Book Launch
Defining the Moment: Understanding Brain Death in Halakhah
Rabbi David Shabtai, MD will be launching his new book with a lecture for the Medical Ethics Society of Yeshiva University at The Seforim Sale, this Sunday, February 19th, at 7pm (Belfer Hall, room 218). Learn more about the book at www.DefiningTheMoment.com or purchase it directly at Amazon.
To celebrate the book’s debut, the book is being offered at a 15% discount at the Seforim Sale and in the Glueck Beit Midrash of YU available after the lecture. The book is always available at Amazon.
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R. Gil, in any given debate you will have dishonest people on both ends of the rope.
I am always eager to learn new things, and I appreciate R. Shabtai and R Student for pointing out lacunae in my knowledge and understanding. However, as demonstrated in my article here: http://text.rcarabbis.org/problems-with-defining-death-as-the-irreversible-cessation-of-circulation-what-would-we-measure-and-why-by-noam-stadlan-md/ I am familiar with the distinctions that they mention. We can go on and on parsing the specifics of what Rav Shabtai said or meant. Two points that I have already been made which I guess have to be repeated:
1. Regardless of how Rav Shabtai meant to parse his words, after making his statment about the Rabbanut, he did not go on to mention anything about other results from applying testing criteria, and the listener comes away with the impression that the Rabbanut thinks that a paralyzed person is dead.
2. The main point of discussion hinges on what the Rabbanut meant and what current supporters of the Rabbanut position hold. As I pointed out, there is an obvious opening for Rav Shabtai since they say ‘irreversible cessation of respiration.’ My point, which I think is shared by supporters of the Rabbanut position, is that the meaning is irreversible cessation of repiration in the context of severe brain damage. That certainly is what the tests are looking for.
Rav Shabtai would be correct if he pointed out that there was an apparent discrepancy between definition and criteria(referred to as issues with internal validity- I think first coined by Karen Gervais) but that is not the point he was making. He was denigrating the Rabbanut position by pointing out that it results in incoherent results. I have used this approach myself. But he is making it seem as if this is a result of the rabbanut position, rather than more accurately identifying it as his own interpretation of the rabbanut position, with which many reasonable rabbonim, including R. Carmel et al, would vehemently disagree.
Rav Shabtai writes that he has not taken a position on the matter. I have not read the book. It may be totally true that he does not take a position on the matter in the book. I am not addressing the book, which I ordered today from Amazon. I am addressing the lecture, where Rav Shabtai clearly does take a position on brain death. I also think that in the lecture, the issue of the Rabbanut, among others, was presented in a fashion that was not fair to both sides. There have been papers in the past that purported to be ‘fair and unbiased’ when in fact they were everything but that.
Rav Shabtai, at least in the lecture, seems to support the idea that life is present when ‘vital function’ is present. If we really want to move a conversation forward, it would be helpful for Rav Shabtai to give the particular tests and results that need to be seen so that one can know if vital function was present or not. It would also be helpful to precisely define vital function, rather than just give examples.
Rav Student- actually now I will demand an apology for your implication that my remarks demonstrate dishonesty. I did not engage in any sort of ‘cynical misinterpretation’. Leaving an audience with the impression that the Rabbanut criteria results in labelling a paralyzed person as dead without providing any hint of disagreement is wrong, and, in my opinion, reveals a bias. Feel free to disagree, but calling me dishonest is insulting. I wont even dignify your remark regarding HODS with an answer.
Dr. Stadlan: If I were your department head in a university, I would bring you up on charges of professional misconduct. A young would-be scholar announces a new book and you, an established scholar, without even reading the book, declare based on a clip from a lecture that he is either ignorant or dishonest. That is character assassination that may very well effect his livelihood. How dare you?
He has already explained what he meant, which was painfully aware to me and which I explained to you a long time ago. Yet you failed to listen charitably, or contact him directly, and instead attacked him in the comments to a blog. That is unprofessional, disgraceful.
And not only do you fail to apologize or retract, you demand an apology?!?!
Repent and apologize. And take some time to think about your online behavior and how it impacts others professionally.
Hirhurim please STOP putting words into DR.Stadlan mouth/comments please qoute for me where he was insulting dishonest etc… you continue to avoid his main הערות instead you כדרכך בקודש focus on the trivial stuff. He did not attack Dr. Shabtai in any of his previos comments, like I wrote earlier whenever there is a hot issue and you clearly have your opinion you negate the other side completly without honest משא ומתן. where is there “character assassination” please show an example. I think Dr. S was very respectfull in all his comments, and he backs up what he writes..
question to Rabbi Shabtai. If you can please clarify your comment regarding Christopher Reeve. You state: “Christopher Reeve clearly fits the criteria of ICSR since he was irreversibly unable to breathe on his own (there is no debate on that matter)” I would like to debate that. There is no scientific evidence that his inability to breathe was irreversible. I think something that many people are often unclear on (including rabbis, doctors and other experts) is what irreversible means clinically. In the Rabbanuts 1987 decision it is my understanding that they did require irreversible in they definition. No one could tell Mr. Reeve that his spinal cord injury was irreversible as their is no scientific proof of that. In fact many people (including Mr. Reeve from what I read in the papers) make attempts to wean off the respirator because spinal cord injury does not always cause irreversible cessation. Most people with spinal cord injuries (like myself) have very slow improvement over time.
The rabbanut I believe must have understood the difference between the 2 and therefore defined death based on someone never ever being able to breathe on their own again…
In addition to that, I do believe that the rabbis who were involved with that statement in 1987 and defined death as ICSR, also made an assumption that we are talking about a situation where the person is not awake and having other brain stem functions working. I am not discussing criteria, rather definition. My question is this; besides the above that Mr. Reave did not have irreversible cessation. Lets even say we can prove it was irreversible in his case. Do you truly believe that if you took him to the rabbanut in 1987 that they would say: “yes, he can’t breathe therefore he meets our criteria for death” I find that difficult to believe . They did not give their ruling in a vacuum. They gave their ruling on the heels of the Harvard Criteria which was certainly discussing breathing due to brain stem death.
disclaimer: I do follow rabbi Ovadia Yosef’s halachik decision that brain stem death is the definition of death (as is clearly spelled out in his Grandson’s book), I also support the medical decision that brain stem death is death, and I support HODS. I have met doctors that support brain death and doctors that disagree with it. I have met rabbis that support it and those that don’t. I believe both sides are honest and have the proper intentions. I am not new to Hirhurim as I always enjoy reading articles here but I am new to posting here. As a neurologist I have been called many times to evaluate whether a person has ICSR and whether a person has brain death so have been intimately involved in personally examining many patients in this situation. Thank you for this most interesting dialogue on the subject.
