We can continue here, or by phone (052-3320543), or by email (mikyab@gmail.com)

I’m uploading the correspondence that continued by email:

Hello Michael,

Following our short correspondence on your website, I decided it would be best to formulate my thoughts and send them to you by email.
You were absolutely right that I corresponded with you about Ockham’s razor around 10 years ago when I was a researcher in the United States. I was quite surprised that you remembered—I get the impression that you receive hundreds of questions and inquiries a day.
For me, that discussion was very interesting and enriching. I still think that assuming multiple entities of a known type is simpler than assuming the existence of an entity of a new type, but as I think we concluded back then—both approaches can be considered rational in both our eyes 🙂

So here is the question on which I’d like to hear your opinion: what is a person’s death?
Let me begin by saying that of course this is a weighty question, with countless aspects and even weightier implications, so I will focus only on a small part of it (in my view), about which I previously held discussions with Rabbi Prof. Steinberg and Rabbi Dr. Shafran. I did not agree with their positions. Perhaps out of misunderstanding. This part mainly concerns fundamental definitions and the way Jewish sources relate to the practical aspects of determining death.

So, as is customary in a conceptual discussion, let’s start with defining terms.
1. What is the definition of “a person’s death”? In my opinion, the most precise and broad definition of this concept should be by negation—that is, “the end of a person’s life,” and from there we should focus on what a “living person” is. In modern times this question is no longer as simple as it once was, because modern medicine can maintain the body of a sick person, including organ transplantation by donation of an organ (or part of one) from another person, from an animal, or even by implantation of an artificial mechanical organ. In light of this, in my view the definition of a “living person” should focus on the one thing that is almost not transplantable—a functioning brain. It is fairly banal to say that without a functioning brain a person has no consciousness, and in my opinion body parts connected to one another without any consciousness/awareness/ability to choose are not a “living person” but a “collection of living organs.” It is important to qualify this by saying that even a person who lacks consciousness because of age (a premature newborn who has just been born) or because of a temporary health/physiological state (anesthesia, certain coma states, deep sleep)—he too is certainly a living person. Therefore, in my opinion, the full definition of a “living person” is “a person with consciousness, or with the ability to develop / return to consciousness.” I will not go into the definition of “consciousness” itself, or more generally from what level of higher brain activity one may say that a person “has enough consciousness/awareness/ability to choose,” because one can easily slide here into a slippery slope that could lead, in extreme cases, to forced euthanasia of people with intellectual disabilities as the Nazis did. But I do think one can say that consciousness cannot exist without the functioning (of one sort or another) of the higher parts of the brain (the hemispheres themselves). Brainstem function is also important for the existence of consciousness, of course, but the function of that part is necessary but not sufficient (at least at the current level of medicine; one can imagine a theoretical future possibility in which hemispheric function could be maintained even without the brainstem).
In effect, I am defining the “human being” here as “one who has actual or potential consciousness.”
It is important to emphasize that I am not entering into the definition of what “life” is. That is not the question under discussion; I am dealing only with the definition of a “living person.”
In his lecture, Rabbi Dr. Shafran argued that the definition of death depends on cultural and religious aspects, and that even today there is no definition of death accepted by all humanity. I think this claim is inaccurate, and that any educated person from any culture would, in my opinion, agree that if we destroy the brain, then the rest of the body (even if very well maintained artificially by technology) is not a “person,” whereas a person’s head that is carrying on a conversation or discussion and is maintained by technological means without the rest of the body (not possible now, but certainly imaginable in the not-so-distant future) is indeed a person.
If we agree on this definition, then a person’s death can be defined as “the complete initial absence, or complete and irreversible disappearance, of the capacity for consciousness.”
I would be glad to hear your opinion on this definition. If you do not agree with it, then there is no point in your wasting time reading the rest of the text—in that case it would be better to focus on discussing the definition itself before moving on. Of course I would like you to address this definition not only philosophically/scientifically/universally, but also from the perspective of Jewish sources.

