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February 19, 2011

How Brain Stem Death Works

Brain and brain stem To understand why Rabbi Moshe Tendler and dozens of other rabbis rule that brain stem death is death according to halakha, Jewish law, watch this video.

 

Better yet, watch this video with rabbis Hershal Schachter, Mordechai Willig, Asher Busch, and/or other rabbis who want you to believe that a brain stem dead individual is alive:

 

Comments

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Why such focus on death ?

We live in a pathological age. Many Israelis are obsessed by pathology and darkness. I have been to two funerals in my life. I love the fact that I know the universe is stable, ordered, benevolent and expansive. We should be seeking settings whereby the chance of brain injury is reduced down to zero. What we focus on can determine our reality.

An over-interest in a pathology is a pathology in itself.

adam-the universe is stable but youre not.

To jancsipista,

Slander will get you nowhere. Would you like to discuss the issue at hand or just snipe ?

adam-well you think that this issue is nonsense what is there to discuss with you?

To jancspista,

In fact I can't be bothered communicating with slanderers, underminers and marginalisers at the moment. I have better things to do this afternoon. I like spaces where people can interact and discuss on important issues. I enjoy intellectual challenges.

adam- you write here such unbeleivable nonsence it boggles my the mind i am sorry but youre a shoite a tottal fool you think youre superior to others its too much, youre right i wont even bother to write youre on a different planet then others so it seems, with youre nonsensical writing , stable univers what in the world are you talking about

The argument isn't whether medicly or legally the brain-stem-dead patient is dead (though that is debatable and many doctors are not convinced) the argument is whether halachicly the patient is dead. You may have noticed the video did not bring up yoma 85a nor the mishna in ohalas thus it is minimally helpful in settling the debate

The argument isn't whether medicly or legally the brain-stem-dead patient is dead (though that is debatable and many doctors are not convinced) the argument is whether halachicly the patient is dead. You may have noticed the video did not bring up yoma 85a nor the mishna in ohalas thus it is minimally helpful in settling the debate

Posted by: Bob | February 19, 2011 at 08:38 PM

Please.

A brain stem dead person cannot even attempt to breathe on his own, and the the Genmra and the Mishna do not envision artificial respiration.

Past that, no one of note argues that the brain does not begin to liquefy almost immediately after blood flow to the brain ceases, and in autopsies of brain stem dead people bits of brain matter are found in the spinal cord – which can only happen through liquification.

That some rabbis are delusional does not change the medical and scientific facts.

"I love the fact that I know the universe is stable, ordered, benevolent and expansive."

Adam, aside from being the messiah, you are also rather sheltered. Come with me on cancer center rounds and see if you still think this. I have a dying 20 year old woman with metastatic cancer I'd like you to heal.

To Maven et.al.

I am not criticising the importance of this issue. I am well aware of human suffering on many levels.

Cancer is a metaphor for something that eats away at someone. Many people have repressed traumas that affect them in later life. Cancer can be healed. A very good friend of mine had a remission of cancer of the spleen in 1997 after my intervention. She is now a happy mother. I will not go into what transpired to heal her. You would have to hear the full story and chronology of events. It is a remarkable story. I have learnt through bitter experience that sometimes people prefer to stay in denial than face the truth head on. Mindset and setting create dis-ease. The prophecies are crystal clear that dis-ease can be eliminated over time from the realm of human affairs with the right management structure in place from Jerusalem.

Of course some people are in advanced stages of disease. Offering false hope to them is foolhardy. I try to pick my words and audience wisely. I cannot overestimate enough however the primary importance of mindset and setting as contributory factors towards dis-ease.

Blessings to all those who work with the sick and injured.

Shmarya

Please.

A brain stem dead person cannot even attempt to breathe on his own, and the the Genmra and the Mishna do not envision artificial respiration.


how could you say such a thing, of course they new about and envision artificial respiration they new all I am sure of that.

How do I know this?

My rebbie in 12th grade told me so

Again it doesnt matter what you or even someone knowledgeable on the subject thinks. It matters what the sources tell us. Even those who accept brain-stem-death do so because they feel it satisfies the Gemara;s criteria, not because it seems right to them. You cant fault orthodox Rabbbis for following orthodox sources and not their own intuition. Orthodox halacha doesnt work that way.
Nobody of note or even without note (orthodox at least) views the beginning of brain liquefaction as an acceptable definition of death (in of itself), thus that part of your comment indicates how little you know on the subject.

A very good friend of mine had a remission of cancer of the spleen in 1997 after my intervention. She is now a happy mother. I will not go into what transpired to heal her.

I wonder what the CPT code (medical procedure code) is for kabbalistic healing - not otherwise specified.

Again it doesnt matter what you or even someone knowledgeable on the subject thinks. It matters what the sources tell us. Even those who accept brain-stem-death do so because they feel it satisfies the Gemara;s criteria, not because it seems right to them. You cant fault orthodox Rabbbis for following orthodox sources and not their own intuition. Orthodox halacha doesnt work that way.
Nobody of note or even without note (orthodox at least) views the beginning of brain liquefaction as an acceptable definition of death (in of itself), thus that part of your comment indicates how little you know on the subject.

Posted by: Bob | February 19, 2011 at 09:36 PM


however, when it comes to these type of issues it is almost useless to look at previous sources since those sources are based on old an science that we know today is wrong

Again it doesnt matter what you or even someone knowledgeable on the subject thinks. It matters what the sources tell us. Even those who accept brain-stem-death do so because they feel it satisfies the Gemara;s criteria, not because it seems right to them. You cant fault orthodox Rabbbis for following orthodox sources and not their own intuition. Orthodox halacha doesnt work that way.
Nobody of note or even without note (orthodox at least) views the beginning of brain liquefaction as an acceptable definition of death (in of itself), thus that part of your comment indicates how little you know on the subject.

Posted by: Bob | February 19, 2011 at 09:36 PM

No. Your comment shows how little you know about the science and the halakha.

