Medical ethics in Judaism: What does the Torah know about modern medicine? Machon '18

Abortions

(כב) וְכִֽי־יִנָּצ֣וּ אֲנָשִׁ֗ים וְנָ֨גְפ֜וּ אִשָּׁ֤ה הָרָה֙ וְיָצְא֣וּ יְלָדֶ֔יהָ וְלֹ֥א יִהְיֶ֖ה אָס֑וֹן עָנ֣וֹשׁ יֵעָנֵ֗שׁ כַּֽאֲשֶׁ֨ר יָשִׁ֤ית עָלָיו֙ בַּ֣עַל הָֽאִשָּׁ֔ה וְנָתַ֖ן בִּפְלִלִֽים׃ (כג) וְאִם־אָס֖וֹן יִהְיֶ֑ה וְנָתַתָּ֥ה נֶ֖פֶשׁ תַּ֥חַת נָֽפֶשׁ׃ (כד) עַ֚יִן תַּ֣חַת עַ֔יִן שֵׁ֖ן תַּ֣חַת שֵׁ֑ן יָ֚ד תַּ֣חַת יָ֔ד רֶ֖גֶל תַּ֥חַת רָֽגֶל׃ (כה) כְּוִיָּה֙ תַּ֣חַת כְּוִיָּ֔ה פֶּ֖צַע תַּ֣חַת פָּ֑צַע חַבּוּרָ֕ה תַּ֖חַת חַבּוּרָֽה׃ (ס)
(22) When men fight, and one of them pushes a pregnant woman and a miscarriage results, but no other damage ensues, the one responsible shall be fined according as the woman’s husband may exact from him, the payment to be based on reckoning. (23) But if other damage ensues, the penalty shall be life for life, (24) eye for eye, tooth for tooth, hand for hand, foot for foot, (25) burn for burn, wound for wound, bruise for bruise.

(ז) הַמַּפֶּלֶת לְיוֹם אַרְבָּעִים, אֵינָהּ חוֹשֶׁשֶׁת לְוָלָד. לְיוֹם אַרְבָּעִים וְאֶחָד, תֵּשֵׁב לְזָכָר וְלִנְקֵבָה וּלְנִדָּה. רַבִּי יִשְׁמָעֵאל אוֹמֵר, יוֹם אַרְבָּעִים וְאֶחָד, תֵּשֵׁב לְזָכָר וּלְנִדָּה. יוֹם שְׁמוֹנִים וְאֶחָד, תֵּשֵׁב לְזָכָר וְלִנְקֵבָה וּלְנִדָּה, שֶׁהַזָּכָר נִגְמָר לְאַרְבָּעִים וְאֶחָד, וְהַנְּקֵבָה לִשְׁמוֹנִים וְאֶחָד. וַחֲכָמִים אוֹמְרִים, אֶחָד בְּרִיַּת הַזָּכָר וְאֶחָד בְּרִיַּת הַנְּקֵבָה, זֶה וָזֶה לְאַרְבָּעִים וְאֶחָד:

(7) If she miscarries on the fortieth day [since her prior immersion], she need not be concerned that it was a fetus. If [she miscarries] on the forty-first day, she should sit [for the required number of days] for a male and for a female, and for [being] a niddah. Rabbi Yishmael says: on the forty-first day she should sit for [the required number of days for one who gives birth to] a male and for [being] a niddah. On the eighty-first day she should sit for a male and for a female and for [being] a niddah, because [the formation of] a male is completed in forty-one [days], and a female in eighty-one. And the Sages say: this and that [are both completed] in forty-one.

(ד) הָאִשָּׁה שֶׁהִיא יוֹצְאָה לֵהָרֵג, אֵין מַמְתִּינִין לָהּ עַד שֶׁתֵּלֵד. יָשְׁבָה עַל הַמַּשְׁבֵּר, מַמְתִּינִין לָהּ עַד שֶׁתֵּלֵד. הָאִשָּׁה שֶׁנֶּהֶרְגָה, נֶהֱנִין בִּשְׂעָרָהּ. בְּהֵמָה שֶׁנֶּהֶרְגָּה, אֲסוּרָה בַהֲנָיָה:

(4) If a woman is about to be executed, they do not wait for her until she gives birth. But if she had already sat on the birthstool, they wait for her until she gives birth. If a woman is executed, one may use her hair. If an animal has been executed, it is forbidden to make any use of it.

