Announcement: Brain Death Book Launch

 

Book Launch
Defining the Moment: Understanding Brain Death in Halakhah

Rabbi David Shabtai, MD will be launching his new book with a lecture for the Medical Ethics Society of Yeshiva University at The Seforim Sale, this Sunday, February 19th, at 7pm (Belfer Hall, room 218). Learn more about the book at www.DefiningTheMoment.com or purchase it directly at Amazon.
 
To celebrate the book’s debut, the book is being offered at a 15% discount at the Seforim Sale and in the Glueck Beit Midrash of YU available after the lecture. The book is always available at Amazon.

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About the author

Gil Student

Rabbi Gil Student is the founder, publisher and editor-in-chief of Torah Musings.

 
The opinions and facts here are presented solely by the author. Torah Musings assumes no responsibility for them. Please address religious questions to your rabbi.
 

128 Responses

  1. IH says:

    Informative haskama from R. Bleich.

  2. Anonymous says:

    Is R. Bleich not somewhat discredited on this issue after claiming emphatically that R. Moshe could not have held a position which was later repeatedly affirmed by R. Dovid to have been the case? Or will R. Bleich accuse R. Dovid of falsifying his father’s position too? And presumably Rav Ovadiah, who disagrees with R. Bleich on this issue, is incapable of realising when a concept is ‘alien to halachic discourse’ in R. Bleich’s charming terminology.

  3. Shalom Spira says:

    R’ IH and R’ Anonymous,
    Ye’yasher kochakhem for your respective analysis.

    Yes, R. Bleich’s understanding of how RMF approached the subject of brain death was discredited by R. David Feinstein’s testimony. However, I would advance three mitigating considerations in defense of R. Bleich:

    a) R. Bleich did acknowledge the theoretical possibility that perhaps RMF did hold brain death = death, but added that – even if so – RMF must be rejected in favour of Chatam Sofer. [See top paragraph of footnotes on p. 345 of Contemporary Halakhic Problems IV, where R. Bleich writes this. Available online at http://books.google.ca/books?id=IOqQrPlc9ggC&pg=PA414&lpg=PA414&dq=Contemporary+Halakhic+Problems+1995&source=bl&ots=woTdaATt2t&sig=4-l3W65xqWHcGCsutWatAIvXD0o&hl=en#v=onepage&q=Contemporary%20Halakhic%20Problems%201995&f=false

    b) In R. David Feinstein’s testimony on the HODS website, he says that his father did not formally equate brain death with death, but rather he formally equated cessation of respiration with death. “He was very makpid that his words should not be changed. Quote him as is. He cannot breathe. Nothing else,” elucidates R. David Feinstein in the HODS interview. The difference between brain death and respiratory death is semantic, but it may arguably be sufficient to harmonize R. Bleich with R. David Feinstein.

    c) In the newly published volume of Iggerot Mosheh that was just released last year (Vol. 9), a new responsum on the definition of death appears (in the section entitled Iggerot Hashkafah, no. 4), which – if read with sufficient creativity – somewhat admits a pit’chon peh for RSZA (whose reading of Chatam Sofer is shared by R. Bleich), as follows:

    “Behold according to the law of the Torah, it is impossible under any circumstances – even for a great person in Torah – to compel another person in matters of his body and soul regarding the diagnosis of death, [just] because in his opinion he is already dead that he [-the patient] should accept his opinion, nor does any state or government have the authority to say [to others] that they should accept their opinion. Rather the patient himself and his family – they are the ones who must decide this, that is to say [only] if it is not against the Torah, after they will ask the opinion of a great sage and expert in this. And since our country – the United States of America – does not want chas ve-chalilah to compel anyone to violate the laws of the Torah, they [the political legislators] should establish a special provision for what they will determine unto themselves [as a definition of death], that the patient himself and his relatives will not be compelled for anything that they [the political legislators] will decide in this if they [the patient and family] do not want, since this concerns his body and soul. And it seems more to our opinion that this does not pertain to government and state [altogether] since this is a personal matter for every individual and it pertains to the Torah and Halakhah of our faith.”

    I’m not sure, but it sounds to me like RMF is communicating that (i) there is a minimum definition of death (which I interpret to mean, based on the oral testimony of RMF’s entourage on the HODS website, to be irreversible unconsciousness plus irreversible apnea); (ii) a more rigorous standard of death – i.e. RMF recognized that other poskim might disagree with him (as RSZA ultimately would) and claim that even circulation can be safek regarded as a manifestation of the last breath taken, even when the brain stem has died. RMF says that no one, not even a posek, can contradict criteria (i). However, once criterion (i) is met, then it is up to the family of the patient to decide which posek it will ask, and if that posek is more stringent than RMF (which RMF of course feels is unncessary; but he is respectful of the possibility of a conflicting interpretation), then neither the government nor any other posek should force the family to contradict the stringent posek it has chosen.

    So suddenly I realize that the ultimate dispute between RMF and RSZA is not necessarily as great as I initially thought. The only difference between them is that RMF holds every posek can hold his own way regarding (ii), whereas RSZA holds that all of Klal Yisrael is bound by a safek that one must be stringent regarding (ii), and it is only the Noahide “poskim” (i.e. the courts of the Noahides) who have permission to be lenient regarding (ii).

    This is, of course, Shalom Spira’s creative reading of RMF’s latest responsum, and not necessarily what RMF at all intended. Tzarikh iyun…

  4. Anonymous says:

    Rav Ovadia’s grandson R’ Yakov Sason published a sefer on this topic 2yrs ago “Ruach Yakov” see Rav Amar’s Haskama there.

  5. AA says:

    Shalom, you wrote

    “R. Bleich did acknowledge the theoretical possibility that perhaps RMF did hold brain death = death, but added that – even if so – RMF must be rejected in favour of Chatam Sofer”

    This is laughable. R. Bleich says that RMF must be rejected in favor of Chatam Sofer. But you know what, RMF disagrees and RMF feels that his viewpoint can stand even in the face of Chatam Sofer. So we have a machlokes R. Bleich and RMF. I think RMF wins this one.

    b. Brain death = respiratory death. R. Bleich doesn’t accept respiratory death. So R. Bleich is rejecting RDF.

  6. AA says:

    Other than Dr. Shabtai, every single doctor who has written on brain death accepts Rabbi Tendler’s position, every single one. That should tell us something.

  7. Anonymous says:

    AA thanks for pointing out the (obvious) disrespectful tone of Rav B. my way or highway. בקום חילול ה’ אין חולקים כבוד לרב

  8. Shalom Spira says:

    R’ AA,

    Thank you for your illuminating and scholarly rejoinder. It is true – as you write – that RMF understood Chatam Sofer to support his position. But why did RMF hold so, when Chatam Sofer refers to pulse (=heartbeat/circulation) as a sign of life? R. Shabtai Rappaport explains on the HODS website that RMF held Chatam Sofer means that heartbeat is significant since the heart only beats because of the last stores of oxygen spontaneously inhaled. Thus, respiration has not legally ended until heartbeat ceases. R. Rappaport continues that when the brain dead patient is only breathing because of the machine (and has been doing so for at least an hour or even several hours… all the more so if he has been brain dead for days or weeks…), all of the last stores of oxygen have been exhausted, and so RMF held the patient is dead.

    However, it is clear that RSZA disagreed with RMF on this point, and did regard the heartbeat as a possible continuation of the last breath taken even in a brain dead patient. Therefore, (le-havdil ani ha-katan) I have suggested that this dispute may depend on the machaloket ha-poskim regarding bovine lactation on Pesach; viz. is the milk a product only of the food eaten today on Pesach, or even the product of the food eaten many days ago, before Pesach began? [There is also the possibility that Chatam Sofer was completely mistaken, as has been suggested, and he should only have referred to respiration. But can we be absolutely sure that Chatam Sofer was wrong? See also Chiddushei ha-Ran to Chullin 32b, who seems to write (in the sugya of ke-mancha be-dikula damya) that an animal can live without lungs but not without a heart. R. Bleich uses this as a proof in his chapter on artificial heart transplantation in Contemporary Halakhic Problems III.]

    Now, regarding R. David Feinstein, you are correct that he disagrees with R. Bleich. The issue is that R. Bleich said that R. David Feinstein testified that his father did not equate brain death with death. This statement of R. Bleich is technically true. However, R. Bleich neglected to mention the balance of R. David Feinstein’s testimony, viz. his father held that respiratory death = death. [Perhaps R. Bleich was simply unaware of this illuminating information.] Barukh Ha-Shem, this omission was rectified by HODS, which has now publicized R. David Feinstein’s views with accuracy on the video interview.

  9. Hirhurim says:

    AA: Other than Dr. Shabtai, every single doctor who has written on brain death accepts Rabbi Tendler’s position, every single one. That should tell us something.

    Didn’t Dr. Robert Schulman and Dr. Leon Zacharowicz write against brain death criteria?

  10. Anonymous says:

    Dear AA,
    Thank you for your illuminating discussion of the various halachic opinions on this much celebrated debate. I would only wish that before reaching conclusions about Dr. Shabtai’s contribution you would be so good as to read the book first! Conclusions based upon haskamot are certainly not helpful ways of gauging the value of a work. Regardless of what conclusion (if any) is reached by the author, the English-speaking halachic world surely has what to gain from what purports to be an open analysis of an often confusing topic, particularly one informed by an in-depth knowledge of both the halachic perspectives and the medical facts.

  11. AA says:

    Anonymous,

    You wrote

    AA thanks for pointing out the (obvious) disrespectful tone of Rav B. my way or highway. בקום חילול ה’ אין חולקים כבוד לרב

    Yet my comment was deleted by Gil.

  12. daat y says:

    Rav Dovid Feinstein in Sefer Assia 7 P.147 in a letter written Kislev 1,5753,19 years ago stated that his fathers teshuvah of Y.D.3:132 is not forged and that he heard parts of it directly from him.

  13. Anonymous says:

    AA thats twice your comments got deleted, strang…

  14. Hirhurim says:

    And he’s banned. You can’t repeatedly insult gedolei Torah on this blog.

  15. Anonymous says:

    Hirhurim “And he’s banned. You can’t repeatedly insult gedolei Torah on this blog.”

    I think that was exactly AA’s point!

  16. The Dude says:

    The best resource on the subject is Kviat Rega HaMavet, ed. Dr. Mordechai Halperin (Jerusalem: Machon Schlesinger, 2007).

    It is available for purchase here: http://store.medethics.org.il/index.php/books-in-hebrew-1/oe/dod.html

  17. J. says:

    The fact that 19th century poskim discussed heartbeat is not really that relevant. I don’t think there’s a single mid to late 19th century doctor who wouldn’t have mentioned heartbeat as a criterion of death – ‘diber hakasuv be’hoveh’. So I don’t think you can prove from the Maharsham or anyone else of his era that heartbeat is and always has been an intrinsic criterion of the halachic definition of death (when it curiously was barely mentioned before the era of Harvey’s discoveries in halachic literature, and when it was mentioned it was taken to be a respiratory organ.)

    This point is made well in a teshuva on the subject from Kollel Eretz Chemdah in B’Mareh Ha’Bazak (http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf) :

    מהסוגיות המרכזיות ומדעות הראשונים עולה כי הקריטריון לקביעת מוות על-פי ההלכה הוא הפסקת נשימה (כל הבדיקות המופיעות בש”ס מכוונות כנראה לקריטריון זה). גם במקום שמופיע עניין הדופק (פעימות הלב) הוא קשור לנשימה, שכן כך הבינו בזמנו את מקור הנשימה, וכמבואר באריכות בשו”ת “חכם צבי” . מה גם שבסוגיה בירושלמי, וגם לפי דעת רוב הראשונים, בדיקת הלב אינה נזכרת כלל בסוגיה המרכזית ביומא , מכל מקום להלכה נפסק ברמב”ם, בטור ובשו”ע שהכול תלוי בנשימת האף.

