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February 03, 2008

You Be The Rabbi

A person has, God forbid, passed away. Doctors want to perform an autopsy. They have good grounds to do the procedure and believe the knowledge they will gain from the autopsy will help other patients – and, perhaps, avoid more death.

The family of the deceased asks their Orthodox rabbi a question…

…Is this autopsy allowed?

Here are four possible answers the rabbi might give:

  1. No. The autopsy is forbidden. Why? Because there is no immediate benefit to life, no patient is dying right before us that this autopsy could save. (Following the Nodah B'Yehuda, Rabbi Yechezkiel Landau.)
  2. No. The autopsy is forbidden. Why? The deceased did not give his permission. Even if a life could be saved right now, the autopsy is not allowed – unless the deceased granted permission while alive and coherent. (Following Rabbi Yaakov Ettinger.)
  3. No. The autopsy is forbidden. Why? We are forbidden to derive benefit from a corpse. (The Ya'avetz, Rabbi Yaakov Emden.)
  4. Yes. By all means do the autopsy. Why? There are always patients somewhere who can benefit from what the doctors find. Saving a life across the country or across the world is still saving a life. The patient who benefits does not need to be here before us. Further,  preserving life is more important than kavod hameit, honor to the cadaver. But the body must be treated with the utmost respect during the procedure and, after the autopsy, the body parts must be buried according to Jewish law. (Following Rabbi Ben-Zion Uzziel, first Sefardic Chief Rabbi of Israel.)

You'll note that answers 1 and 2 treat the mitzva of kavod hameit expansively while at the same time diminishing the mitzva of pikuakh nefesh, saving life. Number three does, in effect, the same thing to an even greater extreme.

Number 4, however, treats saving life expansively and somewhat diminishes kavod hameit.

We are always commanded to err on the side of life. Therefore, number 4 should be the normative halakha – but, at least for haredim and most right wing Modern Orthodox, it is not.

Why?

Because, historically autopsies and cadaver medical research started (as a widespread, normative practice) at the same time the Haskalah, Enlightenment, took hold.

Who asked these types of questions to rabbis in 1770 or 1870  Prague or Germany? Jews who benefited from the Enlightenment and studied in German medical schools.

Haredi rabbis are still fighting the Enlightenment. They often, however, have no idea that the "halakha" they so desperately try to uphold, often with street demonstrations and riots, was made long ago to fight a battle that Orthodoxy has already decisively lost.

Four poskim. Three Ashkenazim. One Moroccan.

Only one posek views the situation in its correct halakhic setting and only one posek rules correctly – the Moroccan, Ben-Zion Uzziel, who learned Torah without the Hatam Sofer's destructive dogma, "Hadash assur min HaTorah," "Everything new is forbidden by the Torah."

Nothing since the destruction of the Second Temple has been more destructive to Judaism than that bit of wisdom from the Hatam Sofer.

You can read a far kinder treatment of the sources here.

Comments

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If nothing new is allowed to be added to torah, how come they do it all the time?
Obviously by saying you will be frummer if you keep more.

Well, our Ashkenazi brethren are always far more organized than us as far as fund-raising, social action, etc., but as far as rabbinical ruling, our Sephardic rabbonim issue kindler and gentler rulings. In this case case I am just comparing Sephardic to Ashkenazi Orthodox,
obviously not compared to Conservative or Reform.
Having said that, a Doctor (of Biochemistry) who is not Jewish once told me "don't ever sign that organ donation card- if the hospital can't use the organ in question, they will just throw it in the garbage- I've seen it myself".

a Doctor (of Biochemistry) who is not Jewish once told me "don't ever sign that organ donation card- if the hospital can't use the organ in question, they will just throw it in the garbage- I've seen it myself".

He's either a liar or a fool.

Organ donations work nationally. When an organ becomes available, it is matched with the national registry and the best, closest (geographic) match is made.

Organs are not "thrown in the garbage."

he's right, you know. dave, i mean.

No he is not.

B"H
Instead of continuing to lay the blame on Chareidim let's look at this problem from a different - wider perspective.
From Mises.org blog:

Congress could end the organ shortage now.
J.H. Huebert

There are things you can do to help mitigate the shortage of transplantable organs such as kidneys. For example, you can identify yourself as an organ donor on your drivers license. You can join LifeSharers. And if you're really generous, you can give your organs away.

But Congress could end the shortage of transplantable organs entirely right now by repealing the ban on organ sales. Until it does, it will have the blood on its hands of the 6,000 people who die each year on the transplant waiting list.

Read my full op-ed on the organ shortage and our murderous Congress in today's Columbus Dispatch.

also listen to :
On the Ethics of Paying Organ Donors: An Economics Perspective
David Kaserman On the Ethics of Paying Organ Brown Bag Seminar. http://www.mises.org/Controls/Media/MediaPlayer.aspx?Id=2469

PS. I'd think Shmaryah should be especially sympathetic to this solution to organ shortage given that socialized and over-regulated organ distrubution almost cost a life of a man he highly admires Baruch Tegegne just 3 years ago:
Will Canada's socialized medicine kill a hero?
http://www.jewishworldreview.com/0605/tegegne.php3
.

Putting aside someone's views about organ donation, there is also the concern that the medical profession may define death differently than halacha and to that extent harvesting the organs actually constitutes murder according to halacha. There is documented evidence of doctors trying to redefine the time of death for organ donors because often the viability of certain organs, such as the kidneys which is one of the more needed organs, is measured by how many MINUTES after "death" the procedure begins. Harvard Medical School produced a report titled "A Definition of Irreversible Coma" recommending that "death" be redefined to mean when doctors determine that a coma is irreversible for the purpose of making more organs available for transplant. Incidentally, a Harvard researcher also conducted a study that determined that approximately 2% of the patients that meet the more commonly (medically, not sure about halachic) definition of brain death as the time of death would survive their "death." There are also studies of autopsies proving that not all patients diagnosed as being brain dead are in fact brain dead. In one investigation of transplants done at a prestigious hospital in the U.S. the investigator found that the "dead" transplant donors were still being given morphine while they were waiting for the transplant procedure. I trust Shmarya would say that this was because they didn't want the dead fellow to feel any pain.

There is also documented evidence that the treatment of organ donors while they are alive is often different than those of non-donors as doctors often focus on preserving the viability of the organs, which, among other things, may include hastening the time of death. Many of the organs desired for transplants are often the first to fail and waiting for a natural death may mean that those organs are no longer viable. Among other practices, there are documented instances where organ donors were given drugs designed to preserve those organs even though those drugs were detrimental to the donors chances of surviving. This is precisely the concern that led many of the 17th and 18th century halachik authorities to be very suspicious about organ donation. Incidentally, some of this "special care" may wind upon the bill that is paid by the deceased's insurance or family.

What about signing an Halachic donor card? I think there is such thing from the MO rabbinate.

YL –

Sign one.

Anon –

What a load of crap. Again, if you want to make these types of assertions, CITE EXACT SOURCES.

