Rkyhs jewish medical ethics revised

Jewish Medical Jewish Medical EthicsEthics

From Stem Cells to Organ From Stem Cells to Organ TransplantsTransplants

Aaron H. Chevinsky, MD FACSAaron H. Chevinsky, MD FACSChief, Surgical OncologyChief, Surgical Oncology

Morristown Memorial HospitalMorristown Memorial HospitalCo-Director - Carol G. Simon Cancer CenterCo-Director - Carol G. Simon Cancer Center

Clinical Professor of Surgery – Clinical Professor of Surgery – UMDNJ/NJMSUMDNJ/NJMS

Jewish Medical ScholarsJewish Medical Scholars

Rav Moshe Feinstein, The Igros Moshe (1895-1986)

Rav Yosef Kairo, The Bais Yosef ,

author of the Shulchan Aruch

(1488-1575)

Rav Moshe Isserles,

The Rama (1530-1572)

The Rambam, Rabeinu Moshe Ben Maimon (1135-1204)

R’ Eliezer Waldenberg,

The Tzitz Eliezer (1917-2006)

R’ Moshe TendlerYeshiva University Son-In Law of R’ Feinstein

Lord R’ Immanuel Jacobovits Chief Rabbi of Great Britain

(1921-1999)

Dr. Fred Rosner

Jewish Medical EthicsJewish Medical Ethics

The Stem Cell ControversyThe Stem Cell Controversy Genetic Screening and Gene TherapyGenetic Screening and Gene Therapy Organ Donation and TransplantationOrgan Donation and Transplantation End of Life DecisionsEnd of Life Decisions Reproductive IssuesReproductive Issues Cosmetic SurgeryCosmetic Surgery Smoking CigarettesSmoking Cigarettes

You’re very selfish Louis. Those Stem Cell Lines were meant for people

who have lost their organs

Each stored embryo is a stem cell debate

Updated 1/30/2007 4:22 PM ET

What would you do with excess embryos?

Guidelines for stem cell research kindle controversy- CNN

8/24/00

Research avenue adds fuel to stem cell controversyJuly 18, 2001 Posted: 3:15 p.m. EDT (1915 GMT) -CNN

UConn plans to build stem cell institute

By Scott Whipple, Herald Press Staff02/11/2007

Stem-cell researchers look beyond the embryo

By Joyce Howard PriceTHE WASHINGTON TIMES

February 11, 2007 A human embryo in its earliest

stages of development is made up of undifferentiated

stem cells.

The Stem Cell The Stem Cell ControversyControversy What are stem cells?What are stem cells?

Cells with the potential to differentiate into Cells with the potential to differentiate into (become) any cell or tissue in the body(become) any cell or tissue in the body

Where are stem cells found?Where are stem cells found? Aborted fetusesAborted fetuses Umbilical cord bloodUmbilical cord blood Amniotic FluidAmniotic Fluid Adult Bone MarrowAdult Bone Marrow Embryos “left over” from In-vitro Embryos “left over” from In-vitro

fertilizationfertilization

The Stem Cell The Stem Cell ControversyControversy Why are stem cells important?Why are stem cells important?

Understand cellular differentiation Understand cellular differentiation (cancer)(cancer)

Organ TransplantationOrgan Transplantation Replace dysfunctional cells that cannot be Replace dysfunctional cells that cannot be

repairedrepaired Brain (Parkinson’s Disease and Alzheimer’s Brain (Parkinson’s Disease and Alzheimer’s

Disease)Disease) Spinal Cord (Paralysis and Stroke)Spinal Cord (Paralysis and Stroke) Diabetes, Arthritis and Heart DiseaseDiabetes, Arthritis and Heart Disease Liver and kidney failureLiver and kidney failure

Halachic View on Stem Halachic View on Stem Cell ResearchCell Research

Adult and umbilical cord Stem Cells are usableAdult and umbilical cord Stem Cells are usable Pre-implantation embryos are not “alive”Pre-implantation embryos are not “alive”

Cannot be sustained aloneCannot be sustained alone IVF generally permissible by most authoritiesIVF generally permissible by most authorities ““mayim b’alma”mayim b’alma” – mere water. To use a surplus pre- – mere water. To use a surplus pre-

embryo for medical research that will save a life is not embryo for medical research that will save a life is not halachically prohibited (the Beth Din of America made this halachically prohibited (the Beth Din of America made this point in a ruling on August 21, 2001).point in a ruling on August 21, 2001).

