This article is an excerpt from our Sefer

Chapter 1: Illness & End of Life preparations

The Shechina:[1] The Shechina resides on top of the head of an ill person. Therefore, one is not allowed to sit on a higher level than the ill person, as one may not place himself higher than the Shechina. Not to give up hope:[2] One is to pray for a person to be healed even if “a sword is resting on his neck”, and the situation seems hopeless. [See, however, Halacha 4 regarding one who is in pain.]

1. Letting people know of the illness:[3]

When someone has become ill, one is not to spread the word to the public until several days pass.[4] One may, however, spread the word to family and friends even on the first day. If the death is imminent, then one may spread the news even on that day. 

2. The Mitzvah of Bikur Cholim:[5]

A. The Mitzvah:

It is a Mitzvah to visit the sick. Doing so helps revive the ill person.[6]

Bikur Cholim versus Nichum Aveilim: The Mitzvah of Nichum Aveilim is even greater than the Mitzvah of Bikur Cholim, [and hence takes precedence, if one is unable to perform both Mitzvos].[7] If, however, one is able to perform both Mitzvos, then one is to precede the Mitzvah of Bikur Cholim to the Mitzvah of Nichum Aveilim.[8]

B. When to visit:

Which day:[9] Family and friends may visit the ill person right away, while other individuals are only to visit after the passing of three days from when he fell ill. If, however, death is imminent, then everyone may visit immediately.

What time during the day:[10] Ideally, one is not to visit the sick in the first three, and last three, hours of the day.[11] [Practically however, today people are no longer careful in this matter.[12]]  

How often:[13] One may visit the ill even many times in one day, and the more one goes, the more he is praised, so long as one does not overburden the patient.

Bikur Cholim on Shabbos:[14] It is permitted to visit the sick on Shabbos.[15] Nevertheless [one is not to arrange to visit the sick specifically on Shabbos and is rather to arrange to visit him during the week as] it was with difficulty that the Sages allowed visiting the sick on Shabbos.[16] It is therefore improper to do like those who do not visit the sick throughout the week and visit him on Shabbos alone.[17] [If, however, one simply has no time to go during the week, and going on Shabbos will rejoice the ill person, then one is not to abstain from visiting him.[18]] See Halacha 5 regarding how to pray for the sick on Shabbos.

C. Who should one visit:

Every person is encouraged to visit an ill person. Even an adult should visit a child who is ill.[19] Even one who shares the same Mazal as the ill person[20] is to visit him [even though that by doing so, he contracts 1/60^th of the illness[21]].[22]

An enemy:[23] One who is an enemy of the person who is ill, is not to visit him.

If difficult for the patient:[24] Certain illnesses make it difficult for the patient to be visited due to the embarrassment of the ill person, or due to his inability to speak, and in such a case, visitors are not to enter the room of the sick person but are rather communicate with him from the external room.

Gentile:[25] One is to visit an ill gentile due to Darkei Shalom. [This applies even if there are no Jewish patients who also need to be visited at the time.[26]]

D. How to visit:

Sitting down:[27] It is forbidden for the visitor to sit on a higher level than the ill person.[28] Thus, if the ill person is lying on the floor, he may not sit on a bench, char or bed, and is rather to sit on the floor. If, however, the ill person is on a bed or chair, then one may sit in front of him, and so is the custom.

What to do there:[29] Upon visiting an ill person one is to [listen to him discuss his painful situation[30] and] pray for him and arouse divine mercy on his behalf. One who visited the ill and did not arouse mercy for him, has not fulfilled the Mitzvah.[31] In addition, one is to help and assist the ill patient and fulfill his needs.[32] [This is the main purpose of the Mitzvah of Bikur Cholim.[33]] See Halacha 5 for the full details of how to pray for the sick.

What not to do: One may not do, or say, things in the presence of the sick person that can lead him to have a broken heart and fear death.[34] Thus, one may not cry in front of the sick person regarding another person who passed away, even if the deceased is not a relative of the sick person.[35] [See Halacha 3] One is likewise not to say anything that can lead others who are present to begin to cry out of fear of his death, such as to begin saying Viduiy in their presence which can lead them to hysteria.[36]

The reward:[37] One who visits the sick merits in the next world to be saved from judgment in Gehinnom, and in this world merits to be protected by Hashem. He is protected from the Yetzer Hara and from suffering.

3. Keeping a happy mood-Not letting him know of the passing of a relative:[38]

If one is sick [or old], and there is worry that letting him know of the passing, and breaking his heart, can lead to worsening of his condition, he is not to be told of the passing. People who are around him are not to show any signs of mourning; they are not to tear their shirts, cry, or eulogize in front of him.[39] They are not to comfort him, and those who do so are to be quieted. [This applies even if a parent of the sick person passed away, and even if he needs, and is able, to say Kaddish on their behalf.[40] Furthermore, one is not even to eulogize or cry regarding another person who passed away, even if it is not a relative of the sick person.[41] If however the person is not sick to the point that letting him know of the passing can lead him to danger, then he is to be told, and he is to follow the laws of Shiva. The Rebbe did not let his mother know of the passing of his brother during the Shiva, and kept it hidden from her for the rest of her life, for over 12 years.]

4. Laws relating to caretakers of the ill:

Opposite gender-Male and female nurses:[42] It is permitted for a man who is sick to have a female caretaker. This applies even if the caretaker will need to perform intimate tasks, such as changing the person and helping him go to the bathroom.[43] However, a man may not be a caretaker for a woman who is sick if doing so involves dealing with the [intimate[44]] parts of her body, such as to clean her, and help her use the bathroom.[45] If however, it does not involve dealing with [the intimate parts[46] of] her body, there is no prohibition for a man to be a caregiver for a woman.[47] [He may even help her get up and lie down, and help her in non-intimate matters of the like.[48]]

Yichud:[49] When a patient has a caretaker of the opposite gender, care must be taken not to transgress the laws of Yichud during the visitations. Thus, one must provide either a Shomer [spouse/child] or Pesach Pasuach [open door or give keys to neighbors] to insure the laws of Yichud are not broken. If the patient is in a coma or unconscious, there is no Yichud prohibition at all in any case. If the patient is conscious but is impotent due to his illness/weakness, one may be lenient in Yichud in a time of need. This especially applies if there are no expectations of recovery.[50]  

Parent: If one’s parent needs a caretaker, the children are to try to take care of them. If they are unable, they are to hire a caretaker to deal with him/her.[51] Payment for the caretaker is the responsibility of the ill parent, although if they do not have money, the children are obligated to pay as a form of Tzedaka.[52]

5. How to pray for the sick:

The language:[53] When praying and asking for mercy in the presence of the sick person, then one may do so in any language he desires [even if he also understands Lashon Hakodesh]. When, however, one is not in his presence, he is to only ask in Lashon Hakodesh.[54]

The wording:[55] When asking for mercy on behalf of the sick, one is to include in the statement “amongst all the sick of Israel”, thus saying “Hamakom Yiracheim[56] Alecha Besoch Shaar Cholei Yisrael.”[57]

Blessing the ill in Shul:[58] It is customary to bless the ill in Shul [i.e. Mi Shebeirach for Cholim]. [Some Poskim[59] rule one is not to bless a sick person that is not in the city. Other Poskim[60] however argue and allow blessing all ill people even if they are outside the city, and so is the custom.]

How to pray on Shabbos:[61] It is forbidden for one to request physical needs on Shabbos, including the needs of a sick person, for him to become healthy.[62] It is likewise forbidden to bless a sick person on Shabbos.[63] Thus, when visiting a sick person on Shabbos one is to say “Shabbos Hi Milizok Verefua Kerova Lavo.”[64] This applies likewise for the Gabaiy in Shul, that when he performs a Mi Shebeirach for the sick he is not to say “Hamakom Yishlach Refua” but rather “Shabbos Hi Milizok Verefua Kerova Lavo.”[65] If however the sick person is dangerously ill on Shabbos [and may pass away that day] then one may shout and supplicate on his behalf even on Shabbos, even as a congregation.[66] It is likewise permitted to bless an ill person who is dangerously ill on Shabbos.[67] The same would apply to a woman in childbirth who is having difficulty in labor on Shabbos.[68] However, a sick person whose life is not in danger on Shabbos [even though in general his illness is life threatening], it remains forbidden to ask mercy for him, or bless him, on Shabbos being it is possible to do so after Shabbos.[69] If, however, his illness occurred on Shabbos and requires an immediate request of mercy, then an individual may do so even if he is not in danger to die on Shabbos.[70] However, a public prayer may not be held for such a person.[71]

How to pray on Yom Tov: Some Poskim[72] rule that when saying a Mi Shebeirach for the sick on Yom Tov one is to say “Yom Tov Hi Milizok” Others[73] however are accustomed to recite Shabbos Hi Milizok.[74] [The Chabad custom is to recite “Shabbos Hi Milizok” also on Yom Tov.[75]]

Mentioning the name:[76] One who is praying and arousing mercy on behalf of another, is required to mention his name in the prayer, if he is not making the request in front of the person. [Even one who is praying for his father is to mention his father’s name rather than simply say my father.[77] Other Poskim[78] however rule one may say my father, although he is not to mention any honorific title to his name, such as “my master or teacher” and the like, as there is no prestige before G-d.]

