Bioethics I ~ Basic terms

For the facilitator:

~ Present the cases of Terri Schiavo and Jahi McMath. Stop at the disputes - do not disclose what happened at the end. Give teens time to decide what would they do, and why. Make sure that they select the relevant information, particularly in Theresa Schiavo case. Do not tell the “end” of the case before they made up their minds, or at least had a good try at it. THERE IS another source sheet with the stories and basic timelines of the Schiavo and McMath cases:

https://www.sefaria.org/sheets/153210

~ In the discussions, make sure that there is need to answer a few questions:

1. What exactly do the terms "life" and "death" mean, in practical terms?

2. Does anyone own life?

3. Is life a always blessing?

4. Are there times and conditions in which "preserving life" and "permitting death" are at odds with each other?

5. Is all human life equal in value, regardless of circumstances?

Explain that in this (and probably the next) session we will be talking about these two cases in light of Jewish sources.

The value of life

(ה) כֵּיצַד מְאַיְּמִין אֶת הָעֵדִים עַל עֵדֵי נְפָשׁוֹת, הָיוּ מַכְנִיסִין אוֹתָן וּמְאַיְּמִין עֲלֵיהֶן. שֶׁמָּא תֹאמְרוּ מֵאֹמֶד, וּמִשְּׁמוּעָה, עֵד מִפִּי עֵד וּמִפִּי אָדָם נֶאֱמָן שָׁמַעְנוּ, אוֹ שֶׁמָּא אִי אַתֶּם יוֹדְעִין שֶׁסּוֹפֵנוּ לִבְדֹּק אֶתְכֶם בִּדְרִישָׁה וּבַחֲקִירָה. הֱווּ יוֹדְעִין שֶׁלֹּא כְדִינֵי מָמוֹנוֹת דִּינֵי נְפָשׁוֹת. דִּינֵי מָמוֹנוֹת, אָדָם נוֹתֵן מָמוֹן וּמִתְכַּפֵּר לוֹ. דִּינֵי נְפָשׁוֹת, דָּמוֹ וְדַם זַרְעִיּוֹתָיו תְּלוּיִין בּוֹ עַד סוֹף הָעוֹלָם, שֶׁכֵּן מָצִינוּ בְקַיִן שֶׁהָרַג אֶת אָחִיו, שֶׁנֶּאֱמַר (בראשית ד) דְּמֵי אָחִיךָ צֹעֲקִים, אֵינוֹ אוֹמֵר דַּם אָחִיךָ אֶלָּא דְּמֵי אָחִיךָ, דָּמוֹ וְדַם זַרְעִיּוֹתָיו. דָּבָר אַחֵר, דְּמֵי אָחִיךָ, שֶׁהָיָה דָמוֹ מֻשְׁלָךְ עַל הָעֵצִים וְעַל הָאֲבָנִים. לְפִיכָךְ נִבְרָא אָדָם יְחִידִי, לְלַמֶּדְךָ, שֶׁכָּל הַמְאַבֵּד נֶפֶשׁ אַחַת מִיִּשְׂרָאֵל, מַעֲלֶה עָלָיו הַכָּתוּב כְּאִלּוּ אִבֵּד עוֹלָם מָלֵא. וְכָל הַמְקַיֵּם נֶפֶשׁ אַחַת מִיִּשְׂרָאֵל, מַעֲלֶה עָלָיו הַכָּתוּב כְּאִלּוּ קִיֵּם עוֹלָם מָלֵא. וּמִפְּנֵי שְׁלוֹם הַבְּרִיּוֹת, שֶׁלֹּא יֹאמַר אָדָם לַחֲבֵרוֹ אַבָּא גָדוֹל מֵאָבִיךָ. וְשֶׁלֹּא יְהוּ מִינִין אוֹמְרִים, הַרְבֵּה רָשֻׁיּוֹת בַּשָּׁמָיִם. וּלְהַגִּיד גְּדֻלָּתוֹ שֶׁל הַקָּדוֹשׁ בָּרוּךְ הוּא, שֶׁאָדָם טוֹבֵעַ כַּמָּה מַטְבְּעוֹת בְּחוֹתָם אֶחָד וְכֻלָּן דּוֹמִין זֶה לָזֶה, וּמֶלֶךְ מַלְכֵי הַמְּלָכִים הַקָּדוֹשׁ בָּרוּךְ הוּא טָבַע כָּל אָדָם בְּחוֹתָמוֹ שֶׁל אָדָם הָרִאשׁוֹן וְאֵין אֶחָד מֵהֶן דּוֹמֶה לַחֲבֵרוֹ. לְפִיכָךְ כָּל אֶחָד וְאֶחָד חַיָּב לוֹמַר, בִּשְׁבִילִי נִבְרָא הָעוֹלָם. וְשֶׁמָּא תֹאמְרוּ מַה לָּנוּ וְלַצָּרָה הַזֹּאת, וַהֲלֹא כְבָר נֶאֱמַר (ויקרא ה) וְהוּא עֵד אוֹ רָאָה אוֹ יָדָע אִם לוֹא יַגִּיד וְגוֹ'. וְשֶׁמָּא תֹאמְרוּ מַה לָּנוּ לָחוּב בְּדָמוֹ שֶׁל זֶה, וַהֲלֹא כְבָר נֶאֱמַר (משלי יא) וּבַאֲבֹד רְשָׁעִים רִנָּה:

