Physician Assisted Suicide

You shall observe My laws and My rules, so that a person does them and lives by them: I am the LORD.

"And you shall live by them" (Vayikra 18:5) - and not that you shall die by them.

One must not hasten the death of a goses: One in a dying condition is considered a living being in all respects.³He is considered a living being with respect to granting a divorce (provided he is able to speak, according to one opinion in E.H. § 121, 7) ; to giving gifts, and as to a Kohen entering the house of a person in a dying condition, some permit and others forbid. infra § 370. We may not tie up his jaws,⁴So that he does not open his mouth. nor may we annoint him with oil, nor wash him,⁵In order to remove filth. nor stop off his organs of the extremities,⁶This was done in order that the corpse should not swell on account of the air which enters through his open organs. nor may we remove the pillow from under him, nor may we place him on sand, clay-ground or earth, nor may we place on his stomach a dish, a shovel, a flask of water or a globule of salt,⁷These were ancient practices. nor may we summon the towns on his behalf, nor may we hire pipers and lamenting women, nor may we close his eyes⁸For all these hasten his death — TaZ. On closing the eyes, cf. Gen. XLVI, 4, ‘And Joseph shall put his hand upon thine eyes.’ before his soul departs.⁹Tur citing T.H. who derives this from Sem. Cur. edd., however, do not contain all the items enumerated. W.G. a.l. and Sem(H). p. 233; also supra § 337, n. 2. Cf. further Shab. 151a-b, Mishna. And whosoever closes [the dying person's] eyes before death¹⁰Lit. ‘with the departure of the soul.’ is regarded as one who sheds blood.¹¹One must make sure that he is dead, for it is quite possible that the patient has only fainted — Maim. The Talmud (ibid.) and Sem. (l.c.) compare this to a lamp that is going out. If one places his finger upon it, it is immediately extinguished — ShaK. One may not rend garments, nor bare the shoulder in mourning, nor make a lamentation for him, nor bring a coffin into the house in his presence before he dies,¹²A healthy person is, however, permitted to prepare shrouds for himself — T.H. according to Men. 41a. nor may we begin the recital of Ẓidduk Haddin¹ Glos. before his soul departs.¹³T.H. Cf. W.G. a.l. Gloss: Some say that we may not dig out a grave for him. although it is not [done] in his presence, [i.e.,] in the house, — before he dies.¹⁴RIBaSh, Resp. 114. But if this is not done in the presence of the dying person and he would therefore not become aware of it, it is permissible — B.Yos. and BaḤ. However, on the eve of the Sabbath one must be very careful not to open a grave unless there would be sufficient time to bury the corpse. Cf. O.Ḥ. § 547, 9; BaḤ a.l. Mish. Le-Melek, Yad, Ebel IV, 5. It is [likewise] forbidden to dig out any grave to be [left] open until the next day, in which the corpse will not be buried the same day, and there is danger in this.¹⁵R. Yeruḥam on the authority of R. Yehudah the Ḥasid — G. It is likewise forbidden to cause [aught] to hasten the death of one who is in a dying condition, e.g., one who has been in a dying condition for a long time, and could not depart, — [the law is that] we may not remove the pillow or the mattress from under him [just] because some say that there are feathers from some fowl which cause this [prolongation of death].¹⁶Where there exists a possibility that if a certain cure or medicine is administered the patient may live or it may have the opposite effect of hastening his death, the law is that it is permissible to give the medicine or the like after consultation with medical experts — Resp. Binyan Ẓion. One may offer prayers that the suffering person die — RaN (Ned. 40a). He may likewise not be moved from his place. It is also forbidden to place the Synagogue keys under his head in order that he may depart.¹⁷These are all forbidden on account of moving the patient which may hasten his death — TaZ and ShaK. supra n. 7. However, if there is aught which causes a hindrance to the departure of the soul, e.g., [if] near that house there is a knocking sound, viz., a wood-cutter, or there is salt on his tongue, and these hinder the departure of the soul, it is permitted to remove it therefrom, for there is no [direct] act [involved] in this, since he merely removes the hindrance.¹⁸Hag. Alfasi (295b) to M.K. III — G. TaZ contra ShaK. forbids removing salt from his tongue, since in this case too, the patient has to be moved. A.H. agrees with ShaK.

Whoever sheds the blood of a person, by a person shall ones blood be shed; For in God's image God made man.

(4) So, all souls are Mine....

MISHNA: One who injures another is liable to pay compensation for that injury due to five types of indemnity: He must pay for damage, for pain, for medical costs, for loss of livelihood, and for humiliation.

And surely I require a reckoning for your own life-blood I will require it of every beast; of man, too, will I require a reckoning for human life, of every man for that of his fellow man!

[Earlier halakhic source: minor tractate -

Masekhet S'mahot - Evel Rabati]

Someone who commits suicide, we do not deal with him [i.e. his mourning] for any purpose. We do not mourn for him, or eulogize for him, or tear our clothing for him, or remove shoes for him. We only stand for him on a line and say the blessing of mourners for him, and any other thing that is respectful for the living.

A minor, who knowingly commits suicide - is counted as if it was done unknowingly. Such is also the case with an adult who knowingly commits suicide but does so under distress, like King Saul - we do not withhold anything from him.

Who is a considered a suicide? Someone such as a person who said: “I [lit. “he”] is going up to the roof,”, and they saw him go up while angry or he was in distress, and he fell and died, he is considered a suicide. But if he was strangled and hanging in a tree, or dead and found on his sword, he is considered like any other dead person and we may deal with him and do not take anything away from him. HAGAH – One who stole and was killed for this by law of the land, we may mourn for him if there is no danger from fear of the government, and this person is not called a suicide.

One who does not visit the sick cannot seek compassion for him, whether that he live or die: It seems to me that this means that there are times when one must seek compassion for one who it ill that they die, for example, when one is suffering from severe ailments and he will not live....[see story of Rebbi's death in Ketuvot 104]

For the life of this person (who was killed is not the possession of the redeemer of blood but rather) [is] the possession of the Holy One Blessed be He ....

(1) A man is forbidden to injure himself or another. Not only one who inflicts a wound, but anyone who strikes a worthy Jew, whether an adult or a minor, whether a man or a woman, breaks a prohibitive law, as it is written: "He must not lash him excessively" (Deuteronomy 25:3). If the Torah has warned against excess in lashing an offender, how much more should this apply to striking an innocent man.

(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.