I do look forward to reading the book once it is available.
Anonymous: See the end of noam stadlan on February 19, 2012 at 3:55 pm
Perhaps Dr. Hasson’s comment that “[The Rabbanut] did not give their ruling in a vacuum. They gave their ruling on the heels of the Harvard Criteria which was certainly discussing breathing due to brain stem death”, shows that unless you don’t consider ICSR as death (like R. Student does) you find R. Dr. Shabtai’s comment about Mr. Reeve to be facetious. If so, R. Student owes Dr. Stadlan an apology for calling him dishonest.
Thank you anonymous. I specifically stated that I was not addressing the book. The book is being marketed as a fair and balanced look at the topic(I forget the exact wording). I was asked to listen to a tape of a lecture and I commented that the contents of the lecture were not presented in what I would term a fair and balanced way. I think that is pretty important information given how the book is being publicized. I look forward to reading the book, and will be happy to state what I think of the book, and will be happy to state if I think it is fair.
My intent was not to impugn the young scholar, and I apologize to Rav Shabtai if I did. I realize that my words were a bit harsh, and I apologize for that as well. It is clear that Rav Shabtai knows these particular sources. However, I think that the sin committed- passing off one’s personal opinion as the accepted reality- in a matter as important as interpreting the chief Rabbinate position, is quite significant. I am certain that the vast majority if not everyone who has heard the lecture interpreted it as I did. I stand by my assessment that it represented either ignorance or willful mis-statement. Having read the explanation, it still is a misrepresentation that serves the point of view he was advocating at the end of the lecture. Perhaps he meant it in a different way but again, I can only go by what is on the tape. I was not being generous or ungenerous, just listening.
This topic is literally a matter of life and death for many who need organs. It is also obviously a major issue in Orthodoxy that has ramifications on how science is incorporated in Halacha. Everyone is certainly entitled to their opinion, and is entitled to publish their opinion. However, in a matter as important as this, giving widely publicized lectures and publishing books puts an opinion or point of view into the public sphere. Once in the public sphere, some people are going to rely on that opinion. Obviously some opinions are more informed than others. Once an opinion is making its way in the public sphere, I think it is reasonable to ask if it is informed or not. If it is touted as balanced, it is fair to ask if it is balanced or not. If you think that Rav Shabtai is not up to such scrutiny, then perhaps this venue of publicity and publishing a book was not a good idea. What I think is not fair to the public is for information to be put in out for public consumption which is not as described. I have been very clear that I was addressing only the lecture that he gave.
I can see that this discussion is not going to progress, and will refrain from commenting further.
I still await your apology for insinuating that I was dishonest.
A list of some of Dr. Stadlan’s descriptions of Dr. Shabtai’s shiur. He started out thinking that Dr. Shabtai said that Christopher Reeve fit the Rabbanut’s tests of brain death but, after I and Dr. Shabtai pointed out that was incorrect, is now acknowledging that he misunderstood Dr. Shabtai’s intent but believes it was still wrong.
Feb 17, 4:02pm “This a clearly incorrect statement”
Feb 18, 12:24pm “presenting the data against his case in the worst possible light”
3:55pm “a person who supposedly is an expert in the topic either doesn’t know the subject matter or deliberately mis-stated something of significant importance. I chose the latter”
“the statement by Rav/Dr. Shabtai either reveals tremendous ignorance of the relevent sources(which is hard to imagine), or a deliberate misreading.
QED”
4:57pm “That is wrong. I mis-interpreted NOTHING”
“The fact that he knows all the stuff that I posted and still said what he did in the lecture only proves that he deliberately stated something that he knows the Rabbanut did not mean and it’s heirs have clarified.”
5:42pm “it was not intellectually honest”
Rabbi Student: Your accusing Dr. Stadlan of professsional misconduct is absurd. You obviously have no idea of the powers and responsibilities of a Department Chair. Dr. Stadlan made it clear time and time again that he was criticizng the lecture and not criticizing the book which he admitted he had not read. You may think the criticism was unfair, but to term it professional misconduct??? Your bias is showing. I really think you, unfortunately and unwisely, lost your temper.
Dr. Stadlan: “the sin committed- passing off one’s personal opinion as the accepted reality”
A scholar is not allowed to interpret the data in a unique way??? And to defend his interpretation in a new book? Is that not what scholars do? You call that committing a sin? There aren’t enough punctuation marks to express my disappointment in your failure to adequately apologize even after accepting that you misunderstood his words.
Dr. Kaplan: Far be it for me to tell you what academic standards are. If they are that low, I’m disappointed.
It looks like Shabtaut still lives on. And R’ Gil among the Shabta’im.
Rabbi Student: You are confusing academic standards with professional misconduct. I still think you lost your temper.
Personally, I don’t find discussions of me as a person, or my intentions rather helpful or productive. I am ready and happy to stand up to scrutiny – but while I cannot control it, I request that it be done in a respectful manner befitting benei Torah interested in better understanding and applying God’s will to this world.
I wrote this book to advance the actual conversation and discussion on the halakhic issues involved. Sometimes this requires looking at positions critically and analyzing them from a fresh perspective. This is what I have done with the Rabbanut’s opinion.
In case I was not clear earlier – I believe that according to the criteria for death set out by the Rabbanut in 5747, Christopher Reeve should have been considered dead. In my book, I translate and analyze the Rabbanut’s position in detail and explain why this is the conclusion to be drawn from their position. In my previous comment, I explained that this is directly borne out of the Rabbanut’s criteria for death, which was the irreversible cessation of spontaneous respiration and the tests necessary to prove that in brain death are not relevant to other cases, nor are they necessary. I encourage anybody interested in reading more about this distinction to read chapter 4 of my book.
