Mikolot Mayim Rabbim

Here is are some of media links on the RCA’s Vaad Halacha’s paper, which I consider noteworthy, along with some editorial comments [UPDATED 2011-02-11 – split off and expanded from an older, overlong post].

But first, A Comment About Comments

Many of the comments in the blogosphere show that there is considerable disagreement about fact, in addition to the disagreements about doctrine.In previous posts, I expressed the hope that major halakhic authorities, including but not limited to those who already wrote on the issue, would revisit the question of the onset of death in halakha. I did so believing that many important facts that may previously have been ignored, have now become well known, so that we are ready to revisit the issue.

However, seeing how much disagreement there is a about facts, I think that we must also call for a broad based international investigative committee, which should only concern itself with the facts, making no value judgements whatsoever. Let’s remember that science deals with facts, while values are the domain of religion, morality, philosophy, ethics. But having clear facts would surely be most helpful.

Click for more on London Beth Din, Chief Rabbi Lord Jonathan Sacks, the Lancet, the Forward and National Geographic

London Beth Din and Chief Rabbi Sacks

The London Beth Din and the Office of the Chief Rabbi did finally issue a ruling on organ transplantation, and they share the opinion of the VH paper, in that they feel the case for relying on “brain death” is halakhicly insufficiently convincing. Nevertheless, they do not see that as a reason to abstain from donating those organs that can be donated after cardiopulmonary arrest, most notably kidneys. The Chief Rabbi wrote (Organ Donation in Jewish Law, Jewish Chronicle) that he is therefore reaching out to the relevant authorities to create a situation whereby one could be an organ donor after death has definitely set in, according to all relevant views.

There are two kinds of organ donations that do not pose problems in Jewish law. There are organs – a kidney for example – that can be taken from a living donor, who is taking little risk and remains healthy. Currently, 53 per cent of all donors come under this category. We commend such donations and would encourage them wherever possible.

At the other extreme, there are organs that can be taken when the heart of the donor has ceased to function, for example corneas and, again, kidneys. Currently 35 per cent of kidney transplants fall into this category. Here, too, Judaism commends such donations.

These two categories combined cover approximately 70 per cent of all current UK organ donors. Jewish law permits us to be donors in these situations and, if we can, we should. To do so is a mitzvah of the highest kind, saving a life.

…

Plans are already under way to establish a Jewish bioethics-forum where rabbis and doctors can meet regularly to discuss how new biomedical developments can be taken into account in our rulings in Jewish law. Whatever our view on the criterion of death, we should all do our share in saving and honouring life.

I heartily applaud the Chief Rabbi for making the public aware that it ain’t all or nothing, and for working towards a solution.

I cannot deny the personal satisfaction seeing how what he wrote nicely dovetails with what I previously posted (no, I do not think that the Chief Rabbi consulted my blog post; I am just happy to see that my position was reasonable enough to have been developed independently by a far greater thinker, who I most highly respect). I also advocate that as many jurisdictions as possible enable those who so desire, to become post natural cardiac arrest donors, for kidneys, corneas and more. Kidneys are particularly in short supply, and thus increasing the donor pool should be most welcomed by all.

The Lancet

The Lancet (Vol. 377, Jan. 22, 2011) included an editorial on the definition of death in a multicultural society, with half the article discussing the present halakhic controversy. I have no argument with their conclusion, cited below, but find it funny that, while they stress the need to respect different beliefs, they use a highly emotive, negative phrase when describing Chief Rabbi Sacks’ and London Beth Din’s recent ruling on the matter. The Lancet calls it an “apparently regressive interpretation.” Now I know that scientifically, “regressive” does not imply any value judgement, but rather describes a perceived turnaround, but that is not how it is understood in common usage, a point readily picked up by Michael Goldfarb in the Forward (see below). As this editorial discusses the role of emotive language and the need to respect other belief systems, one cannot but wonder about their own insensitivity.

In this context, it is also funny that the Lancet tries to teach how to interpret religious laws, when they opine halfway through, how one must interpret doctrine, as they write:

Any position and policy at the end of life—religious, ethical, or medical—should fulfil three criteria. First, it must be based on sound scientific evidence and understanding. Second, it must have the best intention for both the person whose life has ended and for the person who needs an organ to prolong life. In other words, it must do no harm. And third, it must be understandable and supported by the individual within his or her cultural and belief context.

Of course, they chose their words well. Who would disagree with such lofty values as sound understanding, best intentions not to harm anyone, and understanding and support for the patient’s belief system? Likewise with their (far more respectful) conclusion, where they use words like deep understanding, humane wisdom, and humility. But these lofty words are a mere façade behind which the Lancet engages in what it purports not to do: it’s a disrespect to people’s value systems when an outsider dictates to them how to interpret their doctrines.

The editorial ends with the far more respectful note:

With increasingly multicultural nations it is very important that doctors discuss and are educated about the meaning of death and the cultural sensitivities of different religions. Only a well-informed and knowledgeable workforce that understands and respects different beliefs and anxieties will be trusted at a time when difficult conversations need to be handled sensitively. Faith leaders and doctors need to work together to avoid sowing distrust and confusion. Religious doctrine needs to be interpreted with deep understanding, humane wisdom, and humility.

One would hope that the Lancet will, in the spirit of their conclusion, be supportive of Chief Rabbi Sacks’ call for increasing the opportunities to donate without violating halakha (if one is convinced that relying on “brain death” is such a violation).

The Forward

Picking up on the repercussions of and reactions on London Beth Din’s ruling, the Forward published an article by Michael Goldfarb, who does a very decent job of exploring the British organ donor system, and the consequences and opportunities of the Chief Rabbi’s call for changes in that system. The comments, while few, are interesting to consider, as they show how heated the argument is. Sadly, it is not always easy to find out whose facts are right.

The Forward also published an article by the father and son team Dr. Baruch and R’ Shlomo Brody, who argue (in my opinion rather unconvincingly) that “the case for organ donation within Jewish law remains as strong as ever.” Yours truly contributed some comments expressing disagreement with this point.

Yes, there are some notable first rate posqim who really do sanction relying on “brain death,” such as R’ Gedalya Dov Schwartz שליט”א, Av Beit Din of the Beth Din of America, and I have no issue with people who sign up for organ donation because they rely on his opinion.

However, many of the people who did support the “brain death” standard, did so either because they believed the case for that standard was provable from the basic sources, or because they believed that there was a mini consensus of several major posqim, including R’ Moshe Feinstein and R’ Shlmo Zalman Auerbach on the matter, and those people will now need to reevaluate their position.

Salvation from the Future – National Geographic

While the following item is expected to take years before it will be implantable in humans, I bring the following short National Geographic feature to you, regarding a team that has successfully grown a beating rat heart from stem cells. The team started off with an existing heart of a rat cadaver, which had totally stopped beating (i.e. equivalent to donation after cardio-pulmonary arrest), was emptied of all its cells, so that only a scaffold remained, on which they grew new heart muscle from stem cells. This has two major advantages. First of all, the supply of hearts becomes virtually limitless, as every deceased person can become a post mortem donor, and the hearts are grown to order. Secondly, as the hearts are grown with the recipient’s stem cells, there will be no need for immune system weakening anti-rejection drugs, as the heat will appropriately be recognized by the immune system as part of the recipient’s body.

As I argued in a previous post, the halakhic community should be at the forefront of supporters of this kind of research, as it will allow us to save many, many more lives, without requiring the halakhic decisors to relinquish the position that only cardio-pulmonary arrest defines death (if they are so inclined, as many presently are).

This entry was posted on Friday, February 11th, 2011 at 11:50 am and is filed under English, news. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.