Back in the old days, the chevra kadisha used to place a feather by the nose of a patient and watch for signs of breathing. If none were there, he was declared dead. This lead to the occasional burial of living people, and stories of "dead" people who "woke up" during tahahra.

Today we can do much better than a feather, and we know that brain stem dead people cannot even attempt to breathe on their own, let alone sustain breathing.

That some Orthodox rabbis cannot grasp this simple fact says much about their quality as human beings and religious leaders.

You know less about the subject than I thought. Those who hold that brain-stem-death isnt death do so because they dont view the lack of spontaneous breathing as an indicator of death. I have no idea what you are talking about and sadly neither do you.
what chevra kadisha have done in the past is as irrelevant as what the medical field's opinion is. All that matters in Orthodox halacha is what talmudic sources tell us. No matter how outdated and irrelevant you may view them. Is that really so hard to understand. To me for one it seems that brain-death should be the criteria but that is based n my understanding of yoma 85a. And while I may disagree with those who reject brain-stem-death at least Im honest enough to have read through their opinions. Your last two paragraphs ("Today we can do much better than a feather, and we know that brain stem dead people cannot even attempt to breathe on their own, let alone sustain breathing.

That some Orthodox rabbis cannot grasp this simple fact says much about their quality as human beings and religious leaders.

") indicate that you have not even given a cursory glance to the RCA paper.
how can you be so blatantly intellectually dishonest?

Posted by: Bob | February 19, 2011 at 11:09 PM

Please.

Either you are ignorant or you are lying.

What chevra kadishas did was FOLLOW THE HALAKHA, which was that death was determined by lack of breathing. Rav Moshe mentions this and Dovid Feinstein talks about it on the video HODS made of him.

What you don't know because you are ignorant is that medieval medicine viewed the heart's function differently than how we know it actually works.

The heart was considered to be the organ of breathing, not of circulation, and any mention of cardiac death in halakha refers to that mistaken function of the heart.

Now toddle off.

Glad to know that Sharia and the Catholic and Anglican Churches also support brain stem death as death.

http://www.youtube.com/watch?v=v56S8fl0WpQ
http://www.youtube.com/watch?v=S1g_7mPFmBg

My respect for HOD has seriously dropped after seeing these videos. I don't think peer pressure plays a part in Halacha.

i am very well aware of the relevant facts. you are projecting your ignorance on to me.
allow me to walk you through this, you'll telll me where you get stuck
a) According a possible reading of the gemara, cardiac activity determies life. (this is explicit in Tshvas chasam sofer and chacham tzvi, wether it was based on medieivel medicine (it certainly was in chacham tzvis case he goes through he mistaken beliefs of his time,) is irrelevant thus far
b) Orthodox jews base our life on talmudic sources, certainly in such serious situations
(c we do so even when it is based on a mistake, see the discussion involving killing lice on shabbos, since they arent born, but rather sponteneusly generate, something we now know to be incorrect. this point is really a side point and only neccessary if you hold the brain-stem-dead patient is certainly alive, something Rav shechter does not hold, he views it as doubtful)
d) Since he MAY be alive, as the talmud indicates (again mistakingly, or not0 it is forbidden to unplug a ventilator as that would be "murder"
I'd be happy to walk you through any point you get stuck on

Posted by: Bob | February 20, 2011 at 07:03 AM

Please.

Your comment displays your ignorance.

You're saying that because ONE rabbi in pre-modern times ruled that cardiac death is the determination of death, and a well-known extremist in near-modern times agreed with him, we now have to consider their position as valid, even though we know scientifically and medically it isn't.

What's worse, your understanding of those two positions leaves out the position of the Shulkhan Arukh, which holds that a person with a broken neck is dead, even if he's still 'twitching.' The idea – which you and your rabbinic 'advisers' seem to miss is that once the brain and the body have been irreparably separated, be that trough decapitation or through a broken neck, the person is halakhicly dead.

Brain stem death is irreparable. The patient can't breathe or try to breathe on his own, and his brain has already begun to liquefy.

Yet in your twisted version of halakha, he is possibly alive – something the Shulkhan Arukh and hundreds of other Rishonim and Achronim clearly would have rejected.

If life support and brain scans had been invented before the haskala (which, of course, they could not have been because pre-Enlightenment education could never have produced the science necessary to do it), your rabbis would have no question. A brain stem dead person would be halakhicly dead.

It is only because the Hatam Sofer and his modern day followers reject modernity and do everything they can to make sure there is no 'change' in halakha that this is even an issue.

The science is clear and the halakha is clear.

It is only your rabbis who are lost in clouds.

as long as others foot the bill it is ok with the rabbis to keep someone alive under any circumstances

BUNCH OF OPEKORSIM

first of all As i said I follow those who view brain death as death,.
secondly your post indicates not only your ignorance on the subject but an overall blind-hatred which prevents you from thinking things through and results in absurd self-contradictions:
First you state that " THE HALAKHA, which was that death was determined by lack of breathing" in all times, yet the "Hatam Sofer and his modern day followers reject modernity and do everything they can to make sure there is no 'change' in halakha" , by changing the halacha and demanding cardiac activity to function as well. which is it did the chatam sofer change the halacha and demand new criteria that were never required? Or did he "reject modernity and do everything they can to make sure there is no 'change'"
Incidently you never did tell me which point you had trouble with, Id be happy to explain it to you.

allow me to try another approach which may help you out.
Suppose the gemara stated explicitly that death is determined based on cardiac activity. In that case any Orthodox person (by definition) would Reject brain death (which as you may know does not preclude cardiac activity), even Rabbi Tendler, and the most vocal (orthodox)supporters of brain death would reject it, no matter what every sinlge physician and ethicist says regarding brain death (although it can hardly be said that they all agree). Right? so far so good? Please let me know if you had trouble with that.
Now, as far as some are concerned (such as R' Elyashiv) the gemara essentially says cardiac activity is the determining factor (for the life of me, I dont see it, but they are entitled to their opinion.) Thus no matter what every physician and ethicist says (which again, their views are hardly unanimous), brain death isnt death as long as the heart is still beating. again i'd be more than happy to help if youre stuck on any point

Bob, I have been a physician for 30 years. I have worked in critical care in major university medical centers my entire career.