2. Determining a person’s death.
Now we can move to the stage of determining a person’s death as we defined it in the previous stage. As I wrote earlier, consciousness cannot exist without the functioning of the hemispheres, and therefore “irreversible damage/destruction of the hemispheres” is, in my opinion, a necessary and sufficient condition for determining death according to the above definition. It is important to emphasize that even if the brainstem continues to function (but the hemispheres do not), there is no possibility of consciousness, and therefore this state still meets the definition of a “dead person.”
I intentionally will not go into the question of the technological/medical method for determining “irreversible damage/destruction of the hemispheres,” or the level of precision a technical methodology must have in order to make such a determination safely. That is a separate question with technical, biological, and ethical aspects. It is enough for me to say that if it is determined that there is a sufficiently reliable methodology for making this determination, then it should be used.

And here is my question to you—if you agree with the above definition of a person’s death, would you also agree with the method of determining death that I described?

3. Determining death according to the rules of medical ethics in the eyes of contemporary Jewish ethics experts: focus on “brainstem death” and cessation of breathing.
In all the discussions I attended with Jewish ethics people, and also when reading the sources they cited, it was made unambiguously clear that determining a person’s death when the heart is still beating requires determining brainstem death. This approach is also anchored in the laws of the State of Israel. This approach draws on interpretations in the sources (if I’m not mistaken—mainly from the Talmud) according to which the key to the continuity of life is “breathing.”
I certainly agree with the claim that once brainstem death has been determined, the person is dead. I simply disagree completely with the ethicists I mentioned earlier regarding the reason: they think that the key to being a living person is “breathing,” and since the center in the brain responsible for spontaneous breathing is in the brainstem, destruction of the brainstem totally prevents spontaneous breathing, and then the person is dead. I, on the other hand, think that the main activity of the brainstem is maintaining the state of wakefulness necessary for the existence of awareness and therefore consciousness (in the part of the brain called the medulla oblongata there is a tiny area such that injecting an anesthetic substance into it causes an immediate state of deep coma). In light of this, for consciousness to exist you need both the hemispheres, as mentioned earlier, and the brainstem.
In the context of the period when the Talmud was written, there was no situation that allowed the long-term artificial maintenance of bodily function with the brainstem functioning while the hemispheres were severely damaged, and therefore in that period the absence of breathing was an excellent surrogate marker for determining death. That is not so in our time, and therefore we should not (in my view) rely on past interpretations regarding the determination of death. In one of the discussions on your site you noted that the historical-sociological context is very important in the practical application of Jewish law—and you gave the example of slavery. In my opinion, the technological context determines that in the case of defining death we must recalculate the ways we interpret the sources.
What do you think of that?

And a few other important aspects—
A. I am not dealing with organ transplantation, and indeed the way death is determined has direct implications for the availability of organs for transplant, but this is only a consequential benefit and in my view one absolutely must not bring that consideration into the discussion of determining death itself. Only after the discussion and agreement about determining death is complete can one begin discussing the implementation of the secondary implications.
An extreme example: in an argument I had with Rabbi Prof. Steinberg, we spoke about babies born with a brainstem and no hemispheres at all. These creatures die 100% of the time within a few short weeks and of course categorically cannot develop any consciousness. I thought (and still think) that these creatures cannot be defined as a “person” (just as a beating heart transplanted from a dead person into a living person is not in itself a “living person”), and so in my view they are basically just assemblages of organs. The honorable rabbi disagreed with me and even said rather decisively: who am I to define who is a person and who is not. I didn’t answer him at the time, but we all define every day who is a person and who is not in an intuitive and practical way (“here is a person, here is a chair, here is a monkey,” etc.), so surely it is worthwhile to develop a formal definition…
B. Emotionally it is very hard for an ordinary person to accept that his family member who is lying in bed, breathing on his own, with his heart beating, is actually a “dead person” whose organs are merely still functioning. But that is already a matter of education, explanation, and social conventions, and that too is outside the current discussion.

I am very much looking forward to your insights on the matter

Hello Vladimir.

