10. Critical medical decisions and medical ethics:
*The following is a mere synopsis on the subject of medical ethics and Halacha, and in all cases, a component Rabbi who is expert in the field of medicine and Halacha is to be contacted. One may not rule to himself based on the summary to be brought below, and every question of life and death must be brought before a Rav with the full details of the situation. Details should include:
- The type of illness the patient is suffering from.
- What is the survival rate from the illness and conducted treatment?
- How old is the patient, and how is his general health despite the current illness?
- Is the patient in chronic pain?
- What is the medically recommended form of treatment?
- Does the treatment involve pain and suffering, and can it also possibly shorten his life?
A. Signing a medical proxy form that conforms to Halacha:
It is advised for one who is ill with a terminal illness that he sign a Halachic Medical Directive, which is a document naming a Jewish health care proxy to represent him should he become incapacitated, in order to guarantee the treatment required according to Halacha. One can find such a form in the Chayim Aruchim website http://www.chayimaruchim.com/ and should contact them for any further information.
B. Rabbanim who rule in this field of Jewish law:
Many Rabbanim, even those with much knowledge, age and experience, refrain from ruling on medical questions. The following is a short list of Rabbanim that are available to answer the questions dealing with medical topics:
| Name | Position | Number | Location |
| Chaim Aruchim organization | Project of Aguda. See here: http://www.chayimaruchim.com/ | 718-278-2446 | NYC 24 hour hotline |
|
Rabbi Y.Y. Shusterman
|
Renowned Chabad Posek | 310-2719063 | California |
|
Rabbi Asher Weiss
|
Chief Posek of Shaareiy Tzedek hospital | 0527667339 | Jerusalem [speaks English] |
|
Rabbi David Fink |
Editor of Assia medical journal, Machon Shlezinger, Shaareiy Tzedek | 025868516 | Jerusalem [Speaks English] |
C. Amputation:
If amputating a limb/organ has ability of saving one’s life, one is obligated to do so.[1] One is to force the patient to go through with the amputation even if he refuses, and would rather die than go through the suffering.[2] If it will only help the person live for a short time longer, a Rav is to be contacted.[3]
D. Biopsy:
A biopsy is a surgery, or incision, performed for the purpose of removing live tissue to determine a cause of illness, such as cancer. Sometimes biopsies are performed for verification purposes, despite there being no medical value towards the information, and the question is asked in whether one may have a biopsy done for this purpose, if the doctors are in agreement that it shares no medical value. The following directive was received from one of the leading medical ethics Rabbanim in Eretz Yisrael and is to be used as a general guideline. In all cases of doubt, one is to seek the advice and ruling of a contemporary Halachic authority who contains expertise in this field.
No risks involved: If going through with the biopsy can ascertain that the cancer is benign, and hence calm the patient of his situation, then one may do so for the benefit of the patients mind, despite there being no direct medical benefit involved.[4] If the patient is not in a state of awareness, such as if he is suffering from dementia, but the family desires the biopsy for their own knowledge and clarity, then one should not go through with it, even if there are no real risks involved.[5]
Risks involved: If there are medical risks involved, then one may not go through with the procedure if there is no medical benefit.
Signing a D.N.I./D.N.R./A.N.D. order and pulling the plug:
See Halacha 11!
E. Brain death:[6]
The question of whether brain death is defined as death is highly debated in the Halachic world, and religious circles, and carried ramifications of several Halachic issues, such as removing the patient from life support, and organ transplants. The following is an analysis on the subject and the various positions of the Poskim.
Definition and background: Brain death is the complete cessation of all brain function.[7] It is caused due to extreme trauma or injury to the brain, which blocks the body’s blood/oxygen supply to the brain, and as a result the cells of the brain die. Once the brain is dead, its status is irreversible, and the brain can never again become function-able. Brain death, unlike a coma or vegetative state, causes many of the vital brain-dependent organs to stop, including the lungs. Nevertheless, the function of the heart is independent of the brain and so long as it receives a supply of oxygen, it will continue to function.[8] Prior to the discovery of life support and intubation, one who suffered brain death would also have his heart stop, due to the cease of oxygen supply from his lungs. However, with the discovery and use of life support intubation, it is possible to artificially pump oxygen into the lungs, and thus allow for the continuous function of the heart. This new reality entered both the medical and Rabbinical world into a great debate as to the life/death status of a person who is brain dead, but his heart is pumping due to artificial supply of oxygen. Is the brain the definition of life, and hence one who is brain dead is considered dead irrelevant of his heart’s function, or is life determined by the heart’s function and he is hence still considered alive? Now, while it is clear that according to Halacha that the determining factor of life is one’s ability to breathe and not necessarily one’s pulse[9], nevertheless, it is questionable as to whether this breath must be natural or it suffices even for it to be artificial, so long as he is breathing. Practically, in the secular world it became accepted that a person who is brain dead is deemed dead for all medical and legal purposes and he may be removed from life-support by the hospital.[10] In most states, this may be done even against the will of the family.[11] However, in Halacha the issue still remains a great matter of debate, which touches on various serious Halachic issues when caring for a loved one, such as removal from life support, or allowing organ transplants.