I have never met any physician who disputed the fact that brain death is, in fact, death. It is as certain as any pronouncement of death of a patient has ever been.

I do not know upon what you base your statement to the effect that 'doctors don't all agree that brain death is truly death'.

If you want to argue via ecclesiatic methods about how death is defined by Talmudic and other Jewish religious sources, you are welcome to do so. However, such arguments have no basis in actual proven science. Brain Dead is dead. Period. The earth is round like a ball, not flat like a coin.

Just as you mentioned about the spontaneous generation of maggots, you are welcome to 'believe' because you have taken a vow of religious dogmatic allegiance to the writings of yesteryear and you've granted the status of infallibility to those authors.

Now it's your problem, and it's up to you to spin the ancient writings so as to make them sound relevant and applicable. You are welcome to your thoughts and beliefs, but they are irrelevant to the realities at the bedside in the ICU.

Bob, I would agree with you on something you said at 7:03.

If turning off the ventilator of a brain dead patient is religiously problematic, then do what I did when my father (OBM) was in that state in the ICU.

We decided to 'let him be'. We did not begin any new or additional medications or treatments, and we did not increase the ventilator or pacemaker settings (as is commonly done as last desperate efforts to keep the body going). No additional tests were done, because it would be irrelevant; we would not institute any new treatments. The end had come. His heart stopped about a hour after our family decided his life had come to an end.

His 10 year yahrzeit will be in a few days.

Once a patient is formally declared brain dead, if the family will not agree to end care or otherwise insists we continue full aggressive treatment, such a patient will only last a few more days anyway.

The longest I've ever seen a truly brain dead patient continue on the ventilator with full aggressive support was about 2 weeks.

Bob, the decision I made ten years ago regarding my late father, mentioned 7:12 above, was after prolonged discussion and with the agreement of our rabbi, who is Chabad, and who I hold in the highest esteem.

Death of a Person: The central question in this debate is 'When is a person dead?' Is a person dead when the soul leaves the body, when the body disintegrates, when the heart stops beating, when respiration irreversibly ends? An organism -- that is, a human being -- can be dead, but the organism's heart, kidneys, liver and other organs can remain alive for some time. At what point would you consider the organism 'dead?'

Death of an Organ: An organ can cease to function, but it's cells can remain alive and slowly die at some point later in time. At what point would you consider an organ to be 'dead?'

Brain Death: The brain mainly consists of the cortex (the larger part of the brain) and the brain-stem. Brain death is sometimes used too broadly. A person is brain dead when the cortex and the brain-stem cease to function.

Brain-Stem Death: This occurs when the brain-stem is dead, and by implication, the cortex as well. According to the laws of the United States and Israel, organs are only recovered from people who are deceased as defined by brain-stem death. This means that their brain no longer functions, that they are unconscious and inanimate.

The brain-stem controls respiration, and therefore the supply of oxygen to the body. Without oxygen, the heart can continue to beat only with the aid of a mechanical respirator that pumps blood throughout the body. The blood carries oxygen, essential to keep individual organs 'alive' even though the brain-stem is dead. (Inevitably, even with the use of a ventilator, the heart will shut down.) Brain-stem death (BSD) is examined in more detail below, from a medical, halachic and legal standpoint.

Coma, Deep Coma, Persistent Vegetative State (PVS): These terms imply the cortex is not functioning even if the brain-stem is, and the patient might be able to breathe on his or her own. Deep coma and PVS typically mean that this condition is irreversible. People often confuse PVS with brain-stem death, but they are not the same. Organs are never recovered from patients who are in coma or PVS.

Clinical Death: A term typically used to describe someone whose heart has stopped beating but who can be resuscitated. We sometimes hear stories of people who were 'clinically' dead but were revived.

Beating
There are those Rabbinic authorities who claim that only when a person’s heart has irreversibly stopped beating is he or she dead. From a medical viewpoint, this makes it difficult to transplant organs because once the heart stops pumping oxygenated blood to other organs, they begin to deteriorate and die. These organs are typically no longer viable for transplant.

What most people don't know, however, is that in certain situations it is possible for a donor whose heart has stopped beating to donate their kidneys or liver for up to 40 minutes after cessation of heart beat. (Kidneys and liver are more resilient to oxygen deprivation then other organs.) The ramifications are enormous because of the 80,000 Americans waiting for organs, 50,000 are waiting for kidneys.

Some Rabbis who believe that a person is still alive as long as the heart is beating are Rav Shlomo Elyashiv; Rabbi Elazar Shach, Rabbi J.D. Bleich, Rabbi Mordechai Willig, Rabbi Herschel Schachter, Rabbi Dr. Avraham Avraham (author of Nishmat Avraham), Rabbi Aharon Soloveitchik, Rabbi Eliezer Waldenburg (author of Tziz Eliezer), Rabbi Yitzchok Wiess, Rabbi Nissan Karelitz, Rabbi Shmuel Wozner, Rabbi Yitzchak Kolitz, Rabbi Nosen Gestetner, Rabbi Aharon Kahn, and Rabbi Mayer Scheinberg.

According to Rabbi J.D. Bliech and Rabbi Herschel Schachter, even a decapitated body that had the arteries and viens sewn together at the neck, whose heart is still beating, is alive.

The Debate
The Rabbis of the Talmud contemplate a situation where a person is buried by a collapsed building on the Sabbath. Typically one is not allowed to dig on the Sabbath but of course, if life is at risk, not only is one allowed to dig, one is obligated to do so. If the person is found unconscious, lying inanimate, one must determine if he is dead or alive. If alive, continue digging to free him. If dead, leave him be and stop digging and recover the body only after the Sabbath. There is a debate as to whether or not a beating heart or respiration is a sign of life. The Talmud seems to say that lack of breathing in an unconscious inanimate person is death. The Shulchan Aruch, the book of Jewish Law, and Maimonides rule that way as well. But, there are those Rabbis that interpret the Talmud differently, and insist that a beating heart is clearly an indication of life.

brain death isnt death as long as the heart is still beating. again i'd be more than happy to help if youre stuck on any point

Posted by: Bob | February 20, 2011 at 06:35 PM


The only person "stuck" here is you, Bob.

