Definition of Death in Modern Medicine

1
??"?
????? ??? ????? ?????Definition of Death in
Modern Medicine HalachaB. Gesundheit MD PhD
Unit of Bone Marrow Transplantation, Cancer
Immunotherapy Immunobiology Research Center,
Hadassah Hebrew University Medical Center,
Jerusalem, ISRAEL
http//www.jewishmedicalethics.org gesund
_at_hadassah.org.il
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(No Transcript)
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Time of Death
?????
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Introduction
????? ??? ?????
Time of Death
Definition of Death

• Euthanasia
• Dementia, ALS,
• Neonatology
• Suicide

• Cadaver Organ Donation
• Autopsy

5
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Time of Death
?????

• ??????? ???????
• ????\????? ???? ??????
• ????? ??????
• ??????? ???????
• ???? ??????, ?????? ???? ?????
• ????? ?????
• ????? ???, ????? ?????
• ??????? ???????

• Clinical Relevance
• Continue / Stop treatment
• Organ donation

• Halachic Relevance
• Burial, Mourning, Yahrzeit
• Do not Kill
• Halacha for Shabbat,
• Inheritance
• Medical Clinical Relevance

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General Historical Background
No Breathing No Pulse
Farrell MM, Levin DL. Brain death in the
pediatric patient historical, sociological,
medical, religious, cultural, legal, and ethical
considerations. Crit Care Med. 199321(12)1951-65

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????? ??? ????? ??????
Death Irreversible End of Life (not only one
organ function) Social, philosophical,
religious, legal, emotional etc. components of
the definition
Troug RD, Fackler JC Rethinking brain death. Crit
Care Med 1992201705-13. Review.
8
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Heart Transplantation
1st
(Dec 3rd, 1967)

• ??? ??????? ???? ?-20
• Cardio-pulmonary Resuscitation ("??????")
• Transplantation Medicine
• New Definition of Brain Death (1959)
• 1967 1st Heart transplantation by
• Dr. Christiaan Barnard 1922-2001
• in Cape Town