(5) How do we press the witnesses in a capital case? We bring them in [to the court's chambers] and press them: "Perhaps what you say [isn't eyewitness testimony] is but your own assessment, or from rumors, or your witnessing an actual witness testify, or your reporting what a trustworthy said. Or perhaps you were unaware that by the end we'd interrogate you, with examination and inquiry. Know that capital cases are not like monetary ones. In monetary cases, [a false witness] can return the money and achieve atonement. But in capital cases, the blood of [the victim [and all his future offspring hang upon you until the end of time. For thus we find in regard to Cain, who killed his brother, "The bloods of your brother scream out!" (Genesis 4:10) - the verse does not say blood of your brother, but bloods of your brother, because it was his blood and also the blood of his future offspring [screaming out]! [Another explanation of the verse: for his blood was splattered over the trees and rocks [there was more than one pool of blood]. [The judges' speech continues] "It was for this reason that man was first created as one person [Adam], to teach you that anyone who destroys a life is considered by Scripture to have destroyed an entire world; and anyone who saves a life is as if he saved an entire world." And also, to promote peace among the creations, that no man would say to his friend, "My ancestors are greater than yours." And also, so that heretics will not say, "there are many rulers up in Heaven." And also, to express the grandeur of The Holy One [blessed be He]: For a man strikes many coins from the same die, and all the coins are alike. But the King, the King of Kings, The Holy One [blessed be He] strikes every man from the die of the First Man, and yet no man is quite like his friend. Therefore, every person must say, “For my sake ‎the world was created.”‎ [The judges' speech continues:] "Maybe you [the witnesses] will now say, 'What do we need this, and all this anxiety for [let's not come forward even with true testimony]!' But Scripture has already spoken: "If he be a witness - having seen or known - if he does not express it, he shall bear his sin." (Lev. 5:1) Maybe you will now say, 'What do we need this, to be responsible for another man's death?' But Scripture has already spoken: "When the wicked are destroyed there is rejoicing." (Prov. 11:10)"

(א) כָּל הַהוֹרֵג חֲבֵרוֹ בְּיָדוֹ כְּגוֹן שֶׁהִכָּהוּ בְּסַיִף אוֹ בְּאֶבֶן הַמְּמִיתָה. אוֹ שֶׁחֲנָקוֹ עַד שֶׁמֵּת. אוֹ שְׂרָפוֹ בְּאֵשׁ. הוֹאִיל וַהֲרָגוֹ מִכָּל מָקוֹם הוּא בְּעַצְמוֹ הֲרֵי זֶה נֶהֱרָג בְּבֵית דִּין:

(ב) אֲבָל הַשּׂוֹכֵר הוֹרֵג לַהֲרֹג אֶת חֲבֵרוֹ אוֹ שֶׁשָּׁלַח עֲבָדָיו וַהֲרָגוּהוּ. אוֹ שֶׁכְּפָתוֹ וְהִנִּיחוֹ לִפְנֵי הָאֲרִי וְכַיּוֹצֵא בּוֹ וַהֲרָגַתְהוּ חַיָּה. וְכֵן הַהוֹרֵג אֶת עַצְמוֹ. כָּל אֶחָד מֵאֵלּוּ שׁוֹפֵךְ דָּמִים הוּא. וַעֲוֹן הֲרִיגָה בְּיָדוֹ וְחַיָּב מִיתָה לַשָּׁמַיִם. וְאֵין בָּהֶן מִיתַת בֵּית דִּין:

(ג) וּמִנַּיִן שֶׁכֵּן הוּא הַדִּין. שֶׁנֶּאֱמַר (בראשית ט ו) "שֹׁפֵךְ דַּם הָאָדָם בָּאָדָם דָּמוֹ יִשָּׁפֵךְ" זֶה הַהוֹרֵג בְּעַצְמוֹ שֶׁלֹּא עַל יְדֵי שָׁלִיחַ. (בראשית ט ה) "אֶת דִּמְכֶם לְנַפְשֹׁתֵיכֶם אֶדְרשׁ" זֶה הוֹרֵג עַצְמוֹ. (בראשית ט ה) "מִיַּד כָּל חַיָּה אֶדְרְשֶׁנּוּ" זֶה הַמּוֹסֵר חֲבֵרוֹ לִפְנֵי חַיָּה לְטָרְפוֹ. (בראשית ט ה) "מִיַּד הָאָדָם מִיַּד אִישׁ אָחִיו אֶדְרשׁ אֶת נֶפֶשׁ הָאָדָם" זֶה הַשּׂוֹכֵר אֲחֵרִים לַהֲרֹג אֶת חֲבֵרוֹ. וּבְפֵרוּשׁ נֶאֱמַר בִּשְׁלָשְׁתָּן לְשׁוֹן דְּרִישָׁה הֲרֵי דִּינָם מָסוּר לַשָּׁמַיִם:

...

(ו) אֶחָד הַהוֹרֵג אֶת הַגָּדוֹל אוֹ אֶת הַקָּטָן בֶּן יוֹמוֹ. בֵּין זָכָר בֵּין נְקֵבָה. הֲרֵי זֶה נֶהֱרָג עָלָיו אִם הָרַג בְּזָדוֹן. אוֹ גּוֹלֶה אִם הָרַג בִּשְׁגָגָה. וְהוּא שֶׁכָּלוּ לוֹ חֳדָשָׁיו. אֲבָל אִם נוֹלַד לְפָחוֹת מִתִּשְׁעָה חֳדָשִׁים הֲרֵי הוּא כְּנֵפֶל עַד שֶׁיִּשְׁהֶה שְׁלֹשִׁים יוֹם וְהַהוֹרְגוֹ בְּתוֹךְ שְׁלֹשִׁים יוֹם אֵינוֹ נֶהֱרָג עָלָיו:

(ז) אֶחָד הַהוֹרֵג אֶת הַבָּרִיא אוֹ אֶת הַחוֹלֶה הַנּוֹטֶה לָמוּת. וַאֲפִלּוּ הָרַג אֶת הַגּוֹסֵס נֶהֱרָג עָלָיו. וְאִם הָיָה גּוֹסֵס בִּידֵי אָדָם כְּגוֹן שֶׁהִכּוּהוּ עַד שֶׁנָּטָה לָמוּת וַהֲרֵי הוּא גּוֹסֵס. הַהוֹרְגוֹ אֵין בֵּית דִּין מְמִיתִין אוֹתוֹ:

...

(י) אֶחָד הַהוֹרֵג אֶת יִשְׂרָאֵל אוֹ הַהוֹרֵג עֶבֶד כְּנַעֲנִי הֲרֵי זֶה נֶהֱרָג עָלָיו. וְאִם הָרַג בִּשְׁגָגָה גּוֹלֶה:

(1) If anyone killed another with his own hand, as when he struck him down with a sword or a deadly rock, strangled him to death or burned him alive, he must be executed by the court, because at any rate he murdered a man by himself.

(2) On the other hand, if a man hired a murderer to kill somebody, or sent servants to kill him, or tied him up and put him in front of a lion or similar beast and it killed him, and also if an individual attempted suicide, each of these is guilty of shedding blood and bears the crime of murder; he deserves to die by an act of God, but is not executed by the court.