The ruling: Some Poskim[12] rule that one who is 100% brain dead is considered dead, as it is impossible for him to breathe on his own.[13] Accordingly, one would not be allowed to desecrate Shabbos on his behalf and it would be permitted to remove him from life support [i.e. “pull the plug”]. Majority of Poskim[14], however, rule that he is considered alive and one may hence desecrate Shabbos on his behalf.[15] It would likewise possibly be considered murder to remove such a person from life support, as explained in Halacha G. Another ramification between the two approaches is regarding organ transplants, which generally take place on brain dead patients, as explained in Halacha F. Practically, a Rav who is expert in the medical field is to be contacted, although in general, the approach of Chareidi Jewry is to be stringent and consider the person as alive, while the approach of modern orthodoxy is to be lenient.
Determining brain death:[16] One of the major issues involved in determining death based on cessation of brain function is the ability to diagnose without any doubt that brain function has in truth completely ceased. Practically, there are many methods doctors use to determine brain death, primarily being the inability of the patient to breathe on his own. This can be determined through removing the respirator from the person and monitoring breathing movement. At times a patient can mildly breath on his own, but not enough to live. Such a person is not brain dead.
F. Organ donation/transplant and signing an organ donor card:[17]
The question of organ donation is highly debated amongst Rabbanim and religious circles. Its question touches upon several Halachic prohibitions, which vary based on the state of the patient whose organ is being used. We have divided the ruling to four distinct cases: 1) If the person is alive and healthy: In such a case, the question is raised whether according to Halacha one may donate an organ and take a chance of putting his own life at risk. 2) If the patient is alive and unhealthy: In such a case, donating the organ could be tantamount to murder. 3) If the person is dead: In such a case, donating the organ touches upon the prohibition of benefiting from the dead, and not burying the dead. 4) If the patient is brain-dead: The question in such a case is whether he is still viewed as living. Practically, in the medical field, organ transplants are usually only performed to healthy individuals, or to people who are brain-dead [cases 1 and 4] and not to living people who are unhealthy [case 2] or to people who have already died [case 3].[18] The following is a general background on the subject and the opinions amongst the Poskim who discuss it. Obviously, no individual is to make a decision in such serious matters, and sign on an organ donor card, without first discussing it with a Rav who is an expert in this field.
Case 1: Organ donation from one who is alive and healthy:[19] It is permitted for one who is healthy to donate a non-vital organ from his body for the sake of saving the life of another Jew. This includes the following transplants: kidney[20], bone, bone marrow; whole blood donation[21]; Platelet blood donation[22]; Stem cell donation.[23] Some Poskim[24] however question the allowance of donating an organ, such as a kidney, that may enter the person into danger in a case that it is not certain that the organ receiver will definitely be saved.
Case 2: Organ donation from a Goses or one who is alive and unhealthy:[25] It is forbidden, from both a medical and Halachic perspective, to perform organ transplants from unhealthy individuals whose health can deteriorate as a result of the loss of the limb. Likewise, it is absolutely forbidden for an organ donation to take place prior to death, when the person is in a state of Gesisa and is still Halachically considered alive.[26] [In the first years that heart transplants were practiced, the Gedolei Haposkim[27] unanimously agreed that doing so was absolutely forbidden and considered murder, as often the hearts were removed while the person was still Halachically deemed to be alive, hence murdering the patient, and likewise, in most cases the patient who received the new heart would die.]
