of Altruism in Jewish Ethics” and “Concepts of Autonomy in Jewish Medical Ethics,” in Jewish Thought in Dialogue (Brighton, MA: Academic Studies Press 2009) pp. 326-384.

[2] Tiferes Yisrael to Mishnah Yoma 8:6.

[3] Me’iri, Sanhedrin 72a, and Minchas Chinuch, no. 296.

[4] Mishnah, Avos 4:17.

[5] Ta’anis 18b; Pesachim 50a.

[6] Igros Moshe, Yoreh De’ah II:174:4.

[7] Rishon Letziyon (Istanbul 1750), Yoreh De’ah 247:1 (p. 103a). For further sources, see the articles cited above.

[8] Seridei Aish II:34, comments 12 and 17.

[9] Sefer Chassidim 698.

[10] The question of how, even if it is permissible for a person to sacrifice his life in this case, the doctor is permitted to take his life, is addressed by Rabbi Dr. Michoel Avraham, “Terumat Evarim,” in Techumin (5769) 29 pp. 329-339.