To all readers –

Anon's comment above is full of falsehoods. You can get information from the Halachic Organ Donors Society or from dozens of reputable medical sources. Do not listen to an anonymous blog commenter.

The question is NOT about time of death
Nor is it about organ donation.

--What a load of crap.--

As usual this is the extent of Shmarya's intellectual debate. You can't really think that people take you seriously when you make unsubstantiated statements and your ability to defend your statements is to say this is a load of crap. Then again, megalomania does not have to be based on reason.

--What a load of crap.--

As usual this is the extent of Shmarya's intellectual debate.

What I actually wrote is as follows:What a load of crap. Again, if you want to make these types of assertions, CITE EXACT SOURCES.

To all readers –

Anon's comment above is full of falsehoods. You can get information from the Halachic Organ Donors Society or from dozens of reputable medical sources. Do not listen to an anonymous blog commenter.Cite your sources or go away.

--Cite your sources or go away.--

The issues I cited are well known concerns relating to organ transplants, including concerns by professionals who in principal support transplants (as do most within the medical community). If you are not aware of them then you obviously know very little about this issue and certainly did not research it. Which calls into question the veracity of the statement you made when you begged for donations about the hours of research you put into your posts. For this one you clearly devoted very little, if any, research.

But for the benefit of your readers, here is some information I can provide off-the-cuff. I won't get into the definition of brain death, whether its diagnosis is universally accepted (it is not) and whether doctors have sought to push the envelope on the diagnosis of brain death. The reason I won't do that is because even with all the fooling around with the meaning of brain death it still wasn't enough so a new term was created. Ever hear of NHBD? Obviously not because you claim the my statement was a load of crap so I'll fill you in. It stands for "non-heart-beating organ donation." What it is is a patient that is clearly not dead by any definition but who requires a ventilator and the doctors determine that he is hopeless. So what they do is wheel the fellow into the operating room disconnect his ventilator, wait until his heart stops beating (not until he is brain dead because testing for brain death would take too long) and remove his organs. There have been a few instances where they removed the ventilator and suprise, suprise the fellows heart continued chugging along. This is shocking considering the limited number of NHBD transplants that have occurred to date. There have been many more situations where people have been removed from ventilators under less controversial (legal, not necessarily halachic) circumstances. Not for an organ donation but simply because the family directed the hospital to do so and where the patient's heart kept on beating and even a few situations where the patient had a full recovery. Don't believe me? You don't even have to waste the money you schnorred on a FOIL requests, just google these issues and you'll get all the information you want. BTW, most of these issues have come to light due to Catholic activists. You'll find a number of these folks if you try to google this information and I'm sure they would be glad to share the source for their information with you.

Just to cite one example, in one particular case, a girl shot in the head (though no major blood vessels were hit) was declared dead and a number of her organs removed. After the organs were removed her heart continued to beat for 14 minutes (her breathing had stopped because they cut her diaphragm while removing her organs) after they removed the ventilator. They did not test if she was brain dead before or after beginning the procedure. Before being declared dead she was given 7,000 cc of fluid (an amount the body typically uses over about three days). Standard medical care is to keep fluid administration to a minimum when dealing with brain injuries but it increases the chances that the organs survive. Rubashkin uses a meat hook after a cows throat is cut and Shmarya goes apeshit. Rip out some organs from a human without testing for brain death and whose heart continues to beat for a full 14 minutes after the diaphragm is cut and Shmarya things that perfectly fine. Think this is an isolated case? Think again. These "mistakes" are usually just not uncovered. This one became public because the shooter's defense team was able to force an autopsy and ultimately was able to uncover this information and raise a defense against a murder charge that he didn't kill the girl, the doctors did.

I'll just add, that I am not opposed to organ donations in principal. I can't tell you what the halacha is but where the organ of a dead person is used to save a live one I find it hard to argue against it. But to simply imply that all is fine and dandy in the organ tranplant field is an outright lie.

The issues I cited are well known concerns relating to organ transplants, including concerns by professionals who in principal support transplants (as do most within the medical community). If you are not aware of them then you obviously know very little about this issue and certainly did not research it.

Actually, I deal with medical professionals daily and helped a friend get a kidney transplant a couple of years ago.

You cite no sources, claiming everything you write is well known. It is not.

This silence is not due to a conspiracy of organ harvesting physicians.

The silence comes from the fact that what you write is a load of crap.

Cite sources or go away.

There are also studies of autopsies proving that not all patients diagnosed as being brain dead are in fact brain dead.

This makes no sense. I can't see how an autopsy would be able to demonstrate a misdiagnosis of brain death. The legal determination of brain death involves independent examinations of the patient, separate EEG traces, etc. I can't see how someone could determine that the brain could function by examining a cut up cadaver some significant time after death.

You'd better provide a real citation to this alleged study if you expect us to believe your assertion.

--This makes no sense.--

Brain death for organ donors is often diagnosed not using an EEG. Setting up and performing an EEG can take up to an hour and many organs would not survive that long. Additionally, depending on how you define brain death, that may include situations where there is some brain wave activity that is still showing up on an EEG. They can test for brain death in an autopsy by looking at the level of brain cell destruction or necrosis. Brain cells destruct quite rapidly following brain death. There have been instances where autopsies showed a level of brain cell destruction that is not consistent with a brain death diagnosis and a few situations where a patient was diagnosed as brain dead but the autopsy showed absolutely no brain cell destruction. A number of such autopsies of patients diagnosed as brain dead under medically accepted methods of diagnoses were conducted as part of what is known as "The NINCDS Collaborative Study of Brain Death" and the results of a very significant portion of these autopsies showed that very significant percentages of the brains did not show a degree of necrosis that was consistent with the diagnosis. If you are inclined to researcht this, you can google "The NINCDS Collaborative Study of Brain Death" and you should be able to find a number of medical journal articles on this study that you can purchase.

There is an article written by a Dr. Joshua Kunin about the halachic criteria of brain death that is available online and I've copied a link below. The point he makes (in my view correctly) is that while a number of halachic authorities have sanctioned the notion that death may be defined by brain death, that would require a situation where the brain definitively and completely ceased functioning. However, this is not the medical definition of brain death. In short, even if you approve of the notion of organ donation (which I do in principle), you still need to worry about whether the organs will be removed after the time of death as recognized by halacha which appears to differ from the time of death as recognized by the medical profession, although Shmarya would like you to believe that this concern is, to quote, "a load of crap."

http://www.hods.org/pdf/Kunin%20BSD%20Tradition.pdf

--Actually, I deal with medical professionals daily--

Somehow I highly doubt that unless you got yourself a job as a janitor in a hospital. Not that I think that would be a bad thing. Maybe then you wouldn't have to schnor donations on your blog.

Point of information: Rav Uziel was born in Jerusalem, never lived in Morocco.

--You cite no sources, claiming everything you write is well known. It is not.--

My sincere apologies Master Shmarya. I forgot that only you are entitled to claim things are true without citing sources (even after asking for funds so that you can research those non-existent sources).

--Cite sources or go away.--

Is The NINCDS Collaborative Study of Brain Death or Dr. Kunin's article a source or is that a load of crap as well?