I do indeed correspond and meet with dozens of people every day, but I remember our correspondence very well and very fondly. I have to say that I was very impressed by you (it stayed with me, because usually the doctors I’ve met didn’t impress me very much, especially not on the intellectual-scientific level), and I learned quite a bit from our discussion. So it’s not because of some extraordinary memory of mine. 

I’ll now address your questions in order, but I’ll begin with some general methodological preliminaries.
A. Many rabbis and halakhic scholars are not aware—or perhaps are unwilling to admit—that our ancient sources (the Talmud and the halakhic decisors throughout the generations) did not possess exalted scientific knowledge. They knew about nature and about the human being what the other people of their generation knew. In the Torah, which I believe was received from the Holy One, blessed be He, there are no hints about the question of what death is, nor hints about other scientific findings and knowledge. From this it follows that halakhic commitment requires of me, as a believing Jew, commitment to the values of Jewish law and not to the factual and scientific determinations that appear in it, and not even to its philosophical determinations.
B. The determination of what death is is not purely factual and certainly not scientific, and therefore I also do not see doctors as those authorized or able to determine it. This is a determination that is first and foremost value-based and philosophical, not factual. We must decide, as a matter of values, what needs to exist for us to regard a person as dead (which functions are supposed to disappear from him). After we decide that value-based determination, then the doctor is the one who can and should examine the person in question with scientific tools and tell us when those requirements are met. After his report, one can declare that person dead.
C. Hence, the question whether brain death or cardiac death is the moment of death is not a scientific question, but a value-based one.
D. Incidentally, the same is true regarding the determination of from when a fetus is a person for purposes of permission to abort it. Here too this is a value-based and not a scientific determination, and scientific tests are a technical means for clarifying whether a value criterion is fulfilled. A doctor cannot declare a fetus a person or not a person, but only determine whether the value-based requirements society/morality has decided upon are fulfilled.
E. As stated, halakhic sages have no tools to determine these criteria, since they have no rule or verse they received from above that says this. They determined it according to their understanding, and that binds only by virtue of the formal authority they have, not by virtue of exalted knowledge. And if scientific knowledge has changed, which may affect a change in the value-based position, there is no obstacle to changing it. The determinations we have are the product of value-based and philosophical considerations of early sages, and I do not feel bound by them. In my opinion, they are not binding.
Just to sharpen the point: if today there were a Sanhedrin (the highest and authorized halakhic institution), they would have the authority to determine what death is. Not because they are all-knowing and cannot err, but because the authority to do so is in their hands. Exactly like the authority of the Knesset to legislate (even though its members are not the wisest people alive, and even though of course they make plenty of mistakes). This is formal authority (= based on legal/halakhic status) and not substantive authority (= based on expertise and knowledge). Of course there would still be room to discuss how they themselves ought to make that decision.
F. One remark to sharpen what I’m saying, and one that is very important for the continuation of our discussion. I once wrote an article in which I challenged the accepted example (in a dream), according to which the permission to harvest organs such as a heart or lungs for transplantation in the interval between brain death and cardiac death depends on the definition of the moment of death. I argued there that even if the moment of death is cardiac death—that is, the person is considered alive after brain death—there is still ethical and halakhic justification to do so and “kill” him. The semantics of whether we define him as ‘alive’ or ‘dead’ do not change the objective consideration (which underlies these definitions) that his life is worth less than the life of the transplant recipient. That itself is of course not a simple consideration, and I would not say the same about killing an old person to save a young one, or a sick person to save a healthy one. Here, in my opinion, the difference is dramatic enough to justify organ harvesting. But I brought this up only as a complement to my arguments above, and I see no point in entering that discussion here at this stage.