Case 3: Organ donation after the death of the patient:[28] In general, it is forbidden to remove organs from the deceased and store it in an organ bank for eventual use in a living person, just as one may not perform an autopsy for purposes of medical science, as explained in the previous Halacha. Nevertheless, regarding certain parts of the body[29], there are Poskim[30] who are lenient to permit organ transplants even if the matter is not life threatening. If another Jew is currently in need of an organ transplant to save his life, some Poskim[31] rule it is permitted to use the limb of a deceased to perform the transplant on this Jew. Other Poskim[32], however, prohibit organ donation from a deceased even to help save the life of a Jew with a life-threatening condition.[33]
Case 4: Brain dead patient:[34] Whether one may remove an organ from a person who is 100% brain dead is dependent on the dispute amongst the Poskim in whether one who is 100% brain dead is considered dead or not, as explained in E. According to the lenient opinion there, it would be permitted to perform organ transplants from 100% brain-dead patients. However, according to the stringent opinion there, it would be absolutely forbidden to do so, and one who does so is considered a murderer.[35] According to all, it is absolutely forbidden to perform organ transplants from patients who are in a coma or vegetative state, and are not brain dead.[36] Practically, the Poskim[37] conclude that it is forbidden to perform an organ transplant from a Jewish brain-dead patient, and thus in Eretz Yisrael, it is forbidden for one to sign up for such transplants. However, it is permitted for a Jew to receive an organ transplant in the Diaspora, where the limb is taken from a gentile.
Signing on an organ donor card: Based on all the above information, even if one were to hold like the lenient opinion in Case 3 [that allows organ donation from a dead body in order to save a life], one may not sign an after-death organ donation consent form [such as on the driver’s license], unless provisions are made for it to comply with Halacha, per the directive of a Rav who is knowledgeable in these matters. Halachic matters that must be considered upon signing such a form are: 1) Perhaps we rule like the stringent Poskim above that every organ must be buried and cannot be donated in any situation. 2) Perhaps the organ will go to an organ bank or hospital and not directly to a Jew in need. 3) Perhaps the organ will not go to a Jew at all; 4) Perhaps the organ will be removed after clinical death, but prior to Halachic death, which is tantamount to murder. Most organ donations take place from a brain-dead patient which is under dispute if he is considered Halachically dead. One is to contact his Rav for direction in all of these matters. See http://www.hods.org/ for a USA based Halachic organ donor card which has options of choosing the Halachic opinion one follows, and/or the requirement for consultation with one’s Rabbi after death. See https://www.adi.gov.il for an Israeli based donor card, with a Halachic option. One is to discuss the matter with his Rav prior to all decisions.]
G. Removing patient from life support/Ventilator:[38]
Whether one may remove a person from life support, thus causing his imminent passing, is obviously one of the heaviest moral and halachic questions that a person can face. Its ruling is dependent on several factors already discussed in the previous Halachos, which include the medical state of the patient, as well as the approach one follows in Poskim regarding the definition of Goses and brain death. One thing is clear, a person who is not in a state of Gesisa [near death], does not have proven brain death, and has possible medical recovery, is absolutely prohibited from being removed from the ventilating machine. Thus, one who enters the ICU with lung failure due to a trauma injury [i.e. accident], or due to consuming poison, must be attached to a ventilator to help him breath, and may not have it removed unless several days pass without improvement, and brain death has been established, in which case it is subject to the debate explained next.[39] Likewise, one who is in a coma, or deemed a vegetable, may not be removed from life support. We will now discuss the Halacha regarding removing the ventilator from one who is brain dead.
Cases of brain death: Some Poskim[40] rule that if the patient is 100% brain dead then the person is considered Halachically dead [as explained in E] and life support may be removed. [If, however, he is not deemed to be 100% brain dead, then it is forbidden to remove the machines even according to this opinion, and it is considered murder to do so.] Majority of Poskim[41], however, rule that brain death [even 100%] does not deem a person as dead, as explained in E, and the patient is only deemed dead when his pulse ceases. [Accordingly, it would seem that it is forbidden to ever remove a person from life support and doing so would be tantamount to murder. Certainly, it would be forbidden to remove a Goses from life-support.] Nonetheless, some Poskim[42] rule that even if we accept a brain-dead patient as still being alive, nevertheless, it is permitted, and possibly even obligatory, to remove him from life support due to him having the status of Goses, in which one may remove an item that is refraining him from passing away. According to all opinions, so long as complete brain death, or status of Goses, has not been fully determined, it is forbidden to remove the patient from life-support and doing so is tantamount to murder.[43]
Practical advice-Attaching the life support to a timer: Some Poskim[44] suggest that a permitted, and most Mehadrin, method of circumventing the above question of whether the respirator may be removed, is to initially [when the patient is first connected to it] attach the respirator to a timer and if it is determined that the person is fully brain dead, then one is simply not to attach him back to life support when the time expires, and it is even forbidden to do so. This avoids the question of murder according to the stringent understanding above, as one is simply not doing an action to help him continue to live [which in any event we do not do for a Goses], as opposed to actively shortening his life, which is forbidden even for a Goses.
