[Avodah] Brain Death

[Micha Berger]

On Sun, Jan 23, 2011 at 10:41:21AM -0500, David Riceman wrote:
> I'm saying "alive" and "dead" are primitive concepts which don't need
> definitions. Most actual cases are clear, but some important cases are
> not, and it is for some of those that we rely on hazakos.

Rather than my leaving both questions vague by not even suggesting the
start of answers, let's deal with what the Torah implies is human life.

Hashem takes some mud, "breathes" into it a soul, "vayehi adam lenefesh
chayah". So, what would I conclude? That chayim, in a halachic-chalos
sense of the word, implies some kind of relationshio between body and
soul. One that an unconscious person in a coma has (who is not brain
dead in any sense and whose heart and lungs operate on their own),
and yet someone who was recently niftar and still experiencing chibut
haqever does not.

That's not a scientific concept. The best we can do is find medical states
that are impossible when this connection exists, and test whether they
are present. That's where we get to question 2: establishing a chazaqah
that misah has occured.

Even that may be too weak. Perhaps it's possible that some physical and
thus empirically measurable process is always present when the person
is chai. Then we can know for sure, not just chazaqah, that if we do
not measure that process, he's dead.

Last, it's possible that we can't measure it, we can only measure
something that tends to be true when the person is chai, and thus need
to rely on chazaqah to close that certainty gap.

> Incidentally the distinction between "alive" and "[what] it means to
> be a living person" is too subtle for me. Can you explain it?

I don't make such a distinction. I make one between "alive" in colloquial
senses, the AMA definition, the definitions of various governments'
civil law, and the halachic concept of chayim. There is no reason to
assume they all always refer to the same set of physical medical states.

>> I was suggesting that R' Tendler's and the CR's position is based on
>> defining life in terms of the ability to have a self-caused heartbeat,
>> whereas the majority opinion is based on the ability to have a hea[r]tbeat,
>> regardless of what is making it beat.

To correct myself, as others already did... RMT speaks of self-caused
breathing -- not heartbeat. (Assuming I ignore the part where he instead
says it's about the breath's oxygen reaching the brain. But I can write
a parallel of the rest of this post using that variant.)

It's notable that the metaphor the Torah uses for the soul entering the
body is "vayipach be'apav", and that the Tanakh's usual terms for soul are
all related to breath: neshamah, ruach,and nefesh. I don't know /what/ to
make of it, but there must be some significance to this use of metaphor.
(I presume we agree that if Hashem is described as "vayipach be'apav"
we are speaking idiomatically, not literally.)

> Let's consider another case. If a married man falls into mayim sheyeish
> lahem sof and remains there for, say, 15 minutes, his wife may remarry.
> I would explain that falling and remaining in water creates a hazakah
> that the man is dead.

> RMB, as I understand him (henceforth RMBAIUH), would take that as an
> alternative definition of death (why is it any worse than no heartbeat?).

No, I would agree that we're relying on a chazaqah. However, that's a
different question.

Someone who almost definitely drowned is meis by whatever that word means.
The question of being very specific in our definitions isn't the central
one to knowing whether or not this woman is an almanah.

Is that true in our original case? Is it really about one saying that we
can presume someone is a meis when breathing can no longer be restored to
the body and another says that we can presume it when bedavqa *autonomous*
breathing can no longer be restored?

Or are they arguably in machloqes about what the word meis itself
means. One saying it relates to breath itself, and the other saying it
relates to the capacity to breath on one's own. Based on RMT's words,
he's looking for a different biological capacity because he believes
that misah is defined in terms of that capacity.

Thus, we aren't arguing about how much certainty is necessary, but rather
what it is we must be certain of.

I have a problem assuming it's about chazaqah for another reason...
Most cases of death do not involve donatable organs. Most people die
with organs worn out by age or tainted by disease. So in most cases
where we need to determine death, there is a clear "playing safe" side
to the question.

If everyone agreed what misah is, as well as what are the physical
symptoms of misah, and the question was how much sureness is "sure enough"
for a chazaqah, how could dinei nefashos not rely on the most conservative
test possible?

Tir'u baTov!
-Micha

-- 
Micha Berger             I long to accomplish a great and noble task,
micha at aishdas.org        but it is my chief duty to accomplish small
http://www.aishdas.org   tasks as if they were great and noble.
Fax: (270) 514-1507                              - Helen Keller