(3) How do we know that to be the law? It is written : "Whoever sheds human blood, by human hands shall his own blood be shed" (Genesis 9:6). This refers to one who commits murder himself and not through an agent. "I will require your lifeblood" (9:5) refers to suicide. "I will require it of any beast" refers to one who puts a man in front of a beast to devour him. "Of man I will require a reckoning for human life, of every man for that of his fellow man" (9:5) refers to one who hires others to kill his fellow man. The verb require is explicitly iterated in the three cases to show that the verdict is left with God.

...

(6) Whether a man killed an adult or an infant of one day, male or female, he must be executed if he committed deliberate murder, or exiled if he killed unwittingly. This applies [to a fetus] whose months were complete. But, if he was born with less than nine months he is compared to a natural abortion until his 30th day of life, and one is not killed in the fetus's behalf.

(7) Whether a man killed a healthy individual or a sick man on the verge of death, or even a dying person, he must be executed. But if he was on the verge of death due to physical punishment by the courts, one who kills him is not killed by the courts.

(10) Whether a man killed a Jew or a Canaanite slave, he must be executed on his account; if he killed him unwittingly, he must go into exile.

Clarifying the terms:

פִּקּוּח נֶפֶשׁ Pikuach nefesh is usually translated as "saving a life". The Hebrew however, implies "seeing life" within the other person. The term פִּקֵּחַ pikeach is used for a person who is able to see, as opposed to עִוֵר yver which denotes the person who is blind (also called סַגִי נְהוֹר sagi nehor, "lots of light" in Aramaic).

נֶפֶשׁ is commonly translated as "soul" but it can mean "life" in the sense of something alive.

Pikuach nefesh and Shabbat

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

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).

~ What are the things for which we break Shabbat for?

~ What are the signs of death, here? Why are they important?

~ What is the verse that is used as proof?

~ How do you understand the Schiavo case based in this source? Is it any different than the McMath case?

(ו) אָדָם אֵינוֹ מְטַמֵּא, עַד שֶׁתֵּצֵא נַפְשׁוֹ. וַאֲפִלּוּ מְגֻיָּד, וַאֲפִלּוּ גוֹסֵס. זוֹקֵק לַיִּבּוּם וּפוֹטֵר מִן הַיִּבּוּם, מַאֲכִיל בַּתְּרוּמָה וּפוֹסֵל בַּתְּרוּמָה. וְכֵן בְּהֵמָה וְחַיָּה אֵינָן מְטַמְּאִין, עַד שֶׁתֵּצֵא נַפְשָׁם. הֻתְּזוּ רָאשֵׁיהֶם, אַף עַל פִּי שֶׁמְּפַרְכְּסִים, טְמֵאִים, כְּגוֹן זָנָב שֶׁל לְטָאָה שֶׁהִיא מְפַרְכָּסֶת:

(6) A human does not impurify [others] until his life leaves him. And even someone dismembered or terminally ill, obligates in or exempts from levirate marriage, and qualifies or disqualifies one from eating Terumah [a portion of a crop given to a priest which becomes holy upon separation, and can only be consumed by priests or their household]. And so too domestic or wild animals do not impurify until their lives leave them. If their heads were cut off, even if they are convulsing, they impurify - like the tail of a lizard which convulses [after being cut off].

~ What are the signs of death, here? Why are they important?

~ How do you understand the Schiavo case based in this source? Is it any different than the McMath case?

