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Medical Ethics: Difference between revisions
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→Endangering Yourself to Save Someone Else
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==Organ Donation== | ==Organ Donation== | ||
# One may donate an organ | # One may donate an organ if the donor's health not suffer as a result of the donation. <ref>See Yachava Daat 3:84, Tzitz Eliezer 9:45, Minchat Yitzchak 5:7. Similarly, [https://aiayk.org/pesachaudio/ Rav Asher Weiss (Aguda Teleconference, April 6, 2020, min 20-22)] stated that donating a kidney isn’t risk free but it is minimally dangerous and it is life saving and therefore it is a middat chasidut to do it.</ref> | ||
# It is permissible and a big mitzvah to donate a kidney.<ref>* The Steipler (Kehilat Yakov, Igrot Vreshimot v. 4 siman 10) wrote to Rav Moshe Neislish in 1966 that if the danger from surgery of a kidney transplant is less than 1 in 1000 and the danger afterwards is almost nothing, it is permissible to donate a kidney. | |||
* Rav Shlomo Zalman Auerbach (Shulchan Shlomo Refuah v. 2 p. 44) writes that if the sakana is rechoka (lit. far away; transl. remote) for the donor, as the doctors say, it is permissible to donate a kidney and it is a big mitzvah. Rav Avraham Avraham (Hamayan v. 28:3 p. 25) also quotes Rav Shlomo Zalman as permitting kidney donations in the 1970s.</ref> | |||
==Heart Transplant== | ==Heart Transplant== | ||
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# Some poskim use this principle that it is permitted to endanger oneself for a profession to justify why doctors may treat contagious patients.<ref>Tzitz Eliezer 9:17:5</ref> | # Some poskim use this principle that it is permitted to endanger oneself for a profession to justify why doctors may treat contagious patients.<ref>Tzitz Eliezer 9:17:5</ref> | ||
== Endangering Yourself in Minimal Danger (Shomer Petayim) == | == Endangering Yourself in Minimal Danger (''Shomer Petayim'') == | ||
# A person is allowed to engage in normal activities in society that people aren't concerned that they are dangerous. | # A person is allowed to engage in normal activities in society that people aren't concerned that they are dangerous.<ref>Rav Elchanan (Ketubot n. 136)</ref> | ||
# This principle is known as "''shomer petayim Hashem''," (lit. "Hashem protects the fools"; heb. שומר פתאים ה') which permits a person to act simple and rely on Hashem to be protected. | # This principle is known as "''shomer petayim Hashem''," (lit. "Hashem protects the fools"; heb. שומר פתאים ה') which permits a person to act simple and rely on Hashem to be protected. | ||
# This principle is the reason that women may become pregnant and give birth, even though that inevitably involves some risk (especially earlier in history).<ref>Igros Moshe EH 1:63:1</ref> | # This principle is the reason that women may become pregnant and give birth, even though that inevitably involves some risk (especially earlier in history).<ref>Igros Moshe EH 1:63:1. Binyan Tzion 137 agrees that this is the reason for allowing childbirth but he applies it even if the danger to the mother is greater than a regular birth.</ref> | ||
# Some poskim hold that this concept only permits activities that objectively don't have a risk factor of more than 1/1000. Otherwise, it is considered objectively too risky and forbidden, even if other people do it without concern.<ref>[https://www.torahweb.org/torah/docs/rtwe_shomer2.pdf Rabbi Mayer Twersky] infers from Maggid Mishna that if the danger is 1/1000 or greater it is considered too dangerous even to rely upon ''shomer petayim Hashem''.</ref> | # Some poskim hold that this concept only permits activities that objectively don't have a risk factor of more than 1/1000. Otherwise, it is considered objectively too risky and forbidden, even if other people do it without concern.<ref>[https://www.torahweb.org/torah/docs/rtwe_shomer2.pdf Rabbi Mayer Twersky] infers from Maggid Mishna that if the danger is 1/1000 or greater it is considered too dangerous even to rely upon ''shomer petayim Hashem''. | ||
# Some say that ''shomer petayim Hashem'' is only relevant if it is a risk or danger that applies equally to everyone. However, if there's a risk that only applies to | |||
Igrot Moshe CM 2:76 permits smoking because of shomer petayim Hashem but just writes that it is a danger for only a miyuta d'miyuta of people.</ref> | |||