As WSC noted, the gemara says the world is a flat disk.

Is that true?

Should we pasken life and death halakhot based on the world being flat?

Is a rabbi who does that doing the right thing? If people die as a result is it the rabbi's fault?

The answer is that we don't hold by the science of the Talmud.

Secondly, as I noted above – and which you ignored because it clearly proves you wrong – the Shulkhan Arukh rules that a man whose neck is broken is dead according to halakha, even if he breathing and his heart is still beating.

Why?

Because the functional connection between the brain and body is broken, and the organism can no longer sustain life. It will not recover.

Sadly, the same is true – but even more so – for a brain stem dead person.

Yet the rabbis who you try to defend ignore this and say, "Look, the brain stem dead person still has a beating heart! He's still alive!"

The Shulkhan Arukh and all known halakha before now disagrees with them. The Chacham Tzvi disagrees with them.

What you're left with is the Hatam Sofer's ain hadash b'torah, there is nothing new in the Torah, and the ignorant behavior of rabbis, like Yosef Shalom Elyashiv, who adopt that position when it suits them.

So, tell me, Bob. If a man with a broken neck is halakhicly dead, why is a brain stem dead man halakhicly alive?

I await your answer.

Please do not accept the assertions made here by the Orthodox jew or others. For example, it is crystal clear that Rav Shlomo Zalman Auerbach, ztl, in one of his last communications (in writing), rejected 'brain death' as death in terms of Jewish law (halacha). Similarly, Rav Aaron Soloveitchik ztl and others have testified that the Rav, ie Rav Y. B. Soloveitchik ztl, did NOT accept 'brain death.'

Anyone can contact Rav Zalman Nechemiah Goldberg shlita and learn that his view is being misrepresented in the post above.

The great majority of halachic authorities reject the notion that 'brain death' suffices to declare someone dead, al pi halacha.

It should be noted that at least 10% of patients declared 'brain dead' have parts of their brain still functioning--a fact not provided to Rav Moshe Feinstein, ztl, who states in his teshuva that he was told that the whole brain is liquefied in a person declared 'brain dead' (which is obviously not true).

"Orthodox Jew" cherry-picked some information from an article on the HODS website. You can see that by Googling the first two paragraphs of his comment.

See all the of the article in context and you'll see that "Orthodox Jew" is very dishonest:

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

Please do not accept the assertions made here by the Orthodox jew or others. For example, it is crystal clear that Rav Shlomo Zalman Auerbach, ztl, in one of his last communications (in writing), rejected 'brain death' as death in terms of Jewish law (halacha). Similarly, Rav Aaron Soloveitchik ztl and others have testified that the Rav, ie Rav Y. B. Soloveitchik ztl, did NOT accept 'brain death.'

You're a liar.

What Rav Ahron said was that he did not believe his brother accepted brain stem death because he, Rav Ahron did not and considered harvesting organs from a BSD person to be murder.

But there are plenty of people who heard directly from Rabbi JB Soleveitchik that brainstem death IS death.

In other words, Rabbi Ahron Soleveitchik's opinion is simply that, while the testimony of Rabbi Binyamin Walfish and other s is actual eyewitness testimony and FACT.

RSZA based his opinion on incorrect information given him by RAA. When shown that information was incorrect, he retracted but still did not fully endorse brain stem death.

Anyone can contact Rav Zalman Nechemiah Goldberg shlita and learn that his view is being misrepresented in the post above.

Well, people have been doing that for years and RZNG has not retracted.

The great majority of halachic authorities reject the notion that 'brain death' suffices to declare someone dead, al pi halacha.

This is only true if you don't count National Religious rabbis as halakhic authorities.

A more correct statement would be "the great majority of halachic authorities who never went to college, are illiterate in science, history and other aspects of modernity, and who reject modernity, reject the notion that 'brain death' suffices to declare someone dead, al pi halacha."

Of course, you know this. But you prefer to lie, which says much about you.


It should be noted that at least 10% of patients declared 'brain dead' have parts of their brain still functioning--a fact not provided to Rav Moshe Feinstein, ztl, who states in his teshuva that he was told that the whole brain is liquefied in a person declared 'brain dead' (which is obviously not true).

Actually, you're misquoting Rav Moshe and misrepresenting his position. But you've just lied several times above, so why not lie here, as well?

Posted by: The Neurologist | February 20, 2011 at 09:01 PM

Posted by: A Well Known Neurologist Who Is Also A Known Liar And Who Is Not Highly Regarded By His Peers, In Part Because He Lies, and In Part Because He Isn't Very Bright | February 20, 2011 at 09:01 PM

Wool silk cottonn in regards to your comment that all physicians view brain stem death as death see "Brain Death-Too Flawed to Endure, Too
Ingrained to Abandon‖ The Journal of Law, Medicine and Ethics (2007), (35) 2 273-281. perform a google search you can find many articles written on the subject in many prestigous journals. May your father's neshama have an aliya.

shmarya, I dont consider him alive weve been through this. As far as those who do, I dont recall the words of the mechaber off hand. The gemera that goes through the mishan requires more than just a cracked neck, some of which (arguably) is lacking in the case of a brain-stem-dead patient. Debating brain-stem-death vs cardiac death isnt my point since a. much has been written on it ou dont need me to convince you. and more importantly b. to me it seems that brain-stem is a better definition.
All I am trying to explain to you is that the argument is not based on faulty science but rather based on talmudic sources, the science is really secondary. my comment at 6:35 should help you understand it better

Posted by: Bob | February 20, 2011 at 09:29 PM

It is just the science that is "secondary," Bob – it's the halakha itself.