Whose name do you mention-The father or the mother:[79] When praying for the sick, one is to mention his/her name and the mothers name. Thus, when saying Mi Shebeirach for the sick, one is to mention the mother’s name.

Praying if the person is near death:[80] One is to pray for a person to be healed even if “a sword is resting on his neck”, and the situation seems hopeless.

 

May one pray for a person who has a terminal and painful illness, to pass away?[81] Although one is to pray for a person to be healed even if “a sword is resting on his neck”, and the situation seems hopeless[82], nevertheless, if a person is suffering much pain and has a terminal illness from which there is no known medical recovery, one may pray for the person to pass away.

6. Visiting a Sage/Rabbi:[83]

Some Poskim[84] rule that if one has a relative who is sick, he is to visit the community Sage [or Rabbi or Rosh Yeshiva] so that the Sage request mercy on his behalf.

7. Changing a name due to illness:[85]

It is customary to change the name of a sick person, as the changing of a name tears the evil decree against him.[86] [The name of a person is his channel of life and when the name is changed it has ability to bring the person new life.[87] It is customary to simply add a name to his previous name, and not to completely replace the original name.[88] The new name is to be used by people from now on.[89]]

How is it done?[90] The ill person is blessed in Shul [during a Mi Shebeirach for Cholim] using his new name. [This is customarily done by giving the sick person, or a relative of the sick person, an Aliyah to the Torah, and then recite for him a Mi Shebeirach using the new name.[91] Some are accustomed to reciting certain prayers at this time.]

Which name is the main name?[92] The added name is the main name of the person when it is added due to illness. This applies even if the person is still customarily called by his original name. This however only applies if he is also sometimes called by his new name [or uses it to sign documents or get an Aliyah[93]], if however, he is never called by his new name [and does not use it for documents or Aliyah[94]] then it is not considered his name at all.

Which name comes first:[95] Although one is to mention both the new and old name, the added name is to be written first in all documents, being that it is the main name. It is likewise to be used first when calling the person for an Aliyah to the Torah.[96] This applies even if the person is still customarily called by his original name, so long as he is at times also called by his new name, as stated above.

What name to add:[97] It is customary to add a name that has a connotation of healing and cure, such as Chaim, or Refael, or Shalom, or Azriel, and the like. By a woman, some[98] say one is to add the name Chana, Sarah, or Yocheved, although not the name Rachel, Leah, Bat Sheva, or Tamar.

Must the children use the new name for their ill father: When the father is alive, the new name is to be used, having it precede the original name.[99] If, however, the father passed away due to the illness, then if father was customarily called by the new name, or used the new name for documents or an Aliyah, then the children are to adapt the new name for all legal matters. [However, in such a case his original name comes first. [100]] If, however, the father passed away prior to any of the above occurring then only the old name is to be used for all legal matters.[101]

8. Omens and predictions:[102]

There exist mythologies, including from Jewish sources[103], which claim to be able to predict whether an ill person will live or die through certain signs and actions. One is to ignore these matters and place his trust in G-d and not rely on predictions of any sort.

9. End of life preparations:

A. Settling debts:[104]

A [fatally] ill person is to be told to take care of any important issues [prior to his passing], such as to pay up any debts that he owes or collect debts that he is owed, and to return any items that he has of others, and to collect any items he gave to others. The ill person is to be forewarned that doing these actions should not make him fear death.

B. Writing a will:[105]

One is to write a will as he approaches his day of death.[106] Some communities are accustomed to do so on the third day of illness of a person.[107] The writing of a will is a Segula for a long life[108], and hence does not have to wait until one is nearing death.[109] Doing so does not infringe on the saying “Don’t open the mouth for the Satan.”[110] [Writing a will at an earlier opportunity is especially necessary today where state laws of inheritance widely differ from the Halachic laws of inheritance. Hence, a legally binding will is to be written to insure a Halachically valid inheritance that refrains the children from engaging in battles that involve contradictions between Jewish and state law.] The will is to be written in front of witnesses, and is not to be left to the testimony of one’s father, or wife and children.[111] It is to be legally binding and is hence to be performed under the guidance of a lawyer.[112] If one suspects that writing a will may cause argument and fights amongst the heirs, he is to divide the items prior to his death.[113]

A Halachically valid will: Every country contains inheritance laws that take effect the moment a person dies, if he did not leave an official legally binding will. Being that state law differs from Jewish law, it is therefore necessary to write a will that confers with Jewish law prior to one’s passing. There are clear Halachic guidelines for the order of inheritance and distribution of wealth and property, and there are various laws that dictate whether one can change this order of inheritance.[114] Certain redistributions are not initially allowed to be done, and some do not even carry Halachic legal status.[115] Furthermore, a will may require a Halachic acquisition performed so it is legally binding, and a typical secular will written by one’s attorney may not meet these standards.[116] Thus, in order that one’s wishes of distribution do not contradict Jewish law and are enforceable under both state and Jewish law, it is necessary that one turn to an Orthodox estate planning attorney who has Rabbinical guidance for the writing of wills, so it complies to both the law of the land and law of the Torah.[117]

Inheriting to daughters and to all children equally: As stated above, per Halacha only sons receive the inheritance and not daughters.[118] Nevertheless, there are various entitlements given to daughters, outside of the official inheritance.[119] In addition, many parents would like all their children, including their daughters, to receive an equal share, or some share, and hence diminish any disharmony from erupting after death in regards to the estate. Some Rabbanim thus encourage one to [partially] inherit also to daughters, and so was customarily done hundreds of years prior, as brought in the Poskim.[120] There are numerous Halachically valid ways of facilitating an equal inheritance to all children, such as through writing a Shtar Matana to the children which takes effect while the person is still alive[121], or through writing an IOU document to the daughters that is of greater worth than the estate, hence forcing the sons to equally divide the inheritance.[122] Practically, as stated above, one is to seek Halachic and legal guidance in this matter.

C. Life insurance-The Torah’s perspective:

Many Poskim[123] rule that it is permitted [and one is to be encouraged[124]] to purchase life insurance, and doing so is not a sign of lack of Bitachon and the like. Others[125] however take a colder stance towards its purchase.[126] There is no clear directive of the Rebbe in either direction[127] although in one instance the Rebbe spoke negatively about the matter.[128]

A Kosher policy: One who decides to purchase a life insurance policy must verify that the policy does not involve any Ribis prohibitions, if the policy is taking place through a Jewish owned company or agent. Likewise, some policies ask the owner to allow or provide an autopsy report in order to make a claim in the event of death.  According to Halacha, it is forbidden to sign away the rights for autopsy on a Jewish corpse, due to it being desecration of the dead.

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:

1. The type of illness the patient is suffering from.
2. What is the survival rate from the illness and conducted treatment?
3. How old is the patient, and how is his general health despite the current illness?
4. Is the patient in chronic pain?
5. What is the medically recommended form of treatment?
6. 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.[129] 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.[130] If it will only help the person live for a short time longer, a Rav is to be contacted.[131]

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.[132] 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.[133]

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:[134]

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.[135] 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.[136] 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[137], 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.[138] In most states, this may be done even against the will of the family.[139] 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[140] rule that one who is 100% brain dead is considered dead, as it is impossible for him to breathe on his own.[141] 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[142], however, rule that he is considered alive and one may hence desecrate Shabbos on his behalf.[143] 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:[144] 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:[145]

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]. 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:[146] 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[147], bone, bone marrow; whole blood donation[148]; Platelet blood donation[149]; Stem cell donation.[150] Some Poskim[151] 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:[152] 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.[153] [In the first years that heart transplants were practiced, the Gedolei Haposkim[154] 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:[155] 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[156], there are Poskim[157] 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[158] rule it is permitted to use the limb of a deceased to perform the transplant on this Jew. Other Poskim[159], however, prohibit organ donation from a deceased even to help save the life of a Jew with a life-threatening condition.[160]

Case 4: Brain dead patient:[161] 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.[162] 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.[163] Practically, the Poskim[164] 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:[165]

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.[166] 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[167] 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[168], 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[169] 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.[170]

Practical advice-Attaching the life support to a timer: Some Poskim[171] 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:[172]

It is Biblically forbidden for an autopsy to be performed onto a Jewish body.[173] 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.[174] 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.[175] [If one did so, his wishes are not to be obeyed.[176]]  If, however, the autopsy can possibly bring a cure to a person who is currently ill, then it is permitted to be performed.[177] [Some[178] 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.[179]]

Autopsy as part of a murder investigation to help capture the murderer:[180] 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:[181] It is permitted to remove implanted medical devices from the body, such as a pacemaker, for the sake of future use in other patients.[182]

Biopsy: Some Poskim[183] 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:[184] 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[185] as to whether there is a prohibition to benefit from the body of a gentile. Practically, some Poskim[186] are lenient to allow benefiting from a gentile’s body for the sake of medical science.