(1) One in a dying condition is considered a living being in all respects.³He is considered a living being with respect to granting a divorce (provided he is able to speak, according to one opinion in E.H. § 121, 7) ; to giving gifts, and as to a Kohen entering the house of a person in a dying condition, some permit and others forbid. infra § 370. We may not tie up his jaws,⁴So that he does not open his mouth. nor may we annoint him with oil, nor wash him,⁵In order to remove filth. nor stop off his organs of the extremities,⁶This was done in order that the corpse should not swell on account of the air which enters through his open organs. nor may we remove the pillow from under him, nor may we place him on sand, clay-ground or earth, nor may we place on his stomach a dish, a shovel, a flask of water or a globule of salt,⁷These were ancient practices. nor may we summon the towns on his behalf, nor may we hire pipers and lamenting women, nor may we close his eyes⁸For all these hasten his death — TaZ. On closing the eyes, cf. Gen. XLVI, 4, ‘And Joseph shall put his hand upon thine eyes.’ before his soul departs.⁹Tur citing T.H. who derives this from Sem. Cur. edd., however, do not contain all the items enumerated. W.G. a.l. and Sem(H). p. 233; also supra § 337, n. 2. Cf. further Shab. 151a-b, Mishna. And whosoever closes [the dying person's] eyes before death¹⁰Lit. ‘with the departure of the soul.’ is regarded as one who sheds blood.¹¹One must make sure that he is dead, for it is quite possible that the patient has only fainted — Maim. The Talmud (ibid.) and Sem. (l.c.) compare this to a lamp that is going out. If one places his finger upon it, it is immediately extinguished — ShaK. One may not rend garments, nor bare the shoulder in mourning, nor make a lamentation for him, nor bring a coffin into the house in his presence before he dies,¹²A healthy person is, however, permitted to prepare shrouds for himself — T.H. according to Men. 41a. nor may we begin the recital of Ẓidduk Haddin¹ Glos. before his soul departs.¹³T.H. Cf. W.G. a.l. Gloss: Some say that we may not dig out a grave for him. although it is not [done] in his presence, [i.e.,] in the house, — before he dies.¹⁴RIBaSh, Resp. 114. But if this is not done in the presence of the dying person and he would therefore not become aware of it, it is permissible — B.Yos. and BaḤ. However, on the eve of the Sabbath one must be very careful not to open a grave unless there would be sufficient time to bury the corpse. Cf. O.Ḥ. § 547, 9; BaḤ a.l. Mish. Le-Melek, Yad, Ebel IV, 5. It is [likewise] forbidden to dig out any grave to be [left] open until the next day, in which the corpse will not be buried the same day, and there is danger in this.¹⁵R. Yeruḥam on the authority of R. Yehudah the Ḥasid — G. It is likewise forbidden to cause [aught] to hasten the death of one who is in a dying condition, e.g., one who has been in a dying condition for a long time, and could not depart, — [the law is that] we may not remove the pillow or the mattress from under him [just] because some say that there are feathers from some fowl which cause this [prolongation of death].¹⁶Where there exists a possibility that if a certain cure or medicine is administered the patient may live or it may have the opposite effect of hastening his death, the law is that it is permissible to give the medicine or the like after consultation with medical experts — Resp. Binyan Ẓion. One may offer prayers that the suffering person die — RaN (Ned. 40a). He may likewise not be moved from his place. It is also forbidden to place the Synagogue keys under his head in order that he may depart.¹⁷These are all forbidden on account of moving the patient which may hasten his death — TaZ and ShaK. supra n. 7. However, if there is aught which causes a hindrance to the departure of the soul, e.g., [if] near that house there is a knocking sound, viz., a wood-cutter, or there is salt on his tongue, and these hinder the departure of the soul, it is permitted to remove it therefrom, for there is no [direct] act [involved] in this, since he merely removes the hindrance.¹⁸Hag. Alfasi (295b) to M.K. III — G. TaZ contra ShaK. forbids removing salt from his tongue, since in this case too, the patient has to be moved. A.H. agrees with ShaK.

(1) One who commits suicide wilfully is not attended to at all;¹Lit. ‘in every respect.’ For it is written: ‘And surely your blood of your lives will I require’ (Gen. IX, 5), regarding which R. Eleazar remarked that it means, ‘I will require your blood if shed by yourselves’ (B.K. 91b). RaShBA writes that although the law is that we do not attend to one who commits suicide, nevertheless, this does not apply to burial and shrouds, but only to rending of garments and baring the shoulder in mourning — ShaK. and one does not mourn for him and no lamentation is made for him, nor does one rend [garments] or bare [the shoulder in mourning for him], but one stands for him in the line [of comforters], and one recites over him the mourners' blessing, and whatever [brings] honour [only] to the living [may be done].²Sem(H). II, Thus also Yad, Ebel I, 1 N holds that garments are rent for a suicide and that the passage in Sem. from which our ruling is derived refers to strangers only but not to near-of-kin — ShaK. In a case where the surviving members of the family of a suicide would suffer shame and humiliation, it is permitted to allow them to observe mourning rites — P.Tesh. If no doubts are entertained as to the commision of suicide, the law is that where there are other mourners present at the Synagogue services, the children of a suicidal case should not recite the Kaddish. But if any doubts exist as to whether the person really committed suicide, the children should recite the Kaddish — P.Tesh.

(1) One who commits suicide wilfully is not attended to at all;¹Lit. ‘in every respect.’ For it is written: ‘And surely your blood of your lives will I require’ (Gen. IX, 5), regarding which R. Eleazar remarked that it means, ‘I will require your blood if shed by yourselves’ (B.K. 91b). RaShBA writes that although the law is that we do not attend to one who commits suicide, nevertheless, this does not apply to burial and shrouds, but only to rending of garments and baring the shoulder in mourning — ShaK. and one does not mourn for him and no lamentation is made for him, nor does one rend [garments] or bare [the shoulder in mourning for him], but one stands for him in the line [of comforters], and one recites over him the mourners' blessing, and whatever [brings] honour [only] to the living [may be done].²Sem(H). II, Thus also Yad, Ebel I, 1 N holds that garments are rent for a suicide and that the passage in Sem. from which our ruling is derived refers to strangers only but not to near-of-kin — ShaK. In a case where the surviving members of the family of a suicide would suffer shame and humiliation, it is permitted to allow them to observe mourning rites — P.Tesh. If no doubts are entertained as to the commision of suicide, the law is that where there are other mourners present at the Synagogue services, the children of a suicidal case should not recite the Kaddish. But if any doubts exist as to whether the person really committed suicide, the children should recite the Kaddish — P.Tesh.