Not attaching a patient to life-support: As stated in the next Halacha regarding DNI, a patient who is suffering from a terminal illness and is in constant pain due to it, may have a DNI form signed and is hence not to be attached to life support. See the next Halacha for details in this matter.
H. Autopsy:[45]
It is Biblically forbidden for an autopsy to be performed onto a Jewish body.[46] This applies even if the autopsy is desired to be performed for the sake of advancement of medical science, and for possible use in preventing future deaths.[47] One must thus do all in his power while alive to prevent his body from having an autopsy in case of death, and certainly may not sign to give his body away for autopsy on behalf of medical science.[48] [If one did so, his wishes are not to be obeyed.[49]] If, however, the autopsy can possibly bring a cure to a person who is currently ill, then it is permitted to be performed.[50] [Some[51] however say that this only applies if the person in need of a cure is in the same hospital as the autopsy patient. Practically, a Rav is to be contacted in all cases that the autopsy can possibly lead to a cure for someone who is currently ill.[52]]
Autopsy as part of a murder investigation to help capture the murderer:[53] It is permitted for an autopsy to be performed as part of a murder investigation for the sake of capturing and/or indicting the murderer and avenging his death. Practically, a Rav is to be contacted in all cases that the autopsy can possibly lead to solving a murder investigation.
Autopsy for the sake of removing a pacemaker and the like:[54] It is permitted to remove implanted medical devices from the body, such as a pacemaker, for the sake of future use in other patients.[55]
Biopsy: Some Poskim[56] rule it is permitted to perform a biopsy on a corpse, and remove some tissue or blood, for the sake of medical science.
Desecrating Shabbos to prevent autopsy:[57] It is permitted to transgress Shabbos and perform Rabbinical Melacha in order to prevent an autopsy. See Chapter 2 Halacha 8 for the full details of this matter!
Autopsy on a gentile corpse: It is disputed in Poskim[58] as to whether there is a prohibition to benefit from the body of a gentile. Practically, some Poskim[59] are lenient to allow benefiting from a gentile’s body for the sake of medical science.
Preserving and mummifying a body:[60] The process of preserving a body entails various actions that may be forbidden under the prohibition of desecrating the dead [i.e. removal of internal organs, such as the intestines], delaying the decomposition of the body which is of benefit to the soul, and other prohibitions similar to that of an autopsy. Practically, it is debated amongst Poskim[61] as to whether it is permitted to mummify a body, and under what circumstances and details. In cases that the body will be transported for burial over the course of a number of days in an unrefrigerated compartment, then the custom is to enter anti-decaying chemicals and spices into the body, and if necessary to pump out the moisture and blood from the innards, and place it in a container for burial.[62]
[1] Mor Uketzia 328; Rambam Mamarim 2:4; See Likkutei Sichos 3 Metzora footnote 16
[2] Mor Uketzia ibid;
[3] See Sefer Chassidim 234; Makor Chesed ibid; Kesubos 104a; Nedarim 40a; Bava Metzia 4a
[4] Rav Dovid Fink in name of Gedolei Haposkim from which he heard this from
[5] Rav David Fink; Rav Asher Weiss via phone call
[6] See Nishmas Avraham 2:339 pp. 451-482 in great length for opinions, and correspondence letters of Gedolei Haposkim; Encyclopedia Hilchatit Refuit Vol. 6 “Rega Hamavet”; For the most updated and thorough research on this subject, including the different approaches, supports in the Poskim, and practical rulings of the leading Rabbanim of today as interviewed by the writers-see the journal of the RCA [110 pages long] on this issue titled “Halachic Issues in the Determination of Death and in Organ Transplantation”
[7] Brain death versus a coma or vegetative state: Brain death is very different than a state of coma or vegetative state. A coma or vegetative state simply means the person is unconscious, asleep like, and cannot be awakened. However, the brain, as well as various of the brain dependent organs such as the lungs, still function without artificial help. Likewise, the state of the coma is reversible, and the person can one day wake up and live a healthy life. Brain death, however, is a dead brain that has no function, is irreversible, and causes brain-dependent organs to stop functioning.