Preserving and mummifying a body:[187] 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[188] 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.[189]

11. Resuscitation-May one sign a DNI[190]/DNR[191]/AND[192] order for himself, or for a patient under his care?[193]

A. Introduction:

Understanding resuscitation and DNI/R consent forms: Resuscitation attempts [i.e. C.P.R.[194]] of one who is under cardiac arrest, or has experienced lung [i.e. respiratory] failure, is a common and proven method of saving and/or prolonging the person’s life. Often a patient with lung failure will be attached to life support and be able to live an extended period of time in this method. In other instances, the lifesaving C.P.R. can return a natural pulse and/or breathing to the patient and allow him to live for many years longer. While in normal circumstances, the legal and Halachic protocol obligates the administering of C.P.R. and other lifesaving techniques to a patient in need, the question is raised as to whether one is obligated to perform these lifesaving techniques on a person with a terminal illness, whose quality of life is in any event filled with pain and suffering. Must one extend or help save the life of one who in any event will die in the near future, and whose quality of life is compromised, or is one allowed, or even encouraged, to not perform these lifesaving techniques in order not to increase and prolong his life of misery? From a legal perspective, absent of any signed directive to do otherwise, the universal protocol of medical practitioners, and hospitals, is to always administer CPR and other life saving techniques to all patients, irrelevant of their medical status. However, hospitals do offer the patient, or their health care proxy, the ability to choose to not resuscitate them in the event that they experience cardiac arrest or lung failure, and they will thus allow the patient to die. This is known as a DNR/DNI consent form. If one signs the form, then the hospital, or other medical practitioner [i.e. EMS], will abstain from administering these lifesaving techniques onto the patient if needed, while if the form is not signed, then the normal protocol of CPR is in place. We will now deal with this question from a Halachic perspective, and as to whether one may, should, or may not, sign the above form.

The Halachic discussion: From a Halachic perspective, on the one hand, we find that one is obligated to help save the life of a Jew, even if he can only live momentarily.[195] On the other hand, we find that one who has entered the state of Gesisa[196] [i.e. death is imminent and unavoidable in a matter of days or hours], is not to have things done to delay his death, and on the contrary is to have certain impediments which prevent death to be removed from him.[197] [Although it always remains forbidden to actively do something to hasten the death of any Jew, even a Goses, and doing so is murder, as explained in Chapter 2 Halacha 1A.] The proper balance between these two approaches is as follows: In general circumstances, it is forbidden to sign a DNR/DNI/AND order, which in essence commands all medical practitioners to avoid performance of CPR, or administering a medical respiratory machine to the patient, in the event that he enters cardiac arrest or stops breathing. This is tantamount to signing a death sentence should the patient ever need any of the above procedures performed on him. Nevertheless, based on the precedent explained above regarding a Goses, in certain limited medical circumstances, it is permitted and even Halachically required to sign such documents, as will be explained. In all cases, one must first discuss the matter with a competent Rav who has knowledge and experience in ruling on these matters. The following is a general overview of the subject: 

B. No terminal illness:

In all cases that the patient is not suffering from a terminal illness, it is forbidden to sign a DNR/DNI/AND irrelevant of how much pain the patient is currently in.[198] A terminal illness is defined as any illness that is not curable and will result in certain death [i.e. Cancer, in different forms and stages; ALS]. If the patient is possibly curable, or the illness is not expected to lead to death, it is forbidden to sign a DNR/DNI form irrelevant of the amount of pain the patient is in. 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, as often such an individual will recover lung function after the poison leaves the body, and he recovers from the trauma.[199]

C. Terminal illness but no physical pain:[200]

If the patient is suffering from a terminal illness, which is both not curable and will lead to certain death, but is not found in a state of constant physical pain, then it is forbidden to sign a DNR/DNI even if this is the will of the patient.[201] This applies even if the patient is depressed and has lost the will to live due to other factors.

Patient is in state of Gesisa:[202] If the patient is already in the active state of Gesisa [i.e. imminent death] due to his illness, such as one who has severe and unretractable brain death, then one is permitted, and even obligated, to sign a DNR form, even though the patient is not in pain.

Cardiac arrest or lung failure is a result of illness: Some Poskim[203] suggest that if the patient entered cardiac arrest or lung failure as part of the deterioration of his terminal illness, then there is no obligation to resuscitate him even if the patient is not in pain, such as one with dementia, or in a coma. If, however the cardiac arrest or respiratory failure is due to a side problem, irrelevant of the terminal illness, then one is to resuscitate, unless the next exception applies. 

D. Terminal illness and physical pain:

If the patient is suffering from a terminal illness, which is both not curable and will lead to certain death, and is found in a state of constant physical pain [i.e. cancer; ALS], then if the patient does not want to continue to live in this state, the Poskim[204] rule that it is permitted, and possibly even obligatory [based on directive of a Rav], to sign a DNR/DNI.[205] If, however, the patient expresses desire to continue to live despite his suffering, it is forbidden to sign a DNR/DNI. One is to try to speak to the patient and express to him the spiritual greatness of even one moment of life, and if he nonetheless decides that he does not want to continue to live in this state, one may and should sign the DNR/DNI consent form. 

What treatments may be refrained from this type of patient?[206] In general circumstances, the Halachic allowance of a DNR/DNI order to a patient in the above state is limited specifically to abstaining from performing CPR and intubation in the event of a cardiac arrest, or lung failure. All other medical treatments, however, must be continued for even this patient, including all forms of medicine, oxygen if the patient needs help breathing, and dialysis if the kidneys fails.

Summary: If one is terminally ill, he, or his health care proxy, is not to sign on a DNR/DNI form unless they have discussed the matter with a competent Rav in this field, and received his directive to do so. The following matters are to be brought to the attention of the Rav for his arbitration: 1.      Is the illness Halachically deemed incurable and will it lead towards certain death? What is the estimate of his physician, and what is the standard medical practice? 2.      Is the patient found in enough pain to justify a DNR/DNI even in the event of terminal illness? How often is his pain? How strong is his pain? 3.      What is the patient’s opinion on the matter?   Verifying the details of the DNR/DNI order: In the event that it has been Halachically determined through a Rav that one may sign a DNR/DNI order, one must verify with the medical facility the exact definition of this order, and all treatments it includes and excludes. Some medical facilities will interpret the order to include refraining treatments other than the CPR and respiratory machine. A full discussion with a health care provider is critical so everyone understands the circumstances under which a DNR, DNI, or AND order would go into effect and the specific actions that will or will not be taken.   Reversing the order: DNR/DNI/AND decisions are reversible and can be withdrawn at any time. In addition, the healthcare team must confer with you periodically (every few days or weeks) to verify that you still want the DNR/DNI/AND order in place.

