AND

INSTITUTE FOR CONTINUING

PROFESSIONAL DEVELOPMENT AT

TOURO COLLEGE

NATIONAL JEWISH INSTITUTE

FOR CONTINUING PROFESSIONAL

EDUCATION

PARAMETERS OF RISK

MEDICINE, CULTURE AND

ETHICS

ROLLING THE DICE

RISKY AND EXPERIMENTAL TREATMENTS

WHEN LIFE HANGS IN THE BALANCE

CRITERIA FOR RISKY TREATMENTS

Patient will surely dieComplete cure is possibleMost physicians agreeRabbinic authority agrees

– Rabbi Ya’akov Reischer

DEFINING THE PARAMETERS

1 2 3

How do we define success?

How much risk is acceptable?

How long is chayei sha’ah?

HOW LONG IS CHAYEI SHA’AH?

HOW LONG IS CHAYEI SHA’AH?

Despite the fact that the

boundary marking the transition

from chayei sha’ah to long term

life expectancy is not clearly

delineated, it is logical to assume

that as long as we know that the

illness is already terminal,

regardless of how much time will

pass until death arrives, it is

considered chayei sha’ah.

Rabbi Avraham Yitschak Hakohen Kook

(1865-1935), Mishpat

Kohen 144:3

HOW LONG IS CHAYEI SHA’AH?

HOW LONG IS CHAYEI SHA’AH?

“It does not state clearly the

definition of chayei sha’ah. It

is clear that a life expectancy

of one to two years is not

considered chayei sha’ah,

because if so, what is chayei

olam?

Ultimately everyone is

mortal, and what difference is

there between one year or

two years, or 100 years, since

no one can live forever? Are

we to categorize all life as

chayei sha’ah?

HOW LONG IS CHAYEI SHA’AH?

Nor does it appear correct to say that chayei sha’ah only refers to a situation in which the person will die from the specific illness [that he is seeking a cure from] and not from other ailments; for what difference should it make what illness will cause his death? . . .

HOW LONG IS CHAYEI SHA’AH?

[Rather it would appear

that] just as a tereifah is

defined as an ill person who

will not live more than

twelve months, so too,

anyone whose illness will

not let him live for more

than twelve months is

considered to be in the

category of chayei sha’ah.

However, if the illness will

cause death after twelve

months, this is not chayei

sha’ah but chayei olam.

Rabbi Shlomo Kluger (1783-1869),

cited by Darchei Teshuvah, Yoreh

De’ah 195:6

HOW LONG IS CHAYEI SHA’AH?

tereifah

ravaged / mauled

may die within a year

HOW MUCH RISK IS ACCEPTABLE?

However, this [permission to operate] is only if the chances of life and death as a result of the surgery are equal, but not if, in the majority of cases, the patient will die as a result of the operation.

Rabbi Eliezer Waldenberg (1915-

2006),

Tsits Eliezer, vol. 10, 25:5

HOW MUCH RISK IS ACCEPTABLE?

In a situation when we have otherwise given up hope, we disregard chayei sha’ah, even for a remote possibility that the patient will be healed.

Rabbi Chaim Ozer Grodzinski

(1863-1940), Achiezer, Yoreh

De’ah 16:6

HOW DO WE DEFINE SUCCESS?

Regular life is life without the illness that in the natural course of events, will allow one to live like any normal person.

Obviously this includes situations where the patient is expected to be totally healed. . . but it even includes the more common situation, in which the patient is weak after surgery and needs to attend carefully to many things, such as a proper diet, avoiding excessive exertion, and often, taking various medicines in order to avoid a relapse.

HOW DO WE DEFINE SUCCESS?

This too, is considered like the life of a normal person, since there are many weak people who need to be careful about these matters, and it is possible for them to live for many years, just as long as healthy people, and sometimes even longer . . .

HOW DO WE DEFINE SUCCESS?

If, however, the surgery will only help in

that the patient will be able to continue

in his ill state for a long period of time

instead of a short one, and there is also

the possibility that the surgery could

cause immediate death, then, since, even

if the surgery were to be successful, the

patient would be prone to die from this

illness at any time, even though the

surgery would create the possibility for

him to go on in this dangerous state for a

long time, it is likely, in my humble

opinion, that one should not permit the

surgery.

Rabbi Moses Feinstein (1895-

1986), Igrot Moshe, Yoreh

De’ah 2:36

APPLYING THIS TO TOM?

Lifestyle changes?

Risks of surgery

Experts concur?

Terminal?

Drink?

Smoke? Wife’s opinion?