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.


At 11:22 PM, Anonymous Ari said...

Even if I were to agree to this position (I'm not sure that I do) and assume that a person can give up his own life - how is a doctor permitted to perform the operation? Isn't he taking somebody else's life? This is not similar to the case of Papus and Lalyanus...

At 12:50 PM, Anonymous Mordy said...

By Papus and Lalyanus, weren't they also part of the decree? Meaning, had they not "sacrificed" themselves, wouldn't they have been killed anyway? Is that important?

At 6:12 PM, Anonymous Shalom said...

Did he say that his father agreed to this?

At 9:52 PM, Anonymous Anonymous said...

Why is this not considered a form of suicide. Even a gosses is forbidden to commit suicide?

At 11:54 PM, Anonymous David said...

How would you then explain the story of Papus and Lalyanus?

At 9:44 PM, Anonymous sammy said...

In response to Ari: I'm not sure why there should be such a distinction between the patient and the doctor. If indeed the patient is allowed to sacrifice himself, then it seems to me the doctor isn't doing anything wrong - he is merely acting as the patient's agent. Consider a theoretical case where the patient is a skilled surgeon who could harvest his own organs. Would you say that is the only case where we will allow self-sacrifice?

At 10:47 PM, Anonymous Daniel said...

Presumably this position would admit that indeed it is suicide, yet it's allowed because it is for the purpose of saving a life.

At 11:46 PM, Anonymous David said...


The Tzitz Eliezer (10:25:5) felt that the comparison you are trying to make is invalid. He writes that the doctor is a third party and even if you would agree to R. Eliyahu's position (he doesn't mention R. Eliyahu, but it is the same hypothetical position) - that would only permit a person giving his own life. It would not permit another person to take it from him.

R. Nati Helfgot asked something similar to this at the conference and R. Eliyahu responded along the lines that you suggested. He did not address R. Waldenburg's points though.

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