About a month ago, the launching of the book "Defining the Moment: Understanding brain death in Halakhah" by R. Dr. David Shabtai was announced on the Hirhurim blog. In the comments section, R. Natan Slifkin asked the following question:
Rabbi Shabtai – I have not yet read your book, but it seems that all those who wrote haskamos, and whose positions you discuss, take the approach of paskening this question directly from the Gemara and earlier poskim. Applying this methodology of psak is in turn is based on two presumptions: that Chazal differentiated between the nervous system, the cardiopulmonary system, and the respiratory system – and that they correctly understood the role of each. Do you discuss the nature and validity of these presumptions in the book?
R. Dr. Shabtai didn't reply to the comment and not to a subsequent comment submitted one day later, although he addressed other questions posed to him in the comments. A few days later, R. Slifkin wrote the following on his blog:
I posed [the] question to the author twice, and despite the fact that he was responding to other comments, he did not respond to my question. My guess is that he'd never thought about it, and is uncomfortable with it. I don't blame him for his discomfort.
In the same post, R. Slifkin also wrote that:
Someone who acknowledges that Chazal only possessed the limited scientific knowledge of their era will (hopefully) take this into account. But if someone believes that Chazal could not have been mistaken about scientific matters ... then they will refuse to consider that brain death cannot be resolved via drawing inferences from the statements of Chazal.
On another, more recent, blogpost on Hirhurim, a commenter named "Ephy" wrote:
Rabbi Slifkin does not just hold brain death is the time of death, but rather we should ignore the Gemara on the topic since it was unaware of the brain housing the intellect. This is at odds with Rabbi Tendler etc (by Rabbi Slifkin’s own admission) who analyze the Gemara. Rabbi Slifkin will quickly reject any Gemara that discusses anything that deals with the body science etc.
Now, I'm not sure what is it that R. Slifkin meant when he said that Hazal's limited scientific knowledge have to be taken into account when trying to pasken whether brain death is death or not from Hazal. It could be that he meant what Ephy said he meant, namely, that we have to ignore Hazal's statements on this issue. But it could also be - and that's the way I took it to mean - that all R. Slifkin meant to say was that we have to take Hazal's limited scientific knowledge into account when trying to draw inferences about brain death in Halakhah. But of course, it's possible to draw halakhic inferences about the criteria of death from Hazal.
R. Slifkin asked R. Dr. Shabtai whether he took into account Hazal's limited knowledge. But what about Rashi's limited scientific knowledge? I think that this is something that shouldn't make anyone uncomfortable, as per the famous quote from R. Moses Sofer in his Hidushei Hatam Sofer (Niddah 18a) about Rashi's limited medical knowledge. In the example below, it becomes apparent that (at least in one case) R. Dr. Shabtai assumes Rashi's perfect scientific knowledge. To me, this is quite disturbing.
In chapter 5 of the book, R. Dr. Shabtai deals with the Mishna and Gemara in tractate Yuma (83a, 85a). The Gemara records a dispute between Tana'im regarding a building that collapsed on a person in Shabbat, and the dispute is whether the rubble may be cleared up to the person's nose where they have to check if the person is alive (if he is, they should continue the excavation; if not they must cease), or up to the person's heart (according to Rashi's text.). According to Rav Papa, the dispute is as follows: in the case that the rubble is being cleared from the person head down, everyone agrees that they must only clear up to his nose and check if the person is alive. The dispute is only in the case that they clear the rubble from his feet up. Some rabbis say that they may only clear up to his heart, and some rabbis posit that the rubble can be cleared up until that person's nose.
Says Rashi (Yuma 85a s.v. amar Rav Papa):
אמר רב פפא, מחלוקת מלמטה למעלה - מחלוקת דהנך תנאי - דמר אמר עד לבו ומר אמר עד חוטמו - מלמטה למעלה, שמוצאו דרך מרגלותיו תחלה ובודק והולך כלפי ראשו דמר אמר בלבו יש להבחין אם יש בו חיות שנשמתו דופקת שם ומר אמר עד חוטמו דזימנין דאין חיות ניכר בלבו וניכר בחוטמו.
