Tuesday, September 06, 2005

Treatment of the Dying - Shabbos 151b

Treatment of the Dying - Shabbos 151b
מסכת שבת דף קנ " א ע " ב :
משנה : אין מעצמין את המת בשבת ולא בחול עם יציאת נפש והמעצים עם יציאת הנפש הרי זה שופך דמים . גמרא : תנו רבנן המעצמו עם יציאת הנפש הרי זה שופך דמים משל לנר שכבה והולכת אדם מניח אצבעו עליה מיד כבתה .
Mishnah: The eyes of the dead may not be closed on Shabbos, nor on a weekday as the soul expires, and a person who closes the eyes as the soul expires is a killer. Gemara: The Rabbis taught in a Baraisa: A person who closes another’s [eyes] as the soul expires is a killer. This is analogous to the flame of a candle that is going out — if a person puts his finger on it, it goes out immediately.
In Meseches Semachos1 the Baraisa adds that a person who even touches a dying person is a killer. There are, however, circumstances in which a dying person may be touched. For example, if a fire breaks out in the house in which the person is dying, it is permitted to remove him from the house.2 In the same vein a physician may touch the dying person in order to treat him, so long as there is even the most remote hope that the patient’s life might be extended. Only once the patient is beyond hope, does it become forbidden to touch him. At that point, it is forbidden even to perform the most routine procedures on him, such as checking blood pressure or temperature, or even checking his pulse.3
However, while it is forbidden to shorten the life of a dying person, even by a few moments, it is not necessary to make heroic efforts to prolong life either. In this respect, Rabbi Shlomo Zalman Auerbach4 distinguishes between treatments that meet a patient’s basic natural needs, or that are customary and routine, and treatments that do not meet natural needs and that are not routine.
For example, it is forbidden to deprive the dying patient of oxygen, food or intravenous nutrition. If the patient suffers from diabetes he may not be deprived of insulin. If he is being transfused, he may not be deprived of blood. If he is on a course of antibiotics, it may not be stopped. Yet, there is no obligation to actively treat the patient if the treatment if it will prolong (and certainly if it will cause) suffering and not heal his illness — especially if the patient himself does not want to be treated.
If the dying patient has ceased breathing or his heart has stopped beating, there is no obligation to resuscitate him or attempt to restart his heart.5
Reb Shlomo Zalman also rules that it is permissible to administer morphine and other pain medication to a dying patient, even though the medication may itself kill him or hasten his death. The only restriction that Reb Shlomo Zalman imposes is that no single injection that will inevitably in itself hasten the patient’s death may be administered. It is only permissible to administer the medication in a manner that over time will take its toll. For example, a patient who has difficulty breathing may not be given morphine when it is likely that the morphine will arrest his breathing altogether — as this would be the equivalent of our case of closing the eyes of a dying man — unless the patient is respirated artificially.6
מסכת אבל רבתי פרק א' דין ד': אין מעמצין את עיני הגוסס הנוגע בו ומזיזו הרי זה שופך דמים שהיה רבי מאיר אומר משל לנר שהוא מטפטף כיון שנגע בו אדם מכבהו כך כל המעמץ את עיני הגוסס מעלין עליו כאילו הוא נוטל נשמתו.
חידושי הגרעק"א ליו"ד סי' של"ט סעיף א'.
נשמת אברהם ליו"ד שם סק"ג.
נשמת אברהם שם סק"ד.
כל זה בנשמת אברהם שם, וציין גם לשו"ת אגרות משה יו"ד ח"ב סי' קע"ד ולשו"ת ציץ אליעזר חי"ג סי' פ"ז.
כל זה ג"כ בנשמת אברהם שם.

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