    I’m still unclear as to the extent to which R. Bleich’s position rests on the assumption that Chazal had scientific knowledge beyond that of others in their era. Taking the sugya in Yoma as a whole (including the Yerushalmi) and the way the halacha was actually paskened in the Shulchan Aruch, together with traditional Jewish practice over the centuries (especially before the scientific revolution), it just seems a bit forced to start reading back heartbeat as the ‘siba’ of life, as is R. Bleich’s wont, when it clearly plays a minor role at best.

    None of this means that brain death is necessarily death according to halacha. Rather, the scientific perspective R. Bleich tries to impose on Chazal is the result of developments that occurred a couple of centuries before those which lead some brain death proponents to try to impose their understanding on the sources, and therefore he has a handful of additional sources which vaguely echo his position.

    On a side note, R. Bleich’s unpleasant insinuation that anyone who disagrees with him is motivated by “a desire to adapt Halakhah to contemporary mores” is singularly inappropriate, and is mevazeh great poskim to a greater extent than most of the critical commenters on this blog have done.

  18. Shalom Spira says:

    I thank our Rosh Yeshiva R. Student for his kind support. That said, having contemplated the subject overnight, I do agree with R’ Anonymous, R’ AA, R’ Daat Y and R’ J. that there is legitimate room to challenge two aspects of R. Bleich’s letter of approbation.

    1) R. Bleich calls neurological death “alien to halakhic discourse”. Yet, RSZA – who (unlike RMF) does not accept respiratory death – writes (Shulchan Shelomoh, Erkei Refu’ah II, p. 40) that neurological death in seemingly analogous to the episode of Eli the Kohen Gadol in Chullin 21a. RSZA says not everyone is happy with the equation between Chullin 21a and neurological death (“ve-af she-yesh mefakpekin ve-chosheshin”) but still it is almost a successful equation (“al kol panim safek ha-karov le-vadai mihu havei”). Therefore, RSZA relies on this almost-successful-equation to permit Noahide courts to pasken that brain death = death, and therefore for a Jew to receive a heart in the Diaspora but not to give. Thus, if RSZA is any acceptable barometer of the state of halakhic discourse, “neurological death” is not totaly alien to halakhic discourse. [Some confusion may have been caused by RMF’s erroneous transcription of the neurological death sugya in Chullin 21a in IM YD 2:174, sec. 1. See my comment at http://torahmusings.com/2010/12/death-by-neurological-criteria/ , on Dec. 27, 2010, at 9:04 p.m., where I explain how RMF erred in recapitulating the sugya.]

    2) R. Bleich marshals C. Reeve as proof that respiratory death does not equal death. However, since the gemara in Menachot 37a could be read to teach that consciousness is a sign of life, it is possible to argue that respiratory death = death provided it is coupled with irreversible unconsciousness, a criterion not met by C Reeve. It appears from the testimony of R. David Feinstein and R. Moshe David Tendler that this was RMF’s position, though RMF never spelled it out unequivocally. [RMF was evidently relying on the concept “gedolah shimushah shel Torah yoter mi-limudah” in Berakhot 7b. He was hoping that people would not only read his writings, but consult with his son-in-law who was meshamesh him for a correct intepretation of those writings.] Apparently, RMF understood that when Shulchan Arukh OC 25:5 refers to the brain and heart as the two sources of life, it means we need both sources to be functional, and – moreover – that the brain is characterized by its capability to control motion in all its aspects, including consciousness and respiration.

    Even so, leaving aside those two caveats, I think R. Bleich’s letter is a beautiful expression of praise to a fine student in the RIETS Kollel Elyon, and it is that overall positive theme of R. Bleich’s letter that should be emphasized. [The other letters of R. Shlomo Moshe Amar, R. Gedaliah Dov Schwartz and R. Hershel Schachter are likewise beautiful.] The fact that R. Bleich reiterates his position in his letter of approbation (even if one can legitimately challenge R. Bleich’s position) is a time-honoured technique of the polemics between Beit Shammai and Beit Hillel, who for three years (as recorded in Eruvin 13b) debated the “mother of all debates”; each one saying “halakhah ke-moteinu” and each one saying “halakhah ke-moteinu”.

  19. Lawrence Kaplan says:

    R.Spira: Your learned observations are well taken. I just want to emphasize that I do not think that the bloggers here object to Rabbi Bleich’s reiterating his view in his approbation. We object to his describing views differing from his by the demeaning term “alien to halahkic discourse.”

  20. Anonymous says:

    The Dude wrote: “The best resource on the subject is Kviat Rega HaMavet, ed. Dr. Mordechai Halperin (Jerusalem: Machon Schlesinger, 2007).”

    Like I wrote earlier Rav Ovaida’s grandson R’ Yakov Sason also published a sefer on this topic “ספר רוח יעקב על קביעת זמן המות” its worth buying in addition to R’ Shabtai sefer

  21. The Dude says:

    Unfortunately both of our selections would require people to actually read Hebrew…

  22. Lawrence Kaplan says:

    Dude: You, of course, meant to write “Fortunately.”

  23. Noam Stadlan says:

    The author has a shiur by the same name as the book at YU Torah. In that audio shiur he makes a point of stating that Christopher Reeves(spinal cord injury resulting in the inability to breathe) would have been considered dead according to the criteria of the Chief Rabbinate. This is a clearly incorrect statement(the criteria require knowledge and proof of brain injury- full document available in Hebrew and English on the HODS Website).

  24. Ice Cream says:

    Is this David Shabtai the same guy as the Sephardi who davvens at Breuer’s in Washington Heights?

  25. J. says:

    Rav Schachter gave a fascinating shiur in London on Friday on the topic of organ donation and the definition of death in halacha:
    http://torahway.org.uk/archive/17-02-2012.wma

    He quoted Rav Soloveitchik as raising the question of whether someone in a permanent vegetative state has the din of a human or not, and thuss whether there is an issur of retzicha. He quoted the Rav as saying that we can’t bring sufficient proofs from the Gemara to conclude either way.

  26. The Dude says:

    J.,

    I wonder what year the Rav made those statements.

    As great as the Rav was, shouldn’t we base ourselves on the current research and information available to us?

  27. Yeedle says:

    Kviat Rega Hamavat, which Dr. Halperin edited, only confused me. I ordered Dr. Shabtai’s book and I hope I’ll be able to see beyond the bias and become clear on this issue once and for all.

  28. Yeedle says:

    What persuaded me to buy the book was this line I saw on definingthemoment.com “While long debated in the halakhic literature, a ‘conversation’ between the various approaches is notably lacking. Defining the Moment puts these approaches into perspective by comparing and contrasting them, helping the reader explore how each approach relates both to the science as well as the halakhic tradition.  It neither adopts nor advocates a particular perspective, but instead guides the reader through understanding the spectrum of opinions, creating a ‘conversation’ between them.”

  29. The Dude says:

    Yeedle wrote:

    “Kviat Rega Hamavat, which Dr. Halperin edited, only confused me.”

    Maybe work on your Hebrew!

  30. Noam Stadlan says:

    If you listen to the lecture, the author clearly advocates a certain perspective, including presenting the data against his case in the worst possible light. Whether this approach applies to the book remains to be determined until after a careful reading, but the precedent is not encouraging

  31. Hirhurim says:

    Although Dr. Stadlan is hardly a bystander with no strong opinion on the subject.

  32. Yeedle says:

    “Maybe work on your Hebrew!”

    Lol. No, my Hebrew is in perfect shape. It’s the hodge-podge of opinions and articles that confused me. No one is aiming to give an objective overview of the question, just to present their (pre-determined?) opinion on the matter.

  33. Yeedle says:

    “If you listen to the lecture, the author clearly advocates a certain perspective, including presenting the data against his case in the worst possible light.”

    Dr. Stadlan, would you mind telling me which perspective Dr. Shabatai is advocating?

    “Although Dr. Stadlan is hardly a bystander with no strong opinion on the subject.”

    R. Gil, mind telling me what is Dr. Stadlan’s strong opinion on the subject?

  34. Hirhurim says:

    Dr. Stadlan is very pro-brain death criteria and serves on the board of HODS.

  35. noam stadlan says:

    Yeedle- in the tape the author is very much against defining death using neurological criteria(brain death).

    R. Gil- I label my opinions as opinions, and state the facts as best as I can. I make no secret of what I believe to be true nor of my affiliation with HODS. If you think my opinions and/or biases have led me to write something that is factually wrong at any point in time and in anything I have written, please point it out.

    I was not planning to comment on this post, assuming that at some point I would read the book and come to some conclusion. The book states that it is objective in approach and I was asked to listen to the lecture and give an opinion. Unfortunately the lecture reveals what in my opinion is a clear bias, and I gave an example of fact. Either it is right or wrong. If you think the fact I stated is wrong, please show me where. Otherwise, you have to admit that a person who supposedly is an expert in the topic either doesn’t know the subject matter or deliberately mis-stated something of significant importance. I chose the latter. You can take your pick.

    To be specific, the lecture is available here: http://www.torahcentral.com/YUTorah/lecture.php?752286/Rabbi%20Ezra%20Labaton/Defining%20The%20Moment:%20What%20Does%20It%20Mean%20To%20Be%20Dead?

    from minutes 48-52 he discusses the Rabbanut decision and Christopher Reeve, and states specifically that ‘he met the Rabbanut Criteria for death.’

    The Rabbanut Criteria were published in the Jewish Medical Ethics vol 1 number 2 and state(available here: http://www.hods.org/pdf/Chief%20Rabbinate%20English%20and%20Hebrew%20Side%20by%20Side.pdf):
    “Therefore, one must verify that respiration has permanently and irreversibly ceased. THis can be done by proving that the brain, including the brain stem which controls automatic respiration, has been totally and irreversibly functionally injured.
    In the medical practice, there are five prerequisites for establishing the stae of brain deaths:
    A. Clear knowledge of the cause of the injury
    B. Absolute cessation of spontaneous breathing
    C. Detailed clinical proof of injury to the brain
    D. Objective proof of destruction of the brain stem by objective scientific tests, such as the BAER test

    Christopher Reeve fulfilled at most criteria B(and since he still had intact respiratory centers in the brain, it is doubtful that counts) of these criteria. To state that he fulfilled Rabbanut Criteria is totally and utterly false.

    The only possible way to even think that he fulfilled criteria is to concentrate solely on the very begining, which states that the criteria for death is irreversible cessation of respiration, and ignore the rest which describes tremendous brain damage. While Rabbi/Dr. Shabtai states in the lecture that the brain doesn’t enter into Halachic consideration, it is clear from the Rabbanut Criteria and subsequent statements such as R. Yisraeli’s talmid muvhak R. Carmel(avaliable here: http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf) that the cessation of respiration that counted was only when it was due to irreversible overwhelming brain damage, and not due to spinal cord or phrenic nerve damage. So it seems that R. Shabtai’s claim about the brain not figuring into halacha is suspect as well(the opinion of his Rosh Yeshiva, R. Schachter, actually labels the brain as one of the eivarim sh’hanishama teluya ba, so his statement about brain function, depending on the particulars, probably contradicts his Rosh Yeshiva as well).

    So, the statement by Rav/Dr. Shabtai either reveals tremendous ignorance of the relevent sources(which is hard to imagine), or a deliberate misreading.
    QED

  36. Hirhurim says:

    Case in point where bias comes into play. You misinterpreted his statement and then attacked, throwing so much at people that, given your credentials and expertise, they are intimidated into believing you.

    Dr. Shabtai was discussing the definition of death, not the clinical criteria of proving it. Everything you wrote goes to testing criteria and is irrelevant to his discussion of the definition of death.

    Incidentally, his book explains the difference between these two issues and also contains a chapter on the Rabbanut’s position that contains a complete translation of the Rabbanut’s decision on the subject and a lengthy discussion of it.

  37. Hirhurim says:

    Let me add that R. Shabtai also includes the Rabbanut’s clarification of 23 Tamuz 5747 which sheds important light on the Rabbanut’s intent.