[8] The three most vital organs on which human life is dependent is undoubtably the brain, the lungs and heart. For a person to live there needs to be a constant supply of oxygen to the cells of the body. All three of the above organs place a vital role in this supply. The function of the brain, amongst other functions, is to pump the lung. The function of the lungs is to breath the oxygen into the body. The function of the heart is to spread the oxygen, glucose, and water throughout one’s body. The brain/lung function is called respiratory while the heart function is called circulatory.
[9] See Admur 329:3 [follow breath]; Michaber 329:4; Yuma Mishneh 83a; Gemara 84a for a Machlokes if we follow the heart/pulse or the breath
[10] In the USA, this is called the Uniform Determination of Death Act (UDDA), which was passed in 1981, which gives two classes for the definition of death, one based on cessation of the respiratory function, and the second being the cessation of both the respiratory and circulatory function. This Act was based on the Harvard criteria, which was a study published by the Harvard medical school in 1968 to determine brain death as actual death.
[11] See http:::www.braindeath.org:law.htm for the law in your state. Most [if not all] states give medical personal the sole power of determining whether to remove the person from life support, after determining legal death due to 100% brain death. For example, the state of Texas may remove a patient from life support after determining brain death despite protests from the next of kin. However, the state of New Jersey, requires the medical personal to notify the family in case of brain death and respect their decision, whether to remove the patient from life-support or have him remain. If, however, there is a cessation of both the respiratory and circulatory functions, then he is determined dead irrelevant of the families wishes.
[12] Igros Moshe Y.D. 3:132; 8:54 “The doctors accepted the Halachic position of death, which is the Harvard criteria”[For an in depth analysis as to the true opinion of the Igros Moshe-see Nishmas Avrhama ibid and the above journal]; See Tzitz Eliezer 13:89 based on Chasam Sofer that the inability to breath on one’s own without a machine [i.e. 100% brain death] is defined as death, and 18:31 that permits a c-section to a brain dead woman, in seeming contradiction to his other responses in 10:25 and many other areas brought in coming footnotes. Practically, the Tzitz Eliezer has made it clear that his position is to be stringent, as brought in Nishmas Avraham ibid; Rabbanut Hareishit in 1986, under the council of Rav Mordechai Eliyahu, Rav Shapiro, Rav Zalman Nechemia Goldberg and leading physicians in the Machon Shlezinger institute of Shaareiy Tzedek, have accepted this approach. See the above journal for further discussions they had with the above Rabbanim and if any retracted their rulings; See Encyclopedia Hilchatit Refuit footnote 131 for a list of Poskim who are lenient
[13] The reason: As we rule in Halacha that we follow the breath for determination of life [See, and not the pulse of the heart, and hence if he can no longer breathe on his own, he is considered dead even if his heart still beats. [Igros Moshe ibid] One who is brain dead is considered as if his head is removed from his body, as the brain completely rots. [Igros Moshe 8:54] See also Chasam Sofer Y.D. 338 for a Teshuvah that supports this stance.
[14] Tzitz Eliezer 9:46; 10:25 based on Chasam Sofer and Chacham Tzvi and Rashi in Yuma ibid; See also Tzitz Eliezer 13:89-12-13; 17:66; 18:31; 19:53; 21:28; Minchas Yitzchak 5:7-8; Shevet Halevi 7:235; 8:67;Ruling of Rav Elyashiv, Rav SZ”A, Rav Wozner, as detailed in Nishmas Avraham ibid and the above journal; Rav Elyashiv stated that one who can live for several months is a Safek Goses, Safek alive, and thus a brain dead patient is only viewed as a Safek Goses versus Safek alive. [Nishmas Avraham Y.D. 339 p. 469] However, Rav S”Z Aurbauch stated that a brain dead patient is viewed as a Safek Goses versus Safek dead. [Nishmas Avraham Y.D. 339 p. 467, 473, 477]; See Encyclopedia Hilchatit Refuit footnote 129 for a list of Poskim who are stringent
[15] The reason: As in actuality he is still breathing, and his heart works. It is thus not similar to the case of the Gemara in which case his breathing has stopped and cannot be returned. Alternatively, even the beating of the heart is a sign of life, as implied from Rashi ibid and Chasam Sofer. Alternatively, the reason is because it is not possible to determine 100% brain death.