““Pikuach Nefesh” Pikuach Nefesh” – We are obligated to save lives– We are obligated to save lives Abortion for the sole purpose of harvesting stem Abortion for the sole purpose of harvesting stem

cells is forbiddencells is forbidden Abortion allowed only to “Save” the motherAbortion allowed only to “Save” the mother Abortion generally not allowed for genetic abnormalitiesAbortion generally not allowed for genetic abnormalities Some Poskim allow abortion up to 40 days for thisSome Poskim allow abortion up to 40 days for this

Stem Cell Research by Rabbi Yitzchok A. Breitowitz (2005)Stem Cell Research in Jewish Law by Daniel Eisenberg, MD (2001)Stem cells and halacha by Rabbi Raymond Apple

Genetic Screening and Genetic Screening and Gene TherapyGene Therapy

Genetics in the Bible and TalmudGenetics in the Bible and Talmud In Bereishit Ya-akov manipulates the In Bereishit Ya-akov manipulates the

spotted and speckled sheep to his spotted and speckled sheep to his benefitbenefit

Hemophilia is discussed in Yebamot 64BHemophilia is discussed in Yebamot 64B Bleeding after CircumcisionBleeding after Circumcision

Marriage to a man or woman whose Marriage to a man or woman whose family had epilepsy or leprosy was family had epilepsy or leprosy was prohibited (Talmud, Rambam and prohibited (Talmud, Rambam and Shulchan Aruch)Shulchan Aruch)

Biomedical Ethics & Jewish Law – Fred Rosner, MD

Genetic Screening and Genetic Screening and Gene TherapyGene Therapy

Issues related to genetic screeningIssues related to genetic screening Prediction of incurable diseasesPrediction of incurable diseases

Huntington’s Chorea and Alzheimer’s Huntington’s Chorea and Alzheimer’s Discrimination or shunning of carriersDiscrimination or shunning of carriers

Health and Life Insurance IssuesHealth and Life Insurance Issues Employment IssuesEmployment Issues

Accuracy and predictability of resultsAccuracy and predictability of results ConfidentialityConfidentiality

Obligation to reveal results to spouse or Obligation to reveal results to spouse or familyfamily

Abortions for genetically abnormal Abortions for genetically abnormal fetuses?fetuses?

Rosner, Fred – “Judaism, Genetic Screening and Genetic Therapy” 2006

Diseases for which Diseases for which Genetic Screening Genetic Screening

ExistsExists Ashkenazi Jews – Carrier RiskAshkenazi Jews – Carrier Risk

– Tay-Sachs – 1:25Tay-Sachs – 1:25– Cystic Fibrosis – 1:25Cystic Fibrosis – 1:25– Bloom Syndrome- 1:100Bloom Syndrome- 1:100– Canavan Disease – 1:40Canavan Disease – 1:40– Factor XI DeficiencyFactor XI Deficiency– Familial Dysautonomia – 1:30Familial Dysautonomia – 1:30– Fanconi Anemia – 1:89Fanconi Anemia – 1:89– Gaucher Disease – 1:14Gaucher Disease – 1:14– Mucolipidosis IV- 1:120Mucolipidosis IV- 1:120– Niemann-Pick Disease – 1:90Niemann-Pick Disease – 1:90– Torsion DystoniaTorsion Dystonia


ExistsExists Sephardic JewsSephardic Jews

– Beta ThalassemiaBeta Thalassemia– Familial Mediterranean FeverFamilial Mediterranean Fever– GSPD DeficiencyGSPD Deficiency– Type III Glycogen Storage Disease – Type III Glycogen Storage Disease –

1:701:70


ExistsExists Breast CancerBreast Cancer

BRCA 1 & 2BRCA 1 & 2 2.3% of Ashkenazi Women2.3% of Ashkenazi Women 5x higher than the population5x higher than the population Risks of ovarian, uterine and prostate cancerRisks of ovarian, uterine and prostate cancer No JEWISH obligation to screen or reveal results to No JEWISH obligation to screen or reveal results to

other potential carriers (family)other potential carriers (family) Pancreatic CancerPancreatic Cancer

