Saturday, November 25, 2006

Giving of Oneself

Rabbi Shemuel Eliyahu, chief rabbi of Tzefat and son of former Rishon le-Tziyyon (Chief Sephardic Rabbi of Israel) R. Mordechai Eliyahu, gave a rather interesting shiur at the HODS conference last week (November 16, 2006). I would like to share a brief summary of what he spoke about.

R. Eliyahu discussed the issue of whether one person may place himself into a potentially dangerous situation (safek sakkanah) to save his fellow from an absolute danger / risk to life (vadai sakkanah). This question has been discussed extensively by the posekim (a modern example was the question of the permissibility of kidney donation) and the general consensus is that while a person is certainly not obligated to enter such a safek sakkanah situation, one may nonetheless choose to do so.

This week in particular, it is appropriate to note that the Tzitz Eliezer thought that a person is forbidden to undertake a safek sakkanah to save his fellow (9:45, 10:25:7, 13:100-101 [regarding war]). R. Eliyahu assumed the majority position and did not refer to R. Waldenburg's opinion. Hopefully, the Tzitz Eliezer's position will be the subject of a future post.
In all of the cases discussed by the posekim, the person in question wanted to know if he must / should / should not undertake a safek sakkanah to save his fellow. The danger to the questioner is uncertain. R. Eliyahu posited that we could expand this idea to cases where a person could voluntarily undertake a vadai sakkanah – meaning death – to save his fellow from death.
R. Eliyahu cited the story of Pappus and Lulyanus (Taanit 18b) who gave themselves up to the Roman government – vadai sakkanah (death) – to save the citizens of Lod from certain death. R. Eliyahu argued that all of the sources that seem to say that one may not sacrifice one life to save another – all refer to cases where an outside force is compelling the taking of the life – meaning that no third party can choose one life over another – ein dohin nefesh mipnei nefesh (Sanhedrin 72b). However, if a person would voluntarily offer his own life, like Pappus and Lulyanus – such an act is worthy and such a person is considered holy. [R. Eliyahu limited this position to allow a person to voluntarily forgo hayyei sha'ah only and not more. This was a sub topic of the shiur and will not be addressed here.]

The practical ramifications of this involve a gossess (moribund patient) who previously agreed that were he to become a gossess, he willingly forgoes the small amount of time left in his life so that his organs may be used to save another person (removing the organs results in certain and immediate death). R. Eliyahu argued that since such a patient is a volunteer, he may risk a vadai sakkanah (death) to save another person. He argued this position regardless of how one views brain death – even the position that assumes that a brain dead patient is fully alive, he argued, would agree that such volunteerism is permitted (and possibly praiseworthy).

This is a novel and dare I say, radical position, that I do not believe has received much attention by the medical halakhic community.

Thursday, November 23, 2006

Tzitz Eliezer passes away at age of 89

Rav Eliezer Yehuda Waldenberg best known as the Tzitz Eliezer after his monumental halachic treatise Tzitz Eliezer passed away in Jerusalem on Tuesday Novermber 21, at the age of 89.

He was a leading rabbi and a dayan on the Supreme Rabbinical Court in Jerusalem and was considered an eminent authority on medical halacha. He was the rabbi of the Shaare Zedek Medical Center in Jerusalem.

Rav Waldenberg's involvment in medical ethics began during the period that he served as rabbi of a synagogue adjacent to the old location of Sha'arei Tzedek Hospital in downtown Jerusalem.
Professor Avraham Steinberg, a pediatric neurologist and head of the Medical Ethics Center at Sha'arei Tzedek Hospital recalled that "Doctors who prayed at the synagogue, myself included, started asking him questions. Eventually, he began teaching a weekly medical ethics class for doctors and nurses."

The questions Waldenberg answered were compiled in his Tzitz Eliezer. Though he wrote numerous books and articles in all fields of halacha, he was best known for his decisions on medical issues such as fertility, abortion, organ transplantation, euthanasia, autopsies, smoking, cosmetic surgery, and medical experimentation.

Rav Waldenberg forbade performing elective surgery on someone who is neither sick nor in pain, such as cosmetic surgery, arguing that such activities are outside the boundaries of the physician's mandate to heal. (Responsa Tzitz Eliezer, 11:41; 12:43.) Notably, Rav Moshe Feinstein disagreed with this opinion.

Unlike most halachic authorities, Rav Waldenberg held that abortion performed by a Jew was not considered murder. He allowed first trimester abortion of a fetus which would be born with a deformity that would cause it to suffer. He futher permitted the termination of a fetus with a lethal fetal defect such as Tay-Sachs disease up to the end of the second trimester of gestation. (Ibid. 9:51:3.)

Another unique ruling was Rav Waldenberg's complete opposition to in-vitro fertilization (IVF). He ruled that a child conceived outside the womb, through IVF bears no halachic relationship either to the biological parents or the "surrogate mother," the woman who carries the child to term. According to Rav Waldenberg, the baby produced from IVF is not related to the biological mother and father and, therefore, does not fulfill the Torah injunction to "be fruitful and multiply." As a result, the removal of sperm for the purpose of IVF was prohibited. (Ibid. 15:45.)

He was also one of a small but growing number of rabbis to forbid smoking. (“Should Jewish law forbid smoking?” B’Or ha’Torah 8)

In addition to his magnum opus, a 21-volume set of responsa entitled Tzitz Eliezer, Rav Waldenberg also authored a book on the laws of sea travel on Shabbat called Shvita b'Yam, a book on mourning laws called Ein Ya'akov and a book on legal issues in the modern state called Hilchot Medina.

Wednesday, November 01, 2006

Shomer Shabbos Residency Positions

I am reposting re: shomer shabbos residency positions. Many seniors will begin interviews soon and I would like to solicit your feedback. Information from residents would be extremely helpful regarding their own hospital/program.

For those seeking shomer shabbos or shabbos friendly residency positions--wouldn't it be nice to have an up-to-date list of programs with a few details about what they offer? The immediate solution is simple: organize recent graduates experiences. If you are a recent graduate and would like to help in this effort, please send a list (word.doc) to Please include:
1. Your name and contact information. (Anonymity will be granted if requested)
2. Specialty (ie. radiology, medicine, orthopedics, etc.).
3. Name of hospital.
4. Contact person in the program (usually the program director) with contact information.
5. Any other information that you think is pertinent.
6. How you know about the program (interviewed there, on staff there, etc.).
7. Contact information for someone (or several people) who are currently training in the program or did train in the program.
Yasher Koach to Dr. Dan Eisenberg for his efforts regarding this issue.