(2) Who is [considered] a wilful suicide? — For example, if one stated that he is going up to the roof-top, and they saw him go up at once in anger; or he was in distress, and [then] fell down³By throwing himself down from the roof-top. and died, — [the law is that] such a person is presumed to have committed suicide wilfully. But if they discovered him⁴Sem. has ‘they found him.’ strangled and hung upon a tree, or [they found him] killed⁵ infra § 364, 4. and thrown upon his sword, he is presumed to be like all [other] dead,⁶For it may have been the result of an accident and unintentional. and they attend to him and withhold not from him anything.⁷Yad ibid., derived from Sem(H). II, 2-3. The following rules determine a suicidal case: a) The actual commission of suicide must be observed. A mere indication of suicide is not relied upon, unless the suicide’s previous actions clearly indicate such commision. b) It must be committed wilfully and clearheadedly. c) The expressed intention for such commision must be followed by the act proper. d) In the case of a person found hung, even if the surrounding circumstances lead one to believe that the person took his life, nevertheless, he is not considered a suicide — P.Tesh. If one was not seen going up to the roof-top to take his life in accord with his previous expressed intention, the law is that even if he was later found dead, he is not presumed to be a suicide (RaSHaL) — ShaK. supra c. Gloss: One who stole or robbed⁸The fact that stealing or robbing are punishable by death in no way indicates that the culprit, being aware of the outcome of his crime, may have committed suicide, for it is quite possible that he might have thought that he would not be caught. Nor is he regarded as one who dissociates himself from the practices of the community (v. infra par. 5). If a thief or a robber die a natural death, they are mourned for, provided they repented (supra § 340, 5 refers to one who did not repent) — ShaK., as a result of which was executed by government law,⁹Mord. states that mourning rites are not observed for one who was executed by the government on account of theft. Such a case should be considered as suicide. MaHaRIW (source of this gloss) opposes the ruling of Mord., and maintains that one executed by the government, should be mourned for and is not on an equal footing with a suicide. He holds that Mord. was misled by a corrupt text in Sem. San. 47b where a distinction is made between one executed by a Gentile government and one executed by the Beth Din. In the former case, where execution is not in accordance with Jewish Law, one obtains forgiveness, and should be mourned for; in the latter case death is justly meted out and one is not forgiven. Cf. D.M. and W.G. a.l. is to be mourned for, if no danger will [result] through him on account of the fear of the government;¹⁰ San. 11a; Sota 48b. Otherwise, mourning could be regarded as an act of provocation. One who threw himself into the river is not considered a suicide, for prior to drowning, he is cast about by the waves, and no doubt, before he drowns, he repents — G.Mah. One who murdered a fellow Jew and was exemuted by government law is mourned for — B.L.Y. One who takes his life in order to avoid being subjected by others to inhuman torture is not considered a suicide — B.L.Y. and he is not designated a wilful suicided.¹¹MaHaRIW s. 114 — G.

(3) A minor who commits suicide wilfullly, is considered as though it were [done] unintentionally.¹²Sem(H). II, 4-5. Since he is of immature mind. The same is applicable to an imbecile — Tur. And likewise, one who was of age, and committed suicide wilfully, [being under pressure, as [in the case of] King Saul,¹³For whom suicide was permitted lest the Philistines torture him. Yeb. 78b: ‘“For Saul” (II Sam. XXI, 1) because he was not mourned for properly.’ also Gen. R. Noah XXXIV, 1 Thus also N and Asheri. On King Saul’s tragic death v. I Sam. — [the law is that] they withhold not from him a thing.

One who does such (previously described) actions, placing oneself in danger....

"And surely ('akh'-I require a reckoning for your blood - Gen. 9:5). This includes one who strangles himself [i.e., a suicide is punished].

You might think that even one in the
in the plight of Saul [who committed suicide to save himself from the Philistines, I Sam. 31:4]: therefore we have 'akh' [It is a principle of exegesis that ak and rak (excepting, save that) are limiting particles]. You might think, even one like Hananiah, Mishael and Azariah [who risked their lives, which is akin to suicide, in order to sanctify God's name]: therefore we have 'akh.

[Soncino translation and foot-notes.]
...

... Rabbi Akiva expounded, Every person who sheds blood, it is as if he has diminished the Image. What is the prooftext? "One who shed the blood of a human, by a person shall his blood be shed." Why? "Because in the image of God, He made man (Gen 9:6)."

The Gemara asks: And should one not transgress the prohibition of idol worship to save his life? But isn’t it taught in a baraita: Rabbi Yishmael said: From where is it derived that if a person is told: Worship idols and you will not be killed, from where is it derived that he should worship the idol and not be killed? The verse states: “You shall keep My statutes and My judgments, which a person shall do, and he shall live by them” (Leviticus 18:5), thereby teaching that the mitzvot were given to provide life, but they were not given so that one will die due to their observance.

(1) It is mandatory upon the whole house of Israel to sanctify this Great Name, for it is said: "And I shall be sanctified among the children of Israel" (Lev. 22.32). They are also charged not to blaspheme Him, for it is said: "And ye shall not profane My holy Name" (Ibid.). How are these commandments to be observed? If an idolater will force an Israelite to transgress one of the commandments of the Torah and threaten him with death for disobedience, it is mandatory that he transgress the commandment and be not put to death, for it is said concerning the commandments: "That which a man may do and live by it" (Ibid. 18.5)—"live by it, but not die for it". ¹Sanhedrin, 74a; Yoma 85a; Abodah Zarah, 26b. C. G.Thus, if he chose death and did not transgress, his blood be upon his own head.

If he then gets up and walks outdoors upon his staff, the assailant shall go unpunished, except that the assailant must pay for the injured party's time off from work and certainly for the cure.

(2) Whereat are these words directed? Concerning all other commandments, save idolatry, adultery and blood-shed. For respecting these three commandments, if one will say to him: "Transgress one of the three, or die," he shall die, and not transgress. Whereat are these words directed? When the idolater intends to have a personal enjoyment, as when he forces an Israelite to build his house, or cook his meals on a Sabbath, or when he forces a Jewish woman, and in like matters; but if he merely intended to make him violate commandments, then, if it happen between themselves, and there be no ten Israelites present, it is mandatory to transgress and not die; but if he forces him to go astray from one of the commandments in the presence of ten Israelites, he must suffer death and not transgress, even though the idolater did not intend to lead him astray save from one of the rest of the commandments.

(3) Someone on whom a collapse [as of a building] has fallen, and itis doubtful whether he is alive or dead, doubtful whether he is there or not, and even if he is there it is doubtful whether he is Jewish or and idolater, they remove the collapse for him even though there are several doubts.

But take utmost care and guard yourself (your nefesh/body) scrupulously, so that you do not forget the things that you saw with your own eyes and so that they do not fade from your mind as long as you live...

R. Shilat (Refua, Halakha, v' Kavanot) argues that perhaps Lev. 18:5 and 19:16 imply the need to protect life in order to serve God. Further, Deut. 4:9 may imply that if one's suffering is preventing one from remembering, 'pen-tishkakh', perhaps we might not be obligated in the mitzvah of 'hi-shameir lekha', guarding our bodies.

(Jason Weiner, p. 39).

Even if they found him [in exremis], that he can only live for a short hwile, they remove the collapse and check until his nose, and if they do not sense at his nose life then he is definitely dead - it does not matter whether they reached his head or his feet first....

... Do not stand [idly] by the blood of your fellow: I am the Lord.