(ו) הָאִשָּׁה שֶׁהִיא מַקְשָׁה לֵילֵד, מְחַתְּכִין אֶת הַוָּלָד בְּמֵעֶיהָ וּמוֹצִיאִין אוֹתוֹ אֵבָרִים אֵבָרִים, מִפְּנֵי שֶׁחַיֶּיהָ קוֹדְמִין לְחַיָּיו. יָצָא רֻבּוֹ, אֵין נוֹגְעִין בּוֹ, שֶׁאֵין דּוֹחִין נֶפֶשׁ מִפְּנֵי נָפֶשׁ:

(6) A woman who was having trouble giving birth, they cut up the fetus inside her and take it out limb by limb, because her life comes before its life. If most of it had come out already they do not touch it because we do not push off one life for another.

יצא ראשו - באשה המקשה לילד ומסוכנת וקתני רישא החיה פושטת ידה וחותכתו ומוציאתו לאברים דכל זמן שלא יצא לאויר העולם לאו נפש הוא וניתן להורגו ולהציל את אמו אבל יצא ראשו אין נוגעים בו להורגו דהוה ליה כילוד ואין דוחין נפש מפני נפש ואם תאמר מעשה דשבע בן בכרי (שמואל ב כ) הנה ראשו מושלך אליך דדחו נפש מפני נפש התם משום דאפילו לא מסרוהו לו היה נהרג בעיר כשיתפשנה יואב והן נהרגין עמו אבל אם היה הוא ניצול אע"פ שהן נהרגין לא היו רשאין למסרו כדי להציל עצמן אי נמי משום דמורד במלכות הוה והכי מפרש לה בתוספתא (דתמורה): משמיא קא רדפי לה - לאמיה:
its head came out: With a women that is experiencing difficulty giving birth and is in [mortal] danger. And it is taught in the first section [of this teaching], "the midwife extends her hand and cuts it up and extracts [the pieces];" as the entire time that that it has not gone out into the air of the world, it is not [considered] a soul, and [so] it is possible to kill it and to save its mother. But when its head came out, we cannot touch it to kill it, as it is like a born [baby]; and we do not push off one soul for the sake of another. And if you will ask [from] the story of Sheva ben Bichri - [wherein it is written] (II Samuel 20:21), "behold, his head is sent to you" - they pushed off one life for the sake of another; there, it was because even if they had not delivered him, he would have been killed in the city when Yoav would have seized it, and they would have been killed with him. But if he would have [otherwise] been saved - even though they would have been killed - they would not have been allowed to deliver him [to Yoav] in order to save themselves. And also (another answer) is that it is because he was a rebel to the kingdom, and so is it explained in the Tosefta (of Terumah).