BRCA 2BRCA 2 Also associated with male breast cancerAlso associated with male breast cancer

Colon CancerColon Cancer FAP & HNPCCFAP & HNPCC Huntington’s ChoreaHuntington’s Chorea

Daniel Eisenberg, MD

Genetic Screening Causes Controversyby Aaron Klein

Dor Yeshorim, an international genetic testing program operating within the Jewish community, was brought to Yeshiva University by YCSC on Tuesday March 10, giving students an opportunity to utilize its services. The program is aimed at couples who wish to get married, and determines their genetic compatibility by screening the blood of each individual and testing for evidence of unexpressed (recessive) genetic diseases.

Genetic Screening and Gene Genetic Screening and Gene TherapyTherapy

Tay-Sachs DiseaseTay-Sachs DiseaseScreening prior to marriage is encouragedScreening prior to marriage is encouragedAbortion is not permitted for this per R’ FeinsteinAbortion is not permitted for this per R’ Feinstein

Only permitted to prevent injury to the motherOnly permitted to prevent injury to the motherPhysical or Psychological RiskPhysical or Psychological Risk

Abortion up to 3 mos is permitted per R’ WaldenbergAbortion up to 3 mos is permitted per R’ WaldenbergUp to 6 months for a fetus with a terminal conditionUp to 6 months for a fetus with a terminal conditionTzitz Eliezer - Allowable if deformity causes sufferingTzitz Eliezer - Allowable if deformity causes suffering

Dor YeshorimDor YeshorimProvides confidential screening for orthodox couplesProvides confidential screening for orthodox couples

Pre-Implantation screening a controversial optionPre-Implantation screening a controversial optionIn Vitro FertilizationIn Vitro Fertilization

Biomedical Ethics & Jewish Law – Fred Rosner, MD

Jewish Medical Law – Avraham Steinberg, MD

Daniel Eisenberg, MD

Gene TherapyGene Therapy

The modification of an existing cell by The modification of an existing cell by injecting new or corrected DNAinjecting new or corrected DNA

Would be permissible to restore healthWould be permissible to restore health Modifying sperm, ovum, or fertilized egg Modifying sperm, ovum, or fertilized egg

permitted since it is “not a person yet”permitted since it is “not a person yet” R’ Moshe Hershler warns of potential problemsR’ Moshe Hershler warns of potential problems

Prohibition of mating diverse animals, sowing Prohibition of mating diverse animals, sowing different seeds, wearing mixed garmentsdifferent seeds, wearing mixed garments

Does changing the genes change the individualDoes changing the genes change the individual Genetically modified foods are of great debateGenetically modified foods are of great debate

Rosner, Fred – “Judaism, Genetic Screening and Genetic Therapy” 2006

Organ Transplantation

Organ Donation & Organ Donation & TransplantationTransplantation

Autograft – Transplant from the personAutograft – Transplant from the person Allograft – Transplant from human donorAllograft – Transplant from human donor Xenograft – Transplant from an animalXenograft – Transplant from an animal Living or Cadaveric (dead person)Living or Cadaveric (dead person) Whole organ or partWhole organ or part Transplantable OrgansTransplantable Organs

Blood and Blood Products, Bone Marrow, BoneBlood and Blood Products, Bone Marrow, Bone Cornea, Heart, Kidney, Liver, Lung, Pancreas, SkinCornea, Heart, Kidney, Liver, Lung, Pancreas, Skin


What is the Biblical source for organ donation? What is the Biblical source for organ donation? "And you shall surely heal" (Exodus 21:19)"And you shall surely heal" (Exodus 21:19) "And you shall restore (a lost object, which surely includes "And you shall restore (a lost object, which surely includes

health)" (Exodus 23:4) health)" (Exodus 23:4) "You shall not stand on the blood of your fellow" (Leviticus "You shall not stand on the blood of your fellow" (Leviticus