An absolute load of crap.

That study – which you seem to misrepresent – was published in 1980, 28 years ago. Worse yet, it relies on data that is many years older than that.

Medical science has come far since then.

Now slink off.

I should mention the article you link to by Joshua Kunin was clearly refuted in subsequent editions of Tradition by Dr. Edward Reichman and by Rav Moshe Feinstein's family.

Here is the pdf download of the exchange (scroll down to the Brain Death letters):

http://www.hods.org/pdf/communications.pdf

Dr. Kunin's childish understanding of Rav Moshe's teshuvot would be laughable if it did not cause so much harm to people who might otherwise be saved by an organ donation.

You have complete refutation of Dr. Kunin's views by Rabbi Dovod Feinstein, Shabtai Rappoport, Rev Moshe son-in-law, Rabbi Dr. Moshe Tendler, Rav Moshe's son-in-law, and literally dozens of Rav Moshe's students.

All this could easily have been known to Josh Kunin before he wrote his hit piece. But he did not ask, instead relying on the views of rabbis close to Shmuel HaLevi Wosner, who intentionally chose to misrepresent waht Rav Moshe wrote and how he paskined.

So, Anon – you have cited "sources" – biased, poorly written, and sometimes well out of date. Slink away.

I should have linked to Rabbi Dr. Edward Reichman's Tradition piece, as well.

He thoroughly refutes Dr. Kunin who, quite clearly, is either more challenged intellectually than possible for a doctor or who, more likely, is dishonest.

Here is the Reichman article:

http://www.hods.org/pdf/Reichman%20BSD%20Tradition.pdf

HODS has a long list of scholarly articles and responsa posted here:

http://www.hods.org/English/h-issues/articlesE.asp

Sorry. That truncated.

HODS has a long list of scholarly articles and responsa posted here:

http://www.hods.org/English/h-issues/articlesE.asp

You can also view video testimony from various rabbis here:

http://www.hods.org/English/h-issues/videos.html

--That study – which you seem to misrepresent – was published in 1980, 28 years ago. Worse yet, it relies on data that is many years older than that.--

As usual, when you can't refute a statement you just assert that a commenter misprepresented a study and assume everyone will accept your statement as gosel. The study was published in 1980 but it is still commonly referred to in the medical literature as it is one of the most extensive studies of this kind. As far as advancements in medical science, on the contrary, the definition of brain death has been expanded since that time so the concerns raised by that study are even more true today.

--I should have linked to Rabbi Dr. Edward Reichman's Tradition piece, as well.--

Yes you should have as Dr. Reichman, unlike you, acknowledges that "there is no consensus in the halakhic world about
whether brain death constitutes halakhic death, there still remains healthy debate in the spirit of elu ve-elu divrei Elokim hayyim." I would also suggest that you read Dr. Reichman's article before you cite to it. He does not refute Dr. Kunin's argument relating to the whether brain death as defined by the medical community can be used as a proper definition of death according to halacha even accordign to those poskim who believe that brain death in theory would be an acceptable criteria. Rather the crux of his argument is that even if Dr. Kunin is correct that we can't rely on the brain death standard we can rely on an alternate criteria, namely that the irreversible cessation of spontaneous respiration is a sufficient criteria of death. According to the sources that Dr. Reichman cites, irreversible cessation of spontaneous repiration would be an acceptable standard whether or not accompanied by brain death. Dr. Reichman's argument is that if a patient is diagnosed as brain dead than it is certain that there also exists irreversible cessation of spontaneous respiration (you often can't test for cessation of spontaneous respiration on its own for two reasons, first you don't know if it is irreversible, second the patient is often on a respirator and you can't disconnect the respirator unless you've made this evaluation first). There are two problems with Dr. Reichman's assertion. First, there are a number of instances where patients that were diagnosed as brain death did have spontaneous respiration when disconnected from the respirator. The situation I cited above where a girls heart beat for 14 minutes after organs were removed is an extreme case (yes, I know that a heart beat is not the same as spontaneous respiration but in that isntance respiration was not possible since the diaphragm was cut in the process of removing the organs), but there are many more where a patient is declared brain dead, they bring him into the operating room and shut down the respirator and then they say oops he was not as dead as we thought he was. This means that either brain death as defined by the medical community does not mean what Dr. Reichman suggests or that brain death is often misdiagnosed. Either would be a problem for a organ donation accordign to halacha. The second problem is that there is not a universal definition of brain death and there is a constant effort to expand the definition to increase the supply of organ donations.

Oh Arrogant One, is this attack only on Rabbi Moses Sofer of Chadash min Hatorah minayin or does it extend to the first Moses of the Torah itself?

It's a farce how you bring the Tendlers as proof when they are infamous distorters of Rabbi Feinstein's rulings.

There is even a video interview of Rabbi Dovid Feinstein by HODS where they ask him about Moses Tendler behaving as such on this very topic. Rabbi Dovid Feinstein danced around the question and did not answer it.

People can read Dr. Reichman's letter and his article and see for themselves.

What Dr. Reichman clearly shows (and he is supported, as I noted by all of Rav Moshe Feinstein's family) is that Josh Kunin's understanding of Rav Moshe's teshuvot is both wrong and childish.

The rest of what you cite is clearly refuted by Dr. Reichman:
While varying percentages of patients may
have ongoing, recorded physiological function or brains that remain
partially anatomically intact, ALL (100%) of these patients have no
spontaneous respiration, and if disconnected from the ventilator,
NONE (0%) of these patients will breathe spontaneously.In effect what you are doing is blurring the line between halakhic death – which is the issue – and minor brain function.

As Dr. Reichman later notes, after the heart has ceased being able to support life, for a time it still has some remaining function. Still, the patient has DIED. So, to, the brain can retain some traces of function but NOT be able to support life. And, therefore, the patient is DEAD.

There are two schools of halakhic thought on brain death. One, Rav Moshe and the Rabbinute. Two, Israel haredi gedolim– and their handlers.

Like with the famous decapitated sheep experiment (or the Slifkin Ban, or the wig ban, etc., ad nauseum, facts do not get in the way of these handlers.

Still, a Jes can hold like these people. You do.

But that does not mean that everyone must, and it does not mean that Josh Kunin's foolishness must be adhered to as if it were Torah mi Sinai.

Anyone interested in the truth can read the various articles posted by HODS and see the videos. Both links are in my comments above.

And I must emphasize that you are misrepresenting the science, as well.

This trace remaining brain function is just that – trace. It is not enough to support life.

Are there ever case of medical error? Could someone be declared brain dead but not be?

Yes.

Mistakes happen.

Just as patients are declared not to be brain dead when they are, in fact, brain dead.

Even more, mistakes are not confined to modern science – rabbis make them, as well.

There are examples in halakhic literature of takanot made by rabbis with regard to burial.

These takanot ordered hevra kadishas to wait extra time before declaring a person dead.

Why the extra wait?

Because, very, very rarely, someone was declared dead only to "wake up" in the middle of his funeral.

