In
the past two issues, we have outlined some of the basic issues
regarding risky medical procedures. The Gemara specifically permits one
who is expected to live only a very short while (Chayei Shaah) to
undergo a medical procedure that involves a great risk. Last week we
discussed how much risk is tolerated and what is considered Chayei
Shaah. This week we shall continue our discussion of this topic with a
discussion of two more facets of this issue. We will discuss whether
one is ever obligated to undergo a hazardous medical procedure, and
whether one may risk very brief Chayei Shaah for an extended period of
Chayei Shaah.
Risky
Surgery to Eliminate Pain
Rav Moshe Feinstein (Teshuvot Igrot Moshe Yoreh Deah 3:36) argues that
one may not undergo very risky surgery merely to eliminate pain. He
addresses a case where the patient would be able to live a number of
years even without a surgery if he would remain in bed and would not
walk. Rav Moshe rules that we may undergo very hazardous surgery only
in order to save one’s life, but not to eliminate pain or
enhance one’s quality of life. Perhaps Rav Moshe reasons that
since our bodies belong to Hashem, we have no right to endanger our
bodies merely for our convenience.
On the other hand, Rav J.David Bleich (Tradition Spring 2003) presents
a possible alternative opinion. He notes that Rav Yaakov Emden (Mor
UKetzia 328) writes (in the eighteenth century) that a high-risk
surgical procedure that is intended to alleviate the excruciating pain
of kidney stones or gallstones is “Karov LeIsser”
(close to being forbidden). Rav Bleich notes that Rav Emden regards it
as “Karov LeIsser” and not actually forbidden,
unlike Rav Moshe who specifically writes that such a risky procedure is
technically forbidden. Rav Bleich writes that an analogous contemporary
situation would be surgery to sever a nerve in order to eliminate pain
(though I am unsure if the modern surgery is as risky as the surgery
described by Rav Yaakov Emden).
In addition, Rav Eliezer Waldenberg (Teshuvot Tzitz Eliezer 13:87)
specifically permits administering morphine to a very sick patient
despite the risk involved (morphine depresses the respiratory system).
Among the reasons offered by Rav Waldenberg for his leniency is that
for a very ill patient, extreme pain may hasten death. Rav Shlomo
Zalman Auerbach (cited in Shmirat Shabbat KeHilchata 32: footnote 150)
suggests that it is permitted to administer morphine on Shabbat because
great pain may endanger the patient (recall that we are permitted to
violate Torah prohibitions on Shabbat only to save a life, but not
merely to eliminate pain).
Moreover, Rav Bleich writes that it seems that the Rama (Y.D. 241:13)
permits assuming a considerable risk in order to alleviate pain. The
Rama permits one to amputate a limb in order to eliminate pain. Rav
Bleich observes that in the time of the Rama (sixteenth century)
amputation of a limb was accompanied by significant risk to the
patient. To this Rav Moshe might respond that he forbids only surgery
that involves considerably more risk than the surgery described by the
Rama.
We may add that it is also possible that circumstances have changed
since Rav Moshe issued his ruling in 1972. The current generation that
has grown up with central heating and air conditioning along with other
comforts unavailable to earlier generations probably has a dramatically
lower tolerance for pain than previous generations. Thus, extreme pain
constitutes a much greater danger for the current generation than in
earlier times. It is also possible that Rav Moshe forbids very risky
surgery only in the case he described where the surgery was to be done
to eliminate psychological pain of the patient being confined to his
house. However, it is possible that Rav Moshe would permit even a very
risky medical procedure to eliminate true physical pain.
Risky
Surgery: Obligatory or Discretionary
Ordinarily, one is obligated to undergo medical treatments. Indeed, the
Halacha believes that a duly constituted and recognized Beit Din is
authorized to coerce an unwilling patient to undergo medical treatment
(Mishna Berura 328:6 and the soon to be published Gray Matter volume
two). The reason for this appears to be that since our bodies belong to
Hashem, we have no right to neglect our health. Just as a guardian of
an object must properly guard the item under his watch, so too we must
guard our health, for we are only guardians of the body that Hashem has
given us.
However, Rav Moshe Feinstein (ad. loc.) and Tiferet Yisrael rule that
even in cases where Halacha permits one to risk Chayei Shaah and
undergo very risky surgery in the hope of achieving a cure, one is not
obligated to risk his Chayei Shaah. I have not found a single authority
that disagrees with this ruling.
Rav Bleich offers a very cogent explanation of this ruling. He explains
(as we have cited in the past two weeks) that the Halacha obligates us
to guard our bodies in the manner that prudent people normally guard
their bodies. Rav Bleich also notes that Hashem has created people with
different temperaments (Berachot 58a states that just as our faces
differ, so too our temperaments differ.) Some people tolerate more risk
than others.
Both the risk-averse and the risk-tolerant individual might be acting
prudently, as there is a range and variation for what is regarded as
reasonable behavior (Rav Bleich offers the example of investment
strategy; some will invest very conservatively, others will invest
aggressively, and yet others will seek to balance conservative and
aggressive investments.) Thus, just as the person who is willing to
risk his Chayei Shaah is guarding his body appropriately, so too the
individual who does not wish to risk his Chayei Shaah is guarding his
body properly, as some people are by nature more conservative than
others.
Next week we shall, IY”H and B”N, complete our
discussion of hazardous medical procedures with a discussion of the
role of the Rav in the decision making process in this context.
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