The Gemara challenges: This verse is necessary for teaching a different halakha, that which the school of Rabbi Yishmael taught. As the school of Rabbi Yishmael taught: When the verse states: “Verappo yerappe,” from here it is derived that permission is granted to a doctor to heal. The Gemara answers: If so, let the verse write: Verofeh yerappe, meaning: And a doctor shall heal. Learn from the phrase employed that the one who caused the injury is liable to give monetary compensation for medical costs in a case of damage.

And now, O Israel, what does the LORD your God demand of you? Only this: to revere the LORD your God, to walk only in His paths, to love Him, and to serve the LORD your God with all your heart and soul.

SLS: if we are unable to revere, love and serve, are we obligated to prolong life?

Anyone who can save and does not save transgresses 'do not stand by the blood of your neighbour'. And, also...one who sees his friend drowning in the sea, bandits attacking him or a bad animal attacking him, .... or...who hears [others]...plotting harm...[etc.]...

In my humble opinion, the reason that the Torah warns us about care of the body/soul is because the Holy One created the world with lovingkindness in order to bring goodness to created beings so they would realize God's greatness and serve God through Mitzvot and Torah. As Isaiah (43:7) states: "All who are called through My name, whom I created, formed and made for My Glory," I have given reward in their world. And one who endangers herself, is as one who loathes the will of the Creator's, not wanting to serve God, nor to receive God's reward...and there is no more scornful contempt than this....

(1) [The laws of] Shabbat are suspended (pushed aside) where there is a life-threatening situation, as are all mitzvot of the Torah. Therefore, one who is dangerously ill, and an observant person, even if s/he occasionally transgresses because of temptation, and even a day-old infant, it is a mitzvah to violate Shabbat. Even if the patient refuses, we force him/her to accept help. It is a grave sin to carry piety to the point of idiocy and refuse treatment because it would violate a law. About such a person Gen. 9:5 states: concerning the blood of your soul, I demand an account. Praiseworthy is the one who is quick to desecrate Shabbat for someone who is gravely ill. Even if a non-Jew is present, every effort should be made for a Jew to do [what is needed]...Even if the threat to life is uncertain, it is a mitzvah to desecrate Shabbat for him, doing all the Toraitic prohibitions, because nothing stands before a life-threatening situation, because Torah was given for the sake of life....

Saving a life suspends [the laws of] Shabbat, as it suspends all mitzvot. As is stated in Lev 18:5 "and you will observe all my statutes and laws so that a person will do them and live through them. In Yoma 85b, the Sages state, "and live by them and not die by them". Thus it is a mitzvah and obligation for any Jew to desecrate the Sabbath for any person who is dangerously ill. The Sages stated in Yerushalmi Yoma 41b, be quick to desecrate Shabbat in order to save a life, even [violating] those labors (melakhot) mentioned in the Torah is praiseworthy. Questioning is condemned and the one who questions is as one who sheds blood. And further the Sages say, Yerushalmi Sanhedrin 37a, all who save [even] one (Jewish) soul is as if sustaining an entire world.

(3) Someone on whom a collapse [as of a building] has fallen, and itis doubtful whether he is alive or dead, doubtful whether he is there or not, and even if he is there it is doubtful whether he is Jewish or and idolater, they remove the collapse for him even though there are several doubts.

When a person commits suicide [kills oneself with clarity of mind], we do not engage in activity on their behalf at all. We do not mourn for him or eulogize him. We do, however, stand in a line to comfort the relatives, recite the blessing for the mourners and perform any act that shows respect for the living.

What is meant by a person who commits suicide? Not necessarily one who climbs up on a roof, falls, and dies, but rather, one who says: "I am going up to the top of the roof." If we see him climb up immediately in anger or know that he was distressed and see him fall and die, we presume such a person is one who committed suicide. If, however, we see him strangled and hanging from a tree or slain and lying on the back of his sword, we presume that he is like all other corpses. We engage in activity on his behalf and do not withhold anything from him.

(32) The definition of a goses, as distinct from a treifah, must be clearly understood. A goses does not have any specific pathology. [He is comparable to] a clock that is running down. Hakodosh Baruch Hu, as punishment for Adam's eating from the Tree of Knowledge, declared that death shall be the experience of man until Moshiach comes and the resurrection of the dead occurs. Thus, there is a finite time that man can live. The goses is an individual whose time to die has come. Lacking any specific pathology, he is not classified as a treifah but as a normal member of mortal society. Shortening his life is tantamount to taking the life of a healthy person. This is why our sages warn that a goses should not be "touched." Touching does not refer to essential care for his comfort, such as cleansing and providing liquids by mouth to overcome dryness, [but means that] we must be careful not to do anything that could possibly shorten his life. It is the weakened state that was of such concern to our sages, and hence a goses cannot be "touched."

(8) 8. When, by contrast, a person is considered treifah,even though he eats, drinks and walks in the market place, one is not held liable by an earthly court for killing him. Every person is presumed to be physically sound, and a person who kills him should be executed unless it is certainly known that he is a treifah, and the physicians say that his infirmity does not have any remedy for humans and it will surely cause his death, if no other factor does first.

They found Rabbi Ḥanina ben Teradyon, who was sitting and engaging in Torah study and convening assemblies in public, with a Torah scroll placed in his lap.

We learned in the mishna that Rabbi Tarfon says: Over water one recites: Who creates the many forms of life and their needs. Rava bar Rav Ḥanan said to Abaye, and some say to Rav Yosef: What is the halakha in this dispute? He said to him: Go out and observe what the people are doing and act accordingly.

If one's father or mother has become mentally disordered, he should make an effort to behave toward them according to their state of mind until they will be shown mercy [and get cured]. But if he is unable to endure the strain any longer, because they have become utterly insane, he may leave them and go elsewhere, charging others to take proper care of them.

We learned in the mishna that Rabbi Tarfon says: Over water one recites: Who creates the many forms of life and their needs. Rava bar Rav Ḥanan said to Abaye, and some say to Rav Yosef: What is the halakha in this dispute? He said to him: Go out and observe what the people are doing and act accordingly.

The Gemara suggests: Let us derive a general principle that human dignity takes precedence over all mitzvot in the Torah from this case. This possibility is rejected: This is a special case, because a case of “sit and refrain from action” [shev ve’al ta’aseh] is different. Engaging in the burial of a met mitzva is not actually in contravention of a mitzva. Rather, by doing so he becomes ritually impure and is then rendered incapable of fulfilling that mitzva. We cannot derive a general principle from here that human dignity would also override a Torah prohibition in a case where that prohibition is directly contravened.

