Tag Archives: Brain Death

Two recent news items paradoxically raise the promise of more organ donations and the eventual end of them altogether. Facebook’s recent introduction of an organ donor status (link), an attempt to boost donor participation, affords a welcome opportunity to discuss a recent comprehensive work on Judaism and the definition of death. While many organs, particularly those most in demand, may ...

According to the Israeli Chief Rabbinate, which famously ruled in favor of brain stem death criteria in 1986, most organ donations from a brain stem dead patient are contrary to Jewish law. This surprising position and the background that led to it are explored by Naftali Moses, PhD in his recent book, Really Dead?: The Israeli Brain-Death Controversy 1967-1986. With rabbinically approved organ donation in Israel once again in the news, this fascinating book, adapted from the author’s doctoral dissertation, offers timely guidance on how Israel got to where it is.

Rabbi Joseph B. Soloveitchik‘s view on any subject is significant because of his stature as a leading scholar and the influence his students exert on the contemporary Orthodox community. His position on brain death was hotly contested in 1991, and I can now post a long-lost letter on this subject sent by his family. But let us first look at ...

Rabbi Richard Weiss, MD / The determination of death is one of the most challenging bioethics issues of the past several decades. Various aspects of brain death as the definitive determinant and definition of death have been extensively and intensely discussed and debated in a wide spectrum of literature. Recognizing this point—that Judaism is not unique in its continued deliberations regarding this matter—can be very useful for all who are actively engaged in analyzing the halachic view of brain death. One citation, for example, which presents a wide variety of opinions in the secular, medical and general philosophical arena, is an article by David DeGrazia in the Stanford Encyclopedia of Philosophy, entitled “The Definition of Death”, published October, 2007. One can readily appreciate the ongoing debate that extends far beyond the Jewish community. It is true that brain death has been legally accepted in almost all of the fifty United States, with some states accommodating religious or moral objections. This fact, however, has not inhibited continued healthy discussions on the matter. Similarly, continued healthy discussions in the halakhic world should be encouraged.

Professor Steven H. Resnicoff / If someone who is brain dead is halachically alive, a matter of significant halachic debate, secular adoption of the brain death standard could, in a number of ways, lead to the murder of Jews and non-Jews. A goses is someone who is dying and is imminently terminal. His life is likened to the flame of a flickering candle. It is forbidden to touch or move such a person for any purpose other than to help the goses, lest such touching or movement extinguish the flame. According to some rabbinic decisors, including R. Shlomo Zalman Auerbach, people on respirators who are believed to be brain dead have the halachic status of safek goses, to whom these prohibitions would apply. Nevertheless, upon a finding of brain death, secular law would allow a hospital certain rights such as to cease treatment or to extract organs. Consequently, the hospital conducts tests to determine whether the patient is or is not brain dead. Such testing is not designed to benefit the patient who is tested, but in order to authorize the giving of his organs—or his hospital bed—to someone else. According to R. Shlomo Zalman Auerbach, these tests, either because they inevitably involve some touching or movement of the patient, or because they involve the injection of radioactive material (even small amounts, and even through existing intravenous lines), are absolutely prohibited and involve possible murder.

Rabbi Avi Shafran / Internal organs are most successfully transplanted when “harvested” from a ventilated patient, whose blood remains oxygenated and circulating. From the perspective of halacha, or Jewish religious law, that raises a serious question and, in its wake, ethical dilemmas. A diagnosis of “brain death” – when tests indicate that a person has suffered irreversible cessation of all brain function – is considered by contemporary medicine and secular law to be sufficient to constitute death, thereby permitting the removal of organs. In cases involving medical matters, scientific realities play an important role in the deciding of halacha. But Jewish law’s rules, judgments and definitions do not necessarily parallel those either of medical science or society. Machines and observations can measure electrical activity in the brain and “invoked potentials”; but the determination of when a soul has left a body is something less easily calibrated. To an observant Jew, halacha alone serves as the determinant.

Rabbi Michael Broyde / Before beginning any discussion on this topic, it is worth noting the obvious: Jewish law is made up of timeless principles and timely applications of these principles. Discussions of the interaction between timeless principles and timely applications frequently are disconcerting to Orthodox Jews because they wish for halacha to generate answers that are always timeless. In areas where the scientific and medical data is still evolving, this is virtually impossible. Hence, the word “tentative” is in the title. New data will certainly generate different answers. “Brain death” is a misnomer. Nearly everyone agrees that as a matter of Jewish law (as well as common sense), were full cellular death to take place in the brain, such a person would be dead.[1] Indeed, the common functions associated with human existence would cease after this event – which we can refer to as “physiological decapitation” – and human life would then cease.

Rabbi Basil Herring / Few would reasonably deny that when it comes to our dealings with each other, we Jews are a particularly passionate people. Of course, holding strong convictions is a good thing – and might even be a sine qua non to survival when other nations have disappeared – to the extent that it generates uncompromising commitment to our deeply held beliefs and moral principles. But when passion leads us to intolerance and invective, it not only diminishes the cogency of our positions, it more ominously undermines the very warp and woof of the moral fabric that holds us together as a community and people.

Rabbi Yaakov Weiner / UPDATED A number of great rabbis throughout the ages have accepted breathing and heartbeat as the parameters of death. However, we witness today that a clinically dead person, displaying neither breathing nor heartbeat, may be successfully revived. Does this state of affairs clash with the definition of death of our sages? I submit that the definition of death is primarily a matter of metaphysical, and not physical, change. It is contingent upon the soul leaving the body, as we find in the Mishnah (Ohalot 1:6): “A human [body] does not cause impurity until the soul departs.” No one can perceive the soul as it leaves the body; all that is available are signs of the event. In the time of the Talmudic sages, these signs were the cessation of both breathing and heartbeat. Today, however, via medical technology a clinically dead person can often be resuscitated. Such a case proves, albeit in ex post facto fashion, that the soul has not yet left the body. The definition of death has not changed; the signs have.

Rabbi Moshe D. Tendler / Brainstem death, a.k.a. neurological death: a.k.a. respiratory death, raises the bar above respiratory death by requiring the “total cessation of all brain functions including the brainstem.” This definition is accepted internationally. It conforms fully with the halacha as stated in the Talmud (Yoma 85a) as elucidated by Rashi, “if he appears to have died, no movements are discerned… to ascertain the truth, examine if there is breath in his nostrils. If he does not exhale, he has surely died.” The B.S.D. protocol requires testing to ascertain that the patient does not respond to any stimulus. The neurological exam must affirm: unreactive pupils, no elicited eye movements, no motor response to stimulation, no grimacing, no blink response, no gag reflex, no respiratory movements such as cough, sigh or hiccup. Only after such affirmation the APNEA test is performed to confirm that without the pumping action of the ventilator, there is no autonomous breathing. Confirmatory tests can be performed if required to satisfy those who so demand. These can include a nuclide scan to confirm that no blood is reaching the brain; a test to prove that the brain is not utilizing glucose; as well as others. In truth, the clinical findings of the B.S.D. protocol are definitive such that confirmatory tests are not usually needed.