This happened because the technology of the era used to detect death – a feather held by the nose to detect breathing – was not foolproof.

Yet most rabbis did NOT make such takanot. Why?

Because we do not poskin from the et=xtreme, unusual case.

Burials still took place on time.

So, too, should organ transplants today.

It's a farce how you bring the Tendlers as proof when they are infamous distorters of Rabbi Feinstein's rulings.

I clearly "brought" Dovid Feinstein, Shabatai Rappoport, the Tendlers and dozens of Rav Moshe's students.

--There are two schools of halakhic thought on brain death. One, Rav Moshe and the Rabbinute. Two, Israel haredi gedolim– and their handlers.--

The school of thought that adopts a more restrictive approach towards brain death is not limited to Israeli haredi gedolim. It includes many MO gedolim such as Rabbi J. David Bleich and Rav Herschel Schachter. Try doing some homework next time it may prevent you from looking like an idiot.

--Anyone interested in the truth can read the various articles posted by HODS and see the videos. Both links are in my comments above.--

I strongly recommend that as Shmarya doesn't seem to have the integrity to accurately describe the state of halacha in this regard.

For those of you that sign some sort of organ donor card or leave instructions to family members to donate organs, I encourage you to bear in mind that the criteria for defining death, particularly brain death, vary from state to state and from physician to physician. Not all of the criteria used will meet the definition of death according to halacha. Accordingly, steps should be taken in consultation with your posek to ensure that this is conducted in accordance with halacha.

--ALL (100%) of these patients have no
spontaneous respiration, and if disconnected from the ventilator,
NONE (0%) of these patients will breathe spontaneously--

You are completely avoiding the issue here. The issue I am addressing is not whether complete brain death or irreversible lack of spontaneous respiration is or is not death, but whether the mecically accepted definition of death meets this standard. The above condition would satisfy the halachic criteria of death as defined by Rabbi Feinstein, not because the patient is brain dead (which would require complete cessation of brain activity to meat the halachic definition of death on its own) only because of the lack of spontaneous respiration. However, it is uncontroverted that there are accepted brain death criteria that are used by reputable hospitals that do not ensure to a close to 100% certainty that there can be no spontaneous respiration.

--Mistakes happen.--

It is not just mistakes. In order to ensure greater availability of organs, many hospitals will intentionally adopt a criteria which has a margin of error (i.e. some live folks will be declared dead). I suggest that you read Volume 66 of the Journal of Philosophy and Medicine which includes a collection of essays relating to the use of brain death as a criteria of death. Perhaps then you won't have such a myopic view of this issue.

1. J. David Bleich is not MO – he is haredi.

2. You completely confuse the issues at hand. You disingenuously tried to convince raders that live patients are being killed for their organs.

This is false.

As Reichman clearly shows, residual brain function is not life.

3. As for you haredi gedolim, they TAKE organs harvested using Harvard Brain Death criteria. They just won't allow a Jew to DONATE.

If you and the gedolim you shill for were honest, you would refuse to take organs received through the Harvard Brain Death criteria.

I suggest you start a halakhic society to do just that, and that you spend your ample time and restrictive talents signing up as many haredim and haredi rabiis as you can.

--J. David Bleich is not MO – he is haredi.--

and so is Rabbi Schachter? or is it anyone that disagrees with your warped sense of halacha is automatically haredi?

--You completely confuse the issues at hand.--

I was quite clear what the issue I addressed was, but I'll lay it out again so that even you can understand. The issue is whether "death" as defined by the medical profession is consistent with "death" as defined by halacha. The answer is sometimes yes, sometime no.

--You disingenuously tried to convince raders that live patients are being killed for their organs.--

What I try to explain to your readers is that you would like to hide the fact that the definition of death is not always consistent with the term as used in halacha.

The issue is whether "death" as defined by the medical profession is consistent with "death" as defined by halacha. The answer is sometimes yes, sometime no.

That is a complete misrepresentation of the facts.

To the haredi rabbis you shill for, in practice, brain death is never halakhic death – although it may be halakhic death in theory.

For Rabbi Moshe Feinstein, the Israel Chief Rabbinate and dozens of Rav Moshe's students, brain death is always halakhic death – that is what Dr. Reichman so ably shows.

--That is a complete misrepresentation of the facts.--

I guess in Shmarya world if you repeat this multiple times it becomes true. I must say you are really convincing. Lucky for you the medical meaning of brain death is not defined by the ability to think or someone might be coming for your organs already.

Dr. Kunin interprets R. Moshe to
have required both complete absence of all measurable physiological
connection between the brain and the body and complete decomposi-
tion of the brain tissue. If this were true, the medical literature cited
would indeed necessitate a re-evaluation of the original pesak. However,
while this is one theoretical interpretation, it is not directly supported
from the responsa. Nowhere does R. Moshe state unequivocally that
either absence of all physiologically measurable activity or complete
brain decomposition is required for the halakhic determination of
death. The only very clear, absolute, and irrefutable requirement
according to R. Moshe is cessation of independent respiration. This
interpretation of the position of R. Moshe is confirmed by R. Dovid
Feinstein (video interview at www.hods.org):
My father’s position was very simply that the stopping of breathing is
the point of death. It doesn’t matter if the heart functions or doesn’t
function. That is the way he explained the Gemara in Yoma. . . . If the
breathing has stopped, then he is considered dead. . . . Anything else is
not a criterion.
R. Shabtai Rappoport has likewise confirmed this position: “Once we
know that a person’s spontaneous breath stopped, this is considered to
bedeath. This I heard from R. Moshe himself” (video interview at
www.hods.org).
The sole criterion of irreversible cessation of respiration is unques-
tionably met in the current brain death criteria. As such, the recent
medical literature would in no way affect the original pesak. Anon is either mistaken or lying. Either way, he is worng.

--Anon is either mistaken or lying. Either way, he is worng.--

Thank you for repeating what I said. Though I'm not sure how if you repeat what I said and assert it is the truth that you can then say that I'm either mistaken or lying. Then again, logic does not appear to be your strong point.

So lying it is.

You have proven time and again to be disingenuous, at one point admitting you continued behaving this way because you "enjoyed it."

Any reader can download the Kunin article, the Reichman article and their exchange of letters.

From that, everyone can see that there are two ways of approaching brain death.

Rav Moshe's way, the way the Chief Rabbinate adopted, is NOT effected by trace or peripheral brain activity remaining after brain death. Why? Because halakha's definition of death is cessation of breathing. All brain death is is a way to ascertain cessation of breathing (when modern life support mechanisms are present).

The second way, that of Israeli haredi gedolim, argues that, even though brain death appears to be actual death, as long a patient can be vented and 'survive,' we must consider him to be alive, EVEN IF THERE IS NO SPONTANEOUS BREATHING.

It may be some of these Israeli gedolim think that people put on life support lack spontaneous breathing.

This is FALSE.

People are vented because their breathing is too weak to support life. They breath spontaneously but not strongly or efficiently enough to support life. Without artificial ventilation they would die in a matter of minutes or hours.