"Said Rav Papa, the dispute is from bottom upward" - the dispute of the Tana'im in which one side said that [they remove the rubble] up to his nose and the other side said that [they remove the rubble] up to his heart, "bottom-up" - it is in a case where they found the person's feet first and the excavate him toward his head. One side says, his heart can be checked whether it has a pulse, and the other side said that there are cases in which the pulse is too weak and there's still a breath in his nose.
According to Dr. Avraham Steinberg, both positions in the Gemara agree that the lack of respiration is the sole requirement to determine death. However, when the victim is found feet-first, some rabbis say that checking for lack of heartbeat is enough since if there's no heartbeat, it's impossible for the person to still be breathing. (As a side note, this is only a viable explanation if you assume that Hazal knew respiration is impossible when the heart isn't beating anymore. If you posit - as R. Slifkin probably does - that Hazal didn't know that, we're forced to say that some tana'im held that both, checking for pulse and for respiration are valid criteria.)
Asks R. Dr. Shabtai (p.75):
If both opinions maintain that cessation of respiration is sufficient criteria to establish death, why doesn't the [nose] opinion rely on cessation of heartbeat, as the [heart] opinion does, when the victim is uncovered feet-first? If there's no heartbeat, the victim cannot be breathing; why then require continued checking until [the nose] if breathing is not physiologically possible? Reading the Talmud as describing the criteria for death invariably leads to this conundrum.
Except, of course, if you believe that Hazal didn't know that. But R. Dr. Shabtai's isn't the only one guilty here of ignoring this possibility. It is Dr. Steinberg - on whose approach R. Dr. Shabtai is asking - that ignored the possibility that Hazal simply weren't aware that cessation of heartbeat invariably means cessation of respiration (although, as we noted earlier. one can take Dr. Steinberg's approach with the slight modification that the "heart" position held that both, lack of respiration AND lack of heartbeat are correct criteria to determine death). But what bothered me is the answer R. Dr. Shabtai gives to this conundrum:
Rashi therefore explains that the Talmud is not debating the actual criteria for death - cessation of heartbeat or respiration - but only the particular tests used to determine whether some previously agreed upon criteria have been met. Both opinions agree that a person cannot breathe without without a heartbeat; the question is only whether a chest exam is sufficiently sensitive to diagnose a heartbeat.
R. Dr. Shabtai then goes on to explain that according to Rashi, both positions in the Gemara agree that the criteria for death is the irreversible cessation of heartbeat. The dispute is only on the tests required to determine that the criteria has been met. According to the "heart" position, checking the heart for a pulse is enough to determine whether the heartbeat has ceased or not. According to the "nose" position, that is not sufficient, and the nose has to be checked for respiration. Only when there's no respiration can we be sure that there is no cardiac function.
Besides for the obvious problem which R. Dr. Shabtai fails to address, which is that checking for respiration is NOT a valid test to determine cardiac function, since the heart can continue beating even when respiration has stopped (and which is, ironically, only a problem for R. Dr. Shabtai who assumes that Hazal were up-to-date with their scientific knowledge), R. Dr. Shabtai's entire presentation of Rashi's approach is based on the mistaken premise that not only did Hazal know that cessation of heartbeat is a sure sign of cessation of breathing, but Rashi knew that as well, and therefore explained the Gemara as as relating to tests that are made to determine criteria not even hinted at in the Gemara!
R. Dr. Shabtai finishes off the passage with the following word:
In summary, Dr. Steinberg maintains that [checking the nose] and [checking the heart] are disparate criteria for death and that R. Papa concludes that both opinions essentially agree that cessation of respiration is the determining factor. Rashi, on the other hand maintains that the Talmud's question relates to the accuracy and sensitivity of different possible tests of cardiac function - assuming that cardiac criteria and cardiac criteria alone determine death.
To me, this is a misrepresentation of what Rashi says, and is based on the assumption that Rashi is aware of the fact that lack of heartbeat invariably shows on cessation of respiration. Take away this assumption, and there remains almost no basis for explaining Rashi the way R. Dr. Shabtai does.