Bioethics: Abortion and Jewish Law (1 of 4).

The case of abortion primarily discussed by the Talmud refers to what we call today “therapeutic abortion”, i.e., when the life of the pregnant mother is in danger, and the doctors estimate that the only way to save her life is by taking out/killing the unborn baby. Independently of how Jewish Law considers the status of an unborn baby–we will analyze that later on–in this case, the early Talmudic sources (Mishna Aholot, 7:6, written ca.200 CE) already established unequivocally that if necessary, the unborn baby should be sacrificed in order to save the mother’s life. The Mishna understand that this is a case of rodef (“chaser”, a potential killer) and therefore the principle of “self defense” is applied: If A is attacked by B, if necessary, A can kill B to save his life (habba lehorgekha, hashkem lehorgo, Sanhedrin 72a). The baby, ironically, is viewed as an “involuntary” rodef.

The Talmud analyzes the Mishna’s statement and asks what happens when the baby is actually at the very process of birth. Should we still apply the same criteria of self defense and allow to sacrifice the life of the baby to save the life of the mother? After all, in this extremely difficult situation, the mother is also a rodef toward the unborn baby! The answer of the rabbis, in very simple terms, is that before the baby is born, the life of the mother has priority, because the life of the baby is still a ‘potential life’. But once the baby is born, i.e. when at least the head and /or the majority of the body is already outside, his life could not be sacrificed, and both mother and baby are in an equal situation. The doctors should try their best to save both lives.

(Adapted from penine halakha, Rabbi E. Melamed, liqutim B, page 241-242).

JEWISH CREATIVITY AT ITS BEST 🙂

Jacob meets Esav… and a surprising alternative ending

Organ donation cards

In the previous weeks (see here), I explained the opinions of the Rabbis regarding living organ donation, and the differences on opinion over the determination of the moment of death, which affects the Rabbis’ ruling on cadaveric organ donation.

In our days, the willingness to donate one’s organs is stated in the driver license or in a card that one carries in his or her wallet. The practical question we will address today is, what is the best way to declare that one wishes to donate his or her organs.

In my opinion, the best recommendation (and what I have personally done) for a Jewish person who wishes to donate his organs, is to register in the Halachic Organ Donor Society, and to carry their card in his wallet.

The advantages of this card, compared to the general statement written in the driver license, is that the HODS card specifies the following points:

1. Organs should be removed only if they are to be transplanted, not for research or experimentation. Due to the importance Judaism gives to the integrity of the body at the time of burial, only the possibility to save a life outweighs those concerns.

2. To insure that medical care is not compromised in most sensitive moments, the HODS card specifies that:“Transplants may commence only after a medical team, that is independent of the attending physicians and that is unaware that I am a potential organ donor, determines death ….”

3. It also indicates that the body damage should be minimized: “All medical procedures must be done with proper respect, and minimum damage, to the cadaver.” To this effect, consultations will be made with a family-appointed rabbi.

4. Finally, it gives the carrier the option to choose between one of the two major Halakhic opinions prevalent on determination of death: a. Irreversible termination of breathing activity, for those who follow the more stringent rabbinic opinion, or b. Irreversible brain stem death, for those who follow the Chief Rabbinate of Israel’s opinion.

Each person should consult with his or her Rabbi to make a final decision on this delicate issue.

For those who wish to register as potential Halakhic organ donors, see here .

For Israel, see here.

May Hashem bless all of us with good health and a long life!

*For Israel see here

Organ donation: the heart or the brain?

As we explained last week, the issue of cadaveric organ donation in Jewish Law depends directly on the criteria applied to define death. First of all, as we said, there is a practical issue. Vital organs like the heart cannot be removed for transplant unless the heart is beating. And according to certain Rabbinical criteria, while the heart is beating, the patient is still alive, even if he is brain dead (see for example here). The Biblical source for this opinion is that when man was created the Torah describes that God insufflated in Adam’s innert earthly body a “breathing of life” (nishmat chayim), which indicates that life is determined by breathing.