  38. noam stadlan says:

    R. Gil- The problem with what you wrote is that he specifically stated “Christopher Reeve fulfilled the Rabbanut CRITERIA for death.” That is wrong. I mis-interpreted NOTHING. He may have meant something different, but his errors in precision dont create errors in my understanding. I am not expected to be a mind reader.

    Regardless of definition versus criteria, in a one hour lecture, he did not state that the Rabbanut nor it’s primary intellectual progeny would vehemently disagree with his characterization of their definition. He gave only HIS somewhat arbitrary view of the Rabbanut definition. One that makes his position look better. That is a definition of bias- not presenting all the facts, just selecting the ones that fit your point of view.

    I am only commenting on the lecture, not on the book. As stated, I haven’t read the book. If all you knew about the subject was the result of listening to the lecture, you would come out thinking that the Rabbanut position results in thinking that a paralyzed person is dead. Of course you would think that position was wrong(somewhat ironic given that some of the positions you have defended, when applied with precision, give much more incoherent results).That is a deliberate mischaracterization of the position.

    My first post had no details, just the statement. I only put the detailed analysis in when you challenged me. I made it as plain as possible and included English sources when possible so that the reading public can make their own conclusions. I even included the ‘limmud zechut’ on how R/Dr. Shabtai’s statement could be factually correct, even though it gives the totally wrong impression.

    I was very fair to R. Shabtai, and much more fair to R. Shabtai than he was to the Rabbanut in his lecture. The fact that he knows all the stuff that I posted and still said what he did in the lecture only proves that he deliberately stated something that he knows the Rabbanut did not mean and it’s heirs have clarified. Just listen to the tape and read the sources. It is very clear.

    I do not mean to intimidate any one, and I wouldn’t want anyone to listen to me just because of what I do or don’t do. I put forward facts and logic. If they sway you- fine. If they don’t, also fine- but at least put forward something to support your opposition other than accusing me of bias.

  39. Hirhurim says:

    I’m sorry but I have to disagree. You are being uncharitable. He spokee for a few minutes on the subject and was very clear that he was referring to the Rabbanut’s definition of death. Yes, he used the word “criteria” but in what context? You are misinterpreting his usage to mean clinical criteria for establishing death which no reasonable listener would do. You are taking one sentence out of context and then declaring him wrong and irresponsible and demanding an apology. What bias???

  40. Anonymous says:

    Hirhurim with all due respect you appear to be a very open minded person however you always FLY to the right of issues, very biased which is your right.

    DR.Stadlan like I wrote earlier you probaly would enjoy the sefer Ruach Yakov on this topic.
    ואת והב בסופה

  41. Hirhurim says:

    I am not always on the right but in this case I have become convinced that many proponents of brain stem death are not only wrong but dishonest. Dr. Stadlan’s cynical misinterpretation of Dr. Shabtai’s words are just one example. I hope he is ready for the insults and denunciations the HODS crew will be feeding the Jewish media.

  42. Anonymous says:

    Hirhurim you wrote: “I have become convinced that many proponents of brain stem death are not only wrong but dishonest” Are you saying/accusing the Gedolim who hold like this DISHONEST?

  43. noam stadlan says:

    I am not demanding an apology. I am not demanding anything.

    I am pointing out one simple fact: R. Shabtai, in a lecture, stated that the Rabbanut would consider Christopher Reeve dead. This is a fact. The listener leaves the lecture with that ‘fact.’ There is no discussion of other interpretations of the rabbanut position.

    The second fact I am pointing out is that this is not how the Rabbanut would have understood their position, R. Carmel would have understood the position, and in fact is a very forced interpretation based on a narrow reading of a small part of the opinion. You can disagree with this also, but if you are please provide sources.

    The conclusion I am drawing is that R. Shabtai probably knew all of the above data and presented the Rabbanut position in this partular way for his own polemical purposes, and it was not intellectually honest.

    Again, feel free to disagree and give me a more charitable explanation that is reasonable. He goes out of his way to discuss how the rabbanut would rule on Christopher Reeve.

    I think I have provided adequate sources and references for the basis of my opinion.

    I did not take him out of context. He discusses the Rabbanut position and then brings up Christopher Reeve to specifically make the point that the Rabbanut would consider him dead.

    Feel free to disagree. My opinion is that the facts back me up.

    By the way, this was an introductory sort of shiur. and you are assuming that the listener is sophisticated enough to automatically understand and apply the differences between ‘definitions of death’ and ‘criteria for death’ and intuit exactly what R. Shabtai meant. He said that under Rabbanut Criteria Mr. Reeve would be alive. And you think that the listener would think to himself “hmmm Rav Shabtai must be referring only the the Rabbanut conception of the idea of death, and not to the specific rules that they apply to determine death. If they applied their specific rules for determining death, certainly the Rabbanut would not have determined Mr. Reeve to be dead. Rav Shabtai certainly packed a lot of meaning into that one sentence.” Really??
    I think that the listener hears that sentence and thinks “wow, the Rabbanut think a guy who is thinking and talking is dead? how did they get it so wrong?”
    But of course, I am the one who is biased.

  44. Anonymous says:

    In addition you did not answer Dr.Stadlan’s last comment. You write “I have become convinced that many proponents of brain stem death are not only wrong but dishonest” without explainig how you are conviced they are “wrong” “dishones”, you need to submit proof, dont you think?

  45. Hirhurim says:

    Dr. Stadlan: Again, you are making a category mistake. You are confusing the definition of death with the clinical test to determine that a patient is dead. After making that mistake, you continue to state your misinterpretation as facts and then make the outrageous statement that “Rav/Dr. Shabtai either reveals tremendous ignorance of the relevent sources(which is hard to imagine), or a deliberate misreading. QED”

    You misunderstood, either intentionally or otherwise, and then insulted. All this without reading the book. You are the one displaying ignorance by making the category mistake, not Dr. Shabtai. You also quote R. Yosef Carmel’s responsum while inexplicably failing to cite the Rabbanut’s own published material on the definition of death which supports Dr. Shabtai’s contention and has nothing to do with the tests administered to establish death.

    Anonymous: You are correct that I have not submitted proof. I asserted my opinion. I have no intention of getting into it here.

  46. David Shabtai says:

    Thank you all for taking the time to comment. I sincerely hope that this book will be a source of Talmud Torah. My goal in writing it was to create a ‘conversation’ or dialogue between the positions. As noted, I do not take a position on the matter – because I am not a posek. Determining the moment of death has serious ramifications and should be determined only by those halakhic decisors who are considered by all to be of sufficient stature to adjudicate a matter that may border on potential murder. There are great poskim on both sides of the issue – I am certainly not one of them.

    To respond to Dr. Stadlan’s point: I believe that according to the Rabbanut’s position of 1987, they would have to consider Christopher Reeve to be dead. As strange as this may seem, it is a weakness of their argument. This conclusion is clearly borne our of the letter send by the secretariat of the Rabbanut, sent to “kevod ha-rabbanim shlit”a di be-khol attar ve-attar.” This letter explains their position clearly (instead of just stating it), but is unfortunately hard to come by. It is translated in chapter 15 of my book.

    I believe that Dr. Stadlan is confusing the notions of _tests_ and _criteria_ for death (discussed in more detail in chapter 4). Criteria for death are those physiological characteristics that must be absent for a person to be considered dead. Tests are medical exams necessary to prove that the criteria have been met. Criteria represent certain values that in turn represent a certain definition – or philosophical notion – of what death is. Tests are questions of reality – does this patient meet the criteria.

    The Rabbanut’s criteria for death (at least in 1987) was the irreversible cessation of spontaneous respiration (ICSR). The Rabbanut is clear that the brain per se, does not play a role in these criteria.

    The tests are necessary to prove the inability to breathe and the brain stem exams in particular were included to prove that the cessation of respiration was irreversible. The tests are intended merely to prove the criteria, but in and of themselves are not particularly significant.

    Christopher Reeve clearly fits the criteria of ICSR since he was irreversibly unable to breathe on his own (there is no debate on that matter). While his brain stem was intact, the brain stem tests do not apply to him, nor do they have to, since they do not relate to his situation. Tests are just gauges of reality: is this patient experiencing the irreversible inability to breathe? It doesn’t matter how you prove that, just that you do. The Rabbanut’s tests were solely intended to prove that in the context of brain death. They are intended as clinical parameters to test whether in the context of what appears to be brain death (until the tests are performed), is the person incapable of breathing on his own (which would clinch the diagnosis).

    They are not relevant to Christopher Reeve, who everybody admits was unable to breathe on his own without the need for brain stem exams.

    If your criteria for death is ICSR – and I am pretty convinced that this was the Rabbanut’s opinion in 1987 – then Christopher Reeve meets these criteria. I believe that this is a very strong question.

    One response, which I am guessing that Dr. Stadlan is intimating, is that it is not ICSR per se that is the criterion for death, but rather the brain stem injury that leads to ICSR. According to this approach, Christopher Reeve was alive since his brain stem was intact. While this is indeed a valid approach to brain death, in my opinion, this is not the approach of the Rabbanut of 1987.

  47. Anonymous says:

    Hirhurim again you write that Dr.Stadlan is being insulting don’t you think your comment “I have become convinced that many proponents of brain stem death are not only wrong but dishonest” is more severe than insulting? Like R’ Dr Shabtai wrote there are Goanim on both sides of this issue

  48. Hirhurim says:

    Of course there are Geonim on both sides of the debate. I specifically wrote “many proponents” in order to exclude both the Geonim and the many honest people. And if we want to find the origin of the insulting, neither this comment thread nor Rav Bleich’s approbation are the place to look. There’s a long history here.

  49. Anonymous says:

    OK, however you call those Geonim “dishonest”

  50. Hirhurim says:

    No, only those “many proponents”

  51. Yeedle says:

    R. Gil, in any given debate you will have dishonest people on both ends of the rope.

  52. noam stadlan says:

    I am always eager to learn new things, and I appreciate R. Shabtai and R Student for pointing out lacunae in my knowledge and understanding. However, as demonstrated in my article here: http://text.rcarabbis.org/problems-with-defining-death-as-the-irreversible-cessation-of-circulation-what-would-we-measure-and-why-by-noam-stadlan-md/ I am familiar with the distinctions that they mention. We can go on and on parsing the specifics of what Rav Shabtai said or meant. Two points that I have already been made which I guess have to be repeated:

    1. Regardless of how Rav Shabtai meant to parse his words, after making his statment about the Rabbanut, he did not go on to mention anything about other results from applying testing criteria, and the listener comes away with the impression that the Rabbanut thinks that a paralyzed person is dead.

    2. The main point of discussion hinges on what the Rabbanut meant and what current supporters of the Rabbanut position hold. As I pointed out, there is an obvious opening for Rav Shabtai since they say ‘irreversible cessation of respiration.’ My point, which I think is shared by supporters of the Rabbanut position, is that the meaning is irreversible cessation of repiration in the context of severe brain damage. That certainly is what the tests are looking for.
    Rav Shabtai would be correct if he pointed out that there was an apparent discrepancy between definition and criteria(referred to as issues with internal validity- I think first coined by Karen Gervais) but that is not the point he was making. He was denigrating the Rabbanut position by pointing out that it results in incoherent results. I have used this approach myself. But he is making it seem as if this is a result of the rabbanut position, rather than more accurately identifying it as his own interpretation of the rabbanut position, with which many reasonable rabbonim, including R. Carmel et al, would vehemently disagree.

    Rav Shabtai writes that he has not taken a position on the matter. I have not read the book. It may be totally true that he does not take a position on the matter in the book. I am not addressing the book, which I ordered today from Amazon. I am addressing the lecture, where Rav Shabtai clearly does take a position on brain death. I also think that in the lecture, the issue of the Rabbanut, among others, was presented in a fashion that was not fair to both sides. There have been papers in the past that purported to be ‘fair and unbiased’ when in fact they were everything but that.

    Rav Shabtai, at least in the lecture, seems to support the idea that life is present when ‘vital function’ is present. If we really want to move a conversation forward, it would be helpful for Rav Shabtai to give the particular tests and results that need to be seen so that one can know if vital function was present or not. It would also be helpful to precisely define vital function, rather than just give examples.