19:16)19:16) Organs may be given to or used from Non-Jews Organs may be given to or used from Non-Jews Living DonorLiving Donor

Obligation to donate – Cannot be CoercedObligation to donate – Cannot be Coerced Risk to the donor must be minimalRisk to the donor must be minimal Kidneys, bone marrow, blood and split liver donationsKidneys, bone marrow, blood and split liver donations

Cadaveric DonorCadaveric Donor ““Pikuach Nefesh”Pikuach Nefesh” – Overrides issues of desecration of the – Overrides issues of desecration of the

deaddead Brain Death – Brain Stem DeathBrain Death – Brain Stem Death You may ventilate a “Brain Dead” individual to keep the You may ventilate a “Brain Dead” individual to keep the

organs aliveorgans alive Rabbi Dr. Moshe Tendler


Xenotransplantation (Animals) Xenotransplantation (Animals) Man is not permitted to cause needless pain to Man is not permitted to cause needless pain to

animals, but man is given dominion over themanimals, but man is given dominion over them This is allowable (Rabbi Dr. Moshe Tendler)This is allowable (Rabbi Dr. Moshe Tendler) Even from nonkosher animals (Pig Heart Valves)Even from nonkosher animals (Pig Heart Valves)

Artificial or Synthetic OrgansArtificial or Synthetic Organs Generally allowableGenerally allowable Heart valves, artificial joints, synthetic skinHeart valves, artificial joints, synthetic skin Dialysis and cardioplumonary bypass Dialysis and cardioplumonary bypass Artificial Heart?Artificial Heart?

It is a mitzvah to donate organs either It is a mitzvah to donate organs either when alive or after death (when alive or after death (Midat Midat ChasidutChasidut))

Harvard Ad Hoc Committee on Brain DeathIn 1968, this committee of the Harvard Medical School published a

report describing the following characteristics of a permanently nonfunctioning brain, a condition it referred to as "irreversible coma,"

now known as brain death: Unreceptivity and unresponsitivity--patient shows total

unawareness to external stimuli and unresponsiveness to painful stimuli;

No movements or breathing--all spontaneous muscular movement, spontaneous respiration and response to stimuli are

absent; No reflexes--fixed, dilated pupils; lack of eye movement even when hit or turned, or ice water is placed in the ear; lack of response to noxious stimuli; unelicitable tendon reflexes. In addition to these criteria, a flat (EEG) was recommended. The committee also noted that drug intoxication and hypothermia which can both cause reversible loss of brain functions should be excluded as causes. The report was used in determining patient care issues and organ transplants. The condition of irreversible coma, i.e., brain death, needs to be distinguished from the persistent vegetative state, in which clinical presentations are similar but in which patients manifest cycles of sleep and wakefulness. [See President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death (Washington, DC: U.S. Government Printing Office, 1981)].


Jewish Definitions of Death stem from Jewish Definitions of Death stem from discussions on the Sabbathdiscussions on the Sabbath

Babylonian Talmud – Yoma 8:6-7Babylonian Talmud – Yoma 8:6-7 It is permissible to clear debris from a fallen It is permissible to clear debris from a fallen

building to ascertain if someone is alive.building to ascertain if someone is alive. If he is found alive, the debris can be cleared – If he is found alive, the debris can be cleared –

otherwise leave him until after Shabbatotherwise leave him until after Shabbat You must clear off the nostrils to check for You must clear off the nostrils to check for

breathing.breathing. ““In whose nostrils was the breath of the spirit In whose nostrils was the breath of the spirit

of life”of life” – Genesis 7:22 – Genesis 7:22 Rashi – No air emanates from the nose Rashi – No air emanates from the nose Rambam – No sign of breathing detected at the noseRambam – No sign of breathing detected at the nose R’ Joseph Karo - Shulchan AruchR’ Joseph Karo - Shulchan Aruch - - Orach Chayim 329:4Orach Chayim 329:4

““If one cannot detect signs of respiration at the If one cannot detect signs of respiration at the nose, then he is certainly deadnose, then he is certainly dead.”.”