(1) The Torah has granted the physician permission to heal,¹B.K. 85a derived from the words, ‘And to heal he shall heal’ (Ex. XXI, 19). and it is a religious duty²Ned. 41b, Asheri s.v. רפואת. The apparent contradictory terms ‘permission’ and ‘religious duty’ on explained as follows: True healing is the result of efficacious prayer. But not every person merits such consequences. Man, therefore, has to rely upon natural cures too, through the permission granted the medical man to administer treatment, who in turn is religiously dutibound to perform his duty — TaZ. In this sense TaZ explains the passage in Ber. 60a bot. On the question of cures in the Talmud, cf. R. A. Eger a.l.; M.K. 11a, Tosaf. s.v. כוורא; Kol Bo(G) § I, sec. which comes under the rule of saving an endangered life.³T.H., derived from Yoma 83a-b. Cf. O.Ḥ. § 328, 4. If he withholds [treatment] he is regarded as one who sheds blood;⁴Derived from Y.Yoma VIII, 5(45b). Cf. O.Ḥ. ibid. par. 2. and even if there is someone else who can heal him; for not from every one does one merit to be healed.⁵Y. Ned. IV, 2(38c). Nevertheless, on should not occupy himself with medical treatment unless he is an expert and there is none other greater than he; for if not so, he is regarded as one who sheds blood.⁶This follows a fortiori from all other laws and teachings of the Torah which only an expert is permitted to deal with. Cf. San. 84b; Kid. 82a, Mishna. If one administered medical treatment without the permission of the Jewish Court,⁷Or nowadays without a medical diploma — A.H. he is subject to payment of indemnities, even if he is an expert; and if he administered medical treatment, having the permission of the Jewish Court, and erred, causing [thereby] injury [to the patient], he is exempt by the laws of man and is held responsible by the laws of Heaven.⁸Tosef(Ẓ). B.K. VI, 17. This applies only if it was the result of his negligence. Otherwise, he is regarded as not having committed any sin — A.H. If he caused injury intentionally, even after having permission of the Court, he is held responsible by the laws of man — ShaK. If he caused death and it became known to him that he acted inadvertently, he is banished⁸Tosef(Ẓ). B.K. VI, 17. This applies only if it was the result of his negligence. Otherwise, he is regarded as not having committed any sin — A.H. If he caused injury intentionally, even after having permission of the Court, he is held responsible by the laws of man — ShaK. on account of him.⁹Tosef. ibid. according to version of N in T.H. Cf. W.G. a.l.

In support of this last claim, the Gemara cites a baraita in which the Sages taught: There are three whose lives are not lives, and they are as follows: One who looks to the table of others for his sustenance; and one whose wife rules over him; and one whose body is ruled by suffering. And some say: Even one who has only one robe. Since he cannot wash it properly, he suffers from lice and dirt. The Gemara comments: And the first tanna, who did not include such a person, maintains: It is possible for him to examine his clothes and remove the lice, which would alleviate his suffering.

(2) "A valiant woman, who can find" (Proverbs 31:10): That is the Torah; "and further than pearls (peninim) is her price" - as it was 'in front of Me and inside (lefanim)' and Moshe merited to bring it down to earth. "Her husband puts his confidence in her, and lacks no 'booty'" - that there is nothing lacking in it. Another explanation: "A valiant woman, who can find" - They said, "There was a story about Rabbi Meir who was sitting and expounding in the study hall on Shabbat afternoon, when two of his sons died. What did his mother do? She placed both of them on the bed and spread a sheet over them. At the end of Shabbat, Rabbi Meir came home from the study hall. He said to her, 'Where are my two sons?' She said [back], 'They went to the study hall.' He said to her, 'I scanned the study hall and I did not see them.' They gave him the cup of Havdalah and he separated [the days of the week with the closure of Shabbat]. He repeated and said, 'Where are my two sons?' She said, 'They went elsewhere and they are coming now.' She placed food in front of him and he ate and blessed. After he blessed, she said to him, 'I have a question to ask you.' He said to her, 'Say your question.' She said to him, 'Rabbi, before today, a man came and deposited something with me, and now he is coming to take it. Should we return it to him or not?' He said, 'My daughter, one who has a deposit with him must return it to its owner.' She said to him, 'Were it not for your consent, I would not have given it to him.' What did she do? She grabbed his hand, brought him up to that room, had him approach the bed and took off the sheet from upon them. When he saw both of them dead and laying upon the bed, he began to cry and say, 'My sons, my sons, my teachers, my teachers - my sons in the way of the world, my teachers in that they would enlighten my eyes with their Torah.' At that time, she said to Rabbi Meir, 'Rabbi, is this not what I told you - do I not need to return the deposit to its Owner?' He said, '"The Lord has given and the Lord has taken; may the name of the Lord be blessed"' (Job 1:21)." Rabbi Chanina said, "With this thing, she consoled him and his mind became composed - that is is why it states, 'A valiant woman, who can find.'" Rabbi Chama bar Chanina said, "On account of what did the sons of Rabbi Meir become liable and die at one time? Because they were accustomed to leaving the study hall to sit with food and drink." Rabbi Yochanan said, "Even with trifling matters - as when the Torah was given to Israel, he only warned them about the words of Torah, as it is stated (Deuteronomy 26:16), 'This day the Lord, your God, commands you to do.'"