    Rav Student- actually now I will demand an apology for your implication that my remarks demonstrate dishonesty. I did not engage in any sort of ‘cynical misinterpretation’. Leaving an audience with the impression that the Rabbanut criteria results in labelling a paralyzed person as dead without providing any hint of disagreement is wrong, and, in my opinion, reveals a bias. Feel free to disagree, but calling me dishonest is insulting. I wont even dignify your remark regarding HODS with an answer.

  53. Hirhurim says:

    Dr. Stadlan: If I were your department head in a university, I would bring you up on charges of professional misconduct. A young would-be scholar announces a new book and you, an established scholar, without even reading the book, declare based on a clip from a lecture that he is either ignorant or dishonest. That is character assassination that may very well effect his livelihood. How dare you?

    He has already explained what he meant, which was painfully aware to me and which I explained to you a long time ago. Yet you failed to listen charitably, or contact him directly, and instead attacked him in the comments to a blog. That is unprofessional, disgraceful.

    And not only do you fail to apologize or retract, you demand an apology?!?!

    Repent and apologize. And take some time to think about your online behavior and how it impacts others professionally.

  54. Anonymous says:

    Hirhurim please STOP putting words into DR.Stadlan mouth/comments please qoute for me where he was insulting dishonest etc… you continue to avoid his main הערות instead you כדרכך בקודש focus on the trivial stuff. He did not attack Dr. Shabtai in any of his previos comments, like I wrote earlier whenever there is a hot issue and you clearly have your opinion you negate the other side completly without honest משא ומתן. where is there “character assassination” please show an example. I think Dr. S was very respectfull in all his comments, and he backs up what he writes..

  55. Henry Hasson says:

    question to Rabbi Shabtai. If you can please clarify your comment regarding Christopher Reeve. You state: “Christopher Reeve clearly fits the criteria of ICSR since he was irreversibly unable to breathe on his own (there is no debate on that matter)” I would like to debate that. There is no scientific evidence that his inability to breathe was irreversible. I think something that many people are often unclear on (including rabbis, doctors and other experts) is what irreversible means clinically. In the Rabbanuts 1987 decision it is my understanding that they did require irreversible in they definition. No one could tell Mr. Reeve that his spinal cord injury was irreversible as their is no scientific proof of that. In fact many people (including Mr. Reeve from what I read in the papers) make attempts to wean off the respirator because spinal cord injury does not always cause irreversible cessation. Most people with spinal cord injuries (like myself) have very slow improvement over time.
    The rabbanut I believe must have understood the difference between the 2 and therefore defined death based on someone never ever being able to breathe on their own again…

    In addition to that, I do believe that the rabbis who were involved with that statement in 1987 and defined death as ICSR, also made an assumption that we are talking about a situation where the person is not awake and having other brain stem functions working. I am not discussing criteria, rather definition. My question is this; besides the above that Mr. Reave did not have irreversible cessation. Lets even say we can prove it was irreversible in his case. Do you truly believe that if you took him to the rabbanut in 1987 that they would say: “yes, he can’t breathe therefore he meets our criteria for death” I find that difficult to believe . They did not give their ruling in a vacuum. They gave their ruling on the heels of the Harvard Criteria which was certainly discussing breathing due to brain stem death.

    disclaimer: I do follow rabbi Ovadia Yosef’s halachik decision that brain stem death is the definition of death (as is clearly spelled out in his Grandson’s book), I also support the medical decision that brain stem death is death, and I support HODS. I have met doctors that support brain death and doctors that disagree with it. I have met rabbis that support it and those that don’t. I believe both sides are honest and have the proper intentions. I am not new to Hirhurim as I always enjoy reading articles here but I am new to posting here. As a neurologist I have been called many times to evaluate whether a person has ICSR and whether a person has brain death so have been intimately involved in personally examining many patients in this situation. Thank you for this most interesting dialogue on the subject.

  56. Henry Hasson says:

    I do look forward to reading the book once it is available.

  57. Hirhurim says:

    Anonymous: See the end of noam stadlan on February 19, 2012 at 3:55 pm

  58. Yeedle says:

    Perhaps Dr. Hasson’s comment that “[The Rabbanut] did not give their ruling in a vacuum. They gave their ruling on the heels of the Harvard Criteria which was certainly discussing breathing due to brain stem death”, shows that unless you don’t consider ICSR as death (like R. Student does) you find R. Dr. Shabtai’s comment about Mr. Reeve to be facetious. If so, R. Student owes Dr. Stadlan an apology for calling him dishonest.

  59. noam stadlan says:

    Thank you anonymous. I specifically stated that I was not addressing the book. The book is being marketed as a fair and balanced look at the topic(I forget the exact wording). I was asked to listen to a tape of a lecture and I commented that the contents of the lecture were not presented in what I would term a fair and balanced way. I think that is pretty important information given how the book is being publicized. I look forward to reading the book, and will be happy to state what I think of the book, and will be happy to state if I think it is fair.

    My intent was not to impugn the young scholar, and I apologize to Rav Shabtai if I did. I realize that my words were a bit harsh, and I apologize for that as well. It is clear that Rav Shabtai knows these particular sources. However, I think that the sin committed- passing off one’s personal opinion as the accepted reality- in a matter as important as interpreting the chief Rabbinate position, is quite significant. I am certain that the vast majority if not everyone who has heard the lecture interpreted it as I did. I stand by my assessment that it represented either ignorance or willful mis-statement. Having read the explanation, it still is a misrepresentation that serves the point of view he was advocating at the end of the lecture. Perhaps he meant it in a different way but again, I can only go by what is on the tape. I was not being generous or ungenerous, just listening.

    This topic is literally a matter of life and death for many who need organs. It is also obviously a major issue in Orthodoxy that has ramifications on how science is incorporated in Halacha. Everyone is certainly entitled to their opinion, and is entitled to publish their opinion. However, in a matter as important as this, giving widely publicized lectures and publishing books puts an opinion or point of view into the public sphere. Once in the public sphere, some people are going to rely on that opinion. Obviously some opinions are more informed than others. Once an opinion is making its way in the public sphere, I think it is reasonable to ask if it is informed or not. If it is touted as balanced, it is fair to ask if it is balanced or not. If you think that Rav Shabtai is not up to such scrutiny, then perhaps this venue of publicity and publishing a book was not a good idea. What I think is not fair to the public is for information to be put in out for public consumption which is not as described. I have been very clear that I was addressing only the lecture that he gave.

    I can see that this discussion is not going to progress, and will refrain from commenting further.

    I still await your apology for insinuating that I was dishonest.

  60. Hirhurim says:

    A list of some of Dr. Stadlan’s descriptions of Dr. Shabtai’s shiur. He started out thinking that Dr. Shabtai said that Christopher Reeve fit the Rabbanut’s tests of brain death but, after I and Dr. Shabtai pointed out that was incorrect, is now acknowledging that he misunderstood Dr. Shabtai’s intent but believes it was still wrong.

    Feb 17, 4:02pm “This a clearly incorrect statement”

    Feb 18, 12:24pm “presenting the data against his case in the worst possible light”

    3:55pm “a person who supposedly is an expert in the topic either doesn’t know the subject matter or deliberately mis-stated something of significant importance. I chose the latter”
    “the statement by Rav/Dr. Shabtai either reveals tremendous ignorance of the relevent sources(which is hard to imagine), or a deliberate misreading.
    QED”

    4:57pm “That is wrong. I mis-interpreted NOTHING”
    “The fact that he knows all the stuff that I posted and still said what he did in the lecture only proves that he deliberately stated something that he knows the Rabbanut did not mean and it’s heirs have clarified.”

    5:42pm “it was not intellectually honest”

  61. Lawrence Kaplan says:

    Rabbi Student: Your accusing Dr. Stadlan of professsional misconduct is absurd. You obviously have no idea of the powers and responsibilities of a Department Chair. Dr. Stadlan made it clear time and time again that he was criticizng the lecture and not criticizing the book which he admitted he had not read. You may think the criticism was unfair, but to term it professional misconduct??? Your bias is showing. I really think you, unfortunately and unwisely, lost your temper.

  62. Hirhurim says:

    Dr. Stadlan: “the sin committed- passing off one’s personal opinion as the accepted reality”

    A scholar is not allowed to interpret the data in a unique way??? And to defend his interpretation in a new book? Is that not what scholars do? You call that committing a sin? There aren’t enough punctuation marks to express my disappointment in your failure to adequately apologize even after accepting that you misunderstood his words.

  63. Hirhurim says:

    Dr. Kaplan: Far be it for me to tell you what academic standards are. If they are that low, I’m disappointed.

  64. The Dude says:

    It looks like Shabtaut still lives on. And R’ Gil among the Shabta’im.

  65. Lawrence Kaplan says:

    Rabbi Student: You are confusing academic standards with professional misconduct. I still think you lost your temper.

  66. David Shabtai says:

    Personally, I don’t find discussions of me as a person, or my intentions rather helpful or productive. I am ready and happy to stand up to scrutiny – but while I cannot control it, I request that it be done in a respectful manner befitting benei Torah interested in better understanding and applying God’s will to this world.

    I wrote this book to advance the actual conversation and discussion on the halakhic issues involved. Sometimes this requires looking at positions critically and analyzing them from a fresh perspective. This is what I have done with the Rabbanut’s opinion.

    In case I was not clear earlier – I believe that according to the criteria for death set out by the Rabbanut in 5747, Christopher Reeve should have been considered dead. In my book, I translate and analyze the Rabbanut’s position in detail and explain why this is the conclusion to be drawn from their position. In my previous comment, I explained that this is directly borne out of the Rabbanut’s criteria for death, which was the irreversible cessation of spontaneous respiration and the tests necessary to prove that in brain death are not relevant to other cases, nor are they necessary. I encourage anybody interested in reading more about this distinction to read chapter 4 of my book.

    This is my opinion. The Rabbanut’s position statement did not address Christopher Reeve and I am using the principles they set out and applied them to a situation they did not consider. We can talk about this point, we can discuss it, and we can debate it – but that should be our focus. It is not helpful to simply state that it cannot be true, or that I never heard of such an approach.

    Do I consider this a little bit extreme – to declare dead a person who is talking. Yes. I don’t think that makes the position wrong, just uncomfortable. Are there alternate approaches that manage to avoid this uncomfortable conclusion – absolutely, but, in my opinion, the Rabbanut specifically chose a position that directly leads to this conclusion.

    Addressing Dr. Hasson’s question: We will never know what the Chief Rabbis would have said regarding Christopher Reeve. I tend to agree with Dr. Hasson, that had they been presented with a case similar to Christopher Reeve, they would have thought him to be alive. Right after they said that however, they would need to go back to the drawing board and completely rewrite their position statement, since that conclusion cannot come out of what they actually wrote.

  67. Henry Hasson says:

    thank you for your response. In addition to the other issues, I do not think that the Rabbanut would have to go back to the drawing board since they did at least define it as “irreversible” and someone with a spinal cord injury is not irreversible. that is why neurologists are very makpid in their lashon. injury is not damage or death. injury means he was injured and may improve.

    This is probably what made some uncomfortable with the proposition that Mr. Reeve would be considered dead by the 5747 rabbanut definition. The reason I disagree and do not believe their definition pronounces him dead is because the definition requires irreversible and he was not irreversible.

    I can’t think of a case at this moment of someone who has complete irreversible cessation of breathing and does not have death to the brain stem. That is probably (again an assumption) why the rabbanut was comfortable just stating ICSR because the only situation in which you have that is in brain death, not in brain injury or spinal injury or nerve injury, etc. I don’t see how any doctor can definitively state that Mr. Reeve had irreversible damage/death.

    I will check out chapter 4 when I receive the book. (I too agree that the discussion and debate is important to continue for all sides can benefit from it). thank you again for your responses.

  68. Rabbi Shabtai – I have not yet read your book, but it seems that all those who wrote haskamos, and whose positions you discuss, take the approach of paskening this question directly from the Gemara and earlier poskim. Applying this methodology of psak is in turn is based on two presumptions: that Chazal differentiated between the nervous system, the cardiopulmonary system, and the respiratory system – and that they correctly understood the role of each. Do you discuss the nature and validity of these presumptions in the book?