This is my opinion. The Rabbanut’s position statement did not address Christopher Reeve and I am using the principles they set out and applied them to a situation they did not consider. We can talk about this point, we can discuss it, and we can debate it – but that should be our focus. It is not helpful to simply state that it cannot be true, or that I never heard of such an approach.
Do I consider this a little bit extreme – to declare dead a person who is talking. Yes. I don’t think that makes the position wrong, just uncomfortable. Are there alternate approaches that manage to avoid this uncomfortable conclusion – absolutely, but, in my opinion, the Rabbanut specifically chose a position that directly leads to this conclusion.
Addressing Dr. Hasson’s question: We will never know what the Chief Rabbis would have said regarding Christopher Reeve. I tend to agree with Dr. Hasson, that had they been presented with a case similar to Christopher Reeve, they would have thought him to be alive. Right after they said that however, they would need to go back to the drawing board and completely rewrite their position statement, since that conclusion cannot come out of what they actually wrote.
thank you for your response. In addition to the other issues, I do not think that the Rabbanut would have to go back to the drawing board since they did at least define it as “irreversible” and someone with a spinal cord injury is not irreversible. that is why neurologists are very makpid in their lashon. injury is not damage or death. injury means he was injured and may improve.
This is probably what made some uncomfortable with the proposition that Mr. Reeve would be considered dead by the 5747 rabbanut definition. The reason I disagree and do not believe their definition pronounces him dead is because the definition requires irreversible and he was not irreversible.
I can’t think of a case at this moment of someone who has complete irreversible cessation of breathing and does not have death to the brain stem. That is probably (again an assumption) why the rabbanut was comfortable just stating ICSR because the only situation in which you have that is in brain death, not in brain injury or spinal injury or nerve injury, etc. I don’t see how any doctor can definitively state that Mr. Reeve had irreversible damage/death.
I will check out chapter 4 when I receive the book. (I too agree that the discussion and debate is important to continue for all sides can benefit from it). thank you again for your responses.
Rabbi Shabtai – I have not yet read your book, but it seems that all those who wrote haskamos, and whose positions you discuss, take the approach of paskening this question directly from the Gemara and earlier poskim. Applying this methodology of psak is in turn is based on two presumptions: that Chazal differentiated between the nervous system, the cardiopulmonary system, and the respiratory system – and that they correctly understood the role of each. Do you discuss the nature and validity of these presumptions in the book?
Dear Rav/Dr. Shabtai,
I want to apologize for the tone of what I have written in the comment section, and also if I made inaccurate assumptions regarding your motivations. I had meant to make one small comment regarding your audio presentation, but that obviously turned into much more. As you may have guessed, Rav Student and I have had many arguments on this topic, some of which have been quite heated. Much of what I wrote was for the purpose of defending myself against Rav Student’s attacks, but, regardless of the rationale, I should not have responded to his attacks by attacking you, and I should have been more cognizant of any collateral damage. I am sorry.
I think however, that my first point was indeed valid, and it would be perhaps useful to go over the facts and issues. In your lecture, you make a specific point that according to the Rabbanut criteria, Christopher Reeve would be considered alive. You do not qualify this with ‘in my opinion’. The person listening is left with the unopposed impression that the accepted opinion of the world, or at least according to Rav Shabtai, who is an expert on this topic, is that the Rabbanut criteria are unable to distinguish between someone who is obviously alive and someone who is dead. The result is that they are much less likely to think of the Rabbanut opinion as rational or worthy of support. This supports your viewpoint because in your audio lecture you advocate against accepting brain death as death. If you really want to give a balanced presentation, I strongly suggest that you revise your lecture for the future.
What is the truth? The initial statements of the Rabbanut link the concept of life with respiration. With regard to this particular definition of the concept of life, assuming your statement refers only to this particular part of the definition and no other, your statement is factually correct(assuming that everyone understands that you are referring only to the concept of life and nothing else- something which I sincerely doubt is true). The exact criteria (practical definitions) of the Rabbanut obviously test for brain dysfunction, so your statement is not factually correct regarding the criteria. Please keep in mind that most people (probably everyone until they start looking into it) assume that there is strong internal validity to these definitions (the criteria flow logically from the concept). So, if the concept of death couldn’t distinguish between usually accepted life and death, the criteria (practical rules) cant either. Most people also don’t automatically distinguish between definition and criteria. In your statement, you did not make any distinctions between the Rabbanut concept and criteria, and therefore your statement casts aspersions on the entire Rabbanut definition.
More importantly, later papers, from Rav Yisraeli himself up to the answers Rav Halperin gave to Rabbi Bush back in 2008, make it clear that the Rabbanut define death only when the cessation of breathing is due to brain damage(I can provide references upon request). Therefore, your statement is not true regarding the interpretation that the authors of the definition themselves intended.
From what you wrote, it appears that you feel that your interpretation is historically accurate and the changes were made later. I have no data on this and it certainly could be true. Even if it is true (and I am not doubting you), it doesn’t represent how the Rabbanut criteria were applied at that time, and certainly not what they currently represent.
In summary, even with the most generous interpretation, your statement accurately describes at most a portion of the Rabbanut position at a small window in time, and does not accurately portray the entire position at that time nor the current position. Yet in your lecture you stated, without any modification, that according to the Rabbanut criteria Christopher Reeve would be considered dead. In fact, this was the chief(and only?) argument you used against the Rabbanut criteria.
My initial assumption was that either you did not know all of the above data, or that you knew the data and chose to deliberately portray the Rabbanut in as poor a light as possible. I see that there is a third possibility that I did not consider and perhaps others. If I understand correctly, you feel that you have uncovered something new that was previously unconsidered and wanted to make it public. I can understand that point of view. However, what I want to emphasize is that regardless of the accuracy of this new information, stating just that new information, without providing the entire appropriate context, is very misleading to the audience. Providing just that snippet gives the audience the wrong impression of the Rabbanut position as a whole- they don’t know that your statement doesn’t apply to the specific criteria, they don’t know that Rav Yisraeli and others have addressed your concerns etc.
