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Ventilators/Respirators

Rabbi Mordechai Tendler

testifies as to Rabbi Moshe Feinstein’s position on:

Ventilators/Respirators

[5 minutes 8 seconds]

TRANSCRIPTION OF VIDEO

Rabbi Mordechai Tendler:  

Several times a week we would have questions about end-of-life questions, literally several times a week. I must have gone through several hundred such questions with my grandfather. Almost everybody who had a shot came to my grandfather with such questions. So it was… from around the world.

Interviewer:

And what was his position when someone came in and said that…

Rabbi Mordechai Tendler:

My grandfather’s position about termination of life was… Of course each case was individualistic, but he had certain basic rules. One rule was that he considered the ventilator or respirator as a possible curative factor, not just as a prevention of death. Unlike the discussion in the shulchan arukh, “hakaoas kardom”, of banging or a knock, or salt that just prevents death, he was concerned that maybe this was more than just prevention of death and may be somewhat contributory in a positive sense to life. Though there are people, and he was cognizant, who held differently. There was a t’shuva [response] from somebody up north in Israel. My grandfather felt it was very precise, I don’t recall his name now. Not a well known posek [halachic decisor] in Israel, but his position on this was very clear and thoughtful, which he said was exactly the same discussion as me’neeas, as prevention of death. Grandpa said “It’s a logical approach, but it’s not definitive and thus we have to take the other approach.” Being that it possibly is contributory to life, not just prevention of death, he thought once a person was on a ventilator/respirator he cannot be arbitrarily removed from it. What he did say was that when the person has to be removed for what they used to call suctioning, whether that’s still relevant I’m not sure, at the time it was a medical procedure. Every “X” number of hours they had to take out the tube to suction out the lungs. At that stage, you don’t re-insert it until you’ve ascertained that there’s still neurological function. That was where his t’shuva [responsa] says waiting 10 minutes, 15 minutes, seeing if there’s any independent respiration going on. If there is no independent respiration then do not return it, and if there is of course you put it back in. He also sometimes would recommend, if given the prerogative, to place it on a finite oxygen supply; not to plug it into the hospital supply. So that when the tank ran out, again, you had a chance to ascertain whether the patient was or wasn’t really halachically alive or imperatively associated with the respirator.

That’s so far as removing the respirator. So far as whether or not the respirator should be placed in the first place, he had several criteria. The first was chai aisha ayn mesorin ayn mareechim – that if the patient is in torturous pain you do not extend that person’s life artificially. And the source for that is the gemara by Rav Chanina ben Tradyon. And that’s one of my grandfather’s most fundamental principles in medical ethics, that you do not extend life chai aisha -if it’s only temporary life, meaning you cannot gain at least a year a life. If the person’s to be tortured, if it’s substantial torture similar to being burned alive, you don’t extend that person’s life artificially. The other principle he had was that you’re allowed to gamble chai aisha in order to gauge the possibility of chai normali chai olam — means regular lifespan. So that if a person has a finite life — based on the best medical evidence, he can only live up to a year — and they are contemplating some procedure which would permit you to cure the person and then whatever he’ll live, he’ll live. Maybe the older person will live a short period of time anyway. If it was statistically, if it was within a viable possibility, and he didn’t require too much even a minority possibility, now say 10%,15% chance of success, you are allowed to gamble a guarantee of four months of life for a chance of getting three years of life. And that would impact upon whether or not you would put the person a respirator or go for something more aggressive. Those were the two principles which he tended to use. And then perhaps the third principle was that we did not differentiate quality of life as a factor in defining whether should live or shouldn’t live. Even the vegetative life (shouldn’t happen to anybody) deserves all the consideration of the halacha, all the consideration of the ethical and moral message of the Torah. And you don’t say… Short of a person giving a living will, which is another discussion, if we had to assess it ourselves, we did not differentiate. My father refers to that in his lectures as the slippery slope of medical ethics, that if you start differentiating and defining who does and who doesn’t deserve to live. And my grandfather, though he wasn’t quite enthused with this idea of a slippery slope, did acknowledge the veracity of not differentiating.

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