As soon as you find a plausible explanation for why a man with a broken neck is halakhicly dead, even if his heart beats and he's breathing, but a brain stem dead person is halakhicly alive, please share it.

Of course, you know very well no such plausible explanation exists.

Bob, thank you for the kind words regarding my late father.

I read the article you cited, by Dr. Truog.

His article reviews the misconceptions, misunderstandings, sloppy use of terminology, and surprising lack of knowledge on the subject by physicians and nurses.

At no time does he say that a patient formally declared 'Brain Dead' is not truly dead.
A Brain Dead person is still laying there on the bed with a beating heart and a chest rising and falling as the machine breathes for them. Urine and feces still appear. The skin is warm to the touch. Such an appearance is hard to deal with on an emotional 'gut' level by an observer, even a trained medical professional.

But the brain is not receiving any blood flow; the mechanism for this needs to be understood with a thorough review of intracranial pressure and cerebral perfusion pressure. There is no longer blood flowing up the internal carotid arteries or the vertebral artery. The entire brain is dead. Period.

(Note: 'brain dead' means the same as 'brain stem dead'. I do not know why these two different terms are used on this blog.)

It's hard enough for doctors who aren't up on their knowledge to understand it. For a non-medical person with no secular education, it is impossible to understand the topic.

In the ultra-orthodox world, where doctors are routinely disdained (even as ultra-orthodox patients seemingly act so obsequious in their presence), and science is viewed as some sort of enemy, I cannot expect anything resembling an honest evaluation of the topic from ultra-orthodox sources.

WSC,

I have never met any physician who disputed the fact that brain death is, in fact, death. It is as certain as any pronouncement of death of a patient has ever been.

Once brain death is confirmed in a hospital, does the attending physician call the time of death and declare the patient dead from that moment?

[And if not, what does the hospital wait for?]

Yes, but the patient's family is asked permission- after appropriate counseling by a bereavement team- to turn off the ventilator and stop further treatment.

If they refuse to stop treatment, the hospital will accede to their wishes and continue treatment of the body, so as to avoid any conflicts that would only result in making the hospital look bad in the media.

Such brain dead bodies will succumb in a few days, even with maximum treatment.

I can understand if a religious family, already distraught by the grievous injury that lead to the resultant catastrophe of the brain death, now has to deal with the news that their loved one is declared dead, even though the body is still warm and soft, and the machines and monitors all around are still humming and beeping.
Leaving the machines still going in the interest of the family's wishes is done to avoid them further aggravation and conflict with the hospital, something nobody needs at such a time.

If that patient could have been an organ donor, it's a waste, but I will leave that matter for further discussion.

shmarya, I have no need for such an explanation, as I have told you several times, we agree that brain-stem-death is on fact death. (As if you or even I are on in a position to argue with those who halachicly reject this standard, or for that matter to even agree with those who accept it.)
The only reson i commented in the first place is to explain to you that your premise for this post (as i understood it) is fundamentally flawed. You posted the video (in your words) "To understand why Rabbi Moshe Tendler and dozens of other rabbis rule that brain stem death is death according to halakha, Jewish law," you then go on to mock those "who want you to believe that a brain stem dead individual is alive" however what you fail to understand is that both those who accept brain-death and those who reject it do so based on halachic sources, not based on the consensus of the medical community as unanimous as it may be (a point i'd be willing to concede to "wool silk cotton" it on no way diminshes my point)
again, if you had presented a halchic response as to why brain-death should be accepted based on the shulchan aruch, I wouldnt have argued, becasue i agree. however that is not what you did, you made an argument that is fundamentally flawed from the onset

what you fail to understand is that both those who accept brain-death and those who reject it do so based on halachic sources, not based on the consensus of the medical community as unanimous as it may be (a point i'd be willing to concede to "wool silk cotton" it on no way diminshes my point)
again, if you had presented a halchic response as to why brain-death should be accepted based on the shulchan aruch, I wouldnt have argued, becasue i agree. however that is not what you did, you made an argument that is fundamentally flawed from the onset

Posted by: Bob | February 21, 2011 at 09:48 AM

Wrong.

Brain stem death is equivalent to decapitation or, in the words of the Shulkan Arukh, a broken neck.

I've raised this point multiple times and you admit you can't answer it.

The problem is, Bob, neither can the rabbis who opposes the acceptance of brain stem death as halakhic death.

Do you read my comments before replying? first of all i could answer it, Even a brain-stem-dead patient maintains some brain capacity. The hypothalmus still functions, and in some cases EEG's indicateed electrical activity (both of these points were made in the RCA's paper, and were refrenced to articles in NEJM)This is way of topic, as i have no need/desire to defend those i dont agree with in their halachic position.
Secondly, I dont need an answer, as we are not arguing over that point. Yes a brain dead patient is dead, WE AGREE, how do you not get this? As to how those who disagree with that, contend with the shulchan aruch? I dont know (I do, see above)It isnt relevant to OUR discussion.

Even a brain-stem-dead patient maintains some brain capacity. The hypothalmus still functions, and in some cases EEG's indicateed electrical activity

How is that any kind of an answer?

The same is true – in fact, even more so, for the man with the broken neck – but the man with the broken neck, still breathing and still maintaining a heartbeat, is halakhicly dead.

i was refering to the mishna in ohalos which discusses decapitation, I"m not sure where the shulchan aruch says broken neck is dead.
I have two questions for you (you can skip the second if they are too hard, as it doesnt relate to my main point):

1) If (and that is a big if)the talmud said specificly that as long as their is a heartbeat a person is alive. and every scientist and physician under the sun maintained that a brain-stem-dead person is dead, would you have an easier time understandiing why Orthodox Rabbis reject brain-stem-death as a form of death. In spite of the fact that a top neuroogist in a video maintained that it is?

2) If you are so sure that brain-stem-death is the exact same thing as a broken neck why has their been so much discussion in every medical journal imaginable over the past 40 years or so arguing brain-stem-death pro or con (mostly pro, its simple, they shouldve just asked failed messiah who would expalin that it is the exact same thing as a broken neck? A google scholar search for "brain death" yields an astonishing 1.5 milion hits, quite the overkill for an open and shut case of simply a broken neck that warrants no discussion dont you think?