[16] See Igros Moshe Y.D. 3:132; 8:54; See Tzitz Eliezer 13:89
[17] See Nishmas Avraham 2:339 pp. 294-299 [regarding Goses]; pp. 451-482 [regarding brain-dead]; p. 526 [regarding deceased]; Journal of the RCA [110 pages long] titled “Halachic Issues in the Determination of Death and in Organ Transplantation”; Article of Rav Melameid on http:::www.yeshiva.org.il:midrash:460#8b;
[18] See here: https://www.government.nl/topics/organ-tissue-donation/question-and-answer/if-i-am-a-registered-donor-what-will-happen-to-my-body-after-my- death#:~:text=Organs%20that%20can%20be%20transplanted,are%20transplantable%20forms%20of%20tissue.
[19] See Igros Moshe Y.D. 2:174-4; Tzitz Eliezer 10:25-7; Yechaveh Daas 3:84; Nishmas Avraham 2:530-535
The Halachic issues involved with organ donations when alive: Damaging one’s body, and entering oneself into possible danger. The following Poskim rule one is not obligated to risk his life on behalf of saving another Jew: Admur 329:8; 2nd opinion in parentheses in Admur Choshen Mishpat Hilchos Nizkeiy Haguf Vehanefesh Halacha 7; Issur Viheter 59:38; Elya Zuta 329:4; Smeh 426:2 based on omission of all Rishonim and Poskim; M”B 329:19; The following Poskim rule one is obligated to risk his life to help save a Jew whose life is definitely in danger. [1st opinion in Admur Choshen Mishpat Hilchos Nizkeiy Haguf Vehanefesh Halacha 7; Hagahos Maimanos Rotzeiach 1:14 in name of Yerushalmi; Radbaz Leshonos Harambam 1582]
[20] Igros Moshe ibid; Tzitz Eliezer ibid; Poskim ibid
[21] Igros Moshe 1:103
[22] Nishmas Avraham p. 533 in name of Gedolei Haposkim
[23] Nishmas Avraham p. 533
[24] Minchas Yitzchak 6:103
[25] See Nishmas Avraham p. 294
[26] Tzitz Eliezer 10:25; Igros Moshe C.M. 2:72; Minchas Yitzchak 5:7; See Admur 330:7 that we no longer remove the baby from a pregnant woman who passes away before childbirth, as we suspect that she is still alive and cutting open her stomach to remove the child will kill her. and by the time we can determine her death, the fetus has certainly died
[27] See Minchas Yitzchak 5:7-8; Igros Moshe C.M. 2:72; Tzitz Eliezer 10:25; See Nishmas Avraham 480 for opinion of Rav SZ”A regarding the Diaspora which is mainly gentiles
[28] See Nishmas Avraham 2:339 p. 526
The Halachic issues involved with organ donations from the dead: a) Desecration of the body. 2) Prohibition against benefiting from the body. 3) Transgressing the Biblical command to bury the body. [See previous Halacha regarding amputation]
[29] Such as corneal donation; Skin grafting
[30] See Har Tzevi Y.D. 276; Shevet Miyehuda p. 314 of Rav Unterman [says the limb is considered alive when transplanted]; Seridei Eish 2:120; Yabia Omer Y.D 3:22-23; Other Poskim however prohibit this: See Minchas Yitzchak 5:8; Tzitz Eliezer 13:91; Shevet Halevi 1:211; Rav SZ”A in Nishmas Avraham ibid; See Darkei Chesed 10:5 that all Gedolei Yisrael have protested the removal of the eye for the sake of a corneal transplant to help save the eyesight of an individual “as there is no greater desecration of the dead than this” and it is forbidden to benefit from the dead.