  69. noam stadlan says:

    Dear Rav/Dr. Shabtai,

    I want to apologize for the tone of what I have written in the comment section, and also if I made inaccurate assumptions regarding your motivations. I had meant to make one small comment regarding your audio presentation, but that obviously turned into much more. As you may have guessed, Rav Student and I have had many arguments on this topic, some of which have been quite heated. Much of what I wrote was for the purpose of defending myself against Rav Student’s attacks, but, regardless of the rationale, I should not have responded to his attacks by attacking you, and I should have been more cognizant of any collateral damage. I am sorry.
    I think however, that my first point was indeed valid, and it would be perhaps useful to go over the facts and issues. In your lecture, you make a specific point that according to the Rabbanut criteria, Christopher Reeve would be considered alive. You do not qualify this with ‘in my opinion’. The person listening is left with the unopposed impression that the accepted opinion of the world, or at least according to Rav Shabtai, who is an expert on this topic, is that the Rabbanut criteria are unable to distinguish between someone who is obviously alive and someone who is dead. The result is that they are much less likely to think of the Rabbanut opinion as rational or worthy of support. This supports your viewpoint because in your audio lecture you advocate against accepting brain death as death. If you really want to give a balanced presentation, I strongly suggest that you revise your lecture for the future.

    What is the truth? The initial statements of the Rabbanut link the concept of life with respiration. With regard to this particular definition of the concept of life, assuming your statement refers only to this particular part of the definition and no other, your statement is factually correct(assuming that everyone understands that you are referring only to the concept of life and nothing else- something which I sincerely doubt is true). The exact criteria (practical definitions) of the Rabbanut obviously test for brain dysfunction, so your statement is not factually correct regarding the criteria. Please keep in mind that most people (probably everyone until they start looking into it) assume that there is strong internal validity to these definitions (the criteria flow logically from the concept). So, if the concept of death couldn’t distinguish between usually accepted life and death, the criteria (practical rules) cant either. Most people also don’t automatically distinguish between definition and criteria. In your statement, you did not make any distinctions between the Rabbanut concept and criteria, and therefore your statement casts aspersions on the entire Rabbanut definition.

    More importantly, later papers, from Rav Yisraeli himself up to the answers Rav Halperin gave to Rabbi Bush back in 2008, make it clear that the Rabbanut define death only when the cessation of breathing is due to brain damage(I can provide references upon request). Therefore, your statement is not true regarding the interpretation that the authors of the definition themselves intended.

    From what you wrote, it appears that you feel that your interpretation is historically accurate and the changes were made later. I have no data on this and it certainly could be true. Even if it is true (and I am not doubting you), it doesn’t represent how the Rabbanut criteria were applied at that time, and certainly not what they currently represent.

    In summary, even with the most generous interpretation, your statement accurately describes at most a portion of the Rabbanut position at a small window in time, and does not accurately portray the entire position at that time nor the current position. Yet in your lecture you stated, without any modification, that according to the Rabbanut criteria Christopher Reeve would be considered dead. In fact, this was the chief(and only?) argument you used against the Rabbanut criteria.

    My initial assumption was that either you did not know all of the above data, or that you knew the data and chose to deliberately portray the Rabbanut in as poor a light as possible. I see that there is a third possibility that I did not consider and perhaps others. If I understand correctly, you feel that you have uncovered something new that was previously unconsidered and wanted to make it public. I can understand that point of view. However, what I want to emphasize is that regardless of the accuracy of this new information, stating just that new information, without providing the entire appropriate context, is very misleading to the audience. Providing just that snippet gives the audience the wrong impression of the Rabbanut position as a whole- they don’t know that your statement doesn’t apply to the specific criteria, they don’t know that Rav Yisraeli and others have addressed your concerns etc.

    Let us even assume that you have good reason to counter the explanations of Rav Yisraeli et al. So that is a machloket between Rav Yisraeli and you or whomever you are quoting. Not telling the audience about this machloket, and just assuming that they would agree with your siding against Rav Yisraeli would be, in my opinion, inappropriate. Because, in this situation, the basis of your case that ‘the Rabbanut makes no sense’ is not plain facts on paper, but a judgment as to who has the better argument in that machloket. The audience deserves to know about that machloket and have the opportunity to judge the sides.

    Consider a debate about the justice of the US government. One side claims that the Constitution allows slavery, and this makes the government unjust. This is a true statement only prior to the 13th amendment. After the amendment to outlaw slavery, it is no longer true. One can certainly advocate that the amendment did not go far enough or still allows discrimination, or slavery as punishment, but that is an entirely different argument and much more difficult and complex to make.
    It is hard for me to imagine a situation post 13th amendment where stating that “the constitution allows slavery” is an intellectually honest statement, without including many qualifiers. I think, unfortunately, that your statement regarding Christopher Reeve is very similar. It uses a small sliver of previously accurate reality as a substitute for the actual totality where the previous reality is no longer is accurate.(lest my words be twisted, I am not accusing you of intellectual dishonesty here. I have no doubt that there is an excusing rationale).

    I hope that this explains my comments. I think my point was accurate and justified, but I again apologize for the tone, for the statements made in the process of defending myself, and for making an assumption of motive. Although I do not qualify as a chacham, I accept that I should have been more cognizant of ‘chachamim hizaharu b’divrechem.’ I gently suggest that you also should have been cognizant of this in your audio presentation (unless of course the impression made was the impression intended). I look forward to future discussions and to reading your book.
    Kol Tuv,

    Noam Stadlan

  70. a westreich says:

    As a simple kollel guy, I would just like to summarize, for the layman, what I believe Dr. Stadlan has just responded to Dr. Shabtai. In essence, since it would be preposterous to assume that Christopher Reeve would be defined as dead, we should ignore what the Rabbanut, and subsequent position papers of the Chief Rabbis themselves, laid out for the halachic definition of death, namely lack of spontaneous respiration, and instead adopt the cognitive tests that were used for this determination as the definition itself. This all stemming from the fact that the Rabbanut must have considered all future scenarios that might possible render their definition as completely absurd. Is that about right or am I missing something here?

  71. Noam Stadlan says:

    I am sorry I was not more clear. After the initial Rabbanut paper, Rav Yisraeli and others wrote papers that gave Halachic reasons that make it clear that cessation of respiration only means death if the cessation of respiration is because of brain damage. (Rav Halperin listed a number of sources – most are available online). So, you should ignore nothing. However, you need to realize that there is more to the Rabbanut position than what was published in 1987. The problem represented by Christopher Reeve has been addressed years ago. You can accept the explanations of R. Yisraeli or disagree. . But I do not think it is a fair characterization of the Rabbanut position to ignore them.

  72. Hirhurim says:

    Thank you, Dr. Stadlan, for your honorable apology.

    In his book, Dr. Stadlan spends significant time on the positions of the various chief rabbis, Rav Yisraeli and Dr. Steinberg. He is remarkably thorough.

  73. a westreich says:

    Please let me clarify what you are suggesting. Although the statement of the Rabbanut bases itself on the Chasam Sofer who advocates cessation of spontaneous breathing as the definition of death and mentions nothing of brain injury, Dr. Shabtai should have taken into account the paper of Rav Shaul Yisraeli that essentially is a reinterpretation of that which seems to be quite clear in the original Rabbanut ruling. And all this without the Rabbanut itself issuing a retraction of its original criteria. So the accusation against Dr. Shabtai is that he should have said that Christopher Reeve, according to the Rabbanut ruling, would be dead except according to major reinterpretations of this position that the Rabbanut itself did not formally adopt. Is this really what you mean?

  74. Noam Stadlan says:

    Dr. Shabtai uses Christopher Reeve to discredit the Rabbanut position. He had an obligation to present the entirety of the position, including both the parts that are at odds with his conclusion and how it is been interpreted since the position was written. It took a lot to get the Rabbanut to issue an opinion in the first place and further clarifications(I would suggest that reinterpretation is not an accurate characterization) are not expected to require new official statements. In answer to your question, if you are going to talk about THE Rabbanut position you have to include what the authors wrote subsequently. Especially if they already specifically addressed the problems that you are claiming are present. Rav Yisraeli wasn’t just some guy who commented on the Rabbanut position. He is the one who helped write it and implement it. What he writes subsequently is essentially part of the ruling, especially if no one was opposing what he wrote. He CLARIFIED a point that was ambiguous.

  75. Hirhurim says:

    Dr. Shabtai uses Christopher Reeve to discredit the Rabbanut position

    I think “discredit” is the wrong word. He uses it as a test case to measure the viability of the position. He does this kind of test to ALL the views he examines in the book, which is why I think the book is so valuable.

  76. Noam Stadlan says:

    Let me try to make this as clear as possible. The concept used by the Rabbinate can be interpreted in a number of ways. The steps they list to determine death indicates that they were looking at massive brain injury. R. Yisraeli subsequently clarified that yes indeed they meant massive brain injury and provided Halachic support for that position. It is a misrepresentation to talk about THE position of the Rabbanut if you ignore all of the above and focus on one POSSIBLE interpretation of the original concept. Especially since the issue R. Shabtai raises is specifically addressed and laid to rest

  77. Hirhurim says:

    Dr. Shabtai is certainly being reasonable by relying on the Chief Rabbinate’s official clarification of 23 Tamuz 5747 — issued by the Chief Rabbinate’s secretariat.

    R. Yisraeli’s was not the only subsequent clarification! R. Mordechai Eliyahu also published an article and the Chief Rabbinate’s secretariat issued an official clarification. I believe R. Yisrael Lau did, as well, but I’m not sure if my memory is correct on that. Given all of that, I don’t think R. Yisraeli can be reasonably taken as the sole voice for the Chief Rabbinate.

  78. Hirhurim says:

    And of course R. Avraham Shapira also wrote an article.

  79. David Shabtai says:

    It should be clear that IF the sole criteria for death is ICSR, then somebody who is incapable of ever breathing again on his own is considered dead. Noting Dr. Hasson’s hesitancy regarding the actual diagnosis of Christopher Reeve (see p. 369n4 of my book for my own hesitancy), for the sake of the thought experiment, let us assume that he indeed suffered from ICSR, but not because of a brain stem injury. According to this approach, he would be declared dead.

    When the Rabbanut published their position statement in 5747, they also issued a letter of explanation that painstakingly details the reasons they came to their conclusion. The Chief Rabbis at the time, R. Mordechai Eliyahu zt”l and R. Avraham Shapira zt”l also wrote articles explaining their positions. All three are quite clear that the sole criteria for death is ICSR.

    From p. 279 of the book (the Rabbanut’s explanatory letter):
    “Death is determined by the cessation of respiration and not the destruction of the brain, [although] the destruction of the brain proves that the patient can no longer breathe spontaneously.”

    If they meant that the real criterion for death was ICSR only in the context of brain stem destruction / dysfunction, the it would be the brain stem destruction / dysfunction that is the true criteria for death and not ICSR. This would be very hard to prove from the Talmudic sources, since Hazal were likely unaware of the brain stem’s control of respiration.

    The Rabbanut’s letter and the articles by R. Eliyahu and R. Shapira zt”l do not require “interpretation” or any derashah. In my opinion, they are quite clear in what they believe, that the halakhic criterion for death is ICSR (please see chapter 15 of my book for analysis of how they relate to the notion of potential decapitation). As such, despite whatever discomfort we may feel with this, according to the Rabbanut’s position, Christopher Reeve (at least according to this thought experiment) was dead.