Let us even assume that you have good reason to counter the explanations of Rav Yisraeli et al. So that is a machloket between Rav Yisraeli and you or whomever you are quoting. Not telling the audience about this machloket, and just assuming that they would agree with your siding against Rav Yisraeli would be, in my opinion, inappropriate. Because, in this situation, the basis of your case that ‘the Rabbanut makes no sense’ is not plain facts on paper, but a judgment as to who has the better argument in that machloket. The audience deserves to know about that machloket and have the opportunity to judge the sides.
Consider a debate about the justice of the US government. One side claims that the Constitution allows slavery, and this makes the government unjust. This is a true statement only prior to the 13th amendment. After the amendment to outlaw slavery, it is no longer true. One can certainly advocate that the amendment did not go far enough or still allows discrimination, or slavery as punishment, but that is an entirely different argument and much more difficult and complex to make.
It is hard for me to imagine a situation post 13th amendment where stating that “the constitution allows slavery” is an intellectually honest statement, without including many qualifiers. I think, unfortunately, that your statement regarding Christopher Reeve is very similar. It uses a small sliver of previously accurate reality as a substitute for the actual totality where the previous reality is no longer is accurate.(lest my words be twisted, I am not accusing you of intellectual dishonesty here. I have no doubt that there is an excusing rationale).
I hope that this explains my comments. I think my point was accurate and justified, but I again apologize for the tone, for the statements made in the process of defending myself, and for making an assumption of motive. Although I do not qualify as a chacham, I accept that I should have been more cognizant of ‘chachamim hizaharu b’divrechem.’ I gently suggest that you also should have been cognizant of this in your audio presentation (unless of course the impression made was the impression intended). I look forward to future discussions and to reading your book.
Kol Tuv,
Noam Stadlan
As a simple kollel guy, I would just like to summarize, for the layman, what I believe Dr. Stadlan has just responded to Dr. Shabtai. In essence, since it would be preposterous to assume that Christopher Reeve would be defined as dead, we should ignore what the Rabbanut, and subsequent position papers of the Chief Rabbis themselves, laid out for the halachic definition of death, namely lack of spontaneous respiration, and instead adopt the cognitive tests that were used for this determination as the definition itself. This all stemming from the fact that the Rabbanut must have considered all future scenarios that might possible render their definition as completely absurd. Is that about right or am I missing something here?
I am sorry I was not more clear. After the initial Rabbanut paper, Rav Yisraeli and others wrote papers that gave Halachic reasons that make it clear that cessation of respiration only means death if the cessation of respiration is because of brain damage. (Rav Halperin listed a number of sources – most are available online). So, you should ignore nothing. However, you need to realize that there is more to the Rabbanut position than what was published in 1987. The problem represented by Christopher Reeve has been addressed years ago. You can accept the explanations of R. Yisraeli or disagree. . But I do not think it is a fair characterization of the Rabbanut position to ignore them.
Thank you, Dr. Stadlan, for your honorable apology.
In his book, Dr. Stadlan spends significant time on the positions of the various chief rabbis, Rav Yisraeli and Dr. Steinberg. He is remarkably thorough.
Please let me clarify what you are suggesting. Although the statement of the Rabbanut bases itself on the Chasam Sofer who advocates cessation of spontaneous breathing as the definition of death and mentions nothing of brain injury, Dr. Shabtai should have taken into account the paper of Rav Shaul Yisraeli that essentially is a reinterpretation of that which seems to be quite clear in the original Rabbanut ruling. And all this without the Rabbanut itself issuing a retraction of its original criteria. So the accusation against Dr. Shabtai is that he should have said that Christopher Reeve, according to the Rabbanut ruling, would be dead except according to major reinterpretations of this position that the Rabbanut itself did not formally adopt. Is this really what you mean?
Dr. Shabtai uses Christopher Reeve to discredit the Rabbanut position. He had an obligation to present the entirety of the position, including both the parts that are at odds with his conclusion and how it is been interpreted since the position was written. It took a lot to get the Rabbanut to issue an opinion in the first place and further clarifications(I would suggest that reinterpretation is not an accurate characterization) are not expected to require new official statements. In answer to your question, if you are going to talk about THE Rabbanut position you have to include what the authors wrote subsequently. Especially if they already specifically addressed the problems that you are claiming are present. Rav Yisraeli wasn’t just some guy who commented on the Rabbanut position. He is the one who helped write it and implement it. What he writes subsequently is essentially part of the ruling, especially if no one was opposing what he wrote. He CLARIFIED a point that was ambiguous.
Dr. Shabtai uses Christopher Reeve to discredit the Rabbanut position
I think “discredit” is the wrong word. He uses it as a test case to measure the viability of the position. He does this kind of test to ALL the views he examines in the book, which is why I think the book is so valuable.
Let me try to make this as clear as possible. The concept used by the Rabbinate can be interpreted in a number of ways. The steps they list to determine death indicates that they were looking at massive brain injury. R. Yisraeli subsequently clarified that yes indeed they meant massive brain injury and provided Halachic support for that position. It is a misrepresentation to talk about THE position of the Rabbanut if you ignore all of the above and focus on one POSSIBLE interpretation of the original concept. Especially since the issue R. Shabtai raises is specifically addressed and laid to rest
Dr. Shabtai is certainly being reasonable by relying on the Chief Rabbinate’s official clarification of 23 Tamuz 5747 — issued by the Chief Rabbinate’s secretariat.
R. Yisraeli’s was not the only subsequent clarification! R. Mordechai Eliyahu also published an article and the Chief Rabbinate’s secretariat issued an official clarification. I believe R. Yisrael Lau did, as well, but I’m not sure if my memory is correct on that. Given all of that, I don’t think R. Yisraeli can be reasonably taken as the sole voice for the Chief Rabbinate.
And of course R. Avraham Shapira also wrote an article.