[31] Rav SZ”A in Minchas Shlomo Tinyana 86:5
[32] Minchas Yitzchak 5:7-22, based on Radbaz 3:627; Tzitz Eliezer 13:91
[33] The reason: As the Torah required the entire body to be buried, and there is no Mitzvah to help save another’s life through donating one’s organs. [Poskim ibid]
[34] See the journal of the RCA [110 pages long] on this issue titled “Halachic Issues in the Determination of Death and in Organ Transplantation”
[35] See Nishmas Avraham 2:339 pp. 451-482 in great length for opinions, and correspondence letters of Gedolei Haposkim; Tzitz Eliezer 10:25; Minchas Yitzchak 5:7; Rav Elyashiv; Rav SZ”A as detailed in Nishmas Avraham ibid and the above journal
[36] See Nishmas Avraham ibid p. 480
[37] See Nishmas Avraham ibid p. 477 and 479 in name of Rav SZ”A and Minchas Yitzchak; Heard from Rav Yaakov Yosef za”l
[38] See Tzitz Eliezer 13:89 for a lengthy reply and Psak to the CEO of Shaareiy Tzedek hospital; See also the Journal of the RCA [110 pages long] titled “Halachic Issues in the Determination of Death and in Organ Transplantation”
[39] See Igros Moshe Y.D. 3:132; Tzitz Eliezer ibid
[40] Igros Moshe Y.D. 3:132; 8:54; For an in-depth analysis as to the true opinion of the Igros Moshe-see the above journal; The Rabbanut Hareishit in 1986, under the council of Rav Mordechai Eliyahu, Rav Shapiro, Rav Zalman Nechemia Goldberg and leading physicians in the Machon Shlezinger institute of Shaarei Tzedek, have accepted this approach. See the above journal for further discussions they had with the above Rabbanim and if any retracted their rulings.
[41] Minchas Yitzchak 5:7; Rav Elyashiv; Rav SZ”A as detailed in the above journal; See Tzitz Eliezer 10:25; 13:89 in opinion of Chasam Sofer and Chacham Tzvi and Rashi in Yuma ibid
[42] Rav SZ”A, brought in Nishmas Avraham p. 467 and 477 regarding brain dead patients, that the respirator may be removed once all tests have confirmed that he is fully brain dead; Tzitz Eliezer 13:89 learns it is possibly obligatory; Rav Elyashiv, brought in Nishmas Avraham p. 461 that if he is a Goses the machine may be removed [However, since in his opinion one is only defined as a Vadaiy Goses if he cannot live for more than 24-48 hours, as brought in Nishmas Avraham Y.D. 339 p. 469, which is untrue of brain dead patients, therefore seemingly Rav Elyashiv would not agree that one can remove the respirator from even fully brain dead patients as they are Safek Goses and Safek Chaiy in his opinion]
[43] See Igros Moshe Y.D. 3:132; 8:54 and Tzitz Eliezer ibid; Vetzaruch Iyun why we don’t give him a status of Goses even before 100% brain death and allow the removal of a respirator due to the law of Hasaras Moneia, which is in essence the Heter of the Poskim ibid
[44] Tzitz Eliezer 13:89 [To note however that he implies to rule that one may even remove the patient from life-support, either due to the law of Goses [Hasaras Moneia] or due to that he is considered dead.]; Heard from Rav Yaakov Yosef za”l
[45] Noda Beyehuda Tinyana Y.D. 210; Chasam Sofer 336, brought in Pischeiy Teshuvah 363:5; Sheilas Yaavetz 41; Shagas Aryeh Chadashos 6; Kesav Sofer 175; Maharam Shick 344-347; Binyan Tziyon 170-171; Chazon Ish Ohalos 22:32; Gesher Hachaim 1:3-12; Seridei Eish 2:119; Yabia Omer 3:23; Igros Moshe Y.D. 1:151; Tzitz Eliezer 4:14; Minchas Yitzchak 5:9; See Gesher Hachaim 5:6; Darkei Chesed 10; Nishmas Avraham 2:517-520; Kovetz Hamayan 7 and Asia 4:32; See Nitei Gavriel 48:16
Regarding performing an autopsy on a Nefel: It is forbidden to perform an autopsy on a Nefel. In a case of need, a Rav is to be contacted. [See Maharam Shick Y.D. 323; Binyan Tziyon 119; Nishmas Avraham Volume 2 p. 522; Nitei Gavriel 132:38; 41 footnote 55]
Watching an autopsy: Some Poskim rule it is permitted to watch a live autopsy. [Chelkas Yaakov 1:84; Har Tzevi 288] Others rule it is forbidden. [Maharam Shick 344; Rav SZ”A, brought in Nishmas Avraham ibid p. 517 and 522]