    R. Shaul Yisraeli zt”l was an eminent talmid hakham who presented his opinion on the matter. On many points, it differs from the Rabbanut’s perspective. I deal with his position throughout my book (from the index: 79, 175-8, 181, 191n12, 196-7, 210-15, 226, 258, 275, 296). His arguments take radically different approaches than those suggested by the Rabbanut in its position statement, explanatory letter, and the articles by the two Chief Rabbis. R. Yisraeli is more concerned with analyzing RMF’s position than analyzing what the Rabbanut had previously published. I do not mean to detract from R. Yisraeli’s stature in any way, has ve-shalom, just to note that he is advocating an approach completely different than the Rabbanut. Dr. Stadlan has chosen to call R. Yisraeli’s approach a “clarification” of the Rabbanut’s stance. I think most objective readers will agree with me that it represents a completely different approach – one that indeed requires its own analysis, which I provided in the book.

    Therefore I stand by my original description.

  80. Rabbi Shabtai – since you are still around, can I ask you to address my question?

    To repeat: I have not yet read your book, but it seems that all those who wrote haskamos, and whose positions you discuss, take the approach of paskening this question directly from the Gemara and earlier poskim. Applying this methodology of psak is in turn is based on two presumptions: that Chazal differentiated between the nervous system, the cardiopulmonary system, and the respiratory system – and that they correctly understood the role of each. Do you discuss the nature and validity of these presumptions in the book?

  81. Anonymous says:

    I’m the guy who refrenced the sefer “ruach yakov” from R. Ovadia’s grandson, now that I recieved the book I see that its quoted many times and that R.Shabtai spoke with the grandson directly. This is not a book its a Sefer. However me personally get the feeling when “learning” this sefer, that R.Shabtai has his own opinion and is not totally objective.(which is fine with me)

  82. J. says:

    “This would be very hard to prove from the Talmudic sources, since Hazal were likely unaware of the brain stem’s control of respiration.”

    Were Chazal aware of the heart’s role in pumping blood? Was Rashi?

  83. Noam Stadlan says:

    I don’t have time for a lengthy rebuttal. I will just point out that you have illustrated the breadth of opinions and how stating THE Rabbanut opinion without accompanying discussion is not appropriate. I would note in addition that the Rabbanut criteria were portrayed as THE example of respiratory criteria. If you are insisting on splitting R. Yisraeli off from the Rabbanut criteria(I am not addressing that issue here), his opinion still stands as an example of how the Christopher Reeve problem has been addressed under the respiratory criteria, something unacknowledged in the presentation.

  84. Yeedle says:

    “This is not a book its a Sefer. However me personally get the feeling when “learning” this sefer, that R.Shabtai has his own opinion and is not totally objective.(which is fine with me)”

    Not so fine with me. I’m guessing R. Shabtai’s own opinion is that ICSR cannot be considered as death. Correct me if I’m wrong.

  85. Anonymous says:

    Your guess is right, however this is my opinion.

  86. Hirhurim says:

    After looking through the responsum by R. Yosef Carmel that Dr. Stadlan recommended (http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf), I’m not sure how he answers the Christopher Reeve question. The only possibly relevant paragraphs I see are 1 and 5 (aleph and heih).

    In paragraph 1, R. Carmel stresses that the sole criterion for death is ICSR (Irreversible Cessation of Spontaneous Respiration) and everything else is just to confirm that it is in fact irreversible. In paragraph 5, R. Carmel says that anyone brain dead who continued living was not declared brain dead by the Chief Rabbinate’s or Knesset’s criteria, which would prevent such a person being declared brain dead.

    How do either paragraphs address the question of someone (theoretically Christopher Reeve but his actual condition is irrelevant to the issue) who has suffered ICSR but continues functioning through mechanical breathing?

    Where does he say something equivalent to what Dr. Stadlan claimed? February 19, 2012 at 3:55 pm “While Rabbi/Dr. Shabtai states in the lecture that the brain doesn’t enter into Halachic consideration, it is clear from the Rabbanut Criteria and subsequent statements such as R. Yisraeli’s talmid muvhak R. Carmel(avaliable here: http://www.hods.org/pdf/On%20Brain%20Death%20by%20Rav%20Carmel.pdf) that the cessation of respiration that counted was only when it was due to irreversible overwhelming brain damage, and not due to spinal cord or phrenic nerve damage.

  87. J. says:

    You can always ask them. Eretz Chemdah are pretty good at responding to queries, and I’m sure they would be more than happy to explain their position.

  88. J. says:

    Also, the psak of the Rabbanut bases itself on the teshuva of the Chasam Sofer who is clearly talking about someone who “acts dead”. Thus this whole discussion seems like a non-starter.

  89. S. says:

    Thank you Dr. Shabtai, for your clarification of the Rabbanut’s stance on this important issue.

    Unfortunately, Dr. Stadlan seems very uncomfortable addressing the Rabbanut’s stated opinion, and as such, feels he must resort to apologetics and reinterpretations based on Rav Yisraeli’s approach.

    While this issue is no doubt a very heated and emotional one, let’s take the written word at face value, and not allow our emotions to cloud our unbiased and objective reading of the sources.

  90. Hirhurim says:

    J: R. Carmel/Eretz Chemdah did not claim to answer the Christopher Reeve question. Dr. Stadlan made the connection between the question and that specific responsum. It might answer it. I’m just not sure how.

    But the point about the Chasam Sofer is important. R. Carmel was emphasizing that ONLY cessation of respiration counts as death and that the other considerations, such as “act[ing] dead”, are just to verify that respiration has indeed irreversibly ceased. In the Christopher Reeve (hypothetical) case, we know that spontaneous respiration has irreversibly ceased.

  91. Shalom Spira says:

    Returning the response Mori ve-Rebbi R. Kaplan graciously offered me on Feb. 16 at 1:13 p.m.: I thank Mori ve-Rebbi R. Kaplan for his kind words, and his rejoinder is accepted and well taken.

    Personally, I agree with Dr. Stadlan’s reading of the Israeli Chief Rabbinate decision. Basically, all the Israeli Chief Rabbinate meant to rule was to follow RMF, who – in turn – speaks of irreversible unconsciousness and irreversible apnea as the two criteria of death in IM YD 3:132, basing himself on Chatam Sofer. Interestingly, RMF never related in that responsum to circulatory arrest as the third criterion of death mentioned by Chatam Sofer, but R. Shabtai Rappaport has explained why that is (as per my comment on Feb. 15 at 8:48 p.m.).

    Ye’yasher kochakhem to HODS for publicizing Kollel Eretz Chemdah’s ruling in Be-Mar’eh ha-Bazak Vol. 7 regarding the definition of death. With all due respect to Kollel Eretz Chemdah (whose members are tzaddikim gemurim), here is my rejoinder, point by point:

    [ALEPH] That’s the way Chatam Sofer is explained by RMF, and that pesak halakhah was indeed authoritative in its time. But times have potentially changed, thanks to RSZA who re-interpreted Chatam Sofer to potentially grant significance to circulation as a sign of life, even in an irreversibly unconscious and irreversibly apneic patient. So I think we are basically faced with a RMF vs. RSZA scenario.

    [BEIT] R. Joseph Shalom Eliashiv is not merely concerned about misdiagnosis of respiratory death. Rather, R. Eliashiv believes that respiratory death is insufficient, since he obeys RSZA’s reading of Chatam Sofer. Now, it just so happens that I am possessed by HBLYS (Hen Bi-Kdoshav Lo Ya’amin Syndrome), i.e. I am more impressed by deceased luminaries than by living luminaries, as per Rashi to Genesis 28:13. Thus, I am not particularly impressed so much by R. Eliashiv’s position (which could theoretically change if he enjoys a refu’ah shelemah and he later changes his analysis) as I am impressed by RSZA’s position (-which, to the end of his life, interpeted Chatam Sofer as granting potential significance to circulation).

    [GIMMEL] I agree with Kollel Eretz Chemdah on this point. Citation of the “double murder” responsa of RMF is irrelevant. R. Moshe David Tendler eloquently said as much in his original 1988 debate with R. Hershel Schachter. [N.B. Even R. Schachter didn’t dispute R. Tendler on this particular issue.]
    http://www.yutorah.org/lectures/lecture.cfm/711847/Rabbi_Moshe_D_Tendler/Definition_of_Death_I

    [DALET] This is a very serious problem, and one – in my opinion – where Kollel Eretz Chemdah may be entirely correct. [R. Schachter also admitted as much in his original 1988 debate with R. Tendler, as documented on the HODS website at
    http://www.hods.org/English/h-issues/YouTube_video%20pages/RabbiHershelSchachter.asp ] I agree with Kollel Eretz Chemdah’s sense of social justice, tikkun olam, and the imperative of Kiddush Ha-Shem. Therefore, RSZA’s take-but-not-give prescription appears surprising. On the other hand, one could argue (in defense of RSZA’s take-but-not-give prescription) that Noahides will understand that their standards of death are different under Torah law than Jewish standards (as R. Doron Beckerman has cogently argued on this forum regarding R. Kook’s responsum about anatomy studies in Israeli medical schools). The newly published responsum of RMF in Iggerot Mosheh, Vol. 9 (discussed in my comment on Feb. 15 at 7:57 p.m.) also seems to suggest this might not be a problem. On the other hand, it is still not 100% crystal clear to me that RMF agreed with RSZA (due to RMF’s hesitancy expressed elsewhere; see my comment on Dec. 7, 2010, at http://torahmusings.com/2010/12/brain-death-in-the-news/ ). This is literally the kind of nightmare question our ancestors faced during the Holocaust, viz. sacrificing one person in order to save another. May we be spared from facing this question ourselves.

    [HAY] Kollel Eretz Chemdah is correct. However, due to the advent of the ECMO machine, which functions as an artificial heart, I would argue that even in the case of cardiac arrest, we have not met Chatam Sofer’s criteria of circulatory arrest for sure until some kind of irreversible damage to the circulatory system occurs. [I don’t know how long of a cardiac arrest this necessitates.] This need would flow (no pun intended) from R. Bleich’s chapter on artificial heart transplantation in Contemporary Halakhic Problems III.
    In his excellent lecture this past Sunday night, R. Shabtai implicitly argues against my position
    http://www.yutorah.org/lectures/lecture.cfm/772659/Rabbi_Dr_David_Shabtai/Defining_the_Moment_-_Determining_Death_in_Halakhah
    R. Shabtai believes that no credence should be granted to circulation propelled by an ECMO machine, just like no credence be granted to an outside observer who forcibly claps a corpse’s hands. Therefore R. Shabtai endorses the Bellevue Hospital Protocol, where circulation is artificially maintained in a patient even after irreversible cardiac arrest, so as to preserve the kidneys for future transplantation.
    However, I am not so sure the analogy to clapping the hands of a corpse is entirely compelling. Chiddushei R. Chaim ha-Levi Soloveitchik on Rambam, Hilkhot Yesodei ha-Torah ch. 5 writes that if a Jew is thrown by a terrorist on a baby, crushing the baby to death, the Jew is not at all an accomplice to the murder, since he is merely like a piece of wood or stone in the hands of the terrorist. [Thus, the Jew does not have to be killed by the terrorist in order to avoid being thrown on the baby. This is different – argues Reb Chaim – than a married lady who is assaulted by a stranger against her will. There, although she is completely passive, she must forfeit her life, because gilui arayot is gilui arayot, whether one is active or passive.] Accordingly, when I take the hands of corpse and clap them, the corpse is just like a piece of wood or stone in my hands. The fact that I made the corpse clap its hands doesn’t make the corpse alive. But in the case of artificially circulating blood – all circulation is – by definition – a “ko’ach sheni “. I.e., blood circulates because it is propelled by *something else*, the blood itself is not an excitable tissue. Chiddushei Ha-Ran to Chullin 32b is saying (as interpreted by R. Bleich’s chapter on artificial heart transplantation) that even if the heart no longer belongs to the animal in a halakhic sense (since the trachea has been severed), nevertheless the fact that – in metzi’ut – it is causing the blood to circulate makes the animal alive. So perhaps circulation is circulation, whether active or passive (-analogous to the gilui arayot of which Reb Chaim wrote).