People with no spontaneous breathing are only vented if it appears they will recover from whatever trauma caused breathing to stop. A massive head injury, for example, that causes complete cessation of spontaneous breathing would rarely (if ever) be vented.

The cases dealt with here are people on the cusp of viability/non-viability who were vented and did not improve.

Removal of the vent for "cleaning" or "maintenance," which Rav Moshe also sanctions, is one way of determining death in these cases. If there is no spontaneous breathing, the patient is dead and does not need to be reconnected to the vent.

In that case, the brain is not "completely" dead, there is no complete brain necrosis, yet the patient is halakhicly dead.

Another way to do the same thing is to test for brain activity through various scans now available.

The advantage here is that the heart can be used for transplant this way, as can other organs that would not otherwise survive the respirator "cleaning" test.

Rav Moshe approved this, as did many other rabbis, including the Israeli Chief Rabbinate.

The expectation that the brain would be "completely" dead is not found in Rav Moshe's teshuvot. It is a misinterpretation by Kunin.

As Dr. Reichman points out (and as I quoted exactly in a comment above) some of the patients declared dead in this fashion may have some residual brain activity. Even so, 100% of these patients would not have spontaneous breathing and would therefore be dead according to halakha.

As I also pointed out above, the standard Jewish way of testing for death in the pre-modern era was a feather held near the nose of the body. Cessation of independent spontaneous breathing was what confirmed death.

And so it is today, except that we have far better means to make that assessment and, as a result of those means, we can save many lives.


I have read the above comments with great interest and just wanted to clarify a few medical points (I am a 4th-year medical student at Harvard):

1. I've taken care of several patients who became organ donors. Once this difficult decision was made, many orders for medications which would be normally be lethal were made in order to make the organs more transplantable (such medications include heparin, a blood thinner). These medications are administered while patients are still breathing. A declaration of death is not made until the patient is in the operating room, just before organ harvesting, hours after all of the lethal medications have been administered.

2. In order to prevent the gag reflex/vomiting/aspiration, most patients are heavily sedated while on a ventilator. This sedation can make it very difficult (and sometimes impossible) to determine whether brain-stem reflexes are still present (one of the criteria in determining brain death) and whether or not spontaneous respiration is present. Sedation interferes with spontaneous respiration (which is why all patients undergoing general anesthesia are on a ventilator).

3. None of the imaging technology (brain scans) currently available in major tertiary care hospitals is capable of determining brain function. The declaration of brain death remains a clinical judgement. In my clinical work, I have not had the opportunity to work with a frum physician to see how s/he navigates the halacha of declaring someone dead, but several of the clinical criteria are not in agreement with the halachic criteria.

4. Organ donors are usually young and healthy and the decision to discuss organ donation with the families of these patients is wrenching for the physician. Doctors are not predators hunting for organs.

5. Unusable organs are left with the body of the donor. I have never seen an organ thrown in the trash.

1. The decision is made before the administration of those medications, meaning the patient is already brain dead.

2. The sedation you speak about is normally cut back to check for spontaneous respiration.

I was just with a vented un-sedated patient last week who commincated with me using and and eye jestures. Sedation levels vary, not only based on comfort. Usually the sedation levels are determined by attempts by the patient to pull out the vent.

Since that is impossible in brain dead patients, the level of sedation is determined by perceived level of pain. Therefore, sedation can and is cut back to determine function.

Is Harvard doing something different?

I doubt it.

3. None of the imaging technology (brain scans) currently available in major tertiary care hospitals is capable of determining brain function.

This is false. It can be done and has been done.

4. I have not had the opportunity to work with a frum physician to see how s/he navigates the halacha of declaring someone dead, but several of the clinical criteria are not in agreement with the halachic criteria.

The fact that you use the term "frum physician" tells me you have more than a passing familiarity with Orthodox Judaism. As such, you should know better thann to write "several of the clinical criteria are not in agreement with the halachic criteria" as an unsupported statement.

See the Reichman article:

http://www.hods.org/pdf/Reichman%20BSD%20Tradition.pdf

HODS has a long list of scholarly articles and responsa posted here:

http://www.hods.org/English/h-issues/articlesE.asp

You can also view video testimony from various rabbis here:

http://www.hods.org/English/h-issues/videos.html

4. Agreed.

5. Agreed.


Thank you for the information. I will check out the responsa you posted.

Just to clarify the point about imaging: it is not routinely used to determined brain function for purposes of declaring brain death. CT and MRI scans are routinely done to aid in diagnosis, but these scans show structural lesions (ischemic stroke, bleeding) not functional damage. Other nuclear scans (PET, fMRI) can show function but are not available at these hospitals 24 hours a day. In one month in the Neuro-ICU of a major teaching hospital, I saw more than one hundred patients and a functional scan was never used to determine brain death.

Also, in regard to my first point, while the decision to pursue organ donation has been made when the medications are administered, the patient is not declared "legally dead" until the operating room. This was not meant to imply any ethical impropriety on the part of the physicians, just to point out the strangeness at having to wait to declare a patient's legal death hours after the brain death has been reported to the family.

I wish that more rabbis were informed about the intricacies of organ donation and that they would educate their communities so that people could make an informed as well as halachically sound decision.

I wish that more rabbis were informed about the intricacies of organ donation and that they would educate their communities so that people could make an informed as well as halachically sound decision.

The information exists.

The problem is false and misleading information circulated by people wishing to curtail organ donation based on rulings from haredi poskim who opposed this donation from day one.

ust to clarify the point about imaging: it is not routinely used to determined brain function for purposes of declaring brain death. CT and MRI scans are routinely done to aid in diagnosis, but these scans show structural lesions (ischemic stroke, bleeding) not functional damage.

CT scans can show extent of brain damage.

I think it is also important for people to know there is a difference between a persistent vegetative state and a deep coma on one hand and brain death on the other.

A patient in a PVS or deep coma can breathe on his own and, while the chances of a full recovery are often slim, he is not dead. He reacts to pain and other stimuli.

A brain dead patient cannot breathe on his own and has no reaction to stimuli. He has no chance for recovery. His brain is so damaged that it cannot support life.

--Posted by: JMS | February 05, 2008 at 12:50 AM--

Finally someone speaking some sense.

--A brain dead patient cannot breathe on his own and has no reaction to stimuli.--

Once again you oversimplify the issue. A brain dead patient according to most definitions shows no reaction to commonly tested stimuli and testing for stimuli is one of the methods of diagnosing brain death. What you fail to acknowledge is the following: (i) Patients have been diagnosed with brain death, including after testing for stimuli and finding the patient unresponsive, and subsequently they find that the patient does react to stimuli. This raises the question of whether the observations of a patient not responding to stimuli is truly accurate or determinative. Further, "brain dead" patients often do react to painful stimuli including showing signs of distress when ventilators are removed and showing indications of pain (e.g. raised blood pressure and the release of endogenous catecholamines - which is considered harmful to the harvested organs) when incisions are made as part of the organ removal process. There is disagreement among the medical profession whether the body of an organ donor actually can feel pain or if these are just automated motor responses such as the chicken running around without a head after slaughter. In certain countries, e.g. Britian, it is not uncommon to give the brain dead donor pain medication while organs are removed.