(1) One in a dying condition is considered a living being in all respects.³He is considered a living being with respect to granting a divorce (provided he is able to speak, according to one opinion in E.H. § 121, 7) ; to giving gifts, and as to a Kohen entering the house of a person in a dying condition, some permit and others forbid. infra § 370. We may not tie up his jaws,⁴So that he does not open his mouth. nor may we annoint him with oil, nor wash him,⁵In order to remove filth. nor stop off his organs of the extremities,⁶This was done in order that the corpse should not swell on account of the air which enters through his open organs. nor may we remove the pillow from under him, nor may we place him on sand, clay-ground or earth, nor may we place on his stomach a dish, a shovel, a flask of water or a globule of salt,⁷These were ancient practices. nor may we summon the towns on his behalf, nor may we hire pipers and lamenting women, nor may we close his eyes⁸For all these hasten his death — TaZ. On closing the eyes, cf. Gen. XLVI, 4, ‘And Joseph shall put his hand upon thine eyes.’ before his soul departs.⁹Tur citing T.H. who derives this from Sem. Cur. edd., however, do not contain all the items enumerated. W.G. a.l. and Sem(H). p. 233; also supra § 337, n. 2. Cf. further Shab. 151a-b, Mishna. And whosoever closes [the dying person's] eyes before death¹⁰Lit. ‘with the departure of the soul.’ is regarded as one who sheds blood.¹¹One must make sure that he is dead, for it is quite possible that the patient has only fainted — Maim. The Talmud (ibid.) and Sem. (l.c.) compare this to a lamp that is going out. If one places his finger upon it, it is immediately extinguished — ShaK. One may not rend garments, nor bare the shoulder in mourning, nor make a lamentation for him, nor bring a coffin into the house in his presence before he dies,¹²A healthy person is, however, permitted to prepare shrouds for himself — T.H. according to Men. 41a. nor may we begin the recital of Ẓidduk Haddin¹ Glos. before his soul departs.¹³T.H. Cf. W.G. a.l. Gloss: Some say that we may not dig out a grave for him. although it is not [done] in his presence, [i.e.,] in the house, — before he dies.¹⁴RIBaSh, Resp. 114. But if this is not done in the presence of the dying person and he would therefore not become aware of it, it is permissible — B.Yos. and BaḤ. However, on the eve of the Sabbath one must be very careful not to open a grave unless there would be sufficient time to bury the corpse. Cf. O.Ḥ. § 547, 9; BaḤ a.l. Mish. Le-Melek, Yad, Ebel IV, 5. It is [likewise] forbidden to dig out any grave to be [left] open until the next day, in which the corpse will not be buried the same day, and there is danger in this.¹⁵R. Yeruḥam on the authority of R. Yehudah the Ḥasid — G. It is likewise forbidden to cause [aught] to hasten the death of one who is in a dying condition, e.g., one who has been in a dying condition for a long time, and could not depart, — [the law is that] we may not remove the pillow or the mattress from under him [just] because some say that there are feathers from some fowl which cause this [prolongation of death].¹⁶Where there exists a possibility that if a certain cure or medicine is administered the patient may live or it may have the opposite effect of hastening his death, the law is that it is permissible to give the medicine or the like after consultation with medical experts — Resp. Binyan Ẓion. One may offer prayers that the suffering person die — RaN (Ned. 40a). He may likewise not be moved from his place. It is also forbidden to place the Synagogue keys under his head in order that he may depart.¹⁷These are all forbidden on account of moving the patient which may hasten his death — TaZ and ShaK. supra n. 7. However, if there is aught which causes a hindrance to the departure of the soul, e.g., [if] near that house there is a knocking sound, viz., a wood-cutter, or there is salt on his tongue, and these hinder the departure of the soul, it is permitted to remove it therefrom, for there is no [direct] act [involved] in this, since he merely removes the hindrance.¹⁸Hag. Alfasi (295b) to M.K. III — G. TaZ contra ShaK. forbids removing salt from his tongue, since in this case too, the patient has to be moved. A.H. agrees with ShaK.

§ Rava says: All concede that in the case of one who kills one who has a wound that will cause him to die within twelve months [tereifa] he is exempt from liability, as in a certain sense the legal status of the victim is that of a dead person. All concede in a case where one kills an individual dying from an illness caused at the hand of Heaven that he is liable, as no other individual took action contributing to his death, and the murderer alone took his remaining soul. They disagree only in a case where one kills an individual dying from injury caused at the hand of a person. One Sage, the Rabbis, likens this case to the case of a tereifa, and therefore rules that the one who kills him is exempt. And one Sage, Rabbi Yehuda, likens this case to the case of an individual dying from an illness caused at the hand of Heaven, and therefore rules that the one who kills him is liable.

[This is a seminal responsum presenting the halachic view on most issues of concern in the care of the critically ill. Addressed to several physicians, it is written in a succinct style, for the recipients were all physicians, well trained both in medicine and in Torah study. However, for the general Torah community, some background information is of critical importance lest the translation be a source of confusion and of misapplication of the halachic principle discussed therein. To fully understand Rav Feinstein's halachic reasoning, those studying this teshuvah should read the article entitled "Quality and Sanctity of Life in the Talmud and the Midrash" for orientation.¹Tradition, vol. 28, no. 1 (Fall 1993) pp. 18–27 (co-authored with Dr. Fred Rosner), reprinted below as an appendix. Likewise, the article on brain-stem death in halachah, which contains all the background and source material necessary for understanding Rav Feinstein's halachic ruling, is a necessary accompaniment to this teshuvah.]²See “Anatomy of a Teshuvah,” p. 36f., below.

(1) Short-term Prolongation of Life

(2) [This is a seminal responsum presenting the halachic view on most issues of concern in the care of the critically ill. Addressed to several physicians, it is written in a succinct style, for the recipients were all physicians, well trained both in medicine and in Torah study. However, for the general Torah community, some background information is of critical importance lest the translation be a source of confusion and of misapplication of the halachic principle discussed therein. To fully understand Rav Feinstein's halachic reasoning, those studying this teshuvah should read the article entitled "Quality and Sanctity of Life in the Talmud and the Midrash" for orientation.¹Tradition, vol. 28, no. 1 (Fall 1993) pp. 18–27 (co-authored with Dr. Fred Rosner), reprinted below as an appendix. Likewise, the article on brain-stem death in halachah, which contains all the background and source material necessary for understanding Rav Feinstein's halachic ruling, is a necessary accompaniment to this teshuvah.]²See “Anatomy of a Teshuvah,” p. 36f., below.

(3) I regret that ill health has delayed my responses to the questions you pose, all of which raise issues of the utmost importance if the care of the critically ill is to be administered in accordance with Torah law.

(4) 1. Are there patients who should not be treated so as to prolong their lives for a little while?

(5) This question obviously refers to a terminally ill patient who can live for only several weeks or months, at most. Such patients often should not be treated. The key concern is their quality of life. In cases of intractable pain, we have clear instructions from the account of the death of Rebbe, the compiler of the Mishnah, in Talmud Kesubos 104[a]. The Talmud describes how his students prayed that he would remain alive. His maidservant, seeing the great suffering he was enduring, prayed that the angels above would meet with success [in their prayers for Rebbe's soul to return to Heaven, [so that the rabbis' prayers for his continued life] would not be accepted.

(6) In order to disrupt the rabbis' prayer service, the maidservant knocked down a large urn. This distracted the students, [who momentarily ceased their prayers], and as a result Rebbe was able to die.

(7) The maidservant was a wise woman, learned in the ways of Torah. As recorded elsewhere, [Rebbe's] students learned many things from her, and for this reason the Talmud records that her actions were right and proper. Nedarim 40[a] relates an incident involving the students of Rebbe Akiva. They had neglected to visit one of their colleagues who was ill, and when Rebbe Akiva entered the study hall, he criticized them for this. His rebuke, as understood by the Ran [in his commentary on the Talmud], consisted of the following: "It is sometimes proper to pray to Hashem for the death of a critically ill person, if he is suffering greatly and his condition is really terminal; in short, if there is no rational hope that he will recover."

(8) The Ran concludes that Rebbe Akiva's rebuke of his students was essentially as follows: "Why didn't you visit your sick colleague? You could have helped him or prayed for his recovery. If you were convinced that there was no hope of a recovery, you could at least have prayed for him to die quickly. Even that little help you withheld from him!"

(9) The Ran cites the Gemora in Kesubos, referred to above, as proof that this is, indeed, the proper response for those who want to do the mitzvah of visiting the sick. We see that the Ran assumes that the maidservant's opinion is recorded as the final halachah.