It should be clear that IF the sole criteria for death is ICSR, then somebody who is incapable of ever breathing again on his own is considered dead. Noting Dr. Hasson’s hesitancy regarding the actual diagnosis of Christopher Reeve (see p. 369n4 of my book for my own hesitancy), for the sake of the thought experiment, let us assume that he indeed suffered from ICSR, but not because of a brain stem injury. According to this approach, he would be declared dead.
When the Rabbanut published their position statement in 5747, they also issued a letter of explanation that painstakingly details the reasons they came to their conclusion. The Chief Rabbis at the time, R. Mordechai Eliyahu zt”l and R. Avraham Shapira zt”l also wrote articles explaining their positions. All three are quite clear that the sole criteria for death is ICSR.
From p. 279 of the book (the Rabbanut’s explanatory letter):
“Death is determined by the cessation of respiration and not the destruction of the brain, [although] the destruction of the brain proves that the patient can no longer breathe spontaneously.”
If they meant that the real criterion for death was ICSR only in the context of brain stem destruction / dysfunction, the it would be the brain stem destruction / dysfunction that is the true criteria for death and not ICSR. This would be very hard to prove from the Talmudic sources, since Hazal were likely unaware of the brain stem’s control of respiration.
The Rabbanut’s letter and the articles by R. Eliyahu and R. Shapira zt”l do not require “interpretation” or any derashah. In my opinion, they are quite clear in what they believe, that the halakhic criterion for death is ICSR (please see chapter 15 of my book for analysis of how they relate to the notion of potential decapitation). As such, despite whatever discomfort we may feel with this, according to the Rabbanut’s position, Christopher Reeve (at least according to this thought experiment) was dead.
R. Shaul Yisraeli zt”l was an eminent talmid hakham who presented his opinion on the matter. On many points, it differs from the Rabbanut’s perspective. I deal with his position throughout my book (from the index: 79, 175-8, 181, 191n12, 196-7, 210-15, 226, 258, 275, 296). His arguments take radically different approaches than those suggested by the Rabbanut in its position statement, explanatory letter, and the articles by the two Chief Rabbis. R. Yisraeli is more concerned with analyzing RMF’s position than analyzing what the Rabbanut had previously published. I do not mean to detract from R. Yisraeli’s stature in any way, has ve-shalom, just to note that he is advocating an approach completely different than the Rabbanut. Dr. Stadlan has chosen to call R. Yisraeli’s approach a “clarification” of the Rabbanut’s stance. I think most objective readers will agree with me that it represents a completely different approach – one that indeed requires its own analysis, which I provided in the book.
Therefore I stand by my original description.
Rabbi Shabtai – since you are still around, can I ask you to address my question?
To repeat: I have not yet read your book, but it seems that all those who wrote haskamos, and whose positions you discuss, take the approach of paskening this question directly from the Gemara and earlier poskim. Applying this methodology of psak is in turn is based on two presumptions: that Chazal differentiated between the nervous system, the cardiopulmonary system, and the respiratory system – and that they correctly understood the role of each. Do you discuss the nature and validity of these presumptions in the book?
I’m the guy who refrenced the sefer “ruach yakov” from R. Ovadia’s grandson, now that I recieved the book I see that its quoted many times and that R.Shabtai spoke with the grandson directly. This is not a book its a Sefer. However me personally get the feeling when “learning” this sefer, that R.Shabtai has his own opinion and is not totally objective.(which is fine with me)
“This would be very hard to prove from the Talmudic sources, since Hazal were likely unaware of the brain stem’s control of respiration.”
Were Chazal aware of the heart’s role in pumping blood? Was Rashi?
I don’t have time for a lengthy rebuttal. I will just point out that you have illustrated the breadth of opinions and how stating THE Rabbanut opinion without accompanying discussion is not appropriate. I would note in addition that the Rabbanut criteria were portrayed as THE example of respiratory criteria. If you are insisting on splitting R. Yisraeli off from the Rabbanut criteria(I am not addressing that issue here), his opinion still stands as an example of how the Christopher Reeve problem has been addressed under the respiratory criteria, something unacknowledged in the presentation.
“This is not a book its a Sefer. However me personally get the feeling when “learning” this sefer, that R.Shabtai has his own opinion and is not totally objective.(which is fine with me)”
Not so fine with me. I’m guessing R. Shabtai’s own opinion is that ICSR cannot be considered as death. Correct me if I’m wrong.
Your guess is right, however this is my opinion.
After looking through the responsum by R. Yosef Carmel that Dr. Stadlan recommended (http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf), I’m not sure how he answers the Christopher Reeve question. The only possibly relevant paragraphs I see are 1 and 5 (aleph and heih).
In paragraph 1, R. Carmel stresses that the sole criterion for death is ICSR (Irreversible Cessation of Spontaneous Respiration) and everything else is just to confirm that it is in fact irreversible. In paragraph 5, R. Carmel says that anyone brain dead who continued living was not declared brain dead by the Chief Rabbinate’s or Knesset’s criteria, which would prevent such a person being declared brain dead.
How do either paragraphs address the question of someone (theoretically Christopher Reeve but his actual condition is irrelevant to the issue) who has suffered ICSR but continues functioning through mechanical breathing?
Where does he say something equivalent to what Dr. Stadlan claimed? February 19, 2012 at 3:55 pm “While Rabbi/Dr. Shabtai states in the lecture that the brain doesn’t enter into Halachic consideration, it is clear from the Rabbanut Criteria and subsequent statements such as R. Yisraeli’s talmid muvhak R. Carmel(avaliable here: http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf) that the cessation of respiration that counted was only when it was due to irreversible overwhelming brain damage, and not due to spinal cord or phrenic nerve damage.“
You can always ask them. Eretz Chemdah are pretty good at responding to queries, and I’m sure they would be more than happy to explain their position.
Also, the psak of the Rabbanut bases itself on the teshuva of the Chasam Sofer who is clearly talking about someone who “acts dead”. Thus this whole discussion seems like a non-starter.
Thank you Dr. Shabtai, for your clarification of the Rabbanut’s stance on this important issue.
Unfortunately, Dr. Stadlan seems very uncomfortable addressing the Rabbanut’s stated opinion, and as such, feels he must resort to apologetics and reinterpretations based on Rav Yisraeli’s approach.