Maaseh Shehayah A story with a terminally ill patient who had DNR/I form signed:[207] It was 2:00 am when the Rav received the terrifying phone call from a hysterical individual who had just been informed that his mother had only hours to live, unless they attach her to life support. You see, his mother was suffering from a vicious and malignant tumor, from which there was no foreseen medical hope of recovery. She had been living a years’ worth of pain and agony from the illness. That night she experienced failure of various organs, as a natural cause of the illness, and entered into a gradual state of irreversible brain damage, which would eventually lead her to complete lung failure and death, unless she were attached to life support. The doctors wished to know how to proceed, and as to the will of the family as to whether they want their mother attached to life support, or to allow her die. They had a half hour to play with to make their decision, and so they frantically called the Rav. The Rav, weighing the heaviness of this question, and how literally the life and death of a Jewish soul laid in his words, went on to consult with one of the Gedolei Haposkim who ruled to him that based on the current description of the terminal illness, her great suffering, and her current state of deterioration, it would be encouraged not to place her on life support or delay her death. Upon learning the answer, the relatives immediately signed the DNR/DNI consent form, and within the next half hour, indeed their mother passed away. May her soul be blessed.   A story with a terminally ill patient who did not have a DNR/I form signed:[208] Eli, who was suffering from dementia as a result of recurrent strokes, was not eating and the doctors could not understand the reason for his loss of appetite. While doing a feeding tube operation they discovered abnormalities with the pancreas, and indeed after a quick diagnosis, they discovered that the patient was suffering from stage 4 pancreatic cancer, one of the deadliest cancers in the world, with an only 5% recovery rate. The doctors gave him six months to live. Following protocol in such situations, they asked the family to decide on how to proceed with regards to DNR/I consent forms, and they strongly suggested to sign the form, as the patient has no chance of recovery, and is living a very bad quality of life. The family debated the issue amongst themselves and spoke to one of the Poskim of a known Rabbinical medical ethics organization, as to how to proceed.  One family member returned with a Psak from that Rabbinical board, to sign the form. However, a debate ensued from one of the learned sons, saying that since their father was not in a noticeable state of pain, due to his severe state of dementia, therefore the form should not be signed. The above Posek who gave the go ahead ruling was thus contacted and informed that indeed the patient does not seem to show pain from the illness, and the doctors likewise agreed with this analysis, and his Psak should therefore be rescinded or revised. He therefore conferred with the leading Posek of the organization, who is one of the Gedolei Haposkim of today, and indeed the directive came that under the above circumstances of no pain, the consent form should not be signed.[209] The form was therefore not signed, and the patient was brought to a hospice facility, to remain there for the duration of his illness. Skip a few months and we are now hours away from the wedding of the daughter of this patient, which is taking place thousands of miles away from their father, and a frantic phone call comes from the doctors of the ICU department of Cornell university. They have very unfortunate news to relay. Their father underwent a massive heart attack, and has suffered severe, and irreparable, brain damage and lung failure. However, being that they did not sign the DNR/I form, he was immediately resuscitated, and attached to life support. He is thus still alive, but may leave this world at any moment. As you can imagine, the gruesome news entered the family into pandemonium, as aside for the intrinsic devastation of the news, if their father passes away before the Chuppah, the wedding will need to be postponed until after the Shiva, and the Chuppah is only hours away! A decision was immediately taken, based on the directive of a Rav, to inform the medical facility that no one should be told of the death until the next morning, in order for the wedding to be able to take place. Indeed, there was no phone call, and the wedding was a joyous event as every wedding should be. The Kallah, knew nothing of what was going on, although her siblings were deeply distraught, not knowing to what news they would wake up to after the wedding. The wedding was naturally bittersweet for these siblings, dancing with sorrow and joy. After the wedding they discovered that their father was still hanging on to life. Miraculously, above all expectations, he went on to live for another three months. In this story, we see the revealed Divine providence in not having signed the DNR/I order, as required by Halacha in such a situation, as if it would have been signed, it would have caused him to pass away only hours before the wedding and create an unimaginable reality and pandemonium of delaying the wedding just hours beforehand. May his soul rest in peace!     A reverse Psak of Rav Shlomo Zalman Aurbach relating to the Lubavitcher Rebbe Zatzal, as related by his secretary Rabbi Leibal Groner: On the 27th of Adar Rishon 5752/1992 the Rebbe received a debilitating stroke while at the Ohel of his father in-law, the Rebbe Rayatz. While the Rebbe’s mobility of his right side, and his speech, was impaired as a result, the holy Tzadik’s mind was completely lucid and clear, and many severe questions were answered by the Rebbe, through the nod of his holy head. The Rebbe saw and understood all that was occurring around him. However, exactly two years later, on 4:00 a.m. Thursday morning, on that same fateful date of the 27th of Adar, the Rebbe received a second severe stroke while at a Manhattan hospital, which this time left the Rebbe with 98% brain damage. The doctors caring for the Rebbe explained the seriousness of the situation to the Rebbe’s secretaries, who acted as his legal health proxies, and that they need to consider signing a DNR/DNI consent form. The secretaries decided to send the weighted Halachic question to one of the world’s leading Poskim, Harav Shlomo Zalman Aurbach of Jerusalem. Harav Yossi Eizanbauch of Bnei Brak was contacted by Rabbi Groner and asked to approach Rav S.Z. Aurbauch with the question, although the Rebbe’s name is not to be mentioned, and it is to be asked anonymously. Rav Yossi Eizanbauch asked the weighted question to Rav S.Z. as to whether a DNR/DNI consent order should be signed for the “anonymous” patient, and the Rav replied that he sees his years are limited and that he has thus stopped answering such weighted questions due to fear of the heavenly court which he will soon face. Rav Eizanbauch thus had no choice but to reveal to Rav Shlomo Zalman the identity of the patient, and that it was none other than the Lubavitcher Rebbe. Rav Shlomo Zalman, being taken by surprise, replied that he should return in an hour for an answer. After the hour, the renowned Posek replied that every moment of the Rebbe’s life is precious, and thus they are to do everything possible to keep him alive, even if it entails resuscitation. [This was unlike Rav Shlomo Zalman’s approach of ruling throughout his life, in which he directed for the consent form to be signed in similar and even much less severe situations.] As a result of this Psak, when the Rebbe later went into cardiac arrest on 7:00 am Shabbos, the 2nd of Tammuz, they immediately began efforts of resuscitation, and indeed after 50 minutes of CPR, the Rebbe’s pulse miraculously returned and stabilized. The doctors had never seen anything like this before, that a pulse returned after 50 minutes. They were absolutely amazed, and shocked like they saw a ghost, as from a medical perspective this was literally a resurrection. That evening on 1:00 am Motzei Shabbos, the Rebbe had a further cardiac arrest, and this time the resuscitation efforts did not bear fruit, and the Histalkus of the Holy Tzadik occurred on the special day of Gimel Tammuz.

12. Viduy and other prayers:

A. The laws and customs of Viduy:[210]

The importance of Viduy: All those who confess their sins receive a portion in the world to come.[211] Saying the Viduy is helpful for one’s recovery, as sincere repentance brings merit to the person and can nullify a severe decree from Heaven.[212]

Who recites Viduy? Viduy is recited by both men and women of any age who are ill.

When to recite Viduy?[213] When the ill person is nearing death, he is to be told to confess his sins. [He is not to be told to confess prior to reaching the state of close to death.[214] It is, however, important to get the ill person to recite Viduiy before he reaches a state that he cannot speak, and certainly before he enters an unconscious state. Viduiy is to be recited by him while he still maintains a clear mind and has the strength to recite the Viduy properly.[215] One should not delay reciting Viduy out of fear that it is a bad omen.]

Is it recited on Shabbos and Yom Tov?[216] Viduy may be recited on any day, including Shabbos and Yom Tov.

Persuading the ill person to recite Viduy:[217] The sick person is to be told “Many people who have recited the Viduy and have not died [and instead have gone on to live many long years] and many people who have not recited Viduy have died. In the merit that you will confess, you will live.” [One is not to tell the ill person to confess because he is nearing death.[218] It is a great Mitzvah to talk to the sick person and persuade him to recite Viduy while he is still in a proper state of mind, as stated above.[219]]

If the ill person cannot speak:[220] If the ill person is unable to verbally confess, then he is to confess in his heart [i.e. mind]. [It is important to get the ill person to recite Viduy before he reaches a state that he cannot speak, and certainly before he enters an unconscious state.]

Who may be present:[221] One is not to say Viduy in the presence of ignoramuses, or women and children, as this may lead them to cry [and cause hysteria, and they will cause the ill person to panic]. [It goes without saying that those who cannot control their crying are to leave the area while Viduy is recited.]

How to recite it-Washing hands; Wearing Tzitzis; wearing a Gartel: It is customary to wash one’s hands prior to reciting Viduy.[222] [This is done similar to the morning washing.] One is likewise to wear Tzitzis.[223] Some are accustomed to wear a Gartel while reciting it.[224] One is to give charity prior to confessing.[225]

May a person recite Viduiy if he is dirty with excrement or urine?[226] An ill person is to be clean of feces and urine when reciting Viduiy. If he is unable to do so, it is to be recited without Hashem’s name.

 

B. The Nussach of Viduy:

Viduy may be recited in any language that one understands. One is to perform complete Teshuvah upon reciting it.[227]

The long version: The following version of Viduy is written by the Michaber in Shulchan Aruch chapter 338:2. [The Ramban has a longer version of Viduy which he received from Chassidim and Anshei Maaseh. This version is recorded later on in this chapter together with all the Viduy prayers.]

מודה אני לפניך ה׳ אלוקי׳ ואלוקי אבותי שרפואתי בידך ומיתתי בידך יהי רצון מלפניך שתרפאני רפואה שלימה, ואם אמות תהא מיתתי כפרה על כל החטאים עונות ופשעים, שחטאתי ושעויתי ושפשעתי לפניך, ותן חלקי בגן עדן, וזכני לעולם הבא הצפון לצדיקים.

The short version:[228] One who does not know how to confess [or is unable to say the long Nussach for whatever reason] is to be told to say, “Let my death be an atonement for all my sins.”

Yom Kippur confession:[229] If the sick person desires, he may lengthen in his recital of Viduy and recite the confession prayer said on Yom Kippur. The Nussach of the Yom Kippur Viduy is brought below.

Additional prayers added: There are various customs concerning the order of the Viduy prayers. Some recite the Viduy of the Ramban [brought below] which contains different psalms and verses, as well as a much longer confession prayer.

C. Moda’ah:

Many are accustomed to reciting a Moda’ah[230] together with Viduiy. [The Nussach is recorded below].

D. Asking for forgiveness from others:[231]

Before reciting the Viduy, one should endeavor to ask forgiveness from those whom he may have hurt, or caused pain to. He is also to ask others to pray on his behalf.

E. Blessing one’s children and giving them final directives:[232]

The sick person is to bless his children prior to his passing. He is to wash his hands and place them on the head of his children and recite Birchas Kohanim. He is also to direct them to follow the path of Torah and Mitzvos.

13. Nussach of confession prayers:

A. Nussach of regular Viduy

I acknowledge before You, Lord my G-d and the G-d of my fathers, that my recovery and my death are in Your hands. May it be Your will that You heal me with total recovery, but, if I die, may my death be an atonement for all the errors, iniquities, and willful sins that I have erred, sinned and transgressed before You, and may You grant my share in the Garden of Eden, and grant me the merit to abide in the World to Come which is vouchsafed for the righteous.

 

B. Viduy of Ramban:[233]

Prior to the Viduy one is to recite: “”ה אלוקים אמת ותורתו אמת ומשה נביאו אמת וברוך שם כבוד מלכותו לעולם ועד

Tehillim: One is the to recite the entire Mizmor of Ashreiy Yoshveiy Veisecha [psalm 145]; Mizmor 86 of Tefila Ledavid Hateh Hashem Aznecha; Mizmor 4 of Bekari Aneini; Mizmor 121 of Shir Hamalos Esa Eiynay. After completing the Tehillim one is to recite the following Viduy with great concentration.