In short, people should be aware that there is no single universally accepted definition of brain death. If you want to be an organ donor and you care about doing so in accordance with halacha you need to take some steps to ensure that will be the case. This is of particular concern if someone is declared dead using the non heart-beating donation method where the patient need not be declared brain dead and the patient is deemed to be hopeless and means of life support deemed extraordinary are removed. It is quite likely that the removal of such life support may not be consistent with halachic criteria. Simply signing a blanket organ donor card or the back of your license (if it has an organ donor option) which allows the doctors to decide when your dead does not guarantee a halachic determination. If you would like to be an organ donor, I would suggest that you leave instructions to family or other trusted individuals who will have the exclusive right (not the doctors) to determine when you are dead and when and under what circumstances organs may be harvested. If need be, they can contact a qualified posek (i.e. not some blogger with no medical training who has determined that he is ultimate authority on time of death) who can assist them at the time a decision has to be made. The medical profession discourages this approach to organ donation because often they have to make a decision within minutes whether to harvest an organ before they run the risk that the organ deteriorates to a point where it is no longer viable. I'm not saying they do this with malice or nefarious reasons, but we need to be realistic about the competing incentives here. The need to ensure an adequate supply of organs (which is a laudible goal) creates an incentive for the medical profession to stretch the definition of death often beyond that which is recognized by halacha.

often [doctors] have to make a decision within minutes whether to harvest an organ before they run the risk that the organ deteriorates to a point where it is no longer viable

Realize what this anonymous 'expert' is writing.

Why do doctors often have only minutes before an organ becomes useless for transplant?

Because the patient is DEAD. His brain cannot support life and the organs dependent on it are DYING.

As Dr. Reichman wrote, NONE of these patients (0%, ZERO) can breathe spontaneously. That means 100%vof these patients are dead according to halakha.

If you read anon's last comment carefully, you'll note his definition of "responsive to stimuli" is a slight increase in blood pressure and a release of small amounts of hormones when a vent is removed – and this in a small minority of such patients.

What anon fails to tell you is one can measure the same type of results in decapitated animals like sheep. Those sheep are halakhicly and medically dead, no matter the various minute 'responses' measured.

The criteria for halakhic death is:

1. Complete cessation of spontaneous breathing.

--OR--

2. Decapitation, which includes a crushed (but not decapitated) head.

These are the criteria brought by the Talmud, and they are what has been used by Jews since, at the very latest, late Mishniac times.

Again, all these patients who exhibit trace brain function after being declared brain dead or who show these slight 'reactions' (which anon is kind enough to note many doctors do not believe are reactions at all) are DEAD according to criteria #1.

Israel's haredi gedolim AGREE that criteria #1 is met. They argue, however, that since the APPEARANCE of life can be sustained by using a ventilator, dopamine, and many other drugs, we have to be carful and judge the patient as a safek GOSSES (one in the process of dying), safek meit.

In other words, acording to them, we are in a halakhic no man's land where the patient is either a gosses (and who we are therefore halakhicly forbidden to touch for fear of hastening the death that is both extremely close and inevitable) or a dead man.

Rav Moshe Feinstein and the Israeli Chief Rabbinate also agree that criteria #1 is met – the patient is dead.

These rabbis have only a very minor concern about the issue of gosses because they know what Dr. Reichman knows – every one of these patients cannot breathe spontaneously and are therefore already dead. Their is NO hope of recovery.

In their eyes, all we have done, so to speak, is preserve their bodies especially well.

But, for the sake of being careful, they want criteria #2 to be in place as well, which is defined by them as a brain that is incapable of supporting life, NOT complete brain necrosis.

Again, this criteria is met in all of these patients, even if trace brain function exists.

If anon holds like Rav Moshe, his children and students, most of the RCA, and the Chief Rabbinate, his complaints are invalid.

If he holds like the Israeli haredi gedolim, his complaints make no sense – they already refuse to allow organ donation (but allow haredi to receive organs as transplants).

What anon does is incorrectly blur the line between these two schools of halakhic thought.

This anonymous 'expert' would have you believe the 'findings' he quotes are significant and therefore should change how Jews view organ donation.

Yet the overwhelming majority of medical experts disagree with anon. This findings are NOT significant. Dr. Reichman has done a good job of simply explaining why this is so.

Rabbis in favor of organ donation point out that, when Jews refuse to be organ donors but, at the same time, demand donated organs to save Jewish lives, non-Jews begin to wonder if Jews should be entirely removed from (or dropped to the bottom of) recipient registries, the government-kept lists of those needing organs.

If anon and the rabbis he shills for would start an organization that advocates not donating organs and not receiving organs, and if they each carried a "No Donor, No Recipient" card, their position would be tenable.

But they do not do this.

If organs are taken in a manner that is not consistent with halakha, that means the patient the organs are taken from has been MURDERED.

If so, it should be forbidden to use those organs and all believing Jews who follow these Israeli haredi gedolim should refrain from using such organs and should also openly protest their use.

This does not happen because anon and these rabbis will take but not give. They will use the organs 'harvested' from a 'murdered' donor.

Why?

Because the donor is a non-Jew. And, as we all know, in haredi thought (as opposed to Jewish thought) non-Jewish life is cheap.

All this said, there is one thing anon and I agree on.

If you want to be signed up as an organ donor, do so through HODS:

http://www.hods.org/


The excuse the Israeli haredi gedlim use for taking organs but nit giving them is that the patient is a SAFEK gosses, SAFEK meit.

Therefore, because we are unsure as to whether the patient is in the irreversible stage of dying or is already dead, and because they cannot say the patient is absolutely a gosses, they make a sfake sfaka (a halakhic double doubt) that allows haredim to benefit from these organs while still ot donating themselves.

This double doubt does not exist with organs harvested from Chinese prisoners on death row, which is why Rabbi Elyashiv wrote that it is forbidden to take these organs or to benefit from them in any way.

Still, if the majority of donors were Jews rather than Gentiles, the double doubt that allows the use of Western-donated organs would not be operable.

It is the non-Jewish origin of these donated organs that allows haredim to take organ donations in the first place.

And that, as has been pointed out by many opposing rabbis (see the videos on the HODS site for some of these, especially Rabbi Tendler), causes non-Jews to consider banning Jews from receiving organs, dropping them from recipient lists and will surely kill Jews as a result.

--Because the patient is DEAD. His brain cannot support life and the organs dependent on it are DYING.--

Did you wake up on the wrong side this morning or are you just naturally dense? Most doctors do not take organs from a donor who might survive. However, even after it is clear that someone has no viable chance of survival we still have to make a judgement call as to time of death. According to halacha one may not hasten the death for purposes of donating an organ. Due to the use of life sustaining equipment such as respirators determining the time of death is not a precise science. Since erring on the side of caution means loss of some organs, doctors will try to cut this as close as possible. I suspect that most of the times they get it right or even err on the side of caution (from the donor's perspective). However, there are clearly also times that they are too aggressive by halachic standards. Does this happen 1% of the time or 5% of the time - I don't know, but it happens. Doctors try to push the limits on this diagnosis which, putting aside deep ethical philisophical discussions, is for a very good cause. However, that does not make it consistent with halacha. So in short, if you care about halacha you leave this decision to someone that will make the organ donation decision consistent with halacha. The bottom line is that if we have a patient who we are 90% sure is dead and to the extent he is alive we are 100% sure that he is in a vegetative state and will die within the next few hours, according to halacha you can't remove his organs.

