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Monday, October 29, 2012

Lech Lecha, Bereishis 16:5, Vayeira 18:12. Praying for Miracles

The Gemara in Brachos (60a) seems to say that it is a waste of time to pray that a miracle happen; it is a Tefillas Shav.  The word Shav appears in the Aseres Hadibros, where it means taking Hashem's name in vain- i.e., for nothing.

On the basis of this Gemara, the Steipler is quoted as having said that once doctors have determined that by the laws of nature, בדרך הטבע, the patient cannot live, then it is wrong- assur- to daven that he recover.


בספר 'ארחות רבינו' (ח"א ע' של"ה) שהסטייפלר זצ"ל הורה על חולה שאין תרופה למחלתו על פי דרך הטבע, שאסור להתפלל על נס, שהוא כמי שמתפלל על תחית המתים, או כמי שמתפלל על קטוע אבר שיצמח לו אבר אחר

I also saw an article quoting a highly regarded Rosh Yeshiva in Otniel to the same effect- 
considering the similarity in expression, I assume he was thinking of what the Steipler said:


רב היישוב עתניאל, הרב רא"ם הכהן, פסק כי אסור להתפלל לרפואת חולה שנמצא במצב של מוות מוחי. הרב, שנחשב לבעל השפעה בציבור הדתי, נימק את הפסיקה בכך שמדובר ב"תפילת שווא" - כלומר כזו שאינה יכולה להתקיים בדרך הטבע.

בתשובה שפרסם בעלון "שבת בשבתו", המופץ בבתי הכנסת, הסביר: "האפשרות שהמוח ישוב לתפקד אינה קיימת,
ממש כשם שאיבר חדש לא יכול לצמוח".

There is a great deal to say about this.  Besides the body of one hundred twenty one comments on the ynet site, which comprises an extraordinary compendium of ignoramuses, psychotics, mechutzafim, the willfully blind, and a few reasonably well-informed readers, I had been planning to discuss this issue- whether one may daven for the miraculous recovery of a person that בדרך הטבע is sure to die.  For example, there is the Sforno in this week's parsha (18:12) that says 
ותצחק שרה שחשבה שהיה דבר המלאך ברכת נביא בלבד כענין אלישע לא נבואה ושליחות האל ית'. וחשבה שלא יושג זה בזקנים בברכת שום נביא כי אמנם להשיב הבחרו' אחר הזקנה הרי הוא כתחיית המתים שלא תהיה זולתי במצות האל פרטית או בתפלה משגת חן מאתו:
Note that the Sforno is saying that while it would be a joke to think that a bracha can change the teva, tefilla does have that power.

Other mekoros that I'll discuss if I have a chance:   רמ"א , בכור שור, ישועות יעקב, נפש חיה in OC 187:4 and 682:4 from the Kolbo, Mahrsh"a in Kiddushin 29b, נפש החיים ג' י"ב, רוח חיים ב' ד, רבנו בחיי, and others, all of whom say things that are worth hearing.

But several articles that I recently read motivated me to post this before I was ready to discuss the mekoros in the Gemara, Rishonim, and Achronim.  

First, there was an article that wrote that despite diagnoses of brain death, certain new tests can reveal unexpected brain activity.

But I assumed that the use of the term brain death was just sloppy reporting, because when brain death is diagnosed, there is nothing left- no hope, no improvement, no life, only inexorable and ghastly deterioration.

But then I saw thiswhere on a nationally televised reality show in Denmark, parents of a brain dead woman were encouraged to turn off the respirator so that the doctors could harvest the vital organs and give them to patients that had a chance to live.  And when the respirator was turned off, sholom aleichem, the patient not only didn't stop breathing and die, but she slowly improved to the point that there is a real possibility of a full recovery.

Later, this one joined the ranks.

So I don't know whether one should be mispallel for a person that cannot live על פי דרך הטבע.  There most certainly are cases where it is absolutely clear that the patient is not decaying only because of extreme intervention, and we'll bli neder discuss the issues about davening for a miracle.  But I do know that in other cases where a diagnosis of brain death has been made, tefilla might still be appropriate according to everyone, because one of the following three possibilities might pertain:

Possibility One:   Misdiagnosis due to human error.  This is not necessarily indicative of murderous indifference.  Remember this?  That's why in the beginning of Bava Kamma, Adam is called Mav'eh, and why a mumcheh l'beis din is pattur.  Even the greatest of us needs to be mispallel that we don't err.

Possibility Two:   Misdiagnosis due to incompetence or negligence.

Possibility Three: Intentional misstatement of fact because someone decided that the patient, even if he survived, would not have much quality of life, and the people who need the transplant would live and flourish, so in the balance, it's worth taking harvesting the organs even if it is a little premature.

11 comments:

Eli said...