Posted by: Bob | February 21, 2011 at 04:12 PM

1. The Talmud says the earth is a flat disk. Should we paken like that is true?

Rishonim would not have.

Post-Hatam Sofer robots would.

That says much about the corruption of certain streams of haredi thought.

2. Please. The Shulkan Arukh rules that a man with a broken neck is dead, even if he's breathing and his heart is beating. WSC has already politely shown you that you have no idea what you're talking about, and this remark of yours only makes that clearer.

I see you cant ansewer either of my questions (to be honest, I didnt think youd be able to answer both, but I did think you could ansewr one, oh well I guess we can all be wrong sometimes) WSC and I never disagreed, Im not sure what you are talking about, but then again neither do you.
We dont have to pasken about the world's flatness. If however the gemara said becasue the earth is flat we do xyz we still would, no rishon (at least no consensus) disagrees with that.
You made up that shulchan aruch, there is no such shulchan aruch.

Posted by: Bob | February 21, 2011 at 06:42 PM

Please.

Fred Roser cites that Shulkan Arukh on page 297 of Biomedical Ethics and Jewish Law. (Unfortunately, I don't have it and Google's version doesn't show the page with the footnote, so I can't give you the exact citation, but it's a near exact quote from the Rambam's Mishne Torah, Hilkhot Tumat Meit, 1:15.)

The rest of what you write is gibberish.

If we know something is false, if we have far better means today to test these things tan existed in the 700s, then, yes, we do not rely on the Gemara's errors – especially in case where there is also a clear halakha that says that a man with a broken neck who is still twitching and breathing is halakhicly dead. The Rambam explains that once and injury is so severe that it is clear that the spastic movements, etc., are coming from various locations around the body and not from the central area of command, the brain, then the person is dead.

And that's my point.

And, again, these rabbis who rule the brain stem death is not death and harvesting organs from brain stem dead bodies is murder can only rule that way by ignoring the Shulkhan Arukh.

Is this defensible?

No it is not.

Im surprised you gave the source, and im wondering if you read it as it does not say whay you claim it does. It does say "broken spinal cord" but then it says "and most of the flesh that is with it" something which is clearly not the case in a brain stem dead patient who is fully intact. You are lying when you say the The Rambam discusses central command. It certainly can be argued, that a brain-stem-dead person fits this criteria, but in no way are they exactly yh same. They are not ignoring the shulchan aruch, they are just not willing to make that (short) leap and commit what may POSSIBLY be an act of murder.
nothing I wrote is gebberish, if you have trouble understanding, id be more than happy to explain, please let me know where you have trouble.
Two more points: a) we most deffenitly do things the gemara states based on "mistaken" science. a few examples, killing lice on shabbos is mutar (according to most), we perform metzetzta bepeh (or with a barrier), we draw water for the matza before the night.
b) Time of death isnt fully a scientific question, it inherently is somwhat esoteric, especialy for an orthodox jew as it involves (As the Rambam said) "leaving of the soul" somehing all the scientists in the world cant help us with

WSC,

Thanks for answering. When reading that, the knee-jerk response is to think of the extra bed taken by the corpse, but then I realize that the astronomical payments the family takes care of between the declaration of death and the removal of the body from the room helps hospitals to lower overhead costs and ultimately allows for more coverage for the living in the long run. I so appreciate you letting us know how it works in a real-life situation in a real hospital.

Shmarya,

The Talmud says the earth is a flat disk.

Actually, not. Talmud Yerushalmi 3:1 States that the Earth is round like a ball.

חד מן אילין דבי רבי פזי הוון אילין דנשיתא בעי מחותנתיה והוא לא מקבל עלוי אמר דלא יהון מיתגנו בי מי דמך אמר פנו את הבית מפני הטומאה ותנו מקום כסא ליהושפט מלך יהודה אמרו יבוא זה שרץ אחר כבוד אחר זה שברח מן הכבוד וחכמים אומרים אינו אסור אלא כל שיש בידו מקל או ציפור או כדור מקל שהיה רודה בו את העולם ציפור ותמצא בקן ידי לחיל העמים כדור שהעולם עשוי ככדור

The Talmud Babli (written later) writes nothing that can be proven to outright contradict that. Of course there were some who were unaware of this passage, but you too were unaware of this passage, so you can't really call those people "pillars of halacha," now, can you?

[I'm not arguing with your point. The Rambam definitely thought the Earth was a disk with a hard dome cover and other quirky stuff from Aristotle - even though his work can be "read" to consist with our current knowledge of the world - and he was wrong. He probably considered the Yerushalmi to be a theory but not a fact, and found an alternated source on which to base his conclusions. Most Rishonim and Aharonim, mostly unfamiliar with the work of Aristotle, probably didn't catch the Rambam's weird intentions and read his work in consonance with the Yerushalmi. But, my point is only that you brought a very poor example, for the Talmud does state it clearly (and the Zohar, consistant with the understanding of the Talmud Babli - including erroneous interpretations of geographical references in Eretz Israel - in the 12th century of the still early Rishonim explains the concept of how a global Earth works, with time-zones, continents, and weeks without sunset during summer and without sunrise during winter in the polar regions). So, you kind of went off the reservation with that one.]

Zohar v.3 p.10a (should read "13th century" in previous comment) written by someone absolutely thorough in Talmud Babli (to the point of a flaw, making the same geographical error that R' Shimon b. Yohai, a Palestinian, would not have made):

ובספרא דרב המנונא סבא פריש יתיר, דהא כל ישובא מתגלגלא בעיגולא ככדור, אלין לתתא ואלין לעילא, וכל אינון בריין משניין בחזווייהו, משינויא דאוירא, כפום כל אתר ואתר, וקיימין בקיומייהו כשאר בני נשא ועל דא אית אתר בישובא, כד נהיר לאלין חשיך לאלין, לאלין יממא ולאלין ליליא, ואית אתר דכוליה יממא, ולא אשתכח ביה ליליא בר בשעתא חדא זעירא. ורזא דא אתמסר למאריהון דחכמתא, ולא למפלגי תחומין, בגין דאיהו רזא עמיקא דאורייתא

[Isaia 40:22

"It is He who sits above the circle (חוג) of the earth, And its inhabitants are like grasshoppers, Who stretches out the heavens like a curtain, And spreads them out like a tent to dwell in."