C. Viduy of Yom Kippur for those who want to add:

D. Modah:

_____________________________________________

[1] Michaber 335:3; Shabbos 12b; Nedarim 40a

[2] Brachos 10a in story of Chizkia and Yeshaya the Navi

[3] Taz 335:1; Nedarim 40a

[4] The reason: As when one spreads the word that an individual is sick, and people view him in this status, his Mazal becomes diminished. [Bach, brought in Taz 335:1; Nedarim ibid]

[5] Michaber 335:1; Bava Metzia 30b; See Gesher Hachaim 1

[6] Shach 335:11 in name of Bach

[7] Rama 335:10; Kol Bo

The reason: As in Nichum Aveilim one performs Chesed with both the mourners and the deceased. [See Rambam Avel 14:37]

[8] Shach 335:11 in name of Bach

[9] Michaber 335:1; See Likkutei Sichos 5:78

[10] Michaber 335:4; Nedarim 40a

[11] The reason: As during the first three hours of the morning most sick people feel the healthiest, and hence the visitors will be less encouraged to plead for mercy on his behalf. However, during the last three hours of the day, his illness is most intense and may cause the visitors to give up hope and not pray for him. [Michaber ibid]

[12] Aruch Hashulchan 335:8; See “Mitzvas Bikur Cholim” Siman 5 [p. 121]; Dinei Aveilus 1:15

The reason: As this is not an obligation but merely good advice. [Aruch Hashulchan ibid]

[13] Michaber 335:2

[14] Admur 287:1 and 3

[15] Admur 287:1; Michaber 287:1; Shabbos 12a

[16] Admur 287:3; Shabbos 12b; M”A 287:1; Elya Raba 287:1; Machazik Bracha 287:3; Shaareiy Teshuvah 187:1; Kaf Hachaim 187:6

The reason: As this may lead one to become saddened together with the patient. [Admur ibid]

[17] Admur ibid; M”A 287:1; Machazik Bracha 287:3, brought in Shaareiy Teshuvah 187:1; Kaf Hachaim 187:1

[18] Shaareiy Teshuvah 187:1; Kaf Hachaim 187:1

[19] Michaber 335:2

[20] This is called “Ben Gilo” in the Gemara and Shulchan Aruch, and is interpreted to mean one who shares the same Mazal, which means they were born the same time, by the same constellations. [Taz 335:2; Ran Nedarim 39b]

[21] Shach 335:1; Taz 335:2; Bava Metzia 30b

[22] Michaber ibid; Bava Metzia ibid

[23] Rama 335:2 unlike Maharil who rules an enemy may visit an ill person

[24] Michaber 335:8; Nedarim 41a; Shach 335:6-7 regarding one who suffers from an abdomen illness, in which it is embarrassing for him to be visited, and regarding one who suffers from a head ache or eye pain in which it is difficult for him to speak

[25] Michaber 335:9; Gittin 61a

[26] Shach 335:8

[27] Michaber and Rama 335:3; Shabbos 12b

[28] The reason: As the Shechina resides on top of the head of an ill person and one may not make himself higher than the Shechina. [Michaber and Rama ibid]

[29] Rama 335:4; Beis Yosef in name of Ramban; Nedarim 40a; See Michaber 335:8; “Mitzvas Bikur Cholim” Siman 5 [p. 121]

[30] Michaber 335:8

[31] Rama ibid

[32] Michaber 335:8; Shach 335:11 in name of Bach that by doing so one revives him; Machazik Bracha 287:3; Shaareiy Teshuvah 287:1; Kaf Hachaim 287:6; Aruch Hashulchan 335:3 based on Nedarim 40a that Rebbe Akiva swept and cleaned the floor for a sick person

[33] Machazik Bracha 287:3; Shaareiy Teshuvah 287:1; Kaf Hachaim 287:6; Aruch Hashulchan 335:3

[34] See Michaber 337:1 and 338:1

[35] Shach 337:2; Bach

[36] Michaber 338:1

[37] Nedarim 40a

[38] Michaber 337:1; Miseches Semachos

[39] Wearing Shabbos clothing: A mourner may even wear Shabbos clothing in front of the ill relative in order so the patient does not suspect that he is in mourning. [Chamudei Daniel, brought in Pischeiy Teshuvah 402:1]

[40] Beis Hilel 337

[41] Shach 337:2; Bach

[42] Michaber 335:10; Miseches Semachos 12

[43] Taz 335:5

The reason: As when the man is sick, he does not have any lust or ability to have an erection, while a woman does not have such a strong Yetzer Hara and hence won’t become aroused. [Taz ibid; Birkeiy Yosef 335; See Shach 335:9 in name of Derisha, Bach and Dakei Moshe] Alternatively, even though a woman may become aroused and have forbidden thoughts as a result of the tasks, there is no prohibition involved as women are not prohibited against masturbating and causing their own Zera Levatala. [Birkeiy Yosef ibid] Alternatively, when the woman is healthy, she can control the situation and prevent any wrongdoing from happening. [Beis Yosef and Levush, brought in Shach 335:9; Beir Hagoleh 335]

[44] Shach 335:9 in name of Derisha 335, Bach 335 and Dakei Moshe 335 that only by a stomach illness was this prohibition stated as “When she uses the bathroom, he sees her in both front and back” however by other illnesses it is permitted; Birkeiy Yosef 335 that so is implied from Michaber ibid

Other opinions: Some Poskim rule it is forbidden for a man to care for a female patient even if it does not involve dealing with the intimate parts of her body, but involves touching her body. [See Taz ibid who implies that even other bodily contacts which are done on a constant basis can lead to erection and is therefore forbidden. According to the Beis Yosef and Levush brought in next footnote, it is always forbidden whenever the female patient cannot prevent being taken advantage of.]

[45] Michaber ibid

The reason: As this may lead the man to get excited and have an erection, as a man has a stronger lust than a woman. [Taz ibid; Shach 335:9 in name of Derisha, Bach and Dakei Moshe] Alternatively, when the woman is sick she cannot prevent him from taking advantage of her against her will. [Beis Yosef and Levush, brought in Shach 335:9; Beir Hagoleh 335]

[46] See Poskim in previous footnotes

[47] Taz ibid; Shach 335:9 in name of Derisha 335, Bach 335 and Dakei Moshe 335

[48] Birkeiy Yosef ibid; See previous footnotes

[49] See Nitei Gavriel Yichud 5:3-5

[50] See Kiryas Melech Rav 2:22; Nechpa Bakesef 64; Tuv Taam Vadas Telisa 1:5; Igros Moshe E.H. 4:65-10; Otzer Haposkim 20:5; Nitei Gavriel ibid

[51] See Michaber 240:10 regarding a parent who lost their mind

[52] See Rama 240:12

[53] Michaber 335:5; Shabbos 12a; M”B 101:16; See Admur 101:5

[54] The reason: As the Shechina is present near the ill person and when one requests mercy it reaches straight to Hashem. However, when not in his presence, one needs the assistance of the angels to elevate the request and hence should ask for it in Lashon Hakodesh as the angels don’t understand every language. [Shach 335:3; Taz 335:3; Shabbos ibid] Now, although it is disputed in Rishonim as to whether the angels understand the other languages, and some [Rosh, brought in Admur 101:5] hold they understand all languages other than Aramaic and others [Rif, brought in Admur 101:5] hold they only understand Lashon Hakodesh, nevertheless, by an ill person one is to follow like all opinions being he is in need of mercy and hence he is to pray only in Lashon Hakodesh. [Taz 335:5; Perisha 335, brought in Nekudos Hakesef; Admur 101:5]

[55] Michaber 335:6

[56] Michaber ibid; Admur 287:1; Shabbos 12b

[57] The reason: As when one includes the ill person amongst the rest of Klal Yisrael, his prayers are more greatly heard. [Shach 335:4]

[58] Rama 335:10; See Rama O.C. 54:3; Admur 54:4; Shach 335:10 that some communities were accustomed to blessing the sick between Yishtabach and Yotzer Or.

[59] Maharil, brought in Pischeiy Teshuvah 335:2

[60] Nachalas Shiva 59, brought in Pischeiy Teshuvah ibid

[61] Admur 187:1; 188:8-9

[62] Admur 288:8 and 9

[63] Admur 288:9; M”A 288:14; Bach 288; Shach Y.D. 335:10; Mahariv [Rav Yaakov Veil] 115

[64] Admur 287:1; Michaber Y.D. 335:6

The reason: One is not to request mercy for the person as he does during the week by saying “Hamakom Yiracheim..”, as through asking for mercy one ends up arousing crying and pain. Rather one is required to broaden their minds with words of comfort and encouragement, so the ill person does not feel sad on Shabbos. [Admur ibid] Vetzaruch Iyun why Admur ibid does not mention the reason stated above that it is forbidden to request physical matters on Shabbos, irrelevant of the issue of distress.

