[Avodah] Brain Death

[Harry Maryles]

RNS has written a controversial post where-in he claims that Chazal's
statements about certain vital organs are to be taken literally and not
allegorically as I have always understood them to be. He made these
statements WRT to the controversy over the Halachic determination of
death. RYGB takes him to task on this issue on my blog post today.
 
In the interests of seeking truth -- I believe this is a very important
post and should not be missed:
 
HM

Emes Ve-Emunah
Brain Death and Chazal
Guest Post by Rabbi Yosef Gavriel Bechhofer

   Although approximately 20 years my junior, I consider Rabbi Yosef
   Gavriel Bechhofer to be my Rebbe. For about eleven years he gave what
   is arguably the most popular Daf Yomi Shiur in Chicago history.

   Attendance at his shiur given every day at 6:30 AM often numbered
   between 20 to 30 people. Included among his `students' at this shiur
   were some of the most prominent Jews in Chicago. Names that anyone
   who is aware of who's who in philanthropy would easily recognize.

   The regular attendees included prominent members of the right, left,
   and everything in-between. From Agudah to Mizrachi to Lubavitch. Rabbi
   Yechiel Eckstein, the president and CEO of the Fellowship of Christians
   and Jews was a regular member. After being shunned by some of the
   more right wing Shiurim in the city, he found a friend and mentor in
   Rabbi Bechoffer.

   Rabbi Bechhofer is not only a huge Talmid Chacham who has written
   Seforim in both Hebrew and English - he is an intellectual with
   an advanced university degree. He brings to the table a wealth of
   knowledge - both secular and religious - on many subjects. If one has
   any doubt about the breadth and depth of that knowledge one need only
   access one of his Shiurim given in Chicago given over 20 years ago.
   They are available at his [24]website. He is an independent thinker
   and does not follow anyone in lockstep fashion. He exemplifies the
   title of my blog: Emes Ve-Emunah.

   It is with all that in mind that I asked Rabbi Bechoffer to respond
   to a post written by Rabbi Natan Slifkin.

The issue is how to define the moment of death. The Gemarah tells us that
it is defined in specific ways such as when the heart stops beating or
when there is no longer any breathing. Until the modern era, that was
the way it was universally defined. But in the modern era technologies
have been developed that have found additional ways to determine death -
even while a patients heart continues to beat and he continues to breath
(usually via the aid of medical machinery).

We can now measure brainwaves. When brainwaves cease - a person is
considered medically dead. This means there is no activity going on in the
brain. This is called brain stem death. By keeping the patient breathing
and his heart beating it enables us to use his organs for transplant
purposes which can save many lives. Once those two functions stop -
the organs become necrotic and can no longer be used.

The problem is that the Gemarah does not discuss brain death. So may
Poskim do not accept it. This would make organ transplants impossible.
Rabbi Dr. Moshe Tendler has taken the controversial position that brain
death is indeed death and that Chazal would have been OK with that if
they had the technology. Rabbi Tendler has been the target of some
pretty heavy criticism for that. Rabbi Natan Slifkin (RNS) has made
note of that and defended Dr. Tendler in a recent post. He made some
interesting points. But is he right? Rabbi Bechoffer addresses that
issue in what follows.

This past Thursday, my friend Rabbi Natan Slifkin posted on his blog a
"Summary of the Life/Death Issue."

Rabbi Slifkin's post is an important one, as it goes to the heart
of what many of us find unacceptable with our colleague's approach.
I will try to be as brief as is possible without sacrificing clarity. I
therefore will limit myself for now to the opening section of Reb Natan's
posting. If there is need for further clarification, I will address the
rest of his statements.

RNS writes:
   The overall point of this discussion is to show that Chazal's views
   and rulings on life and death were fundamentally related both to the
   mistaken beliefs of the era about physiology as well as the limited
   medical possibilities. Thus, any halachic analysis of this topic must
   take this into account in order to be valid. Furthermore, our own
   understanding of physiology, together with the medical possibilities
   available to us, mean that brain death should be defined as halachic
   death.

This paragraph really cuts to the heart (no pun intended) of the matter.

When Rabbi Moshe D. Tendler proposed that "brain stem death" be the
criterion by which halachic death be established, he staked out a
controversial position (see the details of the current re-opening of
the controversy at [26]Hirhurim.

Nevertheless, his position was at no time and under no circumstances
predicated on an assumption that Chazal's views and rulings on life
and death were fundamentally related both to the mistaken beliefs of
the era about physiology as well as the limited medical possibilities.
Rabbi Tendler based his argument on a Mishnah in Ohalos and other sources
(see my [27]"The Determination of Death: Halachic Considerations" p.251).

His position took for granted the inviolability of the Halachic system
and of Chazal's unquestioned and unquestionable authority in the
determination and definition of that system and its parameters. Rabbi
Tendler's arguments were within the system - they inhered in its sources
and rulings, and were completely internal and intrinsic. Rabbi Slifkin,
on the other hand, reveals his cards right at the outset. He is here
setting out to demonstrate the "flaws" in the system, and on that basis
to suggest that it is outmoded and only partially relevant to contemporary
issues. His arguments are from without the system, and extrinsic thereto.

This point of view underlies much of my friend and colleague's writings
and is the basis of the uneasiness with which many of us regard his
perspective. We are accustomed to assume that Chazal are the final
arbiters of Halachah regardless of whatever thought process under-girded
their rulings. We assume that those thought processes are those of
human beings far greater than ourselves - of rishonim k'malachim -
and are very reticent to second-guess them, ever.

RNS writes:
    1. Chazal believed that the heart and kidneys are the seat of the
    mind and free will.