Rashi: היושב על חוג: לשון מחוגה עיגול

Rashi preceded the Rambam, but was very well versed in the Talmud.

Anyone who truly understood zemanim understood the Earth's roundness. The first Lubavitcher Rebbe, who at the age of 12 gave lectures in kidush ha-hodesh (not kidush ha-levana) to the elder scholars in his community understood zemanim en par with the author of the Zohar, with Rashi and with the redactors of the Talmud Yerushalmi. In his siddur he writes that on the 17th of Tammuz "in this region" alot ha-shahar is midnight. If you check the coordinates of the city in which he lived at the time the siddur was published you will find that alot ha-shahar fall just a few seconds after midnight. He also rejected Newton's theory of gravity, writing that the theory is a fundamental misunderstanding of the time-space continuum and it is not the reason that matter falls to the Earth, but does not elaborate on the actual reason. It is mentioned numerous times in Chabad Chasidut that time and space are a single creation of God and in fact are one entity (in one place "the two are interdependant and actually are one entity, but this is not the place to go into detail...") - and this, before Einstein's publication of the theory of relativity, which disproves Newton's "gravity." It may not have been "popular" and extrapolating on the matter might have won any of the first five Rabbeim an award in science (not to mention the contribution to development of technology), but it wasn't about presenting ideas that were "popular" and apparently they did not "see the flux compasitor" value in this knowledge. Point is, that it was basic for those who truly understood the laws of zemanim although many, many rabbis did not (and still do not) have the ability to internalize and fully comprehend these concepts.]

Posted by: Bob | February 22, 2011 at 05:51 AM

You're so confused it's truly pitiful.

You don't know how to read the Rambam in context or how to understand it.

Try to process. What the Ramabam (and, by extension, the Shulkhan Arukh) is saying is that when you have an irreparable injury the severs the connection between the brain and the body, and it is an injury that will surely kill the person, the person is halakhicly dead.

The brain stem dead person is more gravely injured than the man the Rambam describes.

He would not be breathing without a machine. His brain is dead. He has no hope for any type of recovery and would be dead under any definition of the term immediately if the respirator was turned off. He can't even attempt to breathe on his own because his brain is dead.

The Rambams person can look at you. He can blink. He may even be able to try to speak. BUT HE IS STILL DEAD UNDER HALAKHA.

I'm not a "liar," Bob, and neither is Rosner.

You, however, are a fool.

You are aliar becasue you said the Rambam said something he did not. Rosner is not a liar, becasue he applied the Ramabam to another very similar case, without pretending all the Ramabm said was "broken neck" But again, this is way beside my original point.

You are very confused, and we have gone way of track so let me try another approach:
There are 3 distict arguments that you are making interchangeably (to be sure, they are in no way contradictory and surely can coexist, but they are distict nontheless)

The arguments are (not in order that you have raised them)
1) According to halacha (you brought Rmabam and shulchan aruch to support this) a brain-stem-dead pateint is dead. (incidently as i have stated several times, we do not argue on this point)
2) While a brain-stem-dead patient may not be dead according to the gemara, we cant rely on the gemara becasue of its lack of understanding/discussion of modern science (You brought this point, when you dodged my question 1 posed yesterday at 4:16)

Now none of these two arguments have direct relevance to my original comment, nor do they have direct relevance to your original post. Neither of thses two arguments is what we are debating, and in one of them we agree.
What we are debating is the 3rd argument (actually 1st) you made, about which this entire post (as ive understood it) is about:
3) A brain stem dead pateint is dead becasue that is the medical consensus, as indicated by the video posted. (implying that anybody who views him as alive, automaticly doesnt understand (or perhaps ignores) the science involved
It is this and only this argument that we are discussing. to which I replied in my first comment "The argument (between Rabbi Tendler et al and the RCA paper)isn't whether medicly or legally the brainstem-dead patient is dead the argument is whether halachicly the patient is dead."
Be careful not to enter argument #2 in response to this, as that is a sepperate issue

Shmarya,

Do you happen to know what Gil Student's view is on stem cell death? I know he is a disciple of Shachter, but he also tries to keep an opened mind and would like to be the posek ha-dorinternet, so I'm just curious, have you collected his opinion on the issue (I assume, like most YU "Giants" he has a halachic organ donor card, I'm not in the US but I'm curious as to how that works if one holds like Schacter)?

I meant "brain stem death..."

Please.

The rabbis who rule brain stem dead patients are alive overwhelmingly DENY THE SCIENCE THAT PROVES THEM WRONG.

Once you expose their ignorance – and, sometimes, their lies – their opinions are revealed for what they truly are.

That leaves a small number of rabbis who oppose recognition of brain stem death because they understand Rashi incorrectly, and do not understand that Rashi though the heart inflated the lungs. Rashi did not understand the circulatory system because the doctors of his day did not understand it.

What we're left with are rabbis who have an understandable emotional reaction to taking an action that looks like it murders a person, even though we know that action – harvesting organs – does not kill the patient, because he is already dead.

I understand that and I can sympathize with that.

What I cannot tolerate are rabbis who are ignorant of the facts, and who rule on matters they have no ability to understand.

And if you want to continue with your foolish line or reasoning, remember that the Vina Gaon and other prominent rabbis from a more sane era made it very clear that a rabbi cannot rule on scientific or other issues that he does not understand. That is why the Gaon studied the science and medicine of his day. But as you well know, Rabbis Elyashiv, Shteinman, Wozner, et al, have not done this today, and rabbis like Hershal Schachter, Mordechai Willig, and J. David Bleich only know science on a simple undergraduate level. None of them should be paskening about an issue they are not equipped to understand. But they do it anyway.