1. Defining the terms
I agree that death is the absence of life. Though I’m not sure that makes defining it any easier. I think the technological-medical improvement you described does not change the situation essentially, but rather makes the question more актуal. Even in the past it was possible to discuss hypothetically whether a person who is artificially kept physiologically alive is considered alive or not, even if there was no technical possibility of doing so. The sages discussed quite a few hypothetical questions (such as flying in airplanes and the like).
The conclusion that follows is that even today it is not right to build a definition of life on the basis of the current technological situation. You propose building the definition of life on what cannot be artificially transplanted, namely the brain. But in the future (not far off) there is no reason this could not be done. We may be able to copy his brain and transplant an identical artificial brain into him, and he could function normally and with the same memories and skills. The question of when a person is considered alive should not depend on a specific technological situation at a specific time, meaning on the fact that at the moment we still do not have the ability to do so.
You might perhaps argue that as long as we have no ability to revive him, then even if we define him as alive there is no point in keeping him alive (because he cannot be saved and his life cannot be improved into normal life with consciousness and so on), or that it is permissible to harvest his organs and kill him in order to save a sick person, but that is an ethical discussion and it does not pertain to the definition of life and death (see my note E in the introduction above). Here you want to deal with the definition of the concepts, and in my opinion by this route you will not be able to progress toward a definition. Beyond that, I am also not sure it is right to begin with such a general and theoretical definition (for the reason in section E above).
You can of course propose a principled definition of life as a person with consciousness, regardless of the current technological-scientific situation. Simply because in your opinion that is the important parameter for defining life. That is a legitimate claim, although even regarding it the discussion is not simple. What about a sleeping person, a person in a coma, someone anesthetized shortly before certain death, and so on.
On this matter I suggested the principle of reversibility. Meaning that if the loss of consciousness is temporary and passing, then he is a living person. But again, I am willing to accept this definition with regard to the justification for harvesting his organs, but not as an objective definition of the concept of death. I do not see any real justification for that.
To be sure, I do not have another objective definition. But precisely because of that, I tend to be stringent and regard a person as dead only if all the conditions are met (there is nothing of life left in him. As a doctor you certainly know how to define that better than I do). As stated, such a definition does not necessarily determine the practical implications (the possibility of harvesting, the prohibition against killing, and so on), and so I am doubtful how significant it is for the discussion at all. I keep coming back to this point because, as a systematic and analytical person, I tend like you to begin a discussion with sharp and clear definitions. But here it seems to me that the definitions are more of a word game serving the results you want, rather than the results actually following from definitions that are independently accepted in a logically compelling way.
Your focus on defining a living person rather than defining life (which, as is well known, is not agreed upon even in the world of life sciences) is very acceptable to me. I think it is very constructive, except that as I’ve argued up to this point, I’m not sure even that is necessary or even possible. It may be that there is neither a necessity nor a possibility to define a living person, and not only life.
What you quoted from Rabbi Shafran are factual claims: what is accepted or not accepted in different societies. But in my view factual claims have no significant standing in a discussion like this. If people think this way or that, that still doesn’t mean they are right. Just as the prohibition against murder cannot be justified by saying that most people think murder is forbidden. This is what is called in philosophy (with some inaccuracy) the naturalistic fallacy—the move from facts to values/judgments.

2-3
2. I’m leaving 2 aside for now, because first we need to conclude the discussion on 1.
3. As I said in my introduction, I do not attach much significance to the Jewish sources in this topic. I can read into them whatever I want, after I become convinced that this is the ethical truth. Therefore, unlike Shafran and Steinberg, I do not engage in a survey of sources on this topic but in conceptual and substantive clarification. I’ll manage with the sources afterward, if at all (because even if I don’t, I don’t think they have authority in such a matter).
From what I’ve just written, you will understand that I completely agree with your position in section 3, contrary to the position of Rabbis Shafran and Steinberg and most of their colleagues. Not necessarily with respect to the definition, but with respect to the status of the sources in the issue of the definition.

Other important aspects
A. From what I’ve said, you can understand that I do not agree with you here. Contrary to my analytical inclination (and probably yours as well), here I think the definition should be subordinate to the implications and not the reverse.
In the argument over who am I to define a person—you are completely right. After all, he too defines a person, and so did the sages of the Talmud on whom he relies. There is nobody else who will do it for us.
B. Completely agree.

My responses in bold font:

A. I understood your approach.
B-C. I completely agree, and that is also why I turned to you and not to my colleagues.
D. Agreed.