Segula: The above statement has mystical meaning, as its Roshei Teves represent the name of Hashem that heals the sick. [Chaim Veshalom Seder Kerias Hatorah; See also Toras Levi Yitzchak Gittin 7; Meiri Shabbos 12; Likkutei Sichos 11:296; 16:520 that Shabbos itself brings the Refua]

Other opinions: Some Poskim rule it is permitted to recite “Hamakom Yiracheim Alecha Besoch Shaar Cholei Yisrael” even on Shabbos. [Ramban, brought in M”A 288:14] However, to say more than this is forbidden according to all opinions. [M”A ibid]

Verachamav Merubim Veshabbaso Shalom: Some Poskim rule one is to conclude the above statement with the words “Verachamav Merubim Veshabbaso Shalom.” [1^st opinion in Admur ibid; Michaber 287:1; Bach 287; Shach 335:5; Shavna in Shabbos 12a; Shaareiy Ephraim 10:44, brought in Shaareiy Teshuvah 288:13] Other Poskim however rule it is not needed to be said. [2^nd opinion in Admur ibid; Rama 287:1; Rambam Shabbos 24:5; omitted in Michaber Y.D. 335:6; Tana Kama in Shabbos ibid; See Taz 287:1;] Practically, the custom is not to say it. [Admur ibid; Rama ibid]

[65] Admur 287:1; M”A 288:14; Shaareiy Ephraim 10:44

Other opinions: Some communities are accustomed to recite “Hamakom Yishlach Lecha Refua Sheleima Besoch Shaar Cholei Yisrael” even on Shabbos, seemingly relying on the opinion of Ramban ibid. [M”A 288:14] However, to say more than this is forbidden according to all opinions. [M”A ibid]

[66] Admur 288:9; Michaber 288:10; Shach Y.D. 335:10

[67] Admur 288:9; Rama 288:10

[68] Admur 288:9; See M”A ibid and Machatzis Hashekel ibid

[69] Admur 288:9; M”A ibid

[70] Admur 288:9; Kuntrus Acharon 288:2; Based on Maharam 603

[71] Admur ibid

[72] See Mateh Ephraim 584:25; Siddur Yaavetz; Likkutei Maharich p. 29

[73] Shaar Hakolel 26:4-2; Sefer Chamisha Mamaros and Chaim Veshalom Seder Kerias Hatorah of Munkatcher; Poskim in Nitei Gavriel Yom Tov 47:22

[74] The reason: As also Yom Tov is called Shabbos. [Shaar Hakolel ibid; Chaim Veshalom ibid] Alternatively, as this statement has mystical meaning, as its Roshei Teves represent the name of Hashem that heals the sick. [Chaim Veshalom ibid; See also Toras Levi Yitzchak Gittin 7; Meiri Shabbos 12; Likkutei Sichos 11:296; 16:520 that Shabbos itself brings the Refua]

[75] See Shaar Hakolel ibid; Received from Rabbi Leibel Groner in written correspondence; And so also ruled to me Rabbi Y.S. Ginzberg and Rav Eli Landau, although they did not receive any explicit tradition in this matter

[76] Admur 119:3; M”A 119:1; See Brachos 34a who says one does not have to mention the name; Admur and M”A ibid establish the Gemara to refer to a case that the ill person is front of him

[77] Kneses Hagedola Y.D. 240 in name of Sefer Chassidim; Rav Akiva Eiger; Kaf Hachaim 119:6

[78] Mavor Yabok Mamar Sifsei Tzedek 8, brought in Chida Shiyurei Bracha Y.D. 335

[79] See Sefer Chassidim 237; Zohar Lech Lecha p. 84; Shulchan Menachem 1:266

[80] Brachos 10a in story of Chizkia and Yeshaya the Navi

[81] Kesubos 104a that Rebbe’s mother prayed for him to die due to his suffering; Nedarim 40a “He does not pray for him to live or die” as explained in Ran ibid; Bava Metzia 4; Aruch Hashulchan 335:3; Igros Moshe Choshen Mishpat 2:73

[82] Brachos 10a in story of Chizkia and Yeshaya the Navi

[83] Rama 335:10

[84] Nimukei Yosef; Ran brought in Beis Hillel 335

[85] Rama Y.D. 335:10; Michaber E.H. 129:18; Rosh Hashanah 16b “Four matters tear the evil decree against a person and one of them is changing the name”; See Yuma 83b

[86] The source: So was seen regarding Sarah, that after her name was changed she was able to have children and the original decree of barrenness was removed. [Rosh Hashanah ibid]

Selling the child: See Sefer Chassidim 245 that it is a Segula for the parents to sell the sick child to another person, and through doing so the child has his decree removed.

[87] Shelah Hakadosh Hakdama Beis Acharon; Tanya Shaar Hayichud Vaemuna 1; Likkutei Torah Bahar p. 41; Igros Kodesh 5:123; See Taamei Haminhagim p. 105 in name of Yechiel Michel; Sefer Chassidim 244 for the effect of the name on the person

[88] See Taamei Haminhagim p. 105

[89] See Igros Kodesh 13:250 [printed in Shulchan Menachem 5:165]

[90] Rama Y.D. 335:10; Shulchan Menachem 5:164

[91] Igros Kodesh 13:250 [printed in Shulchan Menachem 5:165] See however Sefer Hamamarim 1949 p. 90 that when the son of the Alter Rebbe, Avraham, was sick, they changed his name to Chaim Avraham in the presence of a Minyan of Jews, not during Davening or Kerias Hatorah.

[92] Michaber E.H. 129:18; Mordechai; Hagahos Maimanis 3

[93] Beis Shmuel 129:35

[94] Beis Shmuel 129:35

[95] Michaber E.H. 129:18; Igros Kodesh 13:250 [printed in Shulchan Menachem 5:165]

[96] See Beis Shmuel 129:34

[97] Ziv Hasheimos 28:3

[98] Chida in Devash Lefi Mareches Shin 14, brought in Taamei Haminhagim p. 105

[99] Kitzur Shelah Inyanei Sefer Torah, brought in Taamei Haminhagim p. 105

[100] Kitzur Shelah Inyanei Sefer Torah, brought in Taamei Haminhagim p. 105; Minchas Elazar 4:27; Darkei Chaim Veshalom 929

[101] Beis Shmuel 129:35

[102] Beis Lechem Yehuda 335

[103] See Lechem Hapanim Kuntrus Acharon 335 in name of Shvilei Emunah

[104] Michaber 335:7; Miseches Semachos

[105] Sefer Chassidim 718; Yosef Ometz p. 324 in name of Rabbeinu Yerucham; Sefarim in Nitei Gavriel 1:1; See Michaber 335:7 regarding collecting debts and paying loans

[106] Seder Viduy of Ramban, printed in Darkei Chesed p. 256

[107] Chochmas Adam 151:11

[108] Igros Kodesh 4:373 that so was said in past; Heard from Rav Groner in name of the previous Rebbe

[109] See Igros Kodesh ibid; The Rebbe wrote a will sometime in 1987; Heard from Rav Groner

[110] See Kochavei Yitzchak 1:22; Igros Moshe O.C. 2:111; Yechaveh Daas 3:85

[111] Sefer Chassidim ibid

[112] Igros Kodesh ibid

[113] Rama C.M. 257:7; Mavor Yaabok Sifsei Tzedek 8

[114] See Shulchan Aruch Choshen Mishpat chapters 276 for the order of inheritance, and that when there are sons, no one else inherits, including daughters. See chapter 281-282 regarding redistributing the will against the above guidelines, and when it is valid to do so.

[115] See Michaber C.M. 281:1 that certain redistributions, such as completely removing a heir, are legally invalid in all cases; See Michaber 281:5 that redistributions in a Lashon of Yerusha are never legally binding if the person is currently healthy, and they are binding only if the person is ill at the time of the will; See Michaber 281:7 that redistributions are legally binding in all cases if given as an inter-vivo gift prior to death and not Lashon Yerusha. See however Michaber 282:1 and Admur Hilchos Mechira 8 that even when redistribution maintains Halachic legality, it is not initially permitted to do so. However, there are certain cases of exception, and hence a Rav is to be contacted.

[116] Even when a redistribution is legally permitted, often, a Kinyan must be made in order to finalize its legal status, and if a Kinyan is not made, it can jeopardize the entire validity of the will, even if its form of distribution is permitted. This last issue is relevant when one makes a secular will without any formal Kinyan, such as Kinyan Suddar, and enters the question as to whether such a will is legally binding onto the traditional Halachically rightful heirs, even if it was written in a way that does not transgress the laws of Yerusha. This matter is discussed extensively in Achronim, who try to vindicate the custom of many for hundreds of years to rely on a secular will without any formal Kinyan: See Michaber C.M. 281:1-5; Radbaz 1:67; Achiezer 3:34; Igros Moshe E.H. 104; Rama 257:7; Maharam in Mordechai Bava Metzia 254

[117] There are legal and Halachically binding will documents offered by Rabbanim and lawyers that combine one’s secular will with the Halachically permissible terms of contract. For example, if one has a son, and desires to inherit his estate also to his daughter, who Halachically is not meant to receive inheritance in such a case, then he must create a contract which circumvents this prohibition. There are various methods in how this can be accomplished. It is beyond the scope of this book to enter all the details involved in will writing, although we will briefly address inheriting to daughters. The most common method used today is through writing a typical secular will that does not completely leave out any Halachically destined heir, and the attaching to it a Shetar Chatzi Zachar, otherwise known as an IOU document, which enforce the heirs to comply by the will, otherwise they will have to pay the enormous debt written in the IOU. [See Dinei Yerusha by Rabbi Ari Marburger]  

[118] Michaber 276:1; Bamidbar 27:8

[119] Such as giving each unmarried daughter a 10^th of the estate. [Even Haezer 113:4; Kesubos 68a]

[120] See Rama C.M. 281:7 that so is the custom

[121] Rama C.M. 281:7; Mordechai Yeish Nochlin; However, see ibid that only those assets acquired prior to this contract being written are under distribution for the daughter.