Removing a heart pacer and reusing it: See Nishmas Avraham p. 523-526 in name of Poskim; Binyan Av [of Rav Batzri]
[46] The reason: This is forbidden for one of several reason: 1) This defiles the body, and is considered Bizuiy Hameis, which is Biblically forbidden. [Noda Beyehuda and Chasam Sofer ibid] 2) It delays the burial and transgresses Lo Salin. 3) It benefits from the dead, which is Biblically forbidden. 4) It causes pain to the soul who witnesses all that is occurring to his body. [Tosfos Yom Tov Avos 2:7; Rashba 1:369; Sefer Chassidim 1163; See Gesher Hachaim 1:5] See Nishmas Avraham ibid p. 518
[47] Noda Beyehuda Tinyana Y.D. 210; Chasam Sofer 336, brought in Pischeiy Teshuvah 363:5; Poskim ibid
Other opinions: Some Poskim rule it is permitted to perform an autopsy for the sake of medical science. [Mishpitei Uziel Y.D. 25-26]
[48] Chasam Sofer 336, brought in Pischeiy Teshuvah 363:5; Maharam Shick 347; Gesher Hachaim 5:6; Igros Moshe Y.D. 3:140
Other opinions: Some Poskim rule it is permitted to perform an autopsy for the sake of medical science if the deceased gave permission prior to his passing. [Binyan Tziyon ibid 176; Tzitz Eliezer 4:14; See Chelkas Yaakov 4:39; Nishmas Avraham ibid p. 521]
[49] Gesher Hachaim 5:6 based on Michaber 348:3
[50] Chasam Sofer ibid and Nodah Beyehuda ibid, brought in Pischeiy Teshuvah ibid; Poskim ibid; Gesher Hachaim 5:6
Other opinions: Some Poskim rule it is forbidden to perform an autopsy for the sake of medical science even in such a case. [Binyan Tziyon ibid]
Regarding performing an autopsy for the sake of saving a limb of a patient: See Nishmas Avraham ibid p. 520 in name of Poskim.
[51] Nishmas Avraham ibid, as hospitals do not share medical information right away, and hence it is only considered a true “for sake of healing” when the patient is in the same hospital; See Igros Moshe ibid; See Chazon Ish ibid that allowances due to Sakana is only by current events and not possible future events
[52] See Nishmas Avraham ibid
[53] Poskim in Nitei Gavriel 48 footnote 20
[54] See Nishmas Avraham p. 523-526 in name of Poskim; Igros Moshe; Rav SZ”A; Tzitz Eliezer; Shevet Halevi 7:189; Yabia Omer 10:50; Binyan Av [of Rav Batzri]
[55] The reason: As the item was never placed in the body with intent for him to be buried with it, and hence does not receive a benefit prohibition.
[56] Igros Moshe Y.D. 2:151; Rav SZ”A, brought in Nishmas Avraham 2:522
[57] See SSH”K 64:13; Piskeiy Teshuvos 311:1 [old edition and new edition]; Nishmas Avraham 2:533
[57] See Admur 311:2 and 4 that one can take the body from a Karmalis in order to prevent erosion or cremation. [Only by Muktzah were the Sages stringent to limit its desecration and only allow its movement if there is a permitted item on it, as explained in Admur 311:3.]; See SSH”K 64:13; Piskeiy Teshuvos 311:1 [old edition and new edition]; Nishmas Avraham 2:533 in name of Chelkas Yaakov
[58] See Chapter 4 Halacha C!
[59] Even Shoham 30, brought in Pischeiy Teshuvah 349:1; Igros Moshe Y.D. 1:229-6; Yaskil Avdi 6:19; Rav SZ”A, brought in Nishmas Avraham ibid; This follows the lenient opinions brought above who hold it is not prohibited at all, or is merely a Rabbinical prohibition. However according to those opinions who hold it is a Biblical prohibition, it is forbidden to make use of the body even for the benefit of medical science. [See Darkei Moshe Y.D. 368:4]
[60] See Gesher Hachaim 5:7; Darkei Chesed 10:4; See Mishneh Limelech Machalos Assuros 8:18 regarding selling mummies and Aveilus 3:1 regarding Tumas Kohanim from a mummy; Pischeiy Teshuvah 349:2 regarding eating the mummy
[61] See Chasam Sofer Y.D. 336; Radbaz 2:484
[62] Gesher Hachaim ibid
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