1. Defining terms:
I brought up the technological issue only as an illustration, in order to emphasize that consciousness is what, in my opinion, defines the “human being.” I agree that the definition itself should not include a technological element.

I understand your approach here as saying that there is no real justification for delving into the definition of “a person’s death,” and for the practical needs that supposedly depend on this definition, one should deal with each issue on its own merits. These needs include not only the issue of organ transplantation, but also disconnecting from ventilators, stopping complex treatments (such as dialysis and chemotherapy), and the like. I think this is of course a legitimate approach, but if we act in accordance with it together with the very conservative definition you proposed (“a person is alive as long as even part of his body is alive”), the meaning is that all the practical questions become questions of the type “When is it permissible to kill?” or “When is it permissible not to prolong life?” And one more point: according to the definition you proposed, everyone being buried now is being buried while still alive, because tissues like the skin’s connective tissue can continue to live for several days after the heart is no longer functioning.
I did not understand what the objection and/or the objective/ethical/principled problem is that you see in defining a person’s death as “the irreversible disappearance of consciousness.” Is your objection because of concern over what is called a “slippery slope”? In other words, are you expressing concern that the definition itself could be used for unethical purposes, and therefore it is better not to deal with it? Or do you think that consciousness is not a necessary and sufficient condition for defining the person?

Hello Vladimir.

I saw only one point in your remarks for continuing our discussion. You asked why, in my opinion, the disappearance of consciousness is not a sufficient criterion for defining death—whether this is because of a slippery slope or something essential.
All my arguments in the previous letter try to bypass the need to define death. This is based on the difficulty of arriving at such a definition and justifying it reasonably. I have no idea how one can propose a definition and how one would ground it. Therefore, the slippery slope question is tied at the hip to the question whether we have any possibility of arriving at a substantive definition.
Notice that the term “slippery slope” is usually used in two different senses: 1. Rejecting a current claim/act that is acceptable because of fear of future consequences. 2. When there is no clear line, I do not know where to draw it. One may argue that organs should not be harvested from a brain-dead person because in the future they’ll come to take organs from a living person too, or some other problematic result—that is meaning 1. I mean slippery slope in sense 2, namely: I do not know whether a person in a state of brain death is defined as dead because this is a continuum of intermediate states up to the final state where nothing remains and then it is clear that this is death. But until there, all along the way, I do not know how to define where the line passes. This is the sorites paradox, if you know it.
So if you meant slippery slope in sense 2, then my answer is yes. I simply do not know how to define the moment of death on the way toward absolute death.

That is on the conceptual level. But when moving to practice, I make an additional claim: in my opinion, attempts to define the moment of death rely on intuitions that concern the implications of the definition of death, and they have no independent basis in themselves (that is, there are no arguments for why such-and-such a state is itself death). For example, one who defines brain death as death does so only because he thinks it is permissible to take organs after that for transplantation (some would say that he has an interest in taking the organs. Not a personal interest, but it is strange that precisely doctors, especially those engaged in transplants, unanimously agree that brain death is the moment of death). But if so, what is the point of dealing with the definition of death? Just say directly that in your opinion it is permissible to take organs in such a state, without going through the definition of the concept “death.” The same applies to the claims you raised about burying alive. I have no problem burying a creature that is defined as “alive,” so long as it has no relevant functions that prevent this. Its formal definition as dead makes no difference here. If I have intuitions that it may be buried, then I’ll bury it without needing the question whether it is defined as dead or not.
To sharpen the point: once I saw an article by Prof. J. Lavee (I think he was head of the transplant department at Tel HaShomer), who wrote that brain death is the moment of death because it is irreversible (he wrote that no case has ever been documented in which a person returned from brain death to life). To my mind this is a ridiculous criterion, because by that logic the moment of birth is the moment of death. I have never seen a person who was born and did not eventually die. Birth is irreversible. In fact, almost every stage in our life is irreversible.
My claim against him is that one cannot avoid discussing how to define the state itself, and not via its reversibility or irreversibility. Unless you assume that brain death is itself death, irreversibility won’t help you at all. But if you assume that, then why does irreversibility matter? The same applies to all these conceptual definitions. In my opinion they are tools that serve the goals and implications, and therefore they have no value in themselves.