If a woman dies giving birth on Shabbat, it is If a woman dies giving birth on Shabbat, it is permissible to incise the womb and remove the baby permissible to incise the womb and remove the baby (330:5)(330:5)

Rosner, Fred –Biomedical Ethics and Jewish Law - 2001


Modern Jewish Commentary on deathModern Jewish Commentary on death R’ Moses Schreiber (Chatam Sofer – Yoreh Deah 338)R’ Moses Schreiber (Chatam Sofer – Yoreh Deah 338)

If the person is motionless and without pulse in If the person is motionless and without pulse in neck or wrist and no spontaneous breathingneck or wrist and no spontaneous breathing

R’ Isaac Yehudah Unterman (1968)R’ Isaac Yehudah Unterman (1968) One is dead when one has stopped breathingOne is dead when one has stopped breathing

R’ Eliezer Yehuda Waldenberg (Tzitz Eliezer 9:46, 10:25)R’ Eliezer Yehuda Waldenberg (Tzitz Eliezer 9:46, 10:25) Cessation of both respiration and cardiac activityCessation of both respiration and cardiac activity

R’ Immanuel Jacobovits (1968)R’ Immanuel Jacobovits (1968) ““The classic definition of death as given in the The classic definition of death as given in the

Talmud and Codes is acceptable today and Talmud and Codes is acceptable today and correct. However, this would be set aside in correct. However, this would be set aside in cases where competent medical opinion deems cases where competent medical opinion deems any prospect of resuscitation, however remote, any prospect of resuscitation, however remote, at all feasible.”at all feasible.”



R’ Moshe Feinstein (Iggrot Moshe Yoreh R’ Moshe Feinstein (Iggrot Moshe Yoreh Deah 2:174, 2:146, 2:132, Chosen Deah 2:174, 2:146, 2:132, Chosen Mishpat 2:72)Mishpat 2:72)

1968 - Heart transplantation is double murder1968 - Heart transplantation is double murder The donor is killed The donor is killed The recipient’s life is shortenedThe recipient’s life is shortened

It is a mitzvah for the family to donate organs to It is a mitzvah for the family to donate organs to save the lives of others (save the lives of others (Midat ChasidutMidat Chasidut))

1970 - One cannot declare death if “The brain is not 1970 - One cannot declare death if “The brain is not functioning….even if the person is still breathing functioning….even if the person is still breathing [spontaneously].”[spontaneously].”

Removing an organ from someone in a deep coma Removing an organ from someone in a deep coma or persistent vegetative state is against halachaor persistent vegetative state is against halacha

Yachol Linshom (capable of breathing)Yachol Linshom (capable of breathing)Rosner, Fred –Biomedical Ethics and Jewish Law - 2001


R’ Moshe Feinstein (Iggrot Moshe Yoreh Deah R’ Moshe Feinstein (Iggrot Moshe Yoreh Deah 2:174, 2:146, 2:132, Chosen Mishpat 2:72)2:174, 2:146, 2:132, Chosen Mishpat 2:72)

1976 – One is dead if there is no connection between the 1976 – One is dead if there is no connection between the brain and body and there is no spontaneous breathingbrain and body and there is no spontaneous breathing

Absence of a heartbeat is not essential for “death”Absence of a heartbeat is not essential for “death” Absence of cerebral blood flow and lack of respirationAbsence of cerebral blood flow and lack of respiration Halachically equivalent to decapitationHalachically equivalent to decapitation

1980 – Heart, liver and lung transplants permissible1980 – Heart, liver and lung transplants permissible Donor must be completely brain dead (No respirations)Donor must be completely brain dead (No respirations)

Israeli Chief Rabbinical Council – 1987Israeli Chief Rabbinical Council – 1987 Brainstem death is an acceptable surrogateBrainstem death is an acceptable surrogate

Not all agree that heart and lung transplants Not all agree that heart and lung transplants are allowable (R’ Waldenberg -Tzitz Eliezer)are allowable (R’ Waldenberg -Tzitz Eliezer)


End of Life DecisionsEnd of Life Decisions

Withholding care and euthanasiaWithholding care and euthanasia Talmud – One who is dying (Talmud – One who is dying (GosesGoses) is regarded as a ) is regarded as a

living person in all respects (Semachot 1:1)living person in all respects (Semachot 1:1) Goses – One whose death is imminent (3 days)Goses – One whose death is imminent (3 days)