While this issue is no doubt a very heated and emotional one, let’s take the written word at face value, and not allow our emotions to cloud our unbiased and objective reading of the sources.
J: R. Carmel/Eretz Chemdah did not claim to answer the Christopher Reeve question. Dr. Stadlan made the connection between the question and that specific responsum. It might answer it. I’m just not sure how.
But the point about the Chasam Sofer is important. R. Carmel was emphasizing that ONLY cessation of respiration counts as death and that the other considerations, such as “act[ing] dead”, are just to verify that respiration has indeed irreversibly ceased. In the Christopher Reeve (hypothetical) case, we know that spontaneous respiration has irreversibly ceased.
Returning the response Mori ve-Rebbi R. Kaplan graciously offered me on Feb. 16 at 1:13 p.m.: I thank Mori ve-Rebbi R. Kaplan for his kind words, and his rejoinder is accepted and well taken.
Personally, I agree with Dr. Stadlan’s reading of the Israeli Chief Rabbinate decision. Basically, all the Israeli Chief Rabbinate meant to rule was to follow RMF, who – in turn – speaks of irreversible unconsciousness and irreversible apnea as the two criteria of death in IM YD 3:132, basing himself on Chatam Sofer. Interestingly, RMF never related in that responsum to circulatory arrest as the third criterion of death mentioned by Chatam Sofer, but R. Shabtai Rappaport has explained why that is (as per my comment on Feb. 15 at 8:48 p.m.).
Ye’yasher kochakhem to HODS for publicizing Kollel Eretz Chemdah’s ruling in Be-Mar’eh ha-Bazak Vol. 7 regarding the definition of death. With all due respect to Kollel Eretz Chemdah (whose members are tzaddikim gemurim), here is my rejoinder, point by point:
[ALEPH] That’s the way Chatam Sofer is explained by RMF, and that pesak halakhah was indeed authoritative in its time. But times have potentially changed, thanks to RSZA who re-interpreted Chatam Sofer to potentially grant significance to circulation as a sign of life, even in an irreversibly unconscious and irreversibly apneic patient. So I think we are basically faced with a RMF vs. RSZA scenario.
[BEIT] R. Joseph Shalom Eliashiv is not merely concerned about misdiagnosis of respiratory death. Rather, R. Eliashiv believes that respiratory death is insufficient, since he obeys RSZA’s reading of Chatam Sofer. Now, it just so happens that I am possessed by HBLYS (Hen Bi-Kdoshav Lo Ya’amin Syndrome), i.e. I am more impressed by deceased luminaries than by living luminaries, as per Rashi to Genesis 28:13. Thus, I am not particularly impressed so much by R. Eliashiv’s position (which could theoretically change if he enjoys a refu’ah shelemah and he later changes his analysis) as I am impressed by RSZA’s position (-which, to the end of his life, interpeted Chatam Sofer as granting potential significance to circulation).
[GIMMEL] I agree with Kollel Eretz Chemdah on this point. Citation of the “double murder” responsa of RMF is irrelevant. R. Moshe David Tendler eloquently said as much in his original 1988 debate with R. Hershel Schachter. [N.B. Even R. Schachter didn't dispute R. Tendler on this particular issue.]
http://www.yutorah.org/lectures/lecture.cfm/711847/Rabbi_Moshe_D_Tendler/Definition_of_Death_I
[DALET] This is a very serious problem, and one – in my opinion – where Kollel Eretz Chemdah may be entirely correct. [R. Schachter also admitted as much in his original 1988 debate with R. Tendler, as documented on the HODS website at
http://www.hods.org/English/h-issues/YouTube_video%20pages/RabbiHershelSchachter.asp ] I agree with Kollel Eretz Chemdah’s sense of social justice, tikkun olam, and the imperative of Kiddush Ha-Shem. Therefore, RSZA’s take-but-not-give prescription appears surprising. On the other hand, one could argue (in defense of RSZA’s take-but-not-give prescription) that Noahides will understand that their standards of death are different under Torah law than Jewish standards (as R. Doron Beckerman has cogently argued on this forum regarding R. Kook’s responsum about anatomy studies in Israeli medical schools). The newly published responsum of RMF in Iggerot Mosheh, Vol. 9 (discussed in my comment on Feb. 15 at 7:57 p.m.) also seems to suggest this might not be a problem. On the other hand, it is still not 100% crystal clear to me that RMF agreed with RSZA (due to RMF’s hesitancy expressed elsewhere; see my comment on Dec. 7, 2010, at http://torahmusings.com/2010/12/brain-death-in-the-news/ ). This is literally the kind of nightmare question our ancestors faced during the Holocaust, viz. sacrificing one person in order to save another. May we be spared from facing this question ourselves.
[HAY] Kollel Eretz Chemdah is correct. However, due to the advent of the ECMO machine, which functions as an artificial heart, I would argue that even in the case of cardiac arrest, we have not met Chatam Sofer’s criteria of circulatory arrest for sure until some kind of irreversible damage to the circulatory system occurs. [I don't know how long of a cardiac arrest this necessitates.] This need would flow (no pun intended) from R. Bleich’s chapter on artificial heart transplantation in Contemporary Halakhic Problems III.
In his excellent lecture this past Sunday night, R. Shabtai implicitly argues against my position
http://www.yutorah.org/lectures/lecture.cfm/772659/Rabbi_Dr_David_Shabtai/Defining_the_Moment_-_Determining_Death_in_Halakhah
R. Shabtai believes that no credence should be granted to circulation propelled by an ECMO machine, just like no credence be granted to an outside observer who forcibly claps a corpse’s hands. Therefore R. Shabtai endorses the Bellevue Hospital Protocol, where circulation is artificially maintained in a patient even after irreversible cardiac arrest, so as to preserve the kidneys for future transplantation.
