Director, Emergency Services, Bikur Cholim Hospital
I was asked to comment on the Schiavo story: a woman who was
"brain dead" and had her feeding tube removed and about ten
days later died. This story made waves.
I will let you know a few facts about medicine and people
with bad diseases. We have discussed dementia. This is known
by many as senility. Many of these patients are confused and
some are completely non communicative, and have contractions
— that is they cannot move their limbs that become
frozen. They basically are unable to do anything and they
curl up into a ball. Others have bedsores and others cannot
control their body functions. Some need to be fed through a
hole in the abdominal wall. Some have to wear diapers and
some are incontinent. Many need to be on tranquilizers, as
they scream all the time. Some have all of these problems.
Dementia is very challenging.
These people will not get optimal care in Israeli hospitals.
Those with EKG changes will not get the cardiac
catheterization they need. Those with strokes will be sent to
the internal medicine ward instead of to neurology. Those
with need for surgery will not get it, especially
neurosurgery. But that comes with a caveat. Sometimes in
these fragile people the surgery itself may be dangerous, and
this is especially the case in neurosurgery. These patients
will also rarely get put on respirators if their breathing
fails. This is the case in dementia.
Brain death is somewhat different. In major accidents —
lo oleinu — one can see signs of brain death,
but this cannot be known for certain until some time has
What is brain death? This is when most of the brain dies,
leaving only the portion that can control breathing. All
thought processes are gone, but the body is still alive. In
most hospitals in Israel these patients will then be left on
the ward with no or little care until the final conclusion
occurs. Those willing to be organ donors will receive
excellent care — even ICU care, which in Israel is
rationed — until the organs can be harvested.
There are profound halachic problems with a lot of this.
While religious hospitals forbid these practices, individual
physicians who are not religious may ignore these rules. I
for one often find my hands tied, because I cannot get a
consultant to do what is necessary — such as cardiac
catheterization — because he won't do it on demented
patients. On the other side, sometimes the halacha warrants
I am speaking about the reality of what goes on. Some
rabbonim know a lot of medicine or have a readily available
physician to consult with. I found this to be the case with
HaRav Zilberstein here in Israel and others.
The other issue is: what can you do if the decision of the
secular doctors is not within halachic guidelines? Perhaps we
need to support our religious hospitals for at least this
reason. I do not comment on other places such as in some
European countries where the problem is even more acute.
Readers who would like to comment are of course referred to
me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Prostatism is a miserable disease that strikes
many elderly men and can make them dependant on medical
devices for such simple tasks as going to the bathroom.
Surgery can help, but this can leave men with incontinence
and other dysfunctions. Avodart is Glaxo's medicine to shrink
prostates, and it works well, with a minimum of side