# Some say that ''shomer petayim Hashem'' is only relevant if it is a risk or danger that applies equally to everyone. However, if there's a risk that only applies to a specific person or group, such as if they're sick, ''shomer petayim'' is inapplicable.<ref>Igros Moshe EH 1:63:1-2, 4:73:1</ref> | |||
# Some poskim use the concept of shomer petayim Hashem to explain why it is permissible to travel through the desert or take a boat.<ref>Binyan Tzion 137. Rabbi Twersky quotes Shem Aryeh 27 who holds that shomer petayim allows traveling through the desert or in a boat only if there's a parnasa need or another real need.</ref> | |||
==Endangering Yourself to Save Someone Else== | ==Endangering Yourself to Save Someone Else== | ||
# Most poskim hold that it is permissible but not obligatory to endanger oneself in a possibility of danger (''safek sakana'') to save someone else from certain danger.<ref>Mishna Brurah 329:19, Rav Asher Weiss (Minchat Asher 1:115)</ref> | # Most poskim hold that it is permissible but not obligatory to endanger oneself in a possibility of danger (''safek sakana'') to save someone else from certain danger.<ref>Mishna Brurah 329:19, Aruch Hashulchan CM 426:4, Igrot Moshe YD 2:174:2, Rav Elyashiv (Va’vaey Haamudim V’chashukeyhem 13:22), Rav Asher Weiss (Minchat Asher 1:115)</ref> | ||
## Some poskim hold that it is an obligation to endanger oneself to save someone else.<ref>Hagahot Maimoniyot cited by Bet Yosef CM 426:2</ref> | ## Some poskim hold that it is an obligation to endanger oneself to save someone else.<ref>Hagahot Maimoniyot cited by Bet Yosef CM 426:2</ref> | ||
## A minority opinion holds that it is forbidden to endanger oneself to save someone else.<ref>Shulchan Aruch Harav 329:8</ref> | ## A minority opinion holds that it is forbidden to endanger oneself to save someone else.<ref>Shulchan Aruch Harav 329:8</ref> | ||
=== Defining the amount of risk === | |||
# Some say that if the risk is less than 50% to the one saving it is an obligation to save someone in danger.<ref>This is the literal reading of Radvaz. This is how Tzitz Eliezer 10:25:28, Shevet Halevi 5:137:2, Yabia Omer 9:12, Dr. Avraham Steinberg (Encyclopedia of Jewish Medical Ethics v. 3 p. 907), and Rav Gavriel Siner (Or Yisrael v. 78 p. 33) understand Radvaz, that he's discussing if there's more or less than 50% survival rate for the one coming to save. These poskim hold that there's no contradiction between the teshuvot of Radvaz. In 5:1082 he is simply defining the level of sakana he was discussing in 3:627. See Rav Shlomo Amar (Shma Shlomo CM 5:7:8) who addresses this approach and explains it. </ref> Others argue that even if the danger is far less than that there's no obligation.<ref>Rabbi Yitzchak Zilberstein (Shiurei Torah Lrofim v. 2 siman 110) and Minchat Asher 3:123 take Radvaz non-literally. He doesn't mean if there's 50% of survival. He means putting yourself in a situation of sakana, which is a much lower threshold of risk, is forbidden. It is only obligatory to save someone else is the risk is below that threshold. Alternatively, Rabbi J. D. Bleich (Tradition, Spring 1993, Vol. 27, No. 3, pp. 59-89) and Asher Chanan CM 3-4:100 explain that Radvaz's teshuvot contradict each other. According to their approach the halacha follows the teshuva that does not require endangering oneself to save someone else.</ref> | |||
## Others define the threshold at 1 in 1000. If the danger is less than that, it is permissible to save someone in danger.<ref>Kehilat Yakov (Igrot Vreshimot v. 4 siman 10)</ref> | |||
## Others define the threshold at the amount that people would be worried about. If he would do this activity for a specific reason, such as if he was going for a job or another purpose, and wouldn't be worried about the danger, he should do so to save someone else. If he wouldn't enter that situation for any purpose then he is not obligated to save someone in that situation.<ref>Rabbi Yitzchak Zilberstein (Shiurei Torah Lrofim v. 2 simanim 110 and 114)</ref> | |||
=== Saving unique individuals or groups === | |||