(10) Therefore, if a patient is terminally ill and in intractable pain, so that there is no hope of his surviving in a condition free of pain, but it is possible, through medical or technological methods, to prolong his life, then it is improper to do so. Rather, the patient should be made as comfortable as possible, and left without any further intervention. I must emphasize that it is absolutely forbidden to do anything or to provide any drug that will shorten the patient's life for even a moment. To do so would be an act of murder. [Physician-assisted suicide is halachically murder, even though the intent is to shorten the patient's life for reasons of euthanasia.]

(11) If it is possible to provide drugs that will make the patient comfortable so that he will not be in pain, then efforts should be made to prevent the patient from dying. Intervention of this kind is to be continued only if the patient is not halachically considered a goses. The term goses refers to the heavy, labored, erratic breathing that occurs when death is imminent. A goses should not be treated at all. It is forbidden to intervene, lest the intervention shorten the patient's life. As quoted by the Rambam [Laws of Mourning 4:5], a goses is like a sputtering wick. Reaching out to fix it will often extinguish the flame. A patient who is critically ill and unable to breathe is suffering from oxygen hunger. Providing oxygen is required, not to prolong life but to ease the pain of the air hunger. I have been told that [oxygen insufficiency] causes acute pain, and it is our duty to ease the patient's discomfort in such cases. I am aware that this complicates the care of the patient, since it will make it difficult to tell when he has expired. For once the patient has expired [i.e., has been declared brain-stem dead], the respirator should be removed. Therefore I recommend that oxygen be provided in small amounts, i.e., from a small tank, not from the central supply. Every time the oxygen in the tank is used up there is an appropriate opportunity to evaluate the patient to determine whether brain-stem death has occured. The decision either to continue to provide oxygen or to remove the ventilator can then be made.

(12) This suggestion will make it possible to provide appropriate treatment without running the risk of shortening the patient's life, even for a moment. [This succinct comment is in keeping with the analysis given in Iggeros Moshe, Yoreh De'ah III:132.]

(13) 2. The second question concerns the issue of triage, or who should be treated and who should not be treated?

(14) The case you pose concerns two patients who are brought into the hospital, both in need of immediate emergency or critical care. One of them has a good possibility of being cured, but it is not absolutely certain that he needs intensive care, although [this] would be the preferred method of treatment. However, the second patient, for whom intensive care could only provide a postponement of death, cannot live at all without the attention of an ICU [intensive care unit]. Which patient should be given the only bed available?

(15) In my opinion, if both arrive at the same time, the decision should be made on the basis of medical suitability. The one who has the best chance of being treated and cured should be given the available bed. However, if the one who can only live for a short time has already begun treatment before the arrival of the second patient, for whom there is an expectation of a cure, but he can only be saved if the first patient, whose life can only be prolonged for a short time, is removed [from life support], it is forbidden to interrupt the treatment of the first patient in order to save him. The logic is obvious. The individual who can live only a short time is not obligated to forfeit his life for anyone else. Once he has taken possession of the hospital facility and his life depends upon continued treatment, even if his life be but of short duration, his claim takes precedence over all other claims. I see this as a contractual relationship with the hospital and the physicians. The care they provide was assigned to this terminally ill patient and no one can take it away from him. The patient himself is not required to give up his place to the patient who can be cured, and possibly not even permitted to do so voluntarily.

(16) [However, as noted in the case where both arrive at the hospital at the same time,] the selection of the patient more medically suited for treatment should be made even if the first patient, for whom there is no hope of actual cure, arrives first at the hospital. The one with the better chance of survival should be treated. The only time he should not be given preference is when the critically ill patient, who has no hope of cure, has actually begun his treatment, has actually been already placed in the bed in the critical care unit.

(17) It goes without saying, of course, that even if the critical care facility cannot accommodate both patients, the one who is not to be admitted to the critical care unit should be provided with the best care available in some other department of the hospital.

(18) 3. The third question concerns the halachic status of the goses. I have been told that physicians do not recognize this state. Possibly this is because there is no real medical need to define the condition known as goses, since only Torah law requires that a goses not receive any intervention lest his life be shortened. Indeed, it may be that non-Jews are not halachically bound by this concern.

(19) The Talmud and the Rambam [Laws of Mourning 4: [5]], and likewise the Shakh in Yoreh De'ah 339, warn against any kind of intervention with a patient in the goses state; even moving him is prohibited.¹The Talmud refers to the goses as a flickering candle. If you reach out to try to fix the wick, it is likely that you will extinguish the flame. The Talmud [Avodah Zarah 18] describes the martyrdom of Rebbe Chanina ben Tradyon, who was burned at the stake because he had been caught teaching Torah. To prolong his agony, the executioner placed wads of wet wool on his chest. His students, seeing his great anguish, pleaded: "Open your mouth and breathe in the flames so that you will die more quickly." Rebbe Chanina refused, stating that it is forbidden to shorten one's life by any action [of one's own]. However, when the executioner asked Rebbe Chanina whether he would be guaranteed a place in the World to Come if he removed the wads of wool from his chest and increased the flames that he had [earlier] reduced in order to prolong the dying process, Rebbe Chanina answered in the affirmative.

(20) As the Talmud relates, the executioner did so and then threw himself into the flames, committing suicide as an act of contrition. A voice from Heaven was heard announcing that the executioner and Rav Chanina each had a place in the World to Come. This aggadic inclusion in the Talmud teaches us many halachos. In particular the incident suggests that the executioner's act of shortening of Rebbe Chanina's life was not sinful. It may be possible, therefore, to infer that a non-Jew is not bound by the law which forbids shortening the life of a patient in extremis, which halachically is referred to as the goses state.

(21) Other sources, however indicate that there is no difference between Jew and non-Jew in this matter. I refer you to the Rambam's Laws of Kings 9:4, in which it is clearly stated that a non-Jew who kills someone who is critically ill [i.e, not in the goses state but mortally wounded or in a pathological condition] has committed an act of murder. In halachah, a goses is looked upon as having a more significant residual life than the individual known as a treifah. [The goses state should be visualized as analogous to a clock winding down. Until the clock stops, it is still considered to be an active timepiece even if only for another few minutes.]

(22) I am uncertain, therefore, as to whether the halachah distinguishes between Jew and non-Jew in this regard. If there is no such distinction, then the incident concerning the martyrdom of Rebbe Chanina poses a halachic question as to whether the executioner violated the halachah or not. [I would suggest that although it is forbidden even for a non-Jew to hasten the death of a patient in extremis, this was an unusual situation. The executioner, on his own discretion, had reduced the flame and placed the wads of wet wool on Rebbe Chanina in order to prolong his agony. Perhaps we should view his restoration of the original state by increasing the flames and removing the wool, not as hastening Rebbe Chanina's death, but merely as undoing what he had done to prolong the dying process. M. D. T.]