Surrogacy

(כח) וַיְבָ֣רֶךְ אֹתָם֮ אֱלֹהִים֒ וַיֹּ֨אמֶר לָהֶ֜ם אֱלֹהִ֗ים פְּר֥וּ וּרְב֛וּ וּמִלְא֥וּ אֶת־הָאָ֖רֶץ וְכִבְשֻׁ֑הָ וּרְד֞וּ בִּדְגַ֤ת הַיָּם֙ וּבְע֣וֹף הַשָּׁמַ֔יִם וּבְכָל־חַיָּ֖ה הָֽרֹמֶ֥שֶׂת עַל־הָאָֽרֶץ׃
(28) God blessed them and God said to them, “Be fertile and increase, fill the earth and master it; and rule the fish of the sea, the birds of the sky, and all the living things that creep on earth.”
(א) וְשָׂרַי֙ אֵ֣שֶׁת אַבְרָ֔ם לֹ֥א יָלְדָ֖ה ל֑וֹ וְלָ֛הּ שִׁפְחָ֥ה מִצְרִ֖ית וּשְׁמָ֥הּ הָגָֽר׃ (ב) וַתֹּ֨אמֶר שָׂרַ֜י אֶל־אַבְרָ֗ם הִנֵּה־נָ֞א עֲצָרַ֤נִי יְהוָה֙ מִלֶּ֔דֶת בֹּא־נָא֙ אֶל־שִׁפְחָתִ֔י אוּלַ֥י אִבָּנֶ֖ה מִמֶּ֑נָּה וַיִּשְׁמַ֥ע אַבְרָ֖ם לְק֥וֹל שָׂרָֽי׃ (ג) וַתִּקַּ֞ח שָׂרַ֣י אֵֽשֶׁת־אַבְרָ֗ם אֶת־הָגָ֤ר הַמִּצְרִית֙ שִׁפְחָתָ֔הּ מִקֵּץ֙ עֶ֣שֶׂר שָׁנִ֔ים לְשֶׁ֥בֶת אַבְרָ֖ם בְּאֶ֣רֶץ כְּנָ֑עַן וַתִּתֵּ֥ן אֹתָ֛הּ לְאַבְרָ֥ם אִישָׁ֖הּ ל֥וֹ לְאִשָּֽׁה׃ (ד) וַיָּבֹ֥א אֶל־הָגָ֖ר וַתַּ֑הַר וַתֵּ֙רֶא֙ כִּ֣י הָרָ֔תָה וַתֵּקַ֥ל גְּבִרְתָּ֖הּ בְּעֵינֶֽיהָ׃ (ה) וַתֹּ֨אמֶר שָׂרַ֣י אֶל־אַבְרָם֮ חֲמָסִ֣י עָלֶיךָ֒ אָנֹכִ֗י נָתַ֤תִּי שִׁפְחָתִי֙ בְּחֵיקֶ֔ךָ וַתֵּ֙רֶא֙ כִּ֣י הָרָ֔תָה וָאֵקַ֖ל בְּעֵינֶ֑יהָ יִשְׁפֹּ֥ט יְהוָ֖ה בֵּינִ֥י וּבֵינֶֽיׄךָ׃ (ו) וַיֹּ֨אמֶר אַבְרָ֜ם אֶל־שָׂרַ֗י הִנֵּ֤ה שִׁפְחָתֵךְ֙ בְּיָדֵ֔ךְ עֲשִׂי־לָ֖הּ הַטּ֣וֹב בְּעֵינָ֑יִךְ וַתְּעַנֶּ֣הָ שָׂרַ֔י וַתִּבְרַ֖ח מִפָּנֶֽיהָ׃ (ז) וַֽיִּמְצָאָ֞הּ מַלְאַ֧ךְ יְהוָ֛ה עַל־עֵ֥ין הַמַּ֖יִם בַּמִּדְבָּ֑ר עַל־הָעַ֖יִן בְּדֶ֥רֶךְ שֽׁוּר׃
(1) Sarai, Abram’s wife, had borne him no children. She had an Egyptian maidservant whose name was Hagar. (2) And Sarai said to Abram, “Look, the LORD has kept me from bearing. Consort with my maid; perhaps I shall have a son through her.” And Abram heeded Sarai’s request. (3) So Sarai, Abram’s wife, took her maid, Hagar the Egyptian—after Abram had dwelt in the land of Canaan ten years—and gave her to her husband Abram as concubine. (4) He cohabited with Hagar and she conceived; and when she saw that she had conceived, her mistress was lowered in her esteem. (5) And Sarai said to Abram, “The wrong done me is your fault! I myself put my maid in your bosom; now that she sees that she is pregnant, I am lowered in her esteem. The LORD decide between you and me!” (6) Abram said to Sarai, “Your maid is in your hands. Deal with her as you think right.” Then Sarai treated her harshly, and she ran away from her. (7) An angel of the LORD found her by a spring of water in the wilderness, the spring on the road to Shur,

https://surrogate.com/about-surrogacy/types-of-surrogacy/traditional-vs-gestational-surrogacy-whats-best-for-my-family/

The main difference between gestational and traditional surrogacy is simple: in traditional surrogacy, the surrogate’s eggs are used, making her the biological mother of the child she carries; in gestational surrogacy, the surrogate has no biological link to the baby.