ר' בבית שערים הוה אלא כיון דחלש אמטיוהי לציפורי דמדליא ובסים אוירא ההוא יומא דנח נפשיה דרבי גזרו רבנן תעניתא ובעו רחמי ואמרי כל מאן דאמר נח נפשיה דר' ידקר בחרב סליקא אמתיה דרבי לאיגרא אמרה עליוני' מבקשין את רבי והתחתוני' מבקשין את רבי יהי רצון שיכופו תחתונים את העליונים כיון דחזאי כמה זימני דעייל לבית הכסא וחלץ תפילין ומנח להו וקמצטער אמרה יהי רצון שיכופו עליונים את התחתונים ולא הוו שתקי רבנן מלמיבעי רחמי שקלה כוזא שדייא מאיגרא [לארעא] אישתיקו מרחמי ונח נפשיה דרבי אמרו ליה רבנן לבר קפרא זיל עיין אזל אשכחיה דנח נפשיה קרעיה ללבושיה ואהדריה לקרעיה לאחוריה פתח ואמר אראלים ומצוקים אחזו בארון הקדש נצחו אראלים את המצוקים ונשבה ארון הקדש אמרו ליה נח נפשיה אמר להו אתון קאמריתו ואנא לא קאמינא
The Gemara answers: Rabbi Yehuda HaNasi was in Beit She’arim, but when he became ill they transferred him to Tzippori, which is situated at a high altitude and whose air is scented. § It is related that on the day that Rabbi Yehuda HaNasi died, the Sages decreed a fast, and begged for divine mercy so that he would not die. And they said: Anyone who says that Rabbi Yehuda HaNasi has died will be stabbed with a sword. The maidservant of Rabbi Yehuda HaNasi ascended to the roof and said: The upper realms are requesting the presence of Rabbi Yehuda HaNasi, and the lower realms are requesting the presence of Rabbi Yehuda HaNasi. May it be the will of God that the lower worlds should impose their will upon the upper worlds. However, when she saw how many times he would enter the bathroom and remove his phylacteries, and then exit and put them back on, and how he was suffering with his intestinal disease, she said: May it be the will of God that the upper worlds should impose their will upon the lower worlds. And the Sages, meanwhile, would not be silent, i.e., they would not refrain, from begging for mercy so that Rabbi Yehuda HaNasi would not die. So she took a jug [kuza] and threw it from the roof to the ground. Due to the sudden noise, the Sages were momentarily silent and refrained from begging for mercy, and Rabbi Yehuda HaNasi died. The Sages said to bar Kappara: Go and ascertain the condition of Rabbi Yehuda HaNasi. He went and found that Rabbi Yehuda HaNasi had died. He tore his clothing and reversed them so that the tear would be behind him and not be noticed. When he returned to the Sages he opened his remarks and said: The angels [erelim] and righteous mortals [metzukim] both clutched the sacred ark. The angels triumphed over the righteous, and the sacred ark was captured. They said to him: Has he died? He said to them: You have said it and I did not say it, as it had been decided that no one should say that he died.

~ How do you understand the Schiavo case based in this source? Is it any different than the McMath case?

We can divide Rabbinic approaches to death criteria as follows:

  1. Those who believe these passages define death as the irreversible and complete cessation of all vital bodily motion (including heartbeat). These rabbis argue that even though the Talmud seems to be concerned with respiration, its cessation is merely the necessary test, but not the criterion for death. They read this Talmudic ruling as teaching that the criterion for death is actually the irreversible cessation of heartbeat, and that checking for breathing is not as the definition or criterion for death, but merely as one indication of death. They do not agree that brain death is death.
  2. Those who conclude from these that irreversible cessation of breathing is what determines death. These rabbis argue that both of these talmudic teachings — the one on the potential victim of a building collapse and the one on decapitation — are based on the same underlying thesis, which is that when the brain no longer integrates or controls the body’s function, a person is dead. In Talmudic times, these scholars argue, checking for respiration or cardiac criteria was simply the best way of indicating brainstem dysfunction – brain death – and therefore death.

Therefore, three possible Jewish positions are:

  1. Those who believe death is defined by complete cessation of all vital bodily motion, including heartbeat, will require confirmation that the heart has stopped beating and that there is no evidence of any possible signs of life remaining.
  2. Those who focus on irreversible cessation of spontaneous respiration will look for proof that independent respiration will never return by showing that either the heart or the brainstem (which controls respiration) have ceased to function.
  3. Those who define death as complete absence of the head will require confirmation that the head has been completely separated from the body. This would mean the death of each and every cell of the entire brain, which is much stricter than the legally (according to American and Israeli law) accepted definition of brain death (and recent research and sensitive diagnostics have shown that this state is exceedingly rare).

The facilitator should mention the work of Rabbi Jason Weiner at JewishLearning.org as basic to this source sheet.

For closure, the facilitator tells or shows the videos with the end of these cases. Students then revisit their first ideas for the two cases, based on what they’ve learned.