However, I am not so sure the analogy to clapping the hands of a corpse is entirely compelling. Chiddushei R. Chaim ha-Levi Soloveitchik on Rambam, Hilkhot Yesodei ha-Torah ch. 5 writes that if a Jew is thrown by a terrorist on a baby, crushing the baby to death, the Jew is not at all an accomplice to the murder, since he is merely like a piece of wood or stone in the hands of the terrorist. [Thus, the Jew does not have to be killed by the terrorist in order to avoid being thrown on the baby. This is different - argues Reb Chaim - than a married lady who is assaulted by a stranger against her will. There, although she is completely passive, she must forfeit her life, because gilui arayot is gilui arayot, whether one is active or passive.] Accordingly, when I take the hands of corpse and clap them, the corpse is just like a piece of wood or stone in my hands. The fact that I made the corpse clap its hands doesn’t make the corpse alive. But in the case of artificially circulating blood – all circulation is – by definition – a “ko’ach sheni “. I.e., blood circulates because it is propelled by *something else*, the blood itself is not an excitable tissue. Chiddushei Ha-Ran to Chullin 32b is saying (as interpreted by R. Bleich’s chapter on artificial heart transplantation) that even if the heart no longer belongs to the animal in a halakhic sense (since the trachea has been severed), nevertheless the fact that – in metzi’ut – it is causing the blood to circulate makes the animal alive. So perhaps circulation is circulation, whether active or passive (-analogous to the gilui arayot of which Reb Chaim wrote).
[VAV] I agree with Kollel Eretz Chemdah’s refutation of RSZA on the need for “every single brain cell” to die. The basis for refusing to pronounce death until all brain cells to die is RSZA’s understanding of Chullin 21a coupled with Rambam’s Peirush ha-Mishnayot to Ohalot. There is room to argue on RSZA in both directions (i.e. hypothalamic function shouldn’t help since it only internally secrets an internal hormone into the bloodstream and perhaps this does not halakhically count as motion; or – on the contrary – even the absence of hypothalamic function shouldn’t be cause to declare death, since RSZA misread the Rambam. Rambam was saying that the tail twitches when neural control of motion in the lizard is decentralized. Rambam never said that – therefore – if motion is decentralized, the patient is dead.) In any event, RSZA’s reference to “every single brain cell” is almost certainly an error, and should be replaced with “every single cluster of brain cells that cause macroscopic motion”, since – as Kollel Eretz Chemdah correctly states – Halakhah is not concerned with microscopic phenomena.
[ZAYIN] I would argue to the contrary; Encylopedia Talmudit Vol. 9, p. 267, derives from the gemara in Shabbat 129a that whenever there is a dispute among the poskim regarding piku’ach nefesh, we follow the opinion that indicates to desecrate Shabbat. Ergo, we should desecrate Shabbat to prolong the life of a brain dead patient.
[CHET] Unfortunately, this seems impossible, since some poskim disagree with RSZA and forbid deactivation of a ventilator. However, I do agree that all forms of organ transplant which are unquestionably permitted (e.g. blood, bone marrow, living kidney donation) should be proudly encouraged. Barukh Ha-Shem, HODS performs this great mitzvah with excellence.
The upshot seems to be that the clarifications of both Chief Rabbis, as well as the statement of its secretariat in 5747, support the notion that irreversible cessation of spontaneous respiration is the definition of death and brain injury is only to be used as testing to match this criteria. Although Rabbi Yisraeli disagreed and incorporated brain injury into the definition itself, this was in no way reflective of the official stance of the Rabbanut and is to be viewed as a dissenting opinion of one of its advisors, not of the Rabbanut itself. This is borne out by the fact that none of the subsequent clarifications of the office of the Rabbanut seem to backtrack from the original statement or include Rabbi Yisraeli’s definition in their followup releases, and that Rabbi Yisraeli’s work itself does not have the imprimatur of the Rabbanut and was published privately in a hebrew medical journal. Dr. Stadlan has now shifted from accusing Dr. Shabtai of misrepresenting the official position of the Rabbanut to a new charge of not presenting an alternative that is somewhat similar to the actual Rabbanut stance that would answer the difficulties inherent in that approach. Dr. Stadlan, did you expect that Dr. Shabtai’s whole book, which I believe is quite long, be condensed into a 45 minute shiur? Did you really expect that sort of comprehensive analysis in such a short amount of time?
If I have misrepresented in any wat what you have proposed, please correct me. If not, I believe that you owe Dr. Shabtai an apology since, at this point, his academic rigor and professionalism seem to be beyond reproach.
I’m trying to follow this discussion but one thing (probably more than one, but one that I can articulate) is unclear to me: does the Rabbanut require, before brain death is established in an actual case where a decision has to be made whether to, for example, allow organ donation, a test or some other evaluation that results in a positive answer to the question of whether the ICSP results from a brain injury?
He didn’t say to condese his whole book in 45min shiur just the main shitos on the topic.All of Dr.s comments are on the shiur he heard not the sefer.
Joseph Kaplan, I think that the Rabbanut requires the CSR to be completely irreversible. As Dr. Henry Hasson explained above, completely irreversible CSR is only possible after complete brain death. If the Rabbanut requires it to be checked whether the CSR is irreversible, it means that they require tests which determine whether the ICRS results from fatal brain injury.
