Sunday, January 23, 2011

Brain Death versus Cardiac/Respiratory Death

In several recent posts, Rabbi Slifkin has broached the controversial issue of Brain Death in halacha, especially as it pertains to organ donation. Brain Death (BD) is defined as the irreversible cessation of neurological activity in the brain and is measured in several ways, either physically by determining the absence of cranial nerve reflexes, via an EEG test which measures the electrical activity in the brain, or a radionuclide test which measures intracranial blood flow. Cardiac and Respiratory Death (CRD) is the irreversible termination of heart and breathing functions and, if left untreated, is currently understood by medical science to occur at anywhere between 30 seconds to a maximum of ten minutes after the initial cessation.

Up until recently, it has been clearly understood that CRD is the halachic benchmark for death. Thus, a Kohein does not have to leave the room of a BD individual who is hooked up to a ventilator. A BD person whose brother dies childless would prohibit the wife of the dead brother to remarry because she is considered a yevama until "the breath of life" leaves him. The wife of a BD Kohein can still eat trumah etc. etc. Sometime after Rav Moshe Feinstein’s petirah on erev Purim 1986, a controversy arose as to his opinion regarding BD. His teshuvos seem clear on the issue however his son-in-law – Rabbi Moshe Tendler of RIETS – claims that in practical cases his father-in-law paskened that BD was considered halachic death.

This pesak is highly controversial and is rejected by the vast majority of poskim today. Rabbi Slifkin seems to intimate that, at least in some instances, the poskim have not given BD serious consideration in view of current advances in science. He understands that the gemara in Yoma (85) seems clear on the matter however he attributes the gemara’s adoption of CRD to, among other things, Chazal’s antiquated understanding of the heart. In his opinion, Chazal understood the heart as the seat of human intellect, not the brain, and thus, quite naturally, considered CRD the conclusive marker for human death. Rabbi Slifkin writes as follows: "Chazal lived in a world where a person's mind and soul were mistakenly thought to relay their force and influence from the heart, via blood and breath, rather than from the brain, via neurons and nerves. That sentence cannot be emphasized enough."

Here’s what I say. That sentence can’t be deemphasized enough! But more on this in a moment. Before we treat Chazal’s knowledge of the anatomical heart, a lesson in grammar is in order. (Dear Readers: Recently I installed Windows 7 on my computer and ever since then I haven’t been able to get my Hebrew fonts to work so please excuse the transliteration) In lashon hakodesh, the word "lev" means self. It refers to the person’s essence, who he/she really is. In other words, the term lev is properly translated as "mind". Our thoughts, our emotions, our feelings, our personality, our sentient consciousness; these are the things which make up the essence of a human being. In English, this phenomenon is called "mind". In lashon hakodesh, it is called the lev.

So, for example, when the Torah says "ki yetzer leiv ha’adam ra mi’neurav" this means that mankind’s nature is wayward from his youth. It doesn’t mean that he is born with a defective heart. When the Torah states "ani, terem achaleh lidaber el libi", this means when I was finished talking to myself. When the Torah states in the past 4 weeks of kerias haTorah that Hashem hardened the heart of Pharaoh, it refers to his will, not his anatomical heart. When the Torah states "v’chol chacham lev bachaem", this is correctly translated as "every one amongst you with a wise mind". In Tanach, the term lev and its variations are found hundreds of times and each time it refers to the mind or functions of the mind, never the anatomical heart (or maybe almost never). A secondary meaning for lev is the anatomical heart but the primary meaning is mind.

Keeping this in mind, there is no reason to imagine that Chazal used the term lev any differently than it is used in Tanach unless they were specifically discussing the functions of the various anatomical parts of the human body. Rabbi Slifkin claims that Chazal lived during a time when the heart was widely considered the seat of human intellect but so what? This doesn’t prove that they too believed that! In fact, notwithstanding Aristotleian biology, there were indeed individuals who predated Aristotle and who did believe that the brain was the seat of human intellect. Perhaps Chazal followed this view. How does Rabbi Slifkin know that Chazal believed that the heart was the seat of human intelligence? Does he have any explicit quotes from Chazal to that effect? Highly doubtful. Otherwise, he would have provided them.

Of course, Rabbi Slifkin can then turn around and request explicit quotes from Chazal that they understood the brain to be the seat of the intellect and if I can’t provide them, he would then claim that the "rational" thing to assume is that Chazal went with the science of the day. Perhaps he is right, perhaps not. But it’s irrelevant because as it happens I am capable of satisfying such a request.

In Yevamos 9a, Levi asks a kushya on Rebbi. Rebbi considers Levi’s kushya nonsensical so he replies "it seems to me that [you] don’t have any brains in your head!" Now you may think this is an aberration but exactly the same phrase appears in Maseches Menachos 80b under similar circumstances. And if you think that only the Babylonian scholars knew the truth, the exact same phrase re-appears in the Jerusalem Talmud in the sugya in Yevamos!

So, Chazal knew that the brain was the seat of the intellect and yet they considered CRD as the determining factor. Chasam Sofer – in his famous rebuttal to Moses Mendelssohn’s pesak regarding halanas hameis (YD II, 338) – makes it clear that Chazal’s conclusion regarding dofek and neshima (heartbeat and respiration) is immutable and is based on ironclad sources. He even suggests that it is halacha l’moshe mi’sinai! From all apparent readings of his written piskei halacha, R’ Moshe held the same, and he lived in modern times and had access to medical knowledge. Not that I am taking sides on this halachic dispute and neither is Rabbi Slifkin for that matter. But what the good Rabbi did get wrong, as usual, is his underestimation of Chazal’s wisdom.

Now, what is left to explain is the following. If the term lev does indeed mean mind and also the anatomical heart, there must be some connection between the two. What is it? Why is it that in lashon hakodesh the mind shares the same term as the anatomical heart?

This question will be answered in the following post bi'ezras Hashem.

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