Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

11 Nissan 5765 - April 20, 2005 | Mordecai Plaut, director Published Weekly









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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

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 passed.

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 doing less.

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.

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