I think we are being to free with terms. The reason we cant use Christopher Reeve in reality or in your hypothetical scenario you set up is because it does not exist. The rabbanut was not discussing some hypothetical and impossible case of someone having ICSR, they were addressing a real clinical question. The question they were addressing is: if someone has ICSR is he dead?, and their answer was yes. The only way anyone can claim a person has ICSR is by proving that the brain stem has died. I think we keep going in circles because we are not understanding the clinical question they were answering. Even people with severe spinal cord injuries, severe phrenic nerve injuries, etc. will not have a way of proving they are ICSR and therefore are not included in the question to begin with. the rabbanut pesak was not talking about any of these people. Remember cessation of breathing means complete cessation. It means that if we take them off the ventilator for a few minutes and their carbon dioxide level in the blood rises to extremely dangerous levels, their body will not even take the slightest puff. not one piece of muslce will work to expand the lung even in the slightest bit. The body will simply die becuase it has no possible way to ever attempt to survive. That is ICSR and the only way to have that in an irreverisible way is to be dead (brain dead). the doctors and rabbis went to the rabbanut with this question and said does ICSR mean death and they said yes. They asked the question because in America and other countries they were all discussing if ICSR due to brain death is death, so they wanted to know the Jewish view on this matter. No one asked them to define christopher Reeve or hypothetical Christopher Reeve. No body was thinking about or talking about a what if scenario where someone is functioning in all other ways by theoreticaly could never take one puff of breath. that is not the question they were asked so that is not waht they answered. We can not look at the answer without looking at the question that was asked. That is why, to me anyway, it is clear that the rabbanut meant brain death and I find it very hard to imagine that they were talking about theoretical cases that were not clinically relevent at the time. I think it is absurd (pardon the strong word) that anyone would believe that the chief rabbis didnt think carefully about their pesak and that they would have in all honesty considered a functioning person dead for a techincal reason. lets give the chief rabbis a little credit. If they did answer a real clincal question with such a crazy answer, that would be very embarrasing to them. Are we talking theoretically or do we really beleive that if we went to the people and drafted the original letter, that they would say yes – respiration is all that matters and if you find someone who is perfectly functioning but cant breathe without a machine, then he is dead and must be buried immediately despite his objections because of lo talin nivlato al ha’etz? Is that really what we are tring to say here? Again, I am not trying to be rude with my language. As I mentioned in the prior post I honeslty believe everyone here has the best intentions, just trying to better understand. thank you.
sorry for the long posts, but I feel the need to clarify the physiology involved. the human brian is designed to send signals to the body to control all functions of the organism. when times are tough, the brain is programmed to do whatever it takes to survive. it will shut off blood supply to various body parts in order to keep vital organs alive. In a situation where the person holds their person too long as babies are known to do, the brain will even reduce blood supply to itself so that the child passes out, falls to the floor and the autonomic system can take over and force the body to breathe. like i said the brain will do whatever it takes to get a message to the heart, to the lungs, etc. so that they do what they need to do to keep the organism alive even if for just one more second.
this is why as long as their is even a little bit of functioning brain stem and that is all that is left of the brain, it will find a way to get a message to the lung to at least try to take one slight puff. I have examined many patients that have lost almost all functions of the brain and one is convinced they must be brain dead, but when the machines are turned off, that little tiny residual functioning brain does what it can to get a tiny signal through and we watch that very tiny movement of the chest, and we quickly turn the machines back on.
there are serious diseases that cause serious damage to the pathway from the brain to the muscles that have the capability of expanding the lungs. even when they are damaged we can not say that it is irreversible because we know the brain will do what it can to sprout a new nerve or redirect a pathway to a new muscle to get the person to breathe even a tiny bit. no matter how damaged the nerve or muscle, there is a chance.
When however the brain is completely shut off, as we occasionally due with barbiturates when needed, then the brain can not do any of these things and there is complete cessation of spontaneous respiration. this is reversible because we can stop giving the barbiturates the brain will awaken and immediately send signals to breathe.
the only time we know that there is no chance that the brain will find a way to send a signal to breathe is fi the brain is no longer there. when it is completely destroyed, then and only then is there no chance of the organism surviving because the brain is dead and the lung will not expand without the orders coming from the brain. this is why the rabbanut was posek that ICSR is death. It makes perfect physiologic sense, it does not contradict the rabbis that lived in the time of the gemara or later, and it is definitive. Has V’halila that we should think so little of our hachamim that they would declare a person with a functioning brain as dead. I understand the view that disagrees with brain death and wants to use cardiac criteria only. that is fine. But to believe that our chachamim would use a definition of death that would declare a functioning person as dead seems to me that we must think of them in a very poor light. (I am obviously not accusing anyone here of really thinking of our chachamim in a poor light)
I think what we have here is a simple misunderstanding. I am eager to read the coming posts that may elaborate on where I might have erred in my assessment. I also hope that I have somewhat clarified what can sometimes be very complex. The human brain (and all brains for that matter) is truly a remarkable creation of God and maybe even the seat of the soul and of life itself.
Dr. Hasson, I agree with your assessment of the Rabbanut’s approach, and that further, in general all criteria ought to be regarded not as “definitions” of death or life but as criteria by which one can know that death has occurred in cases of true ambiguity. Applying them to a person with whom one can converse is indeed absurd.
However, part of the problem as I see it is that Dr. Stadlan himself uses this type of reductio ad absurdum argument (in other words applying definitions beyond their charitably interpreted scope of application to arrive at conclusions that are absurd in order to show that the definitions themselves are flawed) in refuting several approaches that reject brain death (see his article in Meorot).
We could have a more productive discussion all around by agreeing that the Rabbanut no more thinks that someone who cannot live without a vent is technically dead than R. Bleich would think that an isolated organ kept viable with artificial circulation is technically a living person. All such arguments miss the idea that ambiguous cases that generate the need for precise criteria are the only cases where such criteria are needed; attempting to apply them elsewhere is deeply mistaken and results in absurdities.
Somewhere back in the discussion archives is a long exchange between myself and Dr. Stadlan relating to this point. Hopefully seeing where this type of thinking leads will allow both sides to focus on the substantive local practical question in a manner delimited by pragmatic–not hypothetical– concerns.
I believe Dr. Hasson is agreeing with Dr. Shabtai’s interpretation of the Rabbanut’s position but disagreeing that such a case as the theoretical-Christopher Reeve case is possible.
Dr. Hasson: Are we talking theoretically or do we really beleive that if we went to the people and drafted the original letter, that they would say yes – respiration is all that matters and if you find someone who is perfectly functioning but cant breathe without a machine, then he is dead and must be buried immediately despite his objections because of lo talin nivlato al ha’etz?
I believe Dr. Shabtai earlier answered that he believed that had we presented such a case to the Rabbanut, they would certainly NOT have declared him dead but would have gone back to the drawing room to reassess their definition of death.
Frankly, I’m appalled at Dr. Stadlan’s tactic of attempting to undermine a book (which he admits HE HAS NOT READ) by making absurd criticisms of an audio lecture given by the author.
The excuse of “someone asked me to review the book, so I listened to this lecture” seems beyond ridiculous. I think the tactic is dishonest, underhanded and rather mean-spirited.