[122] Rama ibid that so is custom; This is known as a Shetar Chatzi Zachar

[123] Lechem Shlomo Y.D. 2:67 [Shlomo Zalman Ehrinreich, Rav of Silvaniei 1863-1944]; Peri Hasadeh 2:44; Kochavei Yitzchak 1:22 in the name of the Shinaver Rav; Igros Moshe 2:111; 4:48; Beir Moshe 8:118; Cheshev Haeifod 3:50; Yabia Omer 3:85; Rav Elyashiv in Koveitz Teshuvos 1:19; Teshuvos Vehanhagos 4:325; Kav Hachaim 26

[124] Rav Meir Shapiro, the Rosh Yeshivah of Yeshivas Chachmei Lublin, had a very large life insurance policy, even though he unfortunately had no children. His reason was that since fundraising for the yeshiva was completely on his shoulders, he was concerned that in the event of his premature death, the Yeshiva would be forced to close. We see that he was not concerned with any of the issues discussed below and felt that purchasing insurance was an appropriate course of action.

[125] Even Yisrael 9:161 writes he does not feel right to obligate people to buy life insurance as perhaps the fact that one ‘s family is dependent on him monetarily is a reason in heaven to keep him alive. Likewise, it will remove the great Mitzvah and Zechus that Klal Yisrael has in providing for orphans and widows; See Teshuvos Vehanhagos ibid

[126] The reason: Several reasons and rebuttals are suggested for why one should not purchase life insurance.

1) The Gemara [Sota 48b] states that anyone who has money in his pocket and states “How will I live tomorrow” is amongst those that have little faith. From here it is possible to learn that one should not worry about what will happen after 120 years. On the other hand, the same way one is to continue working each day even though he has money in the bank to last him until tomorrow, so too he should make a life insurance policy. The Gemara’s words mean to say that one should not worry about the issue, however certainly one is to place physical effort to achieve tomorrow’s pay. [Igros Moshe ibid; Yabia Omer ibid]

2) One is not to open the mouth of the Satan and begin discussing matters of death. [See Brachos 19a and 60a; Kesubos 8b; M”A 239:7] Since the policies are based on the death of the policy holder, and it mentions his death in various places of the document, therefore one should not make a policy. On the other hand, the Rivash 114 [based on Menachos 42a and Beis Yosef Yoreh Deah 339] rules that one may purchase a Kever while alive, and hence we see that doing matters that prepare for death is not considered to be opening the mouth of the Satan. [Lechem Shlomo ibid]

3) Perhaps the fact that one’s family is dependent on him monetarily is a reason in heaven to keep him alive. If one purchases a life insurance policy, then this merit will disappear. [Even Yisrael ibid] A counter claim to this is that to contrary, having a life insurance is a Segula for long life being that the Mazal of life insurance companies is to be wealthy, and hence prevent them from losing money by having to pay out a policy in the event of death. [Kochavei Yitzchak ibid]

[127] In response to the authors query addressed to Rabbi Leibel Groner regarding the Rebbe’s position on life insurance, and the rumors that the Rebbe encouraged it, he replied: I have never heard that the Rebbe should encourage it.

[128] In Sichas 13^th Tammuz 1951 the Rebbe stated as follows: “The concept of selling life insurance is a business from the side of Kelipa. Instead of going and announcing to people that they can purchase life, he announces on the contrary that one is to already now to arrange what will happen after 120 years, and therefore everyone should buy a policy through giving a small amount each year and thus being secure that when the time come they will take care of him monetarily. This job requires great effort and is contrary to logic: Why does one need to speak with others about what will happen after 120 years when he can speak to him about joyful matters. The Rebbe Rashab once told a Chassid who desired to write a will which included giving money to charity, that he should give the money now to charity and not wait for later.”

[129] Mor Uketzia 328; Rambam Mamarim 2:4; See Likkutei Sichos 3 Metzora footnote 16

[130] Mor Uketzia ibid;

[131] See Sefer Chassidim 234; Makor Chesed ibid; Kesubos 104a; Nedarim 40a; Bava Metzia 4a

[132] Rav Dovid Fink in name of Gedolei Haposkim from which he heard this from

[133] Rav David Fink; Rav Asher Weiss via phone call

[134] See Nishmas Avraham 2:339 pp. 451-482 in great length for opinions, and correspondence letters of Gedolei Haposkim; 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”

[135] 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.

[136] The three most vital organs on which human life is dependent is undoubtedly 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.

[137] 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

[138] 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.

[139] 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 family’s wishes.

[140] Igros Moshe Y.D. 3:132; 8:54 “The doctors accepted the Halachic position of death, which is the Harvard criteria”; See Tzitz Eliezer 13:89 based on Chasam Sofer that brain-death is defined as death, in contradiction to his other responses in 10:25; 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 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.

[141] 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.

[142] Tzitz Eliezer 10:25 based on Chasam Sofer and Chacham Tzvi and Rashi in Yuma ibid; Minchas Yitzchak 5:7; 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]

[143] 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.

[144] See Igros Moshe Y.D. 3:132; 8:54; See Tzitz Eliezer 13:89

[145] 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;

[146] 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; 2^nd 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. [Hagahos Maimanos Rotzeiach 1:14 in name of Yerushalmi; Radbaz Leshonos Harambam 1582]

[147] Igros Moshe ibid; Tzitz Eliezer ibid; Poskim ibid

[148] Igros Moshe 1:103

[149] Nishmas Avraham p. 533 in name of Gedolei Haposkim

[150] Nishmas Avraham p. 533

[151] Minchas Yitzchak 6:103

[152] See Nishmas Avraham p. 294

[153] 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

[154] 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

[155] 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]

[156] Such as corneal donation; Skin grafting

[157] 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.

[158] Rav SZ”A in Minchas Shlomo Tinyana 86:5

[159] Minchas Yitzchak 5:7-22, based on Radbaz 3:627; Tzitz Eliezer 13:91

[160] 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]

[161] See the journal of the RCA [110 pages long] on this issue titled “Halachic Issues in the Determination of Death and in Organ Transplantation”

[162] 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

[163] See Nishmas Avraham ibid p. 480

[164] See Nishmas Avraham ibid p. 477 and 479 in name of Rav SZ”A and Minchas Yitzchak; Heard from Rav Yaakov Yosef za”l

[165] 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”

[166] See Igros Moshe Y.D. 3:132; Tzitz Eliezer ibid

[167] 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.

[168] 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

[169] 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]

[170] 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

[171] 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

[172] 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]

[173] 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

[174] 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]

[175] 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]

[176] Gesher Hachaim 5:6 based on Michaber 348:3

[177] 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.

[178] 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

[179] See Nishmas Avraham ibid

[180] Poskim in Nitei Gavriel 48 footnote 20

[181] 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]

[182] 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.

[183] Igros Moshe Y.D. 2:151; Rav SZ”A, brought in Nishmas Avraham 2:522

[184] See SSH”K 64:13; Piskeiy Teshuvos 311:1 [old edition and new edition]; Nishmas Avraham 2:533

[184] 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

[185] See Chapter 4 Halacha C!

[186] 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]

[187] 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

[188] See Chasam Sofer Y.D. 336; Radbaz 2:484

[189] Gesher Hachaim ibid

[190] A DNI or “Do Not Intubate” order means that chest compressions and cardiac drugs may be used, but no breathing tube will be placed.

[191] A DNR or “Do Not Resuscitate” order applies to situations where the patient has a respiratory arrest (stops breathing) or a cardiac arrest (heart stops beating). DNR means that no CPR (chest compressions, cardiac drugs, or placement of a breathing tube) will be performed.

[192] An AND or “Allow Natural Death” order is a term used at some hospitals as an alternative to the more traditional DNR order. While a DNR simply states that no attempts should be made to restart breathing or restart the heart if it stops, an AND order is used to ensure that only comfort measures, designed to provide excellent control of pain or other symptoms, are taken. This includes withholding or discontinuing resuscitation, artificial feedings, fluids, and other treatments that prolong the dying process without adding to the patient’s quality of life. Allowing a natural death means not interfering with the natural dying process. It also means that every effort will be made to have the patients time of death be calm and peaceful, with him surrounded by as many family and friends as you wish.

[193] For a Halachic overview of this subject, See: Igros Moshe Y.D. 3:132; Tzitz Eliezer 13:89; Beis Avi 2:153; Nishmas Avrahom 2:483-490 [for summary]; Nitei Gavriel 2:8

[194] Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including a heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. The American Heart Association recommends that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions. It’s far better to do something than to do nothing at all if you’re fearful that your knowledge or abilities aren’t 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone’s life.