While this distinction may be simple, it has several implications that prospective intended parents should take into consideration when comparing traditional surrogacy vs. gestational surrogacy. If you are unsure which type of surrogacy is right for you, here are some of the primary differences between traditional and gestational surrogacy

  • Egg Donor: In gestational surrogacy, an egg donor may be used to create the embryo the surrogate carries. Same-sex couples, single men, and heterosexual couples and women who cannot produce healthy eggs commonly require the assistance of an egg donor in gestational surrogacy. Egg donation is not required in traditional surrogacy because the surrogate uses her own eggs, essentially acting as both the egg donor and the carrier.
  • Medical Procedures: Gestational and traditional surrogacy often involve different medical procedures. In gestational surrogacy, in vitro fertilization (IVF) is used to create an embryo using the intended mother’s (or donor’s) egg and intended father’s (or donor’s) sperm, which is then transferred to the surrogate. IVF can be used in traditional surrogacy as well, but more commonly, traditional surrogacy involves artificial insemination using intrauterine insemination (IUI). IUI is a simpler medical process that usually does not require the surrogate to undergo as many fertility treatments prior to the procedure. In addition, intended mothers do not need to take fertility medications or undergo the egg retrieval procedure in traditional surrogacy, as their eggs are never used in the traditional surrogacy process.
  • Surrogacy Professional: Some surrogacy professionals specialize in either traditional or gestational surrogacy. Because of the legal and emotional complexities of traditional surrogacy, gestational surrogacy agencies are generally more common. Intended parents who choose traditional surrogacy may have fewer options when choosing a professional.
  • Wait Time: Similarly, many surrogates prefer gestational surrogacy because it is less emotionally complicated. In traditional surrogacy, the surrogate is the biological mother of the child she carries, which can make it more difficult to relinquish the baby to the intended parents. Intended parents who choose traditional surrogacy may have more difficulty finding a willing surrogate, increasing their wait time.
  • Legal Process: Laws are complicated no matter what kind of surrogacy a family chooses, but many states that allow gestational surrogacy do not allow traditional surrogacy. It is important to work closely with an attorney to understand your state’s surrogacy laws. In addition, the traditional surrogacy process often involves additional legal actions because of the surrogate mother’s biological connection to the child. Legal processes such as termination of parental rights and stepparent adoption proceedings may be necessary.
  • Surrogacy Cost: Traditional surrogacy tends to be less expensive than gestational surrogacy, primarily because of differences in the medical process. IUI is much cheaper than IVF, and intended parents do not need to pay for egg donation or for fertility treatments for the intended mother because the surrogate uses her own eggs.
  • Risk: While it is rare for any surrogate to challenge a surrogacy agreement in an effort to keep the child, traditional surrogacy does pose a greater legal risk than gestational surrogacy. In traditional surrogacy, the surrogate is the biological mother of the child, which means that if she bonds with the baby, she could potentially change her mind and decide she wants to parent the baby when it is born. The intended parents would then have to try to win custody in court, which could lead to a lengthy legal battle.

Whats the preference? Jewish or Non-Jewish Sperm?

Many rabbis have ruled that sperm donation should be done with non-Jewish sperm in order to avoid the possibility of incest if the child unknowingly marries a sibling years later.

“If you have a non-Jewish male and a Jewish female, the child, for purposes of Jewish law, has no father,” said Rabbi J. David Bleich, a scholar of Jewish medical ethics at Yeshiva University. Without a legally recognized father, the threat of incest under Jewish law is removed, according to Bleich.

Jewish men are prohibited from donating sperm to begin with, since by doing so they would violate traditional Jewish law’s ban on masturbation.

But even non-Jewish donors are not universally accepted. Many rabbinic authorities see any kind of artificial insemination from a donor as a form of adultery.

“It’s a violation of the marital relationship. You’re introducing a third party who is not the woman’s husband,” Bleich said. “If it’s not technically adultery, it’s quasi- adultery.”