# Some say that it is permissible to endanger yourself to save someone who is a talmid chacham and tzaddik.<ref>Sefer Chasidim, Yabia Omer CM 9:12, Yavetz (Migdal Oz Otzer Hatov pina 1 n. 85)</ref> Some forbid this.<ref>Igros Moshe YD 2:174:4</ref> | # Some say that it is permissible to endanger yourself to save someone who is a talmid chacham and tzaddik.<ref>Sefer Chasidim, Yabia Omer CM 9:12, Yavetz (Migdal Oz Otzer Hatov pina 1 n. 85)</ref> Some forbid this.<ref>Igros Moshe YD 2:174:4</ref> | ||
#If a terrorist threatens you "either kill another Jew or I'll kill you," you may not kill another Jew and must give up your life.<ref>Sanhedrin 74b</ref> You must also give up your life and not even murder the other Jew indirectly such as by causing a dog to bite someone to showing a non-Jew where the Jew is hiding in order to kill him.< | #Some say that it is permissible to endanger yourself to save your only son if you're too old to fulfill pru urevu again.<ref>Yavetz (Migdal Oz Otzer Hatov pina 1 n. 85). Rav Zilberstein (Shabbat Shabbaton p. 172-3) quotes Yavetz that a person may not endanger himself to save someone else unless the other person is a bigger talmid chacham and a tzaddik than you, your father, or your rebbe. Even to save your only son it is forbidden to endanger your life for him, unless the father is too old to fulfill pru urevu anymore. Rabbi Zilberstein asks why this is permitted and suggests that since the child could have more children it is like endangering yourself to save many people which is allowed. He also quotes a story about the Shaar Efraim that when his son was deathly sick he davened to Hashem to take him instead and so it happened that his son was healed and he died. However, it isn't a clear proof, says Rav Zilberstein, since davening isn't the same as doing an action.</ref> | ||
#A pregnant doctor who is concerned that if she treats a patient with German measles it may place their fetus at risk is not obligated to treat the patient. However, if the doctor wishes to do so, they may and they should be blessed from heaven.<ref>Rabbi Zilberstein (Bshilvei Harefuah v. 10 p. 58, Asya v. 7 p. 3, cited by Encyclopedia of Jewish Medical Ethics v. 3 p. 907) holds that a doctor who will endanger her fetus by treating her patient is not obligated to do so, but may do so.</ref> | |||
#It is permissible to endanger yourself to save many Jews.<ref>Gemara Tanit 18b, Rav Zilberstein (Shabbat Shabbaton p. 173), Igros Moshe 2:174:4, Mishpat Kohen 143</ref> | |||
=== Doctors endangering themselves to save patients === | |||
# A doctor may take care of a patient with a contagious disease even without proper protection (when it is impossible to get proper protection) to help save the patient.<ref>Tzitz Eliezer 8:15:10:13 based on Sma 426:1 writes that a doctor does not have to place themselves at risk in order to save a sick patient. However, Tzitz Eliezer 9:17:5 presents several arguments why doctors may and should treat contagious patients. 1) He quotes Sht Harama 19 who writes that people shouldn’t be worried about any contagious disease since it isn’t the contagious disease mentioned by the gemara, namely Raatan. Tzitz Eliezer quotes Zera Emet who distinguishes between a general contagious disease and an epidemic, which a person should be worried about. However, he also cites the Knesset Hagedola (Shaarei Knesset Hagedola, Hagahot Hatur YD 335:2) who doesn’t distinguish and holds that a person should be bikur cholim even for someone who is sick with a contagious disease. Tzitz Eliezer concludes that doctors may and should treat patients, even if they have contagious diseases, and fulfill the mitzvah of bikur cholim and rapo yirapeh. 