I think the question of reliability of brain-death decisions should be separated from the possibility of intentional or accidental error.

Regarding the reliability, as you said the Kansas instrument is for people in vegetative state, not brain death. In the Denmark story the hospital acknowledged that they anticipated brain death, but did not actually diagnose it. Certainly, the procedure exercised there is flawed. I don't know about Danish law, but in Israel deciding brain death requires two doctors, not involved in the patient treatment nor having any relation to transplantation treatments, and an indepepndent lab test (in addition to the clinical tests by the two doctors) confirming no brain activity -- see here http://www.health.gov.il/hozer/mk27_2009.pdf

So, regarding the reliability issue, I think it is still the case that there is not even a single reported case worldwide of a patient coming back to life after bona-fide brain death. The Denmark story proves that if something like that happens anywhere in the western world, we would know about it [on the other hand, there are numerous reported cases of people diagnosed as cold-dead and coming back to life].

Misdiagnosis is always an option, for brain death and for heart-death. So one can rephrase the question and ask about a person who was notified his relative is cold-dead, heath, lung and all. Should he continue to daven in hope of intentional or accidental misdiagnosis?

Another point to make is the following: in a famous Teshuva the חת"ס http://www.hebrewbooks.org/pdfpager.aspx?req=14664&st=&pgnum=278
argues with Mendelsohn about a regulation prohibiting Kevurah for 3 days (to avoid the accidents I mentioned above). The חת"ס states that death is defined by Halacha, and even if once in a lifetime someone comes back from the dead we should still bury right away as long as the body is formally-Halachically dead.

So my point is that whether brain-death is death at all should be argued, but if it is Halachically death, then the חת"ס tells us it should be so even if once in a blue moon someone will get back to life.

Barzilai said...

Thank you, as always, for the excellent thoughts and mareh mekomos.

But I believe even the Chasam Sofer would agree that the diagnosis would not preclude tefilla. A possibility, albeit vanishingly small, is all that is needed to stay within דרך הטבע. Otherwise, praying that one win the sweepstakes would also be a תפילת שווא.

Eli said...

So the חת"ס would allow davening a person will become well right after his Kevurah?

Barzilai said...

Nachum J, who had a local dutchman translate the original Danish news broadcast, sent me this letter:

"In a country with relatively lax rules they not only ignored the rules, they lied to the family, presenting their prognosis as if it had already happened- a malicious extension of their misdiagnosis."

Barzilai said...

Eli, there is a difference between reasonable expectation and a tefilla for divine intervention.

Eli said...

The חת"ס did not claim these rare events (where a man woke up after 2-3 days of being considered dead) were super-natural. He just said they are rare enough to ignore, and you can go ahead and bury the guy. If we accept the premise that nevertheless this rare possibility is good enough to allow davening, we could add to any Kevurah a Mi-Sheberach for the diseased.

Of course, not all improbable events are equally improbable. I would argue a revival of a brain-dead person is more rare than (at least in the times of the חת"ס, and earlier) that of a cold-dead body. The former never happened, the latter did many times.

Barzilai said...

As I said, just because we hope that tefilla might be answered that does not mean that we have any expectation that something is likely to have occurred without the tefilla anyway. But for your line about adding a מי שברך to the אל מלא at a funeral you deserve a medal for Shtoch of the Decade.

great Unknown said...

For an overview of the subject of what goes on in that area of the world, see
http://www.patientsrightscouncil.org/site/holland-background/
which has interesting references.

There is also this preview of the inevitable consequence of nationalized health care:
http://www.science20.com/cool-links/death_pathway_euthenasia_nhs_kills_130000_elderly_year_says_doctor-91346

Being a compassionate person, I'm a firm believer in euthanasia, particularly of the involuntary kind. I am thinking of several people who could benefit from this chesed.

Barzilai said...

I have found that words that begin with eu, from the greek for good, are often ominous or cynically self-serving. Like eugenics, euthanasia, and euphemism. And, considering the discussion in YD 344:1-2 and the Aruch Hashulchan there sk 6, Eulogy too.

Anonymous said...

While it may be ossur for others to daven on behalf of one with no chance of recovery al pi revamping we see that is certainly no the case for the choleh himself
Afilu cherev Chadah munach al tzavaro al yimnah atzmo min ha rachanun and we see Chizkiyah was told b nevuah that he would die yet he was mispallel and his tefilos were heeded

Barzilai said...

As I said, much has been said about this issue. Maybe you're right, and for the sick person such a tefilla is ok, although there certainly is no way to read that into the Gemara in Brachos. Or: where a miracle would result in kiddish Hashem be'rabbim; or would benefit all of Klal Yisrael: or involves a navi or someone that lives above teva; or that can be a nes like Esther but not like Krias Yam Suf; of on and on. I just don't have the time to go through them all. That's why I put the marei mekomos in the post.