--If anon and the rabbis he shills for would start an organization that advocates not donating organs and not receiving organs, and if they each carried a "No Donor, No Recipient" card, their position would be tenable.--

One of the dumber comments you've made on this topic so I wasn't going to address it. However, since you seem so enthralled by it that you keep on repeating it I will. No one is saying that organ donation in principal is not acceptable. No one is accusing the medical profession of wholesale murder. The concern is that for a laudible cause they are pushing the limits on the definition of time of death. While we can understand why they would want to err on the side of protecting the patient that has the greater chance of surviving, that is not always consistent with halacha. The vast majorities of organ donations are done in an acceptable manner and there since the individual recipient has not control over the process he is not obligated to avoid being a recipient of an organ donation on the off chance that the one he receives did not comply with halacha. (There is also the notion that very often the organ would be removed anyway since if not him there is the next person on the waiting list.) In contrast if you are directly involved in a specific process, whether you are the doctor peforming the procedure, a donor or making the decision on behalf of a donor then according to halacha you have an obligation to do it right. If the person is a safek meit then you are prohibited from moving forward with the process according to halacha.

--Still, if the majority of donors were Jews rather than Gentiles, the double doubt that allows the use of Western-donated organs would not be operable.--

Please site a source for this (assuming you didn't just make this up). The rabbis I've discussed this issue with have not made any destinction between Jewish and Gentile donors (or the fact that most donors are persumably gentile) as according to halacha murder is prohibited either way.

The bottom line is that if we have a patient who we are 90% sure is dead and to the extent he is alive we are 100% sure that he is in a vegetative state and will die within the next few hours, according to halacha you can't remove his organs.

That is the position of the Israeli haredi gedolim.

It is NOT the position of Rabbi Moshe Feinstein, most of the RCA, the Israeli Chief Rabbinate and others.

If physicians are unsure if the patient is truly brain dead, all poskim agree the organs cannot be taken.

If there is cessation of spontaneous independent respiration the patient is DEAD according to Rav Moshe and the Chief Rabbis.

Again, it is Israeli haredi gedolim who see this situation as one of doubt, in the sense that the patient may not be fully dead and instead may be a gosses, a patient in the throes of death who will absolutely die within a short time.

Therefore these Israeli haredi gedolim always forbid organ donation.

Anon is doing the same thing here. The difference is he is not man enough to admit it.

I should also add this, "The bottom line is that if we have a patient who we are 90% sure is dead and to the extent he is alive we are 100% sure that he is in a vegetative state and will die within the next few hours,shows anon's confusion (or his intentional blurring of the truth).

These patients are not in persistent vegetative states – they are BRAIN DEAD.

As I explained above, these are two very different things.

The vast majorities of organ donations are done in an acceptable manner and there since the individual recipient has not control over the process he is not obligated to avoid being a recipient of an organ donation on the off chance that the one he receives did not comply with halacha. (There is also the notion that very often the organ would be removed anyway since if not him there is the next person on the waiting list.) In contrast if you are directly involved in a specific process, whether you are the doctor peforming the procedure, a donor or making the decision on behalf of a donor then according to halacha you have an obligation to do it right.

This quote proves anon is dishonest or very foolish.

1. If the "vast majority" of organs are correctly taken according to halakha, and if donating organs correctly is permissible for Jews, then there should be no blanket refusal by Jews to donate.

The halakhic donor agreement sponsored by HODS should be enough to allow any Jew to sign up as a potential donor.

Yet Israeli haredi gedolim hold NO ONE can donate organs, that this donation is forbidden according to halakha.

So what anon is doing – again, disingenuously, is misrepresenting both the position of the Israeli haredi gedolim and of their halakhic opponents.

As for the Jewish / non-Jewish issue, I suggest anaon process the rulings of Rabbi Auerbach, et al, forbidding organ donation and then ask why it is that, at the same time, these rabbis will allow their followers to accept organ donations.

The answer is because of the sfaek sfaeka I mentioned a few comments above and because the majority of organs come from non-Jews (or from Jews who have the halakhic status, in some regards, as non-Jews).

--What anon fails to tell you is one can measure the same type of results in decapitated animals like sheep. Those sheep are halakhicly and medically dead, no matter the various minute 'responses' measured.--

I did not fail to say this, I compared it to the chicken running around without a head. The point is two fold (i) that lack of stimuli is a questionable yardstick since even dead people react to some stimuli so we are only testing for certain accepted stimuli, not all, and the distinction as to which stimuli responses may still exist and the patient still be deemed dead may or may not be consistent with halacha. (ii) That there is a debate within the medical community whether the reaction of the organ donor is in fact just an automated motor response of a dead person or if it is possibly something more than that which may mean that the donor may be only safeik meit.

--The criteria for halakhic death is:

1. Complete cessation of spontaneous breathing.

--OR--

2. Decapitation, which includes a crushed (but not decapitated) head.--

duh, not only did I never said otherwise, I also noted that myself earlier. In fact you seemed to conflate the two until I pointed out the distinction. The problem is both require a diagnosis involving a judgement call. Irreversible lack of spontaneous breathing cannot be diagnosed with absolute certainty in part because the patient is on a life support and in part because how do you know for sure that it is irreversible. Brain death as we know it cannot serve as a substitute for decapitation because it requires complete brain death which is not the standard used. So what we are left with is we use the medical standard of brain death to make a judgement that there is irreversible loss of spontaneous breathing. Again this is a judgement call. It is pretty clear that the diagnosis is correct in the vast majority of times. How high is the margin of error? No one knows. Again, I'm not criticizing the medical profession. Whatever margin of error there is involves a person that they can say with a very high degree of certainty if he is not dead will be dead within a very short time. Absent halachic concerns I would probably be 100% behind the process. Problem is that is not good enough for halacha.

--Israel's haredi gedolim AGREE that criteria #1 is met.--

Can't speak for all Israele gedolim or for all haredi gedolim, but the rabbis I've discussed this with who raised concers about the process cited the concern that it is not 100% certain that criteria #1 is met - rather it would be more accurate to say that it is 100% certain that criteria #1 either has been met or will be met very shortly. Again, that doesn't work according to halacha.

--Their is NO hope of recovery.--

You keeping on referring to this but it is irrevelevant. No one disagrees that there is no hope of recovery. The problem is that we still need to establish a time of death according to halacha. The fact that someone has no hope of recovery because he will definitely die very shortly doesn't work if he is not definitively dead already.