Read more: https://forward.com/culture/204212/6-things-you-need-to-know-about-jewish-sperm/

Jewish or Non-Jewish surrogate mother?

Organ Donation

ושמואל אמר לפקח עליו את הגל כי איתמר דשמואל ארישא איתמר אם רוב כותיים כותי אמר שמואל ולענין פקוח נפש אינו כן אם רוב כותיים כותי למאי הילכתא אמר רב פפא להאכילו נבלות אם רוב ישראל ישראל למאי הילכתא להחזיר לו אבידתו מחצה על מחצה ישראל למאי הילכתא אמר ריש לקיש לנזקין היכי דמי אי נימא דנגחיה תורא דידן לתורא דידיה נייתי ראיה ונשקול לא צריכא דנגחיה תורא דידיה לתורא דידן פלגא יהיב ליה אידך פלגא נימא ליה אייתי ראיה דלאו ישראל אנא ושקול מי שנפל עליו מפולת וכו' מאי קאמר לא מיבעיא קאמר לא מיבעיא ספק הוא שם ספק אינו שם דאי איתיה חי הוא דמפקחין אלא אפילו ספק חי ספק מת מפקחין ולא מיבעיא ספק חי ספק מת דישראל אלא אפילו ספק כותי ספק ישראל מפקחין מצאוהו חי מפקחין מצאוהו חי פשיטא לא צריכא דאפי' לחיי שעה ואם מת יניחוהו הא נמי פשיטא לא צריכא לר' יהודה בן לקיש דתניא אין מצילין את המת מפני הדליקה אמר רבי יהודה בן לקיש שמעתי שמצילין את המת מפני הדליקה ואפילו רבי יהודה בן לקיש לא קאמר אלא מתוך שאדם בהול על מתו אי לא שרית ליה אתי לכבויי אבל הכא אי לא שרית ליה מאי אית ליה למעבד תנו רבנן עד היכן הוא בודק עד חוטמו ויש אומרים עד לבו בדק ומצא עליונים מתים לא יאמר כבר מתו התחתונים מעשה היה ומצאו עליונים מתים ותחתונים חיים נימא הני תנאי כי הני תנאי דתניא מהיכן הולד נוצר מראשו שנאמר (תהלים עא, ו) ממעי אמי אתה גוזי ואומר (ירמיהו ז, כט) גזי נזרך והשליכי אבא שאול אומר מטיבורו ומשלח שרשיו אילך ואילך אפילו תימא אבא שאול עד כאן לא קא אמר אבא שאול התם אלא לענין יצירה דכל מידי ממציעתיה מיתצר אבל לענין פקוח נפש אפי' אבא שאול מודי דעיקר חיותא באפיה הוא דכתיב (בראשית ז, כב) כל אשר נשמת רוח חיים באפיו אמר רב פפא מחלוקת ממטה למעלה אבל ממעלה למטה כיון דבדק ליה עד חוטמו שוב אינו צריך דכתיב כל אשר נשמת רוח חיים באפיו וכבר היה ר' ישמעאל ורבי עקיבא ורבי אלעזר בן עזריה מהלכין בדרך ולוי הסדר ורבי ישמעאל בנו של רבי אלעזר בן עזריה מהלכין אחריהן נשאלה שאלה זו בפניהם מניין לפקוח נפש שדוחה את השבת נענה ר' ישמעאל ואמר (שמות כב, א) אם במחתרת ימצא הגנב ומה זה שספק על ממון בא ספק על נפשות בא ושפיכות דמים מטמא את הארץ וגורם לשכינה שתסתלק מישראל ניתן להצילו בנפשו ק"ו לפקוח נפש שדוחה את השבת נענה ר"ע ואמר (שמות כא, יד) וכי יזיד איש על רעהו וגו' מעם מזבחי תקחנו למות מעם מזבחי ולא מעל מזבחי ואמר רבה בר בר חנה אמר רבי יוחנן לא שנו אלא להמית
And Shmuel said: This halakha of the status of a found child is with regard to removing debris from on top of him, implying that if there is a majority of gentiles in the city where he is found, one does not violate Shabbat by removing the debris from the child to save his life. This implies that one does follow the majority in the case of saving a life. The Gemara answers: When this statement of Shmuel was stated, it was stated with regard to the first halakha. Shmuel’s intent was to be lenient, and his statement should be understood as follows: If the majority are gentiles, he is a gentile. Shmuel said: But with regard to the matter of saving a life it is not so. Rather, one saves him based on the uncertainty. § It was taught that if there is a majority of gentiles in the city, a foundling is considered to have the status of a gentile. The Gemara asks: To what halakha does this statement relate? Rav Pappa said: It relates to feeding him non-kosher food. One need not protect the child from every prohibition and may even feed him non-kosher food, as though he were a gentile. It was further taught: If there is a majority of Jews, he is a Jew. The Gemara asks: To what halakha does this relate? The Gemara answers: It relates to returning a lost object to him. In such a case it is assumed that he is definitely a Jew. Consequently, Jews must return lost objects to him, whereas there is no obligation to return lost objects to gentiles. It was further stated: If the city is half gentile and half Jewish, the foundling has the status of a Jew. The Gemara asks: To what halakha does this relate? Reish Lakish said: It is referring to halakhot of damages. The Gemara asks: What are the circumstances? If we say that our ox, i.e., an ox belonging to another Jew, gored his ox, one could ask: How can he make