Because of the complexity of this issue and its repercussions in Israeli society (hospitals, army, etc.), the Chief rabbinate of Israel issued a ruling a few years ago, indicating that in their opinion irreversible brain-death should be considered death, even if the patient is still attached to a ventilator, and his heart is still active. They explained that although there seem to us that the patient is still breathing, once the brain-stem death is determined, the control-center of autonomous breathing is irreversibly deactivated and it has lost forever its control over the heart. They based their opinion on the same source in Bereshit: life is “breathing”, meaning: autonomous breathing, i.e. the capacity to breathe. A patient with a dead brain who still breathes is not really ‘breathing’. It is as if a decapitated body would be, somehow, connected to a ventilator: the heart would still beat because the hearth is an autonomous muscle and it could be kept functioning “mechanically” even when it is not controlled anymore by the brain-stem. But, since there is no possibility for an autonomous breathing anymore, the patient is considered dead and under certain conditions, his organs might be removed for transplant.

(to be continued…)

Organ Donation: the definition of death.

Last week we explained organ donation. We started from the situation in which the donor is alive. This type of organ donation includes bone marrow, blood transfusion and kidney transplant (see here ).

The most common form of organ donation, however, and the most controversial one is the cadaveric organ donation, i.e. donating the organs after one’s death. This is the organ donation which is alluded to in the driver licenses where one authorizes or not to remove his organs for donation.

As we previously explained there is a wide consensus among rabbis about the permission to donate an organ or a segment of an organ while the donor is alive, especially since in our days the risks for the donors have diminished dramatically.

But with cadaveric donation there is a crucial point, which needs to be defined. That is: the definition of “death”. Let me explain: some organs, like the heart for example, cannot be transplanted after they stops functioning. The heart must be removed from the body of the donor while it is still beating.

Up to the 1970s, this operation was impossible because irreversible cardiopulmonary failure was the only standard for determining death. But, later on, scientists developed ventilators and respirators which would maintain the breathing, avoiding the heart from stoping. In a situation known as ‘irreversible stem brain death’, the brain might completely stop its activity, while the patient is still breathing and his heart still beating. The question is: is this patient considered dead because his brain is dead, or is he considered to be still alive, because his heart is still functioning?

The answer to this question would determine the Halakhic status of after life organ donation.

(to be continued…)

Shabbat Shalom!

Understanding brain death, an educational video by HODS

For a comprehensive analysis of all the Rabbinical opinions on this matter and for one of the best available resources about organ donation in Jewish Law, visit: www.hods.org

Organ Donation in Jewish Law

In today’s Halakha we will focus exclusively on living donors. The cases under this category are, for example, kidney donation; bone marrow and blood donation.

It is a consensus among modern orthodox rabbis that one should be willing to undergo a minor risk in order to save someone else’s life.

In the past, many rabbis, among them Rabbi Yitzchak Weiss and Rabbi Eliezer Yehuda Waldenberg z'”l, had certain reservations about the permission to donate a kidney, because they thought that although a person can have a normal life with one kidney, the risks involved for the living donor, during and after surgery, were too high and would endanger his life.

In our days, however, donors are carefully screened physically and psychologically, and the surgical and post-surgical risks of complications for the donor have diminished dramatically, thanks to the advances of modern medicine. Today it is consented by most (if not all!) Modern Orthodox rabbis thatdonating a kidney is at least permitted, if not mandatory. Nevertheless, one may never obligate or coerce someone else to donate an organ, even to save the life of another person.

In his rabbinical response Rabbi Obadia Yosef evaluates the objections of Rabbi Weiss and Rabbi Waldenberg, and asserts that since today the risks involved in kidney donation are so low, it is considered a great Mitzvah to donate a kidney, fulfilling the commandment of saving a life, (piquach nefesh). Donating a kidney to save a life, he suggests, might be also required by the Tora’s commandment “lo ta’amod al dam re’ekha“, “You shall not stand still while your fellowman bleeds to death (i.e. is dying)” .

To understand the impact of this great Mitzva, let us keep in mind that a typical patient who receives a kidney, will live 10 to 15 years longer with a kidney transplant than if kept on dialysis.

(to be continued…)

For a comprehensive and reliable source of information about Jewish Law and organ transplant see Halachic Organ Donors Society