Black PM. Brain death (first of two parts). N
Engl J Med. 1978299(7)338-44 Brain death
(second of two parts). N Engl J Med.
1978299(8)393-401. Presidents Commission for
the Study of Ethical Problems in Medicine and
Biomedical and Behavioral Research Defining
Death. Washington 1981. Wijdicks EF The
diagnosis of brain death. N Engl J Med.
2001344(16)1215-21.
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Heart Transplantation
Ethical / Halachic Questions
Donor
Denise Darvall (25 y) auto crash victim
Recipient
Patient
Louis Washkansky, (53 y), dentist
10
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Spirit Respiration
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Mishnah
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Mishnah Yoma 86-7 . and every possible danger
to human life suspends the laws of the Sabbath.
If debris fall on someone, and it is doubtful
whether or not he is there, or whether he is
alive or dead one should open even on Sabbath
the heap of debris for his sake. If one finds him
alive one should remove the debris, and if he be
dead one should leave him there until the
Sabbath day is over.
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Talmud
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Yoma 85a How far does one search? Until one
reaches his nose. Some say Up to his heart. If
one searches and finds those above to be dead,
one must not assume those below are surely dead.
Are we to say that these Tannaim dispute the
same as the following Tannaim? For it was taught
From where does the formation of the embryo
commence? From its head, as it is said Thou art
he that took me gozi out of my mother's womb,
and it is also said Cut off gozi thy hair and
cast it away. Abba Saul said From the navel
which sends its roots into every direction! You
may even say that the first view is in agreement
with Abba Saul, inasmuch as Abba Saul holds his
view only touching the first formation, because
everything develops from its core middle, but
regarding the saving of life he would agree that
life manifests itself through the nose
especially, as it is written In whose nostrils
was the breath of the spirit of life. R. Papa
said The dispute arises only as to from below
upwards, but if from above downwards, one had
searched up to the nose, one need not search any
further, as it is said In whose nostrils was
the breath of life.
14
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Harvery (1628) ????? ??? ????? ????? ??
??????. Heart has own pace-maker, can function
without body in physiological milieu ? beating
heart does NOT define life. "?? ?????" - ???
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E. Reichman The Halachic Definition of Death in
View of Medical History, Torah Umaddah Journal
1993 (4) 148ff.
15
London, British Library , Harley 5508 (Italy end
of 11th century) ???? ?? ?"? - ???? ?? ?"?
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Mishnah Ohalot 16 A person can not defile as a
corpse until his soul is gone forth, so that
even if he has his arteries severed or even if he
is in his last agonies he still makes levirate
marriage obligatory and liberates from levirate
marriage, qualifies his mother for eating
terumah and disqualifies his mother from eating
terumah. Similarly in the case of cattle or wild
animals, they cannot defile until their soul is
gone forth. If their heads have been cut off,
even though they are moving convulsively, they
are unclean moving. That is to say like a
lizard's tail, which moves convulsively.  
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Gesundheit B, Steinberg A, Glick S, Or R,
Jotkovitz A Euthanasia an Overview and the
Jewish Perspective. Cancer Invest.
200624(6)621-9.
19
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20
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• 1772 ???? ????????? ???? ????? ??? 3 ????
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Jacob Emden  (1697-1776)
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"????" ??????? ?????? ??????
"?? ?? ?????" ("?????? ??????")
Moses Mendelssohn (1729-1786)
Chatam Sofer Moshe Schreiber  (1762-1839)
????? ??????? "????? ??? ?????", ???? ?"?
(???"?), ??' ??-???.
21
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Sheep Experiment Prof A. Steinberg / Rav SZ
Auerbach
????? ?' ?"? ??? ????? ?? ????? ???? ?????!
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Arachin 7a But we have an established
assumption principle that the child dies first,
for we learnt A child one day old inherits and
bequeaths R. Shesheth said in explanation He
inherits the mother's property to bequeath it to
his brothers from his father. Now this as is
clearly indicated applies only to a child one
day old, but not to an embryo, because it would
die first and no son already in the grave can
inherit from his mother to bequeath to his
paternal brothers? This applies only to her
natural death, because the child's life is very
frail, the drop of poison from the angel of
death enters and destroys its vital organs, but
in the case of death by execution she dies first.
Decapitation Brain death with optimal ICU
support (Ventilation, Dopamine drip) vital organs
and fetus can survive
Steinberg A, Hersch M Decapitation of a Pregnant
Sheep A Contribution to the Brain Death
Controversy. Transplantation Proceedings 1995 27
(2),1886-7.
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Time of Death - Rabbinic Controversy
Chief Rabbinate of Israel (1985) RCA Living
Will (1990) Rav MD Tendler Rav SZ Auerbach
(after sheep experiment) Rav M Feinstein
Brain Death
Talmud Yoma 85a Heart function Rav SZ
Auerbach, Rav M Feinstein Rav Y Elyashiv, Rav
Bleich Breathing Sign of Life/Death Rashi,
Maimonides, Chatam Sofer
Cardio-pulmonary Death
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Conclusions

• Pikuach Nefesh overriding value
• ????? ??? ???? ?? ????? ????
• Brain Death is halachically accepted by most
  Rabbinic Authorities
• ???? ???? ? Modern medical questions according to
  the Talmud
• ? Make right decision ahead of time (????? ?'
  ????? ?')
• ? Education of the Jewish Community
• ? Education of Rabbis, medical schools,
• high schools, etc.
• ? Training of Jewish physicians and health
• care providers ? JME
• ? Sign Donor Card according to
• Halachic Guidelines

http//www.hods.org/English/videos
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BIBLIOGRAPHY
????? ??????? "??? ????" ???? ??????????? ??????
??????, ???"?, ??? ?', ???? 819 ????? ?????
??????? "????? ??? ?????", ???? ?"? (???"?), ??'
??-???. ?. ???? "????? ??? ???? ?????? ???????
????????", ??????, ???????, 1983
Abraham Steinberg Encyclopedia of Jewish Medical
Ethics Fred Rosner Modern Medicine and Jewish
Ehtics 2nd edition, 1990 ???
www. jewishmedicalethics.org Abraham Steinberg
Encyclopedia of Jewish Medical Ethics Fred Rosner
Modern Medicine and Jewish Ehtics 2nd edition,
1990 ???