Maimonides – One may not move a dying person or in Maimonides – One may not move a dying person or in any way hasten death (Mishne Torah – Hilchot Avel any way hasten death (Mishne Torah – Hilchot Avel 4:5)4:5)

One may not chop wood or disturb himOne may not chop wood or disturb him R’ Jacobovits – Any form of euthanasia is prohibited R’ Jacobovits – Any form of euthanasia is prohibited

and condemned as murderand condemned as murder Care may be withdrawn which artificially delays the demiseCare may be withdrawn which artificially delays the demise

R’ Waldenberg – Physicians must do everything R’ Waldenberg – Physicians must do everything possible to save a dying patient, even if temporary possible to save a dying patient, even if temporary (Tzitz Eliezer)(Tzitz Eliezer)

Pain killers may be given even if the slow breathingPain killers may be given even if the slow breathingRosner, Fred –Biomedical Ethics and Jewish Law - 2001

End of Life DecisionsEnd of Life Decisions

Resuscitation and withdrawing supportResuscitation and withdrawing support R’ Waldenberg – An artificial ventilator is R’ Waldenberg – An artificial ventilator is

permissiblepermissible One is not permitted to place an incurably or One is not permitted to place an incurably or

irreversibly ill patient on life supportirreversibly ill patient on life support Life support may be disconnected when a patient is Life support may be disconnected when a patient is

halachically deadhalachically dead Nutrition, Hydration and routine life-saving Nutrition, Hydration and routine life-saving

medications must be given even to dying patientsmedications must be given even to dying patients Medications and painful treatment may be refusedMedications and painful treatment may be refused Experimental therapies may (but are not required) Experimental therapies may (but are not required)

be tried of under the care of an “Expert” physiciansbe tried of under the care of an “Expert” physicians


Reproductive IssuesReproductive Issues

In-Vitro FertilizationIn-Vitro Fertilization Fertilization occurs outside the bodyFertilization occurs outside the body The fertilized zygote is re-implanted in the The fertilized zygote is re-implanted in the

mothermother Approved by Chief Rabbi Ovadiah YosefApproved by Chief Rabbi Ovadiah Yosef

What is the status of un-implanted fertilized What is the status of un-implanted fertilized zygotes?zygotes?

May be used for research or discardedMay be used for research or discarded Committee on Medical Ethics – Federation of Committee on Medical Ethics – Federation of

Jewish PhilanthropiesJewish Philanthropies

In Vitro Fertilization: Legal and Ethical Considerations by Fred Rosner, MD

Reproductive IssuesReproductive Issues

Artificial InseminationArtificial Insemination Not allowed with a donorNot allowed with a donor Some consider it adulterySome consider it adultery

Issues of inheritance, legitimacy and incest Issues of inheritance, legitimacy and incest remainremain

From the husband it is permitted (IVF)From the husband it is permitted (IVF)

Surrogate MotherSurrogate Mother Permitted only as a last resortPermitted only as a last resort Forbidden by R’ JacobovitsForbidden by R’ Jacobovits

Embryo TransferEmbryo Transfer Conflicting opinions givenConflicting opinions given Who is the “real” mother –biological or gestationalWho is the “real” mother –biological or gestational

N. Shulman –Jewish Answers to Medical Ethic Questions

A. Steinberg, MD – Jewish Medical Law

Is Plastic Surgery Is Plastic Surgery Permissible Under Jewish Permissible Under Jewish

LawLaw Reconstructive ProceduresReconstructive Procedures

Congenital (from birth) MalformationsCongenital (from birth) Malformations Acquired MalformationsAcquired Malformations

Cosmetic SurgeryCosmetic Surgery Halachic IssuesHalachic Issues

Improving G-ds workImproving G-ds work Risks of surgery Risks of surgery Prohibition on mutilation of the body - Prohibition on mutilation of the body - ChavalaChavala Ethical censure of human vanity - particularly Ethical censure of human vanity - particularly

menmen

R’ Immanuel Jacobovits in Jewish Medical Ethics

Is Plastic Surgery Is Plastic Surgery Permissible Under Jewish Permissible Under Jewish

