Thursday, February 3, 2011

Thoughts on Brain Death 2: Way, Way Out There Department

The Brain Death issue remains perhaps one of the most complicated, difficult and frightening halachic and hashkafic challenges we face today. As a rabbi, I could never make that call to pull the plug and allow the harvesting of organs from one person to another. But, on the other hand, how could I not make the call? How could I rob a person of the potential for rebirth, from the gift of a new heart, or a lung or a liver?
Let's be clear: this decision rests firmly in the hands of the local rabbi (which is an interesting turn of events). With the gedolim lining up on both sides of the issue, families faced with such a drastic and consequential decision often turn to their own spiritual guide - as they should. The rabbi must choose whose psak he wishes to follow. In a world where every small question immediately goes to the rosh yeshiva or the gadol in Israel, small-time rabbis find themselves thrust back into the big-leagues of psak.
Yet, thinking about the "largeness" of the issue, I kept coming back to myself. If, God forbid, someone I loved needed an organ, would I take it? Somehow, with the incentive of a life-or-death decision, the abstract "Brain Death" question would probably matter little to me. After all, with skin in the game the decision becomes that much clearer. I'd probably say, "Well, with great gedolim on the side of accepting the notion of brain death, who am I to argue with them?" I'm pretty sure that I'd take the organ.
If I'd do that, though, how could I possibly dare to prevent someone else from doing the same? How can I be willing to take - which I am - but be wary of giving?
I think I've found an "out." It's way, way out there, so bear with me.
Consider for a moment a tragedy: John suffers traumatic injury resulting from an industrial accident, and doctors agree, using the requisite medical tests, that John is indeed brain-dead. Let us assume for the moment that we reject the notion of brain death, and consider life based solely on cardiac function. At this moment, from this point of view, John remains fully alive.
If, for whatever reason, the doctors needed to stop his heart to conduct a test, but then restarted that heart (which they can now easily do), did they kill him? I think that the answer is clearly no.
But what if they stopped his heart, and put it in another body. Is John now dead? Remember that his heart functioned independently of his body before. It continues to do so now; just in another body. Biologically we know that this is the case. Organ donor recipients must take anti-rejection drugs for the rest of their lives. Their bodies often consider the inserted organ as a foreign force to be rejected and expunged. If that's biologically true, cannot it also be spiritually true.
What I'm getting at here is, who are we to say that the life-force we knew as John ended when we transferred his heart to a different body? Could it be that on some level, John remains alive (or at least his life-force), living in the body of someone else?
To me, the entire brain-death issue smacks of excessive hubris on all sides: doctors think they can define life or death, and rabbis declare with certainty that we can definitively determine when life exactly ends. (To me, the "anti-brain-death" position has always appealed to me because it takes the "who knows?" approach. How can we end a life if we really don't know if it's over? Good question.) Yet, I have come to believe that this question of life is not binary. It's not yes or no, but shades of gray.
Judaism teaches us that there are many levels of life. On the very simplest level, there's something the Torah calls nefesh, and something else called neshama. To the best of my very limited understanding, nefesh refers to the life-force inside us, while neshama is that spark of God which illuminates our humanity. Could it be that the brain-dead person has been separated from his neshama, while his nefesh remains intact? How are we to know?
And if that's the case, when I take John's heart out of his body, it was already separated from his neshama.
And then, when I insert it into a new body and restart that heart, perhaps the nefesh that was, and is John, is still very much alive.