And if you want to say Rav Moshe did it, too, remember that Rav Moshe speant years dealing with this issue, met with scientists and physicians, and worked very hard to understand it. None of the contemporary rabbis I mentioned above have done anything like the level of due diligence Rav Moshe did.

As for your lie about Rosner, I'll address that shortly by posting the text so people can see what an unmitigated fool you are.

Posted by: Maskil | February 22, 2011 at 10:47 AM

Rabbi Gil Student is Hershal Schachter's lap poodle.

He's been censoring even polite comments that make Rabbi Schachter look like a fool or simply prove him wrong.

Okay, apparently nothing has changed over the years. He think Schachter is atzmut u'mahut areingeshtelt in a guf. Thanks for the update.

To go through your examples of the top of my head:
Rav elyashiv rejects brain-stem-death because he understands the gemara (you claim incorrectly, fine) to demand cessation of cardiac death. Rabbi shachter has a unique understnading of ohalahos, as he maintains that the example given there involves an extreme loss of blood. You can say both of these misunderstood their sources. fine i accept that, but that is argument #1 above which we are not having. However none of those two misunderstood the science involved, they just dont pasken (nor does Rabbi Tendler or Dr. Rosner) a halachic question purely based on scientific sources.
I look forward to your providing Dr. Rosner misquoting the Rambam as you did. I doubt it exists, but it would be interesting and at least you can blame your shoddy scholarship on a higher authority, though for future reference it is reccomended to always look up sources on your own.

To go through your examples of the top of my head:
Rav elyashiv rejects brain-stem-death because he understands the gemara (you claim incorrectly, fine) to demand cessation of cardiac death.

Rashi, not the gemara, and it displays a complete ignorance of what Rashi actually thought.

Rabbi shachter has a unique understnading of ohalahos, as he maintains that the example given there involves an extreme loss of blood.

Then RHS is completely disingenuous. Blood isn't getting to the brain, and that can be shown on a brain scan. So that is complete loss of blood's function.

However none of those two misunderstood the science involved, they just dont pasken (nor does Rabbi Tendler or Dr. Rosner) a halachic question purely based on scientific sources.

Neither of these two understand the science involved. But that isn't the key point. The key point is that they don't care about the science.

I look forward to your providing Dr. Rosner misquoting the Rambam as you did. I doubt it exists, but it would be interesting and at least you can blame your shoddy scholarship on a higher authority, though for future reference it is reccomended to always look up sources on your own.

Coming from someone who so completely misunderstands the halakhic and ethical issues here, your remarks about my honesty and Rosner's scholarship mean little.

I'll post it soon. Then you can call Rosner and he can explain to you why you don't know what you're talking about.

Here's the Rosner excerpt, from page 297 of Biomedical Ethics and Jewish Law:

LINK.

http://failedmessiah.typepad.com/Rosner%20excerpt.jpg

Youll note the quote you provided in of the shulchan aruch. Thank you for that, what you earlier lied about was the rambam which says "neck broken and most of flesh cut" (very rough translation, check the original hebrew or if you cant understand it check an English translation)You claimed it said "Brain stem death is equivalent to decapitation " Which while it is a compelling argument (and one that i accept) It isnt hard to see how some are reluctant to stretch that to being equivalant with "broken neck with most of the flesh cut"

At any rate, i seem to have finnaly made some headway you said "Neither of these two understand the science involved. (a baseless accusation but one we can ignore) But that isn't the key point. The key point is that they don't care about the science." That and only that is what we have been discussing, so we can leave the rest out of it. Rav Elyashiv is a senile old fool who cant read Rashi, and Rabbi Shachter is "complelty disingenuous"

now back to our discussion you say " The key point is that they don't care about the science." CORRECT! BINGO! with my help you finaly got it! As ive been saying all along. It doesnt matter what the video or every last neurologist on the planet says says. Halacha (among orthodox jews) is based on our understanding of the sources. That is why Dr. Rosner brings the shulchan aruch to support his position. and that is why the video is irrelevant to our discussion. you state in your post "Better yet, watch this video with rabbis Hershal Schachter, Mordechai Willig, Asher Busch, and/or other rabbis who want you to believe that a brain stem dead individual is alive" What you didnt relaise, but now seem to, is that it wouldnt change a thing to watch the video and nor should it becasue "The key point is that they don't care about the science" All that matters (in orthodox halacha) is what the sources tell us.
Youre welcome, that took effort and perserverence, but you seem to have gotten it. (to be honest i kind of doubted my ability to get throught to you, and i misjudged you you are not complelty thick headed with enough pounding some facts can seep in)

Youll note the quote you provided in of the shulchan aruch. Thank you for that, what you earlier lied about was the rambam which says "neck broken and most of flesh cut"

Please.

What I said was that the Shulkan Arukh was based on the Rambam, not that the two were identical.

Past that, you still don't get it.

All of the rabbis you cite will disagree with the science as science, not just disregard it.

I just read an opinion from Ahron Soloveitchik that has several errors of fact.

Over and over and over again it is clear these men are or were not competent to rule on this issue because they are ignorant of the science.

The Vilna Gaon would not only disregard their rulings, he would disregard their smicha.

You think it is halakhickly acceptable to make halakhic rulings involving advanced science when you don't know advanced science, but it is not.

Saying it is, is a perversion of Judaism and halakhic history.

Shoot i thought you git it, so close.
you say "You think it is halakhickly acceptable to make halakhic rulings involving advanced science when you don't know advanced science, but it is not" I most deffinitly do not!
you claim R" Aaron Slovetchik that had sevearl errors of fact Would you care to list some of them? (We dont have to get into a debate about it, I just would like to determine for myself)

you claim R" Aaron Slovetchik that had sevearl errors of fact Would you care to list some of them?

I intend to do a post about it soon.

Lookin' forward. I'd be happy to check it for you

how soon?

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