This week in Kollel there will be a medical Yarchai Kalah. Since the forum has been basically dead for the last few days, I'll try to revive it with this topic.

The first topic would deal with end of the life issues and when you need heroic efforts to save a terminally ill patient or when you can let the patient die. Does anyone has any proofs one way or another?

quote:

Originally posted by Rav Chaim:
Since the forum has been basically dead for the last few days, I'll try to revive it with this topic.

Was that pun intended?

It was not intended, but in retrospect, it wasn't that bad.

To start with, I'll give a few Mara mikomos for the Olam (all paraphrased from Kollel Iyun Hadaf.

Kesuvos 104a

a) The day Rebbi expired, Chachamim had decreed a fast, and were praying for him.

1. They said - whoever will say, 'Rebbi's soul rested' will be stabbed.

(b) Rebbi's slave went on the roof. 'The higher beings want Rebbi, and also the lower beings - it should be Hash-m's will that the lower beings' request is done.'

1. When she saw how often Rebbi had to go to relieve himself, and remove his Tefilin, and put them on again, and his pain - she said, 'It should be Hash-m's will that the higher beings' request is done.'

i. Chachamim continued to pray that Rebbi live. She took pottery and threw it to the ground. Chachamim stopped praying, and Rebbi died.

From this it would seem that there is a time where the quality of life is not good enough, that it's not worth keeping alive.

In Yoma 85a

) Question: It is *obvious* that if they found the buried man alive, they continue to dig!?

(b) Answer: We dig even if it would only be possible to keep him alive for a short period of time (however short).

This would indicate that we even Mechallel Shabbos in order to keep such a person alive, and in Shulchon Orech it says even if his head is smashed.

I found a teshuva of the Tzitz Eliezer about this topic. I will bring the Teshuva and the last few paragraphs:

שו"ת ציץ אליעזר חלק ה - רמת רחל פרק כח

אם מותר וישנו חיוב לעשות מאמצים להציל גוסס ואם מותר לחלל לשם כך את השבת (סימן של"ט) דיני גוסס סעיף א' שנינו בריש שמחות הגוסס הרי הוא כחי לכל דבר זוקק ליבום ופוטר מן היבום וכו' ואסור לעשות לו דבר שתקרב מיתתו וכן שנינו במשנה דשבת (קנ"א ע"ב) דהמעמץ עיניו של מת עם יציאת הנפש ה"ז שופך דמים.


(ה) וא"כ לפי"ז נלמד גם לשאלתנו דמכ"ש שיש חיוב לעשות מאמצים בחול להצלת נפש הגוסס בדרך הרפואה בכל מידי דאפשר ולו גם לחיי שעה בלבד, כי יקרים מאד רגעי אנוש עלי אדמות ויש קונה עולמו בשעה וברגע אחד בהרהורי תשובה (מעבר יבק חלק שפתי דעת פכ"ו ע"ש). וק"ו בן בנו של ק"ו שמחויבים לעשות כל מאמצי הצלה אפילו משום ס"ס דס"ס של הצלת הגוסס לחברו עוד אל החיים כמיעוטא דחיים.

(ו) וכשרואים שהגוסס סובל בהרבה ומתארך זמן מיתתו ראיתי בספר פחד יצחק שכותב דנכון להתפלל למיתתו בלשון זה: אנא ה' בכח רחמיך הרבים וברוב חסדיך הגדולים י"ר מלפניך שתוציא ממסגר אסיר נפש פלוני או פלונית ותוציאהו מייסורין ב"ב והרוח תשוב אל האלקים אשר נתנה עכ"ל. וכן כותב שם שיתירו כל הקללות, ע"ש. ועמ"ש לעיל בסי' של"ה סעי' ג' באריכות בנוגע אם מותר לבקש רחמים על חולה מסוכן שאין תקוה לרפואתו שימות ע"ש.

(ז) כן אעיר בזה לעיין בספרי שו"ת ציץ אליעזר ח"ד מה שהשבתי בדבר היתר רפוי או נתוח מסוכן לחולה מסוכן, וכן חולה רוח אי מיקרי חולה מסוכן עיי"ש באריכות.

For the reason that the extra minutes or seconds the person has in this life may avail him of the opportunity to do Teshuva one is obliged to try and extend his life.

Quote "For the reason that the extra minutes or seconds the person has in this life may avail him of the opportunity to do Teshuva one is obliged to try and extend his life."

But for this reason, it would seem to contradict what he says in "6" to pray for his death. If we try to extend life, since it's better, since it will give him more time to do T'Shuva, then we should always pray to extend life so to give him more time for T'Shuva

quote:

Originally posted by Rav Chaim:
Quote "For the reason that the extra minutes or seconds the person has in this life may avail him of the opportunity to do Teshuva one is obliged to try and extend his life."

But for this reason, it would seem to contradict what he says in "6" to pray for his death. If we try to extend life, since it's better, since it will give him more time to do T'Shuva, then we should always pray to extend life so to give him more time for T'Shuva

I read that as being in the case where any efforts at extending his life and alleviating his suffering will prove fruitless.

Quote "I read that as being in the case where any efforts at extending his life and alleviating his suffering will prove fruitless."

But the T'fila is that he should die earlier than he would regularly, thus shortening his life and ability to do T'Shuva. I think that contradiction really reflects the contradiction of the 2 Gemaras which I brought. SO whatever you'll answer for the Gemaras you can answer for him. Yet, we need to understand how to answer the gemaras.

Tonight is the Shiur on this issue (the start of the Yarkai Kalah.) We'll se what he says.

It seems that there are two schools of thought on this. Some (including Rav Moshe) want to say from the maid of Rebbi that you shouldn't extend the life of those that are suffering terribly. The Gemara that we dig out someone under the rubble, though he'll only live for a very short time, the Teferes Yisrael claims, is to relieve him of not being able to breath, which is more painful than when he's excavate.

Others (Rav Elyashiv and Rav Shloime Zalman and Tzitz Eliezer that R' Yisrael brought) say that we prolong the life of these people. The case of Rebbi is only through T'fela that we're allowed to. But physically we're responsible to do what we can to heal them for Chayai Shah.

The question arises then, how can we possibly pray that we should be unsuccessful in our responsibility and obligation? Does it make sense to pray to eat Chazer B'oness to go against what he has the obligation not to do? I have a though on this, but I'll leave it to next time. Anyone else has thoughts on this?

I would like to suggest that there are two components of life, the soul and the body. We, as humans, can only treat the body so that it would be a vessel to be able to retain the soul. A broken body cannot hold the soul. The Gemara in Bava Basra 16a as paraphrased by Kollel Iyun Hadaf

3. (R. Yitzchak): The Satan was in more pain than Iyov, it was very hard to ravage his body and preserve his life.

The Gemara gives a parable of a servant getting instructions to break a barrel and retain the wine in it.

Hashem, on the other hand, makes someone die through removing his soul from the body. This is why asking Hashem to remove the soul from the body is not directly a contradiction to us making the body as healthy as possible.

quote:

It seems that there are two schools of thought on this. Some (including Rav Moshe) want to say from the maid of Rebbi that you shouldn't extend the life of those that are suffering terribly. The Gemara that we dig out someone under the rubble, though he'll only live for a very short time, the Teferes Yisrael claims, is to relieve him of not being able to breath, which is more painful than when he's excavate.

It seems that both are in the spirit of relieving suffering. The man who is under the rubble is suffering terribly, and panicking because he cannot breathe. To remove him would (if even for a very short time) in fact give him great relief, thus be in his best interest. Also, it brings up important issues with regard to the divine breath of life being protected. The other situation is also relieving form pain.