Rabbi Tzvi Flaum
HODS Rabbis & Physicians Seminar
Albert Einstein College of Medicine
[Part 1: 8 minutes 58 seconds]
Rabbi Tzvi Flaum- Lecture 1
My focus this afternoon is a little different focus. Instead of being involved in a debate and perhaps even a heated debate, I am switching my Yarmulke now to that of being a malamed, to be a teacher, to be a professor, to go through the primary sources from which all of this debate actually took place and that is: what is the definition of life and death according to Jewish law; the practical applications of this when it comes to how we are supposed to conduct ourselves once we realize the person is dead; as it relates to medical matters; and what obviously applied to modern technology and end-of-life issues.
It’s a lot to be done in an hour and a quarter but I will try to go slowly, systematically. Hold off your questions until the point that I have opened up for questions, and at that juncture I will not hold back any question that you might want to make as long as you have the time frame of which to make the question.
Now, if you turn to page one of the mareh mekoros. The first page of these mareh mekoros is needed to understand this part of the lecture is the gemarah in Masechta Yoma. The context of the gemara is dealing with the halachas of pikuach nefesh, when they are docheh Shabbos, when they are docheh yuntif, when they override Shabbos and yuntif. What do people have to do when they come on location when it comes to medical care and if you notice it says right on the top of the page, you see where it says “1e” in the text, “matzhu chai mefakchin,” if you find a person caught under a building that was collapsed and you found the person alive, the halacha is you have to excavate the location, extract the person, and bring them medical help. The gemara then says well that’s quite obvious, that’s pshita. You gotta tell me that? I understand that. So the gemara says, “Lo tzricha elah afilu l’chayeh sha’ah.” The novel concept the gemara over here is, even though I know the person is not going to live out that Shabbos, by taking the person out of the collapsed building he is going to be able to live perhaps another hour, another two hours. Maybe even only 15-20 minutes. The fact, by taking away the trauma of the building on that person’s body, is facilitating him to have a couple of more minutes of life in this world. The gemarah tells us over here that the mitzvah of pikuach nefesh is doche Shabbos kodesh, even though the person will never ever live to be able to observe another Shabbos in the future. That’s how far pikuach nefesh is doche and the importance of what we call halacha, “chayeh sha’ah.”
Question from audience: I’m gonna ask this one request… I forgot to ask you, because there are people who don’t speak Hebrew and they’re not even Jewish…
Answer: Everything will be translated into English …
So therefore, what we have over here is the concept that even though we know the person only has momentary life, nevertheless, you are halachically required according to Torah law to save and to give value to that concept of momentary life. It is based upon the greater idea, and that is the concept of whether we look upon the quality of life or quantity of life when it comes to Jewish law, and this gemarah source is used as a primary source to show you that Jewish law is not only concerned with quality of life, but it’s even concerned about quantity of life, despite the fact that it doesn’t have the quality of what you would call a normal, happy life. You have to preserve it, sanctify it, and deal with it until you leave this earth and G-d takes your soul away. That’s that major novel concept of the Talmud. Starting off, therefore, this page showing the sanctity of every minute of a life being precious you have to preserve it even with chilul Shabbos.
We then go down in the gemara text to quotation 1d. And that is, what is the diagnosis, the prognosis of the person you find under this rubble? How do you know whether they are dead or alive? What are the signs of life and death?
So, I will read the Hebrew text, but everything will be translated into English. Everybody can understand, but I just have to show the Hebrew text simply to emphasize certain things.
The gemara says, “tanu rabanan, heichan who bodek?” Where do you have to physically check each person to see whether he is alive or dead? Now, the assumption is, now I saw before there was a little question of confusion. You have a person, rachmana l’tzlan, caught under a collapsed World Trade Center. He is surrounded by all sides by rubble. And at this juncture we are assuming nothing of his body is visible except the fact we know he is under there.
So, the gemara says over here, in order to know whether he is dead or alive and any piece of his body that is sticking out of the rubble, Rashi says over here seems to be inanimate, there is no muscular movement and, surely, there is no sound emanating saying, “Help, help me get me out of here.” So what do we have to know whether the person is alive or dead to know whether to call a medical service or to call the chevra kadisha? Which way do we go? “Yesh omrim aficho” Some say… First of all I skipped a line. One says “Bodek afcho” – one says you have to bodek [check] the nose. “Yesh omrim aficho” Some say you have to bodek [check] the heart. Now, I want to point something out to you which is very important. The language of the gemara is, you check the nose and then you check the heart. In Rashi’s text of this, which is a crucial text, the text should really read that I check the heart first and [then] check the nose. The reason is, is because the gemara is going to learn later on, as Rav Pappa says, this was talking about a case where you find a person foot first. If you are finding a person foot first and you start to excavate and clean away all the rubble and you are getting from the person’s feet to the head, the first part of the body that you come close to is the heart first; only after you excavate higher do you get up to the nose. So in the logical sequence, it’s talking about excavating up until you see the heart beat and the other says, no I have to go even further and excavate and go all the way up to where the nose area is. How do I know that?
So if you skip a couple of lines you come to Rav Pappa’s statement, which is quotation F, where Rav Pappa says at the end, “machlokes” – the whole debate whether you check the heart or the nose, if you found the person “me’mata le’malah”, from feet first, “aval me’malah le’mata”, but if you found the person head first in the pile “ken davka l’yah”, as soon as you check the nose, the nasal area and you see that there is no longer any breathing, “ein tzarich,” there is no reason to continue any further because it says in the Torah, “kol asher nishmas-ruach chayim be’apav,” that a person’s soul, you breath it in through his nose and exits through his nose and, if that’s the case, there is no breathing taking place, it’s the sign that the person’s soul left them. Over here the gemara is very explicit. That the only time there is even a question of being bodek the heart or the nose is when you find the person feet first. When you find the person head first, once you check to see there is no longer respiration, the person is declared dead. The ramifications are, once the person is declared dead, I can no longer be mechallel Shabbos to excavate, at least a Jew can’t do that anymore, and that you have to basically wait until after Shabbos to deal with the burial, burial activities.
Now, on a surface level, when you see this text itself and you see the debate whether we check the heart, we check the nose, the question is: What are they debating? And what’s the meaning of the pasuk, “kol asher nishmas ruach chayim be’apav?” What is that being thrown into the literature over here?
So I am going to show you something, one way of learning this gemara. And this is the way some learn the gemara when it comes to those who want to entertain the concept of respiratory death or brain death as an alternative to cardiac death. Let me give you the way that camp learns the gemara without even incorporating Rashi.
What they say is the following: What is the debate whether you check the heart or you check the nose? They learn the debate is: What is the actual sign of life and death? Now, I want to be very careful over here. Life and death means, is the soul still in me or has the soul left me? We call that in Hebrew “yitzias ha’nishama.” That’s a metaphysical concept. What we’re interested to know is – what biological, physiological phenomenon takes place in the body to indicate that this metaphysical state took place? Now how do we know, is there a body indicator to tell us that the soul G-d gave us at the time of our conception has been taken from us? Now that’s metaphysical. We can’t see it. We can’t see the nishama leave. But is there any indicator in the body’s change of status that will indicate that metaphysical fact took place by a physical change in the body. This is the crucial point.