LawLaw R’ Immanuel Jacobovits’ R’ Immanuel Jacobovits’

recommendationsrecommendations Surgical risk must be minimalSurgical risk must be minimal The operation is medically indicatedThe operation is medically indicated

Following an accidentFollowing an accident To prevent grave psychological harmTo prevent grave psychological harm

Correction of the deformity will facilitate or Correction of the deformity will facilitate or maintain a happy marriagemaintain a happy marriage

Correction of the deformity will allow the Correction of the deformity will allow the individual to earn a living or play a individual to earn a living or play a constructive role in societyconstructive role in society

Is Plastic Surgery Permissible Is Plastic Surgery Permissible Under Jewish LawUnder Jewish Law

Rabbi Mordechai Yaacov Breish (Rabbi Mordechai Yaacov Breish (Chelkas YaakovChelkas Yaakov))There is an acceptable amount of riskThere is an acceptable amount of risk

ChildbirthChildbirthBloodletting (Talmudic)Bloodletting (Talmudic)

““Shomer Pasaim Hashem” Shomer Pasaim Hashem” G-d protects the simple (not medically sophisticated)G-d protects the simple (not medically sophisticated)

To prevent psychological pain (Tosofos)To prevent psychological pain (Tosofos)

Rabbi Moshe FeinsteinRabbi Moshe FeinsteinChavalaChavala (self-mutilation) implies only with malice (self-mutilation) implies only with maliceTherefore it is permissibleTherefore it is permissible

R’ Eliezer Waldenberg (R’ Eliezer Waldenberg (Tzitz EliezerTzitz Eliezer) forbids all ) forbids all “elective” surgery that is “cosmetic”“elective” surgery that is “cosmetic”

Jewish Medical Law – Avraham Steinberg, MD

Smoking CigarettesSmoking Cigarettes

Medical Conditions Associated with Medical Conditions Associated with SmokingSmoking

Cardiovascular DiseasesCardiovascular Diseases EmphysemaEmphysema Coronary Artery Disease (Heart Attacks)Coronary Artery Disease (Heart Attacks) Peripheral Vascular DiseasePeripheral Vascular Disease StrokesStrokes

CancersCancers LungLung BladderBladder Mouth, Tongue and LarynxMouth, Tongue and Larynx EsophagusEsophagus PancreasPancreas

Smoking CigarettesSmoking CigarettesChafetz ChaimChafetz Chaim

““Smoking is harmful to the body and Soul”Smoking is harmful to the body and Soul”

R’ Feinstein (1973)R’ Feinstein (1973)It is not proper to start smokingIt is not proper to start smokingNot prohibited because, “The Lord preserves the simpletons Not prohibited because, “The Lord preserves the simpletons (Shabbat 129b & Niddah 31a)(Shabbat 129b & Niddah 31a)

R’ Eliezer Waldenberg (Tzitz Eliezer) – Smoking is ProhibitedR’ Eliezer Waldenberg (Tzitz Eliezer) – Smoking is ProhibitedR’ Aberbach (1969)R’ Aberbach (1969)

Should be prohibited due to the dangerShould be prohibited due to the danger

R’ Chaim David Halevy (1976)R’ Chaim David Halevy (1976)Chief Sephardic Rabbi of Tel-AvivChief Sephardic Rabbi of Tel-AvivSmoking is a violation of Jewish LawSmoking is a violation of Jewish Law

R’ Bleich (1977)R’ Bleich (1977)Many actions are dangerous (crossing the street)Many actions are dangerous (crossing the street)

Dr. A. Abraham citing R’ Ovadiah Yosef (1980)Dr. A. Abraham citing R’ Ovadiah Yosef (1980)““One should do one’s utmost to avoid smoking”One should do one’s utmost to avoid smoking”Smoking is not halachically prohibited (General Consensus)Smoking is not halachically prohibited (General Consensus)

F. Rosner – Biomedical Ethics and Jewish Law

Schussheim, Eli and Eliezer Waldenberg. (“Should Jewish law forbid smoking?” B’Or ha’Torah 8 (1993))

Any Questions?Any Questions?

Rkyhs jewish medical ethics revised

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