    [VAV] I agree with Kollel Eretz Chemdah’s refutation of RSZA on the need for “every single brain cell” to die. The basis for refusing to pronounce death until all brain cells to die is RSZA’s understanding of Chullin 21a coupled with Rambam’s Peirush ha-Mishnayot to Ohalot. There is room to argue on RSZA in both directions (i.e. hypothalamic function shouldn’t help since it only internally secrets an internal hormone into the bloodstream and perhaps this does not halakhically count as motion; or – on the contrary – even the absence of hypothalamic function shouldn’t be cause to declare death, since RSZA misread the Rambam. Rambam was saying that the tail twitches when neural control of motion in the lizard is decentralized. Rambam never said that – therefore – if motion is decentralized, the patient is dead.) In any event, RSZA’s reference to “every single brain cell” is almost certainly an error, and should be replaced with “every single cluster of brain cells that cause macroscopic motion”, since – as Kollel Eretz Chemdah correctly states – Halakhah is not concerned with microscopic phenomena.

    [ZAYIN] I would argue to the contrary; Encylopedia Talmudit Vol. 9, p. 267, derives from the gemara in Shabbat 129a that whenever there is a dispute among the poskim regarding piku’ach nefesh, we follow the opinion that indicates to desecrate Shabbat. Ergo, we should desecrate Shabbat to prolong the life of a brain dead patient.

    [CHET] Unfortunately, this seems impossible, since some poskim disagree with RSZA and forbid deactivation of a ventilator. However, I do agree that all forms of organ transplant which are unquestionably permitted (e.g. blood, bone marrow, living kidney donation) should be proudly encouraged. Barukh Ha-Shem, HODS performs this great mitzvah with excellence.

  92. a westreich says:

    The upshot seems to be that the clarifications of both Chief Rabbis, as well as the statement of its secretariat in 5747, support the notion that irreversible cessation of spontaneous respiration is the definition of death and brain injury is only to be used as testing to match this criteria. Although Rabbi Yisraeli disagreed and incorporated brain injury into the definition itself, this was in no way reflective of the official stance of the Rabbanut and is to be viewed as a dissenting opinion of one of its advisors, not of the Rabbanut itself. This is borne out by the fact that none of the subsequent clarifications of the office of the Rabbanut seem to backtrack from the original statement or include Rabbi Yisraeli’s definition in their followup releases, and that Rabbi Yisraeli’s work itself does not have the imprimatur of the Rabbanut and was published privately in a hebrew medical journal. Dr. Stadlan has now shifted from accusing Dr. Shabtai of misrepresenting the official position of the Rabbanut to a new charge of not presenting an alternative that is somewhat similar to the actual Rabbanut stance that would answer the difficulties inherent in that approach. Dr. Stadlan, did you expect that Dr. Shabtai’s whole book, which I believe is quite long, be condensed into a 45 minute shiur? Did you really expect that sort of comprehensive analysis in such a short amount of time?

    If I have misrepresented in any wat what you have proposed, please correct me. If not, I believe that you owe Dr. Shabtai an apology since, at this point, his academic rigor and professionalism seem to be beyond reproach.

  93. Joseph Kaplan says:

    I’m trying to follow this discussion but one thing (probably more than one, but one that I can articulate) is unclear to me: does the Rabbanut require, before brain death is established in an actual case where a decision has to be made whether to, for example, allow organ donation, a test or some other evaluation that results in a positive answer to the question of whether the ICSP results from a brain injury?

  94. Anonymous says:

    He didn’t say to condese his whole book in 45min shiur just the main shitos on the topic.All of Dr.s comments are on the shiur he heard not the sefer.

  95. Yeedle says:

    Joseph Kaplan, I think that the Rabbanut requires the CSR to be completely irreversible. As Dr. Henry Hasson explained above, completely irreversible CSR is only possible after complete brain death. If the Rabbanut requires it to be checked whether the CSR is irreversible, it means that they require tests which determine whether the ICRS results from fatal brain injury.

  96. Henry Hasson says:

    I think we are being to free with terms. The reason we cant use Christopher Reeve in reality or in your hypothetical scenario you set up is because it does not exist. The rabbanut was not discussing some hypothetical and impossible case of someone having ICSR, they were addressing a real clinical question. The question they were addressing is: if someone has ICSR is he dead?, and their answer was yes. The only way anyone can claim a person has ICSR is by proving that the brain stem has died. I think we keep going in circles because we are not understanding the clinical question they were answering. Even people with severe spinal cord injuries, severe phrenic nerve injuries, etc. will not have a way of proving they are ICSR and therefore are not included in the question to begin with. the rabbanut pesak was not talking about any of these people. Remember cessation of breathing means complete cessation. It means that if we take them off the ventilator for a few minutes and their carbon dioxide level in the blood rises to extremely dangerous levels, their body will not even take the slightest puff. not one piece of muslce will work to expand the lung even in the slightest bit. The body will simply die becuase it has no possible way to ever attempt to survive. That is ICSR and the only way to have that in an irreverisible way is to be dead (brain dead). the doctors and rabbis went to the rabbanut with this question and said does ICSR mean death and they said yes. They asked the question because in America and other countries they were all discussing if ICSR due to brain death is death, so they wanted to know the Jewish view on this matter. No one asked them to define christopher Reeve or hypothetical Christopher Reeve. No body was thinking about or talking about a what if scenario where someone is functioning in all other ways by theoreticaly could never take one puff of breath. that is not the question they were asked so that is not waht they answered. We can not look at the answer without looking at the question that was asked. That is why, to me anyway, it is clear that the rabbanut meant brain death and I find it very hard to imagine that they were talking about theoretical cases that were not clinically relevent at the time. I think it is absurd (pardon the strong word) that anyone would believe that the chief rabbis didnt think carefully about their pesak and that they would have in all honesty considered a functioning person dead for a techincal reason. lets give the chief rabbis a little credit. If they did answer a real clincal question with such a crazy answer, that would be very embarrasing to them. Are we talking theoretically or do we really beleive that if we went to the people and drafted the original letter, that they would say yes – respiration is all that matters and if you find someone who is perfectly functioning but cant breathe without a machine, then he is dead and must be buried immediately despite his objections because of lo talin nivlato al ha’etz? Is that really what we are tring to say here? Again, I am not trying to be rude with my language. As I mentioned in the prior post I honeslty believe everyone here has the best intentions, just trying to better understand. thank you.

  97. Henry Hasson says:

    sorry for the long posts, but I feel the need to clarify the physiology involved. the human brian is designed to send signals to the body to control all functions of the organism. when times are tough, the brain is programmed to do whatever it takes to survive. it will shut off blood supply to various body parts in order to keep vital organs alive. In a situation where the person holds their person too long as babies are known to do, the brain will even reduce blood supply to itself so that the child passes out, falls to the floor and the autonomic system can take over and force the body to breathe. like i said the brain will do whatever it takes to get a message to the heart, to the lungs, etc. so that they do what they need to do to keep the organism alive even if for just one more second.

    this is why as long as their is even a little bit of functioning brain stem and that is all that is left of the brain, it will find a way to get a message to the lung to at least try to take one slight puff. I have examined many patients that have lost almost all functions of the brain and one is convinced they must be brain dead, but when the machines are turned off, that little tiny residual functioning brain does what it can to get a tiny signal through and we watch that very tiny movement of the chest, and we quickly turn the machines back on.

    there are serious diseases that cause serious damage to the pathway from the brain to the muscles that have the capability of expanding the lungs. even when they are damaged we can not say that it is irreversible because we know the brain will do what it can to sprout a new nerve or redirect a pathway to a new muscle to get the person to breathe even a tiny bit. no matter how damaged the nerve or muscle, there is a chance.

    When however the brain is completely shut off, as we occasionally due with barbiturates when needed, then the brain can not do any of these things and there is complete cessation of spontaneous respiration. this is reversible because we can stop giving the barbiturates the brain will awaken and immediately send signals to breathe.

    the only time we know that there is no chance that the brain will find a way to send a signal to breathe is fi the brain is no longer there. when it is completely destroyed, then and only then is there no chance of the organism surviving because the brain is dead and the lung will not expand without the orders coming from the brain. this is why the rabbanut was posek that ICSR is death. It makes perfect physiologic sense, it does not contradict the rabbis that lived in the time of the gemara or later, and it is definitive. Has V’halila that we should think so little of our hachamim that they would declare a person with a functioning brain as dead. I understand the view that disagrees with brain death and wants to use cardiac criteria only. that is fine. But to believe that our chachamim would use a definition of death that would declare a functioning person as dead seems to me that we must think of them in a very poor light. (I am obviously not accusing anyone here of really thinking of our chachamim in a poor light)

    I think what we have here is a simple misunderstanding. I am eager to read the coming posts that may elaborate on where I might have erred in my assessment. I also hope that I have somewhat clarified what can sometimes be very complex. The human brain (and all brains for that matter) is truly a remarkable creation of God and maybe even the seat of the soul and of life itself.

  98. MJ says:

    Dr. Hasson, I agree with your assessment of the Rabbanut’s approach, and that further, in general all criteria ought to be regarded not as “definitions” of death or life but as criteria by which one can know that death has occurred in cases of true ambiguity. Applying them to a person with whom one can converse is indeed absurd.

    However, part of the problem as I see it is that Dr. Stadlan himself uses this type of reductio ad absurdum argument (in other words applying definitions beyond their charitably interpreted scope of application to arrive at conclusions that are absurd in order to show that the definitions themselves are flawed) in refuting several approaches that reject brain death (see his article in Meorot).

    We could have a more productive discussion all around by agreeing that the Rabbanut no more thinks that someone who cannot live without a vent is technically dead than R. Bleich would think that an isolated organ kept viable with artificial circulation is technically a living person. All such arguments miss the idea that ambiguous cases that generate the need for precise criteria are the only cases where such criteria are needed; attempting to apply them elsewhere is deeply mistaken and results in absurdities.

    Somewhere back in the discussion archives is a long exchange between myself and Dr. Stadlan relating to this point. Hopefully seeing where this type of thinking leads will allow both sides to focus on the substantive local practical question in a manner delimited by pragmatic–not hypothetical– concerns.

  99. Hirhurim says:

    I believe Dr. Hasson is agreeing with Dr. Shabtai’s interpretation of the Rabbanut’s position but disagreeing that such a case as the theoretical-Christopher Reeve case is possible.

    Dr. Hasson: Are we talking theoretically or do we really beleive that if we went to the people and drafted the original letter, that they would say yes – respiration is all that matters and if you find someone who is perfectly functioning but cant breathe without a machine, then he is dead and must be buried immediately despite his objections because of lo talin nivlato al ha’etz?

    I believe Dr. Shabtai earlier answered that he believed that had we presented such a case to the Rabbanut, they would certainly NOT have declared him dead but would have gone back to the drawing room to reassess their definition of death.

  100. Superintendant Chalmers says:

    Frankly, I’m appalled at Dr. Stadlan’s tactic of attempting to undermine a book (which he admits HE HAS NOT READ) by making absurd criticisms of an audio lecture given by the author.

    The excuse of “someone asked me to review the book, so I listened to this lecture” seems beyond ridiculous. I think the tactic is dishonest, underhanded and rather mean-spirited.

  101. Joseph Kaplan says:

    my guess is that I’m not the only one who is very appreciative of Dr. Stadlan’s participation in this discussion and his sharing with us of his vast expertise on this complex and controversial topic. And, in his apology to Dr. Shatai should be a lesson and model to those of us whose comments can sometimes get a bit too heated, as the previous comment does.

  102. Lawrence Kaplan says:

    Joseph: I think your description “a bit too heated” was an understatement.

    Superintendant Chalmers: Why don’t you make your very nasty comment about Dr. Stadlan under you own name?

  103. Anonymous says:

    Since DR.S apoligized I think Hirhurin needs to as well.

  104. Steve Brizel says:

    Listening to a lecture, as opposed to actually reading a book, does not strike me as the optimal way to review the same. Despite all the commotion here, all the posts herein have produced are yet another futile exchange between the proponents and skeptics of brain stem death-another chakirah bli shum nafke minah lmaaseh.

  105. MJ says:

    Steve, 99% of the discussion on this site is at about the level of “not having read the book,” and “hakirah bli shum nafke minah lmaaseh” is probably a pretty good description of blog banter in general. So why the umbrage now?