2) He suggests that it is permitted since this is the way of the world for doctors to treat sick patients. 3) Furthermore, for a paid doctor there’s another reason to permit it. Gemara Bava Metsia 112a is clear that a worker can endanger himself for his job. Nodeh Beyhuda YD 10 is a good precedent for this concept. 4) Hagahot Maimoni holds that it is an obligation to enter into risk to save someone else.</ref> | |||
# A medic in the army must save wounded soldiers on the battlefield in times of war, even though it means exposing themselves to risk. However, he is not obligated to enter the war zone to save a non-military patient.<ref>Tzitz Eliezer 12:57, Harefuah Leor Hahalacha v. 4 1:7, Rabbi Zilerbstein</ref> | |||
=== Giving up one's life to save others === | |||
# If a terrorist threatens you "either kill another Jew or I'll kill you," you may not kill another Jew and must give up your life.<ref>Sanhedrin 74b</ref> You must also give up your life and not even murder the other Jew indirectly such as by causing a dog to bite someone to showing a non-Jew where the Jew is hiding in order to kill him.<ref>Yavetz (Migdal Oz Otzer Hatov pina 1 n. 82)</ref> | |||
#If a terrorist threatens you "either let me cut off one limb of your body that won't kill you or I'll kill another Jew," some say that you must allow him to cut off your limb, but most poskim hold that you don't have to, but it is a middat chasidut to do so.<ref>Maharam Ricanti holds that in this case it is an obligation to give up your life. However, Radvaz holds that it is only a middat chasidut. Yavetz (Migdal Oz Otzer Hatov pina 1 n. 83) agrees that it isn't obligation but it is a voluntarily mitzvah if he chooses.</ref> | #If a terrorist threatens you "either let me cut off one limb of your body that won't kill you or I'll kill another Jew," some say that you must allow him to cut off your limb, but most poskim hold that you don't have to, but it is a middat chasidut to do so.<ref>Maharam Ricanti holds that in this case it is an obligation to give up your life. However, Radvaz holds that it is only a middat chasidut. Yavetz (Migdal Oz Otzer Hatov pina 1 n. 83) agrees that it isn't obligation but it is a voluntarily mitzvah if he chooses.</ref> | ||
#If a terrorist threatens you "either give me your sword so that I can kill another Jew or I'll kill you," some say that you may not give up your sword in that case, while most hold that should give up your sword.<ref>Radvaz holds that you may not give your sword in that case. However, Yavetz (Migdal Oz Otzer Hatov pina 1 n. 82) argues because you only need to give up your life not to actively kill someone, but you don't need to give up your life not to passively watch another Jew die.</ref> | #If a terrorist threatens you "either give me your sword so that I can kill another Jew or I'll kill you," some say that you may not give up your sword in that case, while most hold that should give up your sword.<ref>Radvaz holds that you may not give your sword in that case. However, Yavetz (Migdal Oz Otzer Hatov pina 1 n. 82) argues because you only need to give up your life not to actively kill someone, but you don't need to give up your life not to passively watch another Jew die.</ref> | ||
# A minority position holds that it isn't necessary to endure difficult pain in order to save someone else's life, but most poskim disagree and hold that is necessary.<ref>Yavetz (Migdal Oz Otzer Hatov pina 1 n. 83) holds that it isn't an obligation to go through pain in order to save someone's life. However, Magen Avraham and Yabia Omer 9:12 disagree.</ref> | # A minority position holds that it isn't necessary to endure difficult pain in order to save someone else's life, but most poskim disagree and hold that is necessary.<ref>Yavetz (Migdal Oz Otzer Hatov pina 1 n. 83) holds that it isn't an obligation to go through pain in order to save someone's life. However, Magen Avraham and Yabia Omer 9:12 disagree.</ref> | ||
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==Saving Yourself by Endangering Someone Else== | ==Saving Yourself by Endangering Someone Else== | ||