--But, for the sake of being careful, they want criteria #2 to be in place as well, which is defined by them as a brain that is incapable of supporting life, NOT complete brain necrosis.--

Reread Dr. Reichman's article. He acknowledges that criteria #2 may not exist rather that the medical definition of brain death (which is less than criteria #2) is sufficient to diagnose the existence of criteria #1.

--Dr. Reichman has done a good job of simply explaining why this is so.--

Yet you seem to be unable to grasp what Dr. Reichman wrote.

--Rabbis in favor of organ donation point out that, when Jews refuse to be organ donors but, at the same time, demand donated organs to save Jewish lives, non-Jews begin to wonder if Jews should be entirely removed from (or dropped to the bottom of) recipient registries, the government-kept lists of those needing organs.--

That is a valid concern, however, can you cite one halachic authority that this concern would justify something that according to halacha would be murder? Or, to use your terminology, are you just full of crap?

--Because the donor is a non-Jew. And, as we all know, in haredi thought (as opposed to Jewish thought) non-Jewish life is cheap.--

Two things. First of all most of the rabbis I discussed this with that raised the concern I raised in my comments are not haredi. Secondly, none of the rabbis I spoke with, hareidi or not, distinguished between a jewish vs. non-jewish donor. You think some do make this distinction, cite a source.

--All this said, there is one thing anon and I agree on.--

The HODS card authorizes donations only after consultation with a family appointed rabbi and therefore seems to be a halachically acceptible approach to organ donation.

--If there is cessation of spontaneous independent respiration the patient is DEAD according to Rav Moshe and the Chief Rabbis.--

Slight mistatement, it needs to be an irreversible cessation. If you would be having an honest exchange instead of trying to fudge your way through this you would acknowledge that the issue I raised is not whether this standard constitutes death according to halacha, but whether this criteria can be diagnosed with a sufficient level of certainty to satisfy halacha. The medical community acknowledges that there is some small degree of guesswork here, but Shmarya would have us believe that he knows better. Its time to wake up and smell the coffee. The issue is not whether irreversible cessation of spontaneous respiration is a approrpriate standard. The question is also not whether it is diagnosed with 100% accuracy - it is not. The question is whether the margin of error which, as I noted is small, is small enough to not jeopardize the halachic status. This is further complicated by the fact that the standards used differ from hospital to hospital and sometimes from physician to physician.

--These patients are not in persistent vegetative states – they are BRAIN DEAD.--

One moment he is in a coma the next moment he is brain dead. The question is when that moment is. Again, this involves some judgement call and also varies based on the standards used. Further, to repeat myself again, the brain death diagnosis under medical standards, even if accurate, does not satisfy your criteria #2. The question is whether it proves the existence of criteria #1.

I did not fail to say this, I compared it to the chicken running around without a head.

A chicken is not a large mammal. It is different neurologically and physiologically from large mammals and humans. There is no comparison.

If you would be having an honest exchange instead of trying to fudge your way through this you would acknowledge that the issue I raised is not whether this standard constitutes death according to halacha, but whether this criteria can be diagnosed with a sufficient level of certainty to satisfy halacha.

If the respirator is disconnected, 100% of patients will dies within moments because they cannot breathe spontaneously.

Further, they have no hope of ever being able to breathe spontaneously, as Dr. Reichman points out.

The medical community acknowledges that there is some small degree of guesswork here, but Shmarya would have us believe that he knows better.

That "small degree of guesswork" is well within the halakhic parameters of death, something Dr. Reichman also points out.

Further, to repeat myself again, the brain death diagnosis under medical standards, even if accurate, does not satisfy your criteria #2. The question is whether it proves the existence of criteria #1

Dr. Reichman, Rabbis Dovid Feinstein, Shabtai Rappoport, and Moshe Tendler, most of the RCA and the Israeli Chief Rabbinate DISAGREE with your assertion.

See the Reichman article:

http://www.hods.org/pdf/Reichman%20BSD%20Tradition.pdf

HODS has a long list of scholarly articles and responsa posted here:

http://www.hods.org/English/h-issues/articlesE.asp

You can also view video testimony from various rabbis here:

http://www.hods.org/English/h-issues/videos.html

--A chicken is not a large mammal. It is different neurologically and physiologically from large mammals and humans. There is no comparison.--

A chicken is not a large mammal? Wow, thanks for this bit of information. Your point?

--If the respirator is disconnected, 100% of patients will dies within moments because they cannot breathe spontaneously.--

So would thousands and thousands of patients that are clearly not brain dead. Would it be okay to take their organs as well?

--That "small degree of guesswork" is well within the halakhic parameters of death, something Dr. Reichman also points out.--

Perhaps, depending on the standard used. Have you quantified the degree of guesswork so that you can make this determination? I highly doubt it. What margin of error do you think is acceptable by halacha? Also, considering that there are different standard used for determining brain death, please clarify for your readers which standard you are referring to.

1. You used the chicken example incorrectly. I pointed out your error.

2. --If the respirator is disconnected, 100% of patients will dies within moments because they cannot breathe spontaneously.--

So would thousands and thousands of patients that are clearly not brain dead. Would it be okay to take their organs as well?

Circular reasoning.

First of all, those other patients are not also brain dead.

Secondly, Lack of spontaneous respiration combined with other signs related to brain death is what defines death in these cases.

A person who cannot breathe spontaneously (as opposed to the vast majority of patients on respirators who can breathe spontaneously but not well enough to avoid respiratory failure or a heat attack) is already dead according to halakha. The only issue at hand is if his life can be saved, and by this I mean saved and returned to some form of health, not 'living' brain dead on a respirator waiting for his organs to rot within him.

You again misstate the case at hand.

3. --That "small degree of guesswork" is well within the halakhic parameters of death, something Dr. Reichman also points out.--

Perhaps, depending on the standard used. Have you quantified the degree of guesswork so that you can make this determination? I highly doubt it. What margin of error do you think is acceptable by halacha? Also, considering that there are different standard used for determining brain death, please clarify for your readers which standard you are referring to.

This cuts to the heart of your mistake.

The mistakes made by physicians, as Dr. Reichman points out, are not taking organs from people who will otherwise recover or will otherwise live a life other than brain dead on a respirator.

The mistakes are made in determining some of the facets of brain death and these facets by themselves do NOT effect the over all picture.

You disagree with Dr. Reichman, with the vast majority of physicians alive today, will all experts in the field, and with a huge number of American and Israeli poskim.

So here's what you should do – admit that. Say, "I Mr. Anonymous blog commenter, a man without the courage to use my real name, I disagree with these rabbis, doctors and experts."

Instead, you play a deceitful game, trying to make it seem as if these rabbis would somehow agree with you. They do not.

You hold by haredi Israeli rabbis who reject organ donation. Be honest and admit that.

Conversely, you could also admit you do not understand the issues at hand. Of course, you will never do that.

דע מה שתשיב לאפיקורס ... אבל אפיקורס ישראל כ"ש דפקר טפי

Hey us non-jews should have that right (no autopsy) as well. I don't believe in the torah, but I do believe that us non-jews can have that right as well. Dam ashkenazi-elitist!

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