(23) This incident should be viewed as a hora'as sha'ah, a decision which is applicable only under special circumstances, but cannot be applied to other conditions, such as those found in the hospital. Thus we must conclude that it is indeed forbidden to offer any significant intervention to an individual in a goses state for fear that this would shorten his life.

(24) Physicians who are not guided by Torah law may not be aware of this, or may feel that in medical practice it is an inconsequential concern. However, those who observe the Torah must be careful to observe the laws of goses. They should not intervene in any way that is not for the patient's direct benefit. Members of the Chevra Kadisha in every town in Europe were fully familiar with the goses state. They refrained from having any contact with the patient during this period. After the patient's death they undertook every procedure in keeping with the laws governing the honor and dignity due to an individual created in Hashem's image in accord with Torah law.

(25) 4. The fourth question concerns the differentiation between treifah of man and of animal, and distinguishing between a treifah and a goses.¹In animals the term treifah pertains to the dietary laws, but in humans it concerns the laws of homicide. Goses is a state in which death is imminent; treifah refers to a pathological state of a particular organ. Treifah is a technical term referring to a puncture or ulceration of an organ or a condition best identified as edematous or eroded, whether or not there is pus or exudate present. The specific pathologies that make an animal into a treifah vary from organ to organ. Specific details can be reviewed in the Shulchan Aruch, Yoreh De'ah, Hilchot Treifos.

(26) The definition of treifah employed in the dietary laws should not be equated with the definition of treifah as pertaining to the laws of homicide. Veterinary science and clinical medicine have progressed over time. Our understanding of natural law has changed in the course of time, as emphasized by the Tosafists in tractate Mo'ed Katan 11; so has our understanding of diseases and cures.

(27) Therefore, the Talmud's statement, in the chapter in tractate Chulin entitled Elu Treifos, that a treifah cannot live for twelve months, must not be taken literally, as if it were a fact for all times and all places. In the time of the sages, perhaps even including the Amoraim, and certainly the Tannaim, this was the reality. An animal that suffered one of the eighteen pathologies could not survive for twelve months. Even if we could show that there is now a means of curing any of these treifos so that the animal could live, it would not change the halachah. It is a halachah le-Moshe mi-Sinai that these eighteen treifos make an animal unfit for consumption by those who observe Torah law.

(28) This is what the Rambam means when he writes [in Laws of Shechitah 10:12] that it is not proper to add to the list of treifos even if one is certain that the animal is mortally ill and cannot live. The statement in the Talmud that a treifah cannot live refers to the eighteen treifos at the time the Torah was given. The reverse would also be true. If some medical or veterinary treatment had been lost through the centuries, so that an animal that once could have been cured can no longer expect a cure, the animal would still not be classified as a treifah. The explanatory note that a treifah cannot live twelve months is a good statement of the science of the time but has no halachic import. [In short,] the ability to be cured will not make an animal possessing one of the eighteen pathologies kosher, and an animal that is ill but not with one of the eighteen pathologies is not classified as a treifah even if its survival for twelve months is most unlikely. In our days there are obviously many treifos that can live a long and healthy life. Experiments done on animals during research in clinical medicine have clearly shown that one can resect the stomach and intestines and successfully treat the animal so that it becomes healthy and then can live a normal life.

(29) Similarly, lungs have been resected successfully, both in animals and man, and even in the time of the Rambam, as indicated by his language in the Laws of Treifos, there were medical advances that allowed for some of the treifos to be cured. Medical science moves forward over the generations, so that there has occurred a change in the statement that treifos cannot live or, even in the reverse, that certain pathologies can be cured but such cures are no longer available to us. They have been lost with the passage of time. Our knowledge of nature changes, and indeed nature itself may change, but as I have stated above, these developments do not modify the definition of treifah.

(30) This analysis does not apply to [the concept of] treifah in man and its application to the laws of homicide. The definition of treifah in man does in fact depend upon the reality, the knowledge of the day, as to whether the individual concerned can or cannot survive. Thus, if a victim is afflicted with a pathology that in the time of the Talmud would have been considered fatal, but today, because of good medical or surgical management, it can be easily cured, the murderer is to be put to death.¹According to Torah law, if the victim is a treifah, the Beth Din may not put the murderer to death, and punishment is left to Hashem. This halachah is clearly stated by the Rambam in Laws of Murder 2:8, where he defines treifah as follows: "The doctors must say that this pathology has no cure and he will surely die from it." The Rambam does not refer to any specific pathology, as he does in discussing the dietary laws, the laws of treifah in animals. This is because "nature has changed and our knowledge of nature has advanced."

(31) I would like to emphasize that capital punishment is not administered today because we do not have a Sanhedrin convened in the lishkas hagazis.²The Chamber of Hewn Stones in the Temple, where the Sanhedrin used to meet. Once they were forced out of that chamber, they no longer possessed the authority to levy the death penalty. Part of the Sanhedrin's meeting place had the same degree of sanctity as the courts of the Holy Temple, whereas the other part was a secular area which only carried the sanctity of the Temple Mount. It was only when the Sanhedrin of seventy-one could meet on the Temple Mount that the local town Beit Din of twenty-three could accept cases involving capital punishment. Today, however, someone who kills a treifah would be subjected to all sorts of social sanctions, such as the withholding of burial rights so that he could not be buried in a cemetery with other observant Jews, and in addition he would be subjected to any appropriate punishment, other than capital punishment, that is not in violation of the laws of our country. [Explanatory note: Physician-assisted suicide and euthanasia are now being debated; various opinions have been offered as to whether society should give its approval through changes in its laws, and for this reason the Torah view must be heard. Euthanasia is murder, even when the patient can live only for a very short time, a time measured in minutes. Passive euthanasia, i.e., withholding new therapy that could prolong the life of a dying patient, may be an option within halachic parameters. M. D. T.]

(32) The definition of a goses, as distinct from a treifah, must be clearly understood. A goses does not have any specific pathology. [He is comparable to] a clock that is running down. Hakodosh Baruch Hu, as punishment for Adam's eating from the Tree of Knowledge, declared that death shall be the experience of man until Moshiach comes and the resurrection of the dead occurs. Thus, there is a finite time that man can live. The goses is an individual whose time to die has come. Lacking any specific pathology, he is not classified as a treifah but as a normal member of mortal society. Shortening his life is tantamount to taking the life of a healthy person. This is why our sages warn that a goses should not be "touched." Touching does not refer to essential care for his comfort, such as cleansing and providing liquids by mouth to overcome dryness, [but means that] we must be careful not to do anything that could possibly shorten his life. It is the weakened state that was of such concern to our sages, and hence a goses cannot be "touched."

(33) [This prohibition] does not apply to a treifah. No medical intervention is permitted for a goses, since physicians have already concluded that no intervention can benefit him. Routine hospital procedures, such as drawing blood or even taking temperature, have no place in the final hours of a patient's life.