    At least some of Chazal - probably most or all - believed that the
    heart and kidneys are used as the mind and for making decisions
    (free will). Prooftexts are as follows:

	The Rabbis taught: The kidneys advise, the heart considers, the
	tongue articulates, the mouth finishes, the esophagus brings in
	all kinds of food, the windpipe gives sound, the lungs absorb
	all kinds of fluids, the liver causes anger, the gallbladder
	secretes a drop into it and calms it, the spleen laughs, the
	gizzard grinds, the stomach [causes] sleep, the nose [causes]
	wakefulness. (Berachos 61a; similarly in Midrash Vayikra
	Rabbah 4:4)

    This is not an aggadic legend intended to be understood
    metaphorically. The descriptions of the functions of the tongue,
    mouth, esophagus, windpipe, lungs, stomach and nose are all clearly
    scientific descriptions intended to be interpreted literally. The
    account of the liver causing anger is also consistent with standard
    belief in the ancient world. Thus, the account of the function of
    the kidneys and heart are thus also clearly intended to be literal
    descriptions - and there is no important role ascribed to the
    brain. This, too, is consistent with standard Aristotelian belief in
    the ancient world. The Rishonim and Acharonim agree that Chazal were
    speaking literally, as discussed in my monograph, The Question of the
    Kidneys' Counsel. Elsewhere, the Gemara relates halachos pertaining
    to the kidneys of animal offerings to the kidneys' function in man of
    providing counsel. Other Midrashim likewise echo this understanding
    of the role of the various organs:
	"'And God said to Moshe: Pharaoh's heart has become heavy
	(kaveid)' - He was angry. Just as the liver is angry, so too the
	heart of this one became a liver (kaveid), without understanding,
	as a fool. (Midrash Shemos Rabbah)

	"That is to say, the heart of Pharaoh was turned into a liver
	(kaveid) -- just as a liver has no understanding to understand
	and comprehend, so too there was no understanding in his heart
	to understand and comprehend. Therefore, his heart was hardened
	and was stubborn for him." (Midrash Lekach Tov)

	Like everyone else in the ancient world, Chazal thus likewise
	interpreted all Scriptural references to the heart (which most
	people today take as referring to the mind and thus the brain)
	literally. Scriptural references to the heart having various
	emotional states, to it housing wisdom and cognition, and to
	God judging a person based on examining his heart and kidneys,
	were all taken literally by Chazal.

Rabbi Slifkin is quite bold in his assertions. He purports to know
- and to tell us - when an aggadic legend intended to be understood
metaphorically. And he informs us categorically that these prooftexts are
(notwithstanding their Midrashic sourcing!) not metaphorical. But who
designated my friend the arbiter of these matters? One of my favorite
obscure seforim is [28]HaTalmud U'Mada'ei HaTeivel by Rabbi Yekusiel Aryeh
Kamelhar (Lvov, 1928). Rabbi Slifkin is familiar with this work as well,
as he quotes it in "[29]Messianic Wonders and Skeptical Rationalists"
in the Hakirah Torah journal, p. 203).

It is therefore curious that Rabbi Slifkin neglects to inform us of
Rabbi Kamelhar's detailed explanation (loc. Cit. ,p. 30ff.) of the
metaphorical meaning of the Gemara in Berachos, including the references
to the "counseling kidneys," etc. This omission is even more remarkable
considering Rabbi Kamelhar's explanation of the metaphors based on modern
medical knowledge!

Reb Natan's "rush to judgment" continues to be manifest in his citation
of the Midrashim concerning the metamorphosis of Pharaoh's heart into a
liver. A simple computer search would have revealed to him, as it did to
me, the august Chasam Sofer's metaphorical understanding of the Midrash
(Chasam Sofer Al HaTorah - Shemos 7:14; Sefer Chasam Sofer Al Meseches
Pesachim 7b;...or Sefer Agra DKalla 184b)

These are results that I came to in a very quick search. At the very
least, it is intellectually dishonest to not disclose that one's position
is by no means definitive. To respond that one has not done the research
is even more inexcusable.

Thus, it is untenable to assert - unilaterally and unequivocally! -
on the basis of such questionable sources that Chazal believed in a
certain medical system and that their positions are hence faulty.

RNS writes:
    2. Chazal were mistaken in this regard.

    That should be self-evident. We now know that it is the brain that
    is used for all cognitive processes and for making decisions. The
    heart and kidneys have no such role. In fact, the heart can be
    replaced by an artificial pump, and the kidneys can be replaced by
    a dialysis machine. Doing this does not impair a person's mind in
    any detectable, significant way.

    3. There is a fundamental connection between the mind/ free will,
    the soul, and the presence of a live person - and thus the mistaken
    belief that the heart and kidneys house the mind has fundamental
    ramifications on the question of determining death.

As we have demonstrated, Rabbi Slifkin's foundation is far from firm.
There is no definite evidence that Chazal believed that the heart and
kidneys house the mind. My colleague has built a house of cards upon which
he then continues to be dan dinei nefashos. Were I not to know that he is
a soft-spoken and humble person, my mind (the one in my brain...) would
be boggled by the the flippant regard towards Chazal implicit in his
approach. I therefore am dan l'kaf zechus that erroneous per-conceived
notions, traumatic experiences and harsh treatment have boxed Reb Natan
into a weltanschauung and an approach from which it is hard for him to
budge, regardless of its flaws.

posted by Harry Maryles | [30]9:48 AM |

References
24. http://rygb.blogspot.com/
25. http://www.blogger.com/(http://www.rationalistjudaism.com/2011/01/summary-of-lifedeath-issue.html),
26. http://torahmusings.com/2010/12/brain-death-in-the-news/
27. http://www.yasharbooks.com/Open/OpenAccess13.pdf
28. http://hebrewbooks.org/5931
29. http://www.hakirah.org/Vol%206%20Slifkin.pdf