a claim like a Jew? Let him bring proof that he is Jewish, and only then may he take the money for damages, since the burden of proof rests upon the claimant. Since he cannot prove his Jewish status, he has no claim. The Gemara answers: No, it is necessary when his innocuous ox, which has gored fewer than three times, gored our ox, i.e., an ox belonging to a Jew, in which case he gives him half, which is what a Jew pays for damages caused by an innocuous ox. However, a gentile must make full restitution for the damage caused. The foundling does not pay the other half, which a gentile gives to a Jew if his ox harms a Jew’s ox. Let us say to the one who suffered the damage: Bring proof that I am not a Jew and take the money. In that case, the burden of proof rests upon the one who suffered the damage. § It was taught in the mishna: With regard to one upon whom a rockslide fell, and there is uncertainty whether he is there under the debris or whether he is not there; and there is uncertainty whether he is still alive or whether he is dead; and there is uncertainty whether the person under the debris is a gentile or whether he is Jew, one clears the pile from atop him. The Gemara asks: What is the mishna saying? Why does it bring three different uncertainties to illustrate the principle that one violates Shabbat to save a life even in a case of uncertainty? The Gemara explains: It is speaking using the style of: Needless to say, and the mishna should be understood as follows: Needless to say, in a case where it is uncertain whether he is there or not there, one removes the debris, since if he is there and he is alive, one must clear the debris. But even if it is uncertain whether he is alive or dead, one must clear the debris. And needless to say, when there is uncertainty whether he is alive or dead, but it is certain that he is a Jew, one must clear the debris. Rather, one must clear the debris even if there is uncertainty whether he is a gentile or a Jew. § The mishna taught: If they found him alive, they continue to remove the debris. The Gemara is surprised at this: If they find him alive, it is obvious that they remove the debris, since that is saving a life. The Gemara answers: No, it is necessary to teach that one must desecrate Shabbat for his sake even if it is clear that he will live only a short while and will die soon after. § The mishna taught: If they found him dead, they should leave him. The Gemara is surprised at this: Isn’t this also obvious? What allowance might there be to desecrate Shabbat for the sake of a corpse? The Gemara answers: No, this ruling is necessary according to the opinion of Rabbi Yehuda ben Lakish, as it was taught in a baraita: One may not save a corpse from a fire, since one may not violate Shabbat for the sake of the dead. Rabbi Yehuda ben Lakish said: I heard that one may save a corpse from a fire. The Gemara challenges: Even Rabbi Yehuda ben Lakish said this only with regard to a fire because a person is agitated over his dead relative, whose body might burn in the fire. If you do not permit him to remove the corpse he may come to extinguish the fire and transgress a severe Torah prohibition. However, here, in the case of a rockslide or building collapse, if you do not permit him to remove the debris, what might he do? In this case, there is no concern of Shabbat desecration, and preserving the dignity of the dead does not override Shabbat. The Rabbis taught: If a person is buried under a collapsed building, until what point does one check to clarify whether the victim is still alive? Until what point is he allowed to continue clearing the debris? They said: One clears until the victim’s nose. If there is no sign of life, i.e., if he is not breathing, he is certainly dead. And some say: One clears until the victim’s heart to check for a heartbeat. If several people are buried and one checked and found the upper ones under the debris dead, he should not say: The lower ones are likely also already dead, and there is no point in continuing to search. There was an incident