  106. Steve Brizel says:

    MJ-The only umbrage that I have is that the book in question has at best produced a rehash of old positions,.

  107. noam stadlan says:

    Time does not allow me to address all the points that have been raised. The halachic category that defines death as cessation of respiration can contain a number of variants. R. Shabtai took one of those, showed how it fails to correctly identify the category that Christopher Reeve would fall into, and the audience goes home with the impression that all definitions of death based on cessation of respiration are subject to the same fallacy. A problem with a subset of a category was used to raise questions regarding the entire category.

    In the tape,a similar approach was taken with neurological criteria. Functions that may be present after application of usual criteria for death(Harvard criteria in the general sense) were used to discredit the idea of using neurological criteria for death in general. Again, the entire category is tarred by the problems in only a subset(I addressed this issue at length in my critique of the Va’ad Halacha paper).

    I agree entirely that definitions of death need to be consistent from the concept on to the practical criteria(internal validity). They also need to correctly predict the status of well accepted cases(organ donation, Christopher Reeve, etc.) I have used the same argument to show how the positions of Rav Bleich and Rav Schachter are not coherent. However, I took their specific position and discussed how their specific position resulted in the problems. I then discussed how the category in general might produce similar results. I distinguished between a specific position and the category in general. That is a crucial distinction if the positions discussed do not share the characteristics of all positions in the category.

    I am not using my own interpretation of the Rabbanut criteria, nor of Rav Yisraeli’s or Rav Carmel’s. Since there seems to be some misunderstanding, I reproduce below an email that Rav Carmel sent me(and gave me permission to quote in his name). I think this should make it clear that the case of Christopher Reeve does not pose a problem to a major position under the category of Rabbanut criteria, if not THE major current interpretation.

    Dear Dr. Stadlan,
    The issue of determining whether a person is dead or alive is only relevant by a person who appears to be dead, and is not moving or functioning. While this is obvious onto itself, this is also clear from the words of Rashi on the passage in the Talmud which deals with this issue (Yoma 85a). However, if a person is clearly alive, even if he has a spinal cord injury, it is clear that he is not considered dead, just as a person who has a temporary loss of breath is not considered dead.However, if one appears to be dead, then we check if he is alive by his ability to breathe, which is determined by brain death according to the ruling of the Chief Rabbinate. The fact that his heart is being pumped by a machine is irrelevant, as this can be done even if one’s head has been removed (by which it is clear that he is defined as dead), as Prof. Steinberg proved in his famous experiment with the sheep.

    I am not sure if I will have time to respond further, please feel free to email me with any questions noamstadlan at gmail

  108. j sasson says:

    Dr. Stadlan,
    Is that a coherent definition of death?
    To say that life/death under some conditions (we see him moving) is determined by X, and under other conditions (we don’t see him moving) is determined by Y – to me it seems that that is not a definition at all.
    Clearly, a definition of death should be applicable regardless of conditions, and what R Carmel presented fails that test.

  109. I am told by a person who attended a talk by Rabbi J. David Bleich at Manhattan Sephardic Cong. in November 2006 that he said that a headless person with blood circulation is halachically alive. How is that reductio ad absurdium any different from Christopher Reeve being halachically dead?

    Incidentally, Dr. Shabtai, I am still waiting for a reply to my question, which I have asked twice already.

  110. Shalom Spira says:

    Ye’yasher kochakha, R. Slifkin, for identifying an important error that R. Bleich orchestrated. I believe it is important to correct R. Bleich on this matter.

    To elaborate the refutation against R. Bleich: The gemara in Sotah 45b – in the context of a dispute between Rabbi Eliezer and Rabbi Akiva regarding the burial of a met mitzvah – clearly establishes beyond cavil that according to all opinions, a human being is dead the very instant that he/she is decapitated (lo aleinu), even if the body runs away a significant distance, and despite the fact that the heart (obviously) keeps beating while the body runs that significant distance. There, the gemara explains that both Rabbi Eliezer and Rabbi Akiva agree that a human being must be buried at the exact spot over which decapitation occurred (as a function of the real estate principle “met mitzvah kanah mekomo”), even if the body ran away a far distance from that spot, and even if the head rolled away a far distance from the spot. [The only dispute between Rabbi Eliezer and Rabbi Akiva concerns forensics; i.e. how to establish the exact spot over which decapitation occurred.] Thus, it is obvious from the gemara that if a patient is carefully decapitated in an ICU, and the body is maintained on a respirator, and the heart keeps beating indefinitely thanks to the heroic efforts of the ICU clinicians, the patient is still absolutely dead according to Halakhah from the moment he/she was decapitated. How, then, does RSZA (who interpreted – out of safek – Shu”t Chatam Sofer YD 338 to mean that a heartbeat is a potential sign of life even in a patient who has suffered irreversible unconsciousness and irreversible apnea) distinguish a brain dead patient from a decapitated patient? Isn’t it obvious that just as the latter patient is clearly dead – despite the prolonged cardiac activity that can be maintained in the ICU – so too is the brain dead patient dead? It is ludicrous to think that Chatam Sofer ever envisioned such a situation when he spoke of heartbeat as a sign of life. Indeed, Dr. Arthur Eidelman specifically testifies on the HODS website that RMF personally told him that it is for this very reason that heartbeat is irrelevant as a sign of life. And we see this also reflected in the e-mail R. Carmel sent to Dr. Stadlan (-ye’yasher kochakha to Dr. Stadlan for this valuable information).

    I believe the answer to this key question to RSZA was discovered in Summer 2008 when R. Bleich published an article entitled “The Problem of Identity in Rashi, Rambam and the Tosafists”, in Tradition volume 41:2. In that article, R. Bleich argues that a human maintains its living identity in Halakhah (and likewise an animal maintains its living identity in Halakhah) so long as the organism maintains the same properties it enjoyed at birth. Halakhically speaking, human birth occurs with the emergence of either rosho (the fetus’ head) or rubbo (the majority of the fetus’ body) from the mother’s birth canal. Thus, so long as the measurement of “rosho ve-rubbo” continues to anatomically exist, the human being potentially remains a human being. We this reflected in Hilkhot Sukkah: the mitzvah of living in the sukkah can be fulfilled only if both rosho ve-rubbo of the Jew is situated in the sukkah. Thus, given this article of R. Bleich, one could argue that the reason decapitation constitutes instant death is because at the moment of decapitation, the human being no longer possesses a shi’ur of “rosho ve-rubbo”. By contradistinction, the brain dead patient does possess a shi’ur of “rosho ve-rubbo” in the anatomical sense, and so perhaps the patient is not necessarily dead (at least not based on literal decapitation criteria; although perhaps he is dead based on other criteria such as respiratory death – a question which returns us to the challenge of how to interpret Chatam Sofer).

  111. Hirhurim says:

    Dr. Shabtai devotes five pages of his book to discussing the limitations of R. Bleich’s approach, including someone who cannot move but can communicate through brainwaves. There is no approach, including Dr. Stadlan’s, that lacks limitations on the margins.

    The case of someone decapitated but kept alive (according to R. Bleich) is certainly an extreme example of doctors artificially extending the life of someone who would otherwise be dead. It seems to me similar to defining as alive someone who is brain dead. Just an artificial stop-gap of someone who is on the final step toward complete and final death.

    By the way, I don’t believe Dr. Shabtai is obligated to answer your question but I think he has been traveling the past week or so.

  112. “There is no approach, including Dr. Stadlan’s, that lacks limitations on the margins.”

    Sure there is. You can just say that brain death is death. Not because they are not respirating – just because they are brain dead. Covers all cases, does not result in any reductio ad absurdiums.

  113. Hirhurim says:

    How about a disembodied brain? An artificial brain in a human body? A partially artificial brain?

  114. Disembodied brain – alive.
    Artificial brain – no such thing.
    Partially artifical brain – okay, maybe there will be a gray area. But a gray area is not an absurdity like a headless person being rated as alive, or a crippled person being rated as dead.

  115. Hirhurim says:

    Disembodied brain – alive.

    Some might find that counterintuitive.

    Artificial brain – no such thing.

    Yet

    Partially artifical brain – okay, maybe there will be a gray area. But a gray area is not an absurdity like a headless person being rated as alive, or a crippled person being rated as dead.

    Sounds subjective to me

  116. Why on earth is it counterintuitive for a disembodied brain to be alive? It can think, learn Torah, etc.

    When there’s an artificial brain that’s no different from a biological one, then maybe it will be alive.

    Every single field of halachah has gray areas. That’s not at all the same as having a halachic ramification which is absurd – such as a headless body that is rated as being alive, or a paralyzed person who is rated as being dead.

  117. Hirhurim says:

    Apparently, the decision of what is absurd and counterintuitive is entirely subjective. I’m not sure why a disembodied brain being alive is any more or less absurd than a headless body. Neither can survive on their own or perform basic bodily tasks.

  118. C’mon, seriously?

    An elderly, sick person also cannot survive on their own or perform basic bodily tasks!

    A disembodied head can love, can hate, can think. All the things that make us essentially human. How is a headless body remotely comparable?

    Being humanly alive is all about the mind. That’s why if a person is born with two heads, they are rated as two people, but not if they are born with two hearts.

  119. Hirhurim says:

    I did not realize you meant solely a conscious brain. You would qualify as one of those “people” whose view one bioethicist judged absurd:

    http://www.wired.com/wiredscience/2009/01/braindeath/

    “There are people who want to argue that we should define death in terms of higher brain capacities — that if you lose the capacity for consciousness, we should regard you as dead, though you’re breathing without assistance,” said Meilaender. “But suppose we have a body like that. I wouldn’t bury it. It’s lost some human capcities, but it’s not ceased to be a living being.”

  120. First of all, as far as I know, it’s still not entirely, 100% clear that higher brain capacities are completely gone, when lower brain capacities are present. And there can be other reasons why, even in that case, one should keep the lower brain going, which is why I’m inclined to agree with Meilaender. But, supposing one were to be able to 100% establish that all consciousness is gone, never to return – it wouldn’t be absurd to consider such a person dead (and, incidentally, Meilaender does not describe it as such, contrary to how you presented him). Certainly nowhere near as absurd as considering a headless body, or an extracted heart, to be alive.

  121. Hirhurim says:

    I apologize for using the word “absurd”. However, he assumes that it is not a viable definition and you claim that it is. Which goes back to my point about subjectivity.

  122. Incidentally, the arguments advanced against brain death (e.g. in the Wired article) from the fact that such bodies can do functions such as healing wounds and maintaining pregnancies would also apply to decapitated people. This is the same case as the decapitated sheep experiment presented to Rav Shlomo Zalman Auerbach. There’s no reason, certainly not in halachah, to consider such a person (or sheep) alive.

  123. There are some areas where things are not entirely clear and can be reasonably debated – such as whether the loss of higher brain function with presence of lower brain function would constitute brain death. But that doesn’t mean that it’s equally legitimate to propose that headless bodies are alive or that paralyzed people are dead.

  124. Hirhurim says:

    I disagree. This goes to the core of your argument that everything depends on whether someone “can love, can hate, can think”. Your sole argument against a headless body also applies to someone permanently unconscious. You find one absurd (pardon the use of the word) and the other reasonable.

  125. Hirhurim says:

    the arguments advanced against brain death (e.g. in the Wired article) from the fact that such bodies can do functions such as healing wounds and maintaining pregnancies would also apply to decapitated people

    That is only relevant if you consider the brain important to the discussion.

  126. Hmmm, okay, let me think about that. (by the way, I’m not sure that “permanently unconscious” is the correct term for what you’re describing.)

  127. sass says:

    R slifkin,
    Do you have ANY halachic backing for any of thses assertions?

    To me, it seems that you’re deciding matters of life and death based on some personal/arbitrary/preconceived notions of what constitutes life.
    Is that halachic or appropriate?

  128. Akiva says:

    permanently unconscious

    Or anencephalic babies. And Alzheimer’s patients.

 
 

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