[Avodah] Lecture by Rav Moshe Tendler about Brain Stem
hankman at bell.net
Fri Mar 1 06:25:07 PST 2013
I think that taking the gemara that cues in on respiration to literally, might not be the intent there. Perhaps the gemara really means not the muscular act of respiration but the physiological process of respiration, ie, gas exchange that takes place in the lungs, thus the diaphragm is not the key to life but the physiology it enables might be. Similarly, the concern with circulation is also truly a concern with the physiology of gas exchange [and distribution of nutrients and elimination of wastes]. The concern, with the heart muscle is really with that of the function accomplished not the muscle itself]. In their day, these were pretty much the same thing. In our day of course there is a huge difference. I haven’t read R. Bleich but could his notion of “vital motion” really be the idea of “vital physiology” that sustains the entire body. I do not know if that would be consistent with what he wrote, but I think that in our day with our technology many of the gedolim would agree that this would have been what the gemara meant had there been a point in making this difference then. So ultimately the choice comes to the choice between the neurological control and sustenance of body physiology or the physiology of gas [and possibly nutrient]exchange that sustains the vital organs and the body or both.
Rav Micha has listed the position of many gedolim on brainstem death.
However, it is important to know and think about exactly what they held.
Many held that life is present as long as circulation is present. In the
era of modern technology this means that a body without any functioning
cells is still considered alive as long as some machine is pumping blood in
the vessels. So when you think about it a bit, this position makes little
sense. It is a vestige from a time when every function in the body stopped
with the cessation of circulation. When machines can provide circulation to
anything with tubing, it is necessary to identitify exactly why the person
without circulation is dead. This means identifying the function or tissue
which is crucial to the continued life of the person.
Currently there are only three major positions that have identified this
function: R. Tendler's brainstem death, R. Steinberg/Chief Rabinate
brain-respiratory death, and R. Bleich's vital motion. The first two,
while conceptually different, identify a person as dead when they fulfill
neurological criteria for death(Harvard criteria). R. Bleich defines life
as the presence of vital function, but has failed to define exactly what
that is or how exactly to find or measure it. (for a more robust but not
comprehensive critique of his position see my paper here:
R. Bleich is also dependent on Rashi to transform the gemara in Yoma from a
respiration based concept to a circulation based concept. In the recent
Tradition, R. Daniel Reifman has shown how it is very difficult to argue
that circulation is what Rashi had in mind. In addition, R. Bleich depends
on the Chatam Sofer, whom R. Reifman also shows did not intend to establish
circulation as a criteria for death independent of respiration.
It is important to also note that there is little to no support for R.
Bleich from other contemporary gedolim. contrary to the contention of R.
David Shabtai(Defining the Moment), there is little reason to think that
they would automatically move from a circulation based definition of life
to R. Bleich's nebulous 'vital motion'. Furthermore, even R. Bleich
himself(Tradition 16:4) agrees that R. Moshe defined life as the presence
of respiration, consonant with the Chief Rabbinate and R. Steinberg. R.
Moshe certainly does not agree with R. Bleich. SImilarly, RSZA does not
agree with R. Bleich and it is in fact difficult to find any gedolim who
specifically agree with R. Bleich's concept of vital motion. While they
may agree with his opposition to 'brain death', that does not imply that
they agree with his specific definition of death.
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