[195] Admur 329:3; Michaber 329:4; Yuma 85a; See regarding the permission to give medical treatment to a Goses: Shvus Yaakov 3:75, brought in Pischeiy Teshuvah 399:1; Gilyon Maharsha 339

[196] See Nishmas Avraham Y.D. 339 p. 450 that when the author [who is a doctor] asked Rav S”Z Aurbach as to the exact Halachic definition of a Goses, he replied “You’re the doctor”

[197] See Rama 339:1, Taz 339:2 and Shiltei Giborim Moed Katan that it is permitted to remove something that is delaying the death of a Goses, such as if there is a banging noise nearby, it may be stopped. Accordingly, one is certainly not required to help save the life of a Goses; See Beis Yaakov 59, brought in Gilyon Maharsha ibid, that one may not give a Goses medical treatment that will lengthen his death; See also Sefer Chassidim 234, brought in Beis Lechem Yehuda 339, that one is not to scream when a person is in the process of passing away as doing so can cause the soul to return to the body and suffer extra anguish. On this the verse in Koheles states “Es Lamaves/there is a time of death”, meaning to say that when a person reaches his time of death one should not try to elongate it, as even if he lives an extra few days, it will be a life of suffering. [Sefer Chassidim ibid]; See also regarding praying for someone who is ill and in suffering to die: Ran Nedarim 40a based on Kesubos 104a that Rebbe’s mother prayed for him to die due to his suffering; Aruch Hashulchan 335:3; Igros Moshe Choshen Mishpat 2:73

How to answer the source from Admur 329:3 that one may desecrate Shabbos for even momentary life: Admur 329:3, based on the Gemara and Poskim ibid, rules one may desecrate Shabbos for one with a crushed skull even if one knows the person will live only a mere moment longer, even if Shabbos is desecrated. This would imply that every moment of life is precious, and one is obligated to help save him even if he will only live slightly longer. Some Poskim, however, suggest that the case in 329:3 does not refer to a Goses, and there is a difference between a Goses and one with a crushed skull. [Beis Yaakov 59] This however is difficult to accept, as it is clear from the Poskim that the person in question there has a crushed head and is most certainly a Goses who will die at any moment, and thus why would he not be considered a Goses. Perhaps, however, one can differentiate between prolonging the life for a mere moment in a case of a sudden tragedy, to one with terminal illness who is knowing pain, and wants to die. [See Beis Yaakov ibid; See Igros Moshe Y.D. 3:132 who differentiates between natural Goses versus a trauma Goses, however see Tzitz Eliezer ibid who argues] Alternatively, perhaps we can say that it is merely allowed to prolong the life of a Goses and not an obligation. Or, perhaps the difference is regarding the will of the patient, as only when he says that he does not wish to live any longer to we respect his wishes in the state of Goses. Vetzaruch Iyun. See the following Poskim who discuss this issue regarding if indeed one may desecrate Shabbos for a Goses: Beis Yaakov 59, brought in Gilyon Maharsha Y.D. 339, based on Shach 339:1; Shvus Yaakov 3:13, brought in Gilyon Maharsha Y.D. 339; Tosfos Nidda 44b; Chasam Sofer 338; Minchas Chinuch 32 Mileches Hotza; Biur Halacha 329:4 “Ela”; Igros Moshe Y.D. 3:132; Tzitz Eliezer 13:89; Teshuvos Vehanhagos 1:861; Minchas Shlomo 1:91-24; Shevet Halevi 8:86; Divrei Moshe 1:95; Piskeiy Teshuvos 329:6; Poskim in Nitei Gavriel 2:4 footnote 5

[198] The reason: As it is an obligation for one to do all in his power for himself, or another Jew to live, and we do not have any precedent to allow, or not prevent, shortening of life simply to ease one of pain.

[199] See Igros Moshe Y.D. 3:132; Tzitz Eliezer ibid

[200] See Aruch Hashulchan 339:4; Tzitz Eliezer 13:89; Igros Moshe Y.D. 2:174-3; C.M. 2:74-1; 75; Rav SZ”A quoted in Nishmas Avraham 2:339 p. 483-487; Rav Elyashiv, brought in Nishmas Avraham ibid; So I was also ruled by Rav Asher Weiss; Rav Yosef Shusterman and Rav David Fink Tzitz Eliezer 13:89

[201] See Poskim ibid that the allowance is only if the person is in pain, as we should not actively lengthen a painful life that in any event contains a terminal illness.

[202] See Tzitz Eliezer 13:89 based on Poskim ibid regarding Gesisa that one may even remove him from life support, and certainly one is not to reattach him

[203] Rav SZ”A in Nishmas Avraham 2:339 p. 487

Other opinions: Some Poskim rule that one is required to save a person’s life in all situations that he is not living a life of pain, even if he has a terminal illness, and it is thus forbidden to sign a DNI or DNR order in such a case. [Rav Elyashiv, brought in Nishmas Avraham ibid; So I was ruled by Rav Asher Lemel Hakohen]

[204] Rav SZ”A quoted in Nishmas Avraham 2:339 p. 483-487; Rav Elyashiv, brought in Nishmas Avraham ibid; Tzitz Eliezer 13:89; Igros Moshe Y.D. 2:174-3; C.M. 2:74-1; 75; See Aruch Hashulchan 335:3; and all Poskim in next footnote; So I was also ruled by Rav Asher Weiss; Rav Yosef Shusterman and Rav David Fink

[205] The reason: As it is permitted to remove something that is delaying the death of a Goses, and accordingly, one is certainly not required to help save the life of a Goses. [See Rama 339:1, Taz 339:2 and Shiltei Giborim Moed Katan; See Beis Yaakov 59, brought in Gilyon Maharsha ibid, that one may not give a Goses medical treatment that will lengthen his death; See also Sefer Chassidim 234, brought in Beis Lechem Yehuda 339, that one is not to scream when a person is in the process of passing away as doing so can cause the soul to return to the body and suffer extra anguish.] On this the verse in Koheles states “Es Lamaves/there is a time of death”, meaning to say that when a person reaches his time of death one should not try to elongate it, as even if he lives an extra few days, it will be a life of suffering. [Sefer Chassidim ibid] Now, if someone is in suffering, certainly it is forbidden to lengthen their suffering by delaying their death. [Tzitz Eliezer ibid; Igros Moshe ibid; Nishmas Avraham ibid; See also regarding praying for someone who is ill and in suffering to die: Ran Nedarim 40a based on Kesubos 104a that Rebbe’s mother prayed for him to die due to his suffering]

How to answer the source from Admur 329:3 that one may desecrate Shabbos for even momentary life: See footnotes above. Vetzaruch Iyun!

[206] Rav SZ”A brought in Nishmas Avraham 2:339 p. 483; Tzitz Eliezer 13:89; See however, opinion of Rav Elyashiv, brought in Nishmas Avraham ibid p. 488 and of Igros Moshe C.M. 2:74-1 that in certain circumstances one may abstain from even these treatments, however if he needs help breathing he must be given oxygen

[207] Note of the author: I was involved in this story first hand

[208] Note of the author: I was involved in this story first hand

[209] This follows the ruling of Rav Elyashiv, and possibly also Rav SZ”A, quoted above in C, that if there is no pain, one is not to sign the form.

[210] Michaber 338:1

[211] Michaber ibid; Mishneh Sanhedrin 43b

[212] See Michaber ibid “Many have confessed and have lived. In the merit that you will confess, you will live.”; Mavor Yabok Mamar Imrei Noam 15 “Confession many times lessens the illness, as it sweetens the judgment”;

[213] Michaber 338:1; Shabbos 32a

[214] Shach 338:1

[215] Beis Lechem Yehuda 338 in name of Sefer Zichronos: “It is a great Mitzvah to talk to the sick person and persuade him to recite Viduiy while he is still in a clear state of mind, and not to delay until he reaches a state of unconsciousness. A Choleh that has alacrity precedes and recites the Viduy and supplications early while he still has strength available.”; Shlah Pesachim

[216] Mishmeres Shalom Vav 1; Nitei Gavriel 1:8 footnote 9 in name of Poskim

[217] Michaber ibid; Ramban in Toras Hadam

[218] Shach 338:1; Perisha 338

The reason: As this can break his heart and worsen his condition. [ibid]

Other opinions: Some Poskim rule that the ill person is to be told to confess because he is nearing death. [Bach 338, brought in Shach ibid]

[219] Beis Lechem Yehuda 338 in name of Sefer Zichronos

[220] Michaber 338:1; Tur 338

[221] Michaber 338:1

[222] Seder Viduiy of Ramban, printed in Darkei Chesed p. 286; See Beis Lechem Yehuda 338 in name of Sefer Chassidim: “Tzadikim are accustomed to wash their hands prior to passing away”

[223] Seder Viduiy of Ramban, printed in Darkei Chesed p. 286

[224] Nitei Gavriel 1:10

[225] Mavor Yabok Sifsei Tzadik 10

[226] See Shaar Hatziyon 606:22; Nitei Gavriel 1:9

[227] Seder Viduiy of Ramban, printed in Darkei Chesed p. 286

[228] Rama 338:1

[229] Rama 338:2; Kol Bo

[230] A Moda’ah is a proclamation made in front of witnesses in which the sick person states that if at the end of his life the Satan seduces him to deny G-d, it should be viewed as nullified and void. The reason there is worry for such an event is because at the end of one’s life, the Satan tries to persuade a person to deny G-d. See Shlah Miseches Pesachim 147a; Mishmeres Shalom Mem 70; Nitei Gavriel 1:11

[231] Seder Viduy of Ramban, printed in Darkei Chesed p. 286; Mavor Yaabok Sifsei Tzedek 9

[232] Mavor Yaabok Sifsei Tzedek 9

[233] Printed in Darkei Chesed p. 256

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