where they found the upper ones dead and the lower ones alive. The Gemara comments: Let us say that the dispute between these tanna’im who disagree about checking for signs of life is like the dispute between these tanna’im who disagree about the formation of the fetus. As it was taught in a baraita: From what point is the fetus created? It is from its head, as it is stated: “You are He Who took me [gozi] out of my mother’s womb” (Psalms 71:6), and it says: “Cut off [gozi] your hair, and cast it away” (Jeremiah 7:29). These verses suggest that one is created from the head, the place of the hair. Abba Shaul says: A person is created from his navel, and he sends his roots in every direction until he attains the image of a person. The tanna who says that the presence of life is determined based on the nose holds in accordance with the opinion of the tanna who maintains that the formation of a fetus begins with its head. Likewise, the tanna who says the presence of life is determined based on the heart holds in accordance with the opinion of the one who thinks the formation of a fetus begins with its navel. The Gemara rejects this: Even if you say that the formation of a fetus from the navel is the opinion of Abba Shaul, he may nevertheless require one to check the nose for signs of life. Until now, Abba Shaul spoke there only about formation, saying that everything is created from its middle; however, as for saving a life, even Abba Shaul admits that the main sign of life is in the nose, as it is written: “All in whose nostrils was the breath of the spirit of life” (Genesis 7:22). Rav Pappa said: The dispute with regard to how far to check for signs of life applies when the digger begins removing the rubble from below, starting with the feet, to above. In such a case it is insufficient to check until his heart; rather, one must continue removing rubble until he is able to check his nose for breath. But if one cleared the rubble from above to below, once he checked as far as the victim’s nose he is not required to check further, as it is written: “All in whose nostrils was the breath of the spirit of life” (Genesis 7:22). § The Gemara relates: It once happened that Rabbi Yishmael, and Rabbi Akiva, and Rabbi Elazar ben Azarya were walking on the road, and Levi HaSadar and Rabbi Yishmael, son of Rabbi Elazar ben Azarya, were walking respectfully behind them, since they were younger and did not walk alongside their teachers. This question was asked before them: From where is it derived that saving a life overrides Shabbat? Rabbi Yishmael answered and said that it is stated: “If a thief be found breaking in and be struck so that he dies, there shall be no blood-guiltiness for him” (Exodus 22:1). Now, if this is true for the thief, where there is uncertainty whether he comes to take money or to take lives, and it is known that bloodshed renders the land impure, since it is stated about a murderer: “And you shall not defile the land” (Numbers 35:34), and it causes the Divine Presence to depart from the Jewish people, as the verse continues: “In the midst of which I dwell, for I the Lord dwell in the midst of the children of Israel” (Numbers 35:34), and even so the home owner is permitted to save himself at the cost of the thief’s life, then a fortiori saving a life overrides Shabbat. Rabbi Akiva answered and said that it is stated: “And if a man comes purposefully upon his neighbor to slay him with guile, you shall take him from My altar, that he may die” (Exodus 21:14). The phrase “take him from My altar” implies that if the murderer is a priest and comes to perform the service, one does not wait for him to do so but takes him to his execution immediately. But one should not take him from on top of My altar. If he already began the service and is in the midst of it, one does not take him down from the altar immediately but instead allows him to finish his service. And Rabba bar bar Ḥana said that Rabbi Yoḥanan said: They taught only that a priest is not removed from the altar in order to execute him for murder,