To sum up, your understanding of my position is completely correct: one should discuss each question on its own merits—when is it permissible not to prolong life? When is it permissible to kill? When is it permissible to harvest organs? And so on—without discussing the conceptual question of what the moment of death is or what a dead person is. That question has clear endpoints, but every line one draws in the middle seems to me impossible to ground. You want to argue that the life of a person without consciousness is not worth prolonging, then say that directly. Why bring in, in between, the definition of him as dead? In my opinion, people who do offer a definition of death are merely projecting backward their intuitions about the implications of the matter, as I explained.

I repeat: as someone with a strong analytical tendency, and as someone to whom it is very hard when people don’t define concepts and therefore talk nonsense, here the definition adds nothing to the discussion. I have no way to ground it, and I don’t know what to say about it.

One final note. Everything I wrote has an implication. In every intermediate state in which I have no definition of whether the person is alive or dead, I will need a very strong justification to relate to him as dead. For example, in my view a fetus is a living person in every respect. Therefore, the justification for aborting it must be only something connected to matters of life and death (such as danger to the mother). I accept no other justification (social, etc.). The reason is that I do not know how to draw a line on the continuum from fertilized egg to baby as to when it is considered a living person, and therefore the default is that killing it is murder.
The same applies to disconnecting from machines. If you have reached the conclusion that brain death is death, then there is no impediment to disconnecting a person in that state from machines for no reason at all. Just because I feel like it. After all, he is already dead. But in my opinion there is no justification for doing this, because in my view he has the presumption of being alive, unless there is a very weighty reason (such as harvesting his organs to save the life of another person). This is another important difference between someone who acts according to sharp definitions, as you propose, and a skeptic (a believing one) like me. 
So my evasion of a definition is not merely evasion, and it also does not necessarily lead to the same conclusions as those who do propose definitions. It has fairly strong implications.

Hello Michi,

Thank you for the detailed explanation.
So if I understood correctly, you prefer that we discuss each of the relevant cases on its own merits.
If so, in my opinion we still need to draw a line, only this time it will not be a line between life and death, but between life that is worth more and life that is worth less. That indeed allows more flexibility according to the circumstances.
1. Organ harvesting. If we put aside the definition of absolute death, then the possibility of organ harvesting still depends on the definition of “brain death” in the sense that “life in a state of brain death” is worth less than “life in a state that is not brain death.” The ethical question still remains: what exactly about a state of brain death (and according to which definition of brain death) makes the life worth less? Is it irreversible absence of consciousness, or some other criterion? And where does the line pass?
2. The same question regarding disconnecting from machines. It is not accurate to say that disconnection is done “just like that.” We act—and probably will continue to act in the foreseeable future—in a state of limited resources, and maintaining a living body in brain death with the full equipment required for that in an intensive care setting certainly detracts from the ability to help someone else. The consideration here is less direct than in transplantation, and the line in question may shift a little (or a lot), but it still has to be drawn.

And as we already agreed earlier, I as a doctor should not be the one who determines where that line passes ethically (more precisely: I can participate in that discussion, but not as a doctor, rather as a person).

I would be glad to know your position.

Best regards,
Vladimir

You remembered in your first reply that you wrote an article on transplantation—if all my questions are answered there, then I’d be happy if you would simply refer me to it (link or citation).

And just one more note:
My aspiration for sharp definitions (whether absolute death or brain death) stems not only from a personal tendency toward an analytical approach, but also from the fact that my hand is on the switch in the most immediate sense of the word. And for the purpose of making weighty decisions in the middle of the night, it is important that there be (or at least that we strive for) definitions that are as sharp as possible.

Hello Vladimir,

As a rule, I accept your position that usually the line will pass at the point at which consciousness is lost (irreversibly). Still, this is a line with limited warranty, as I explained at the end of my previous letter. That is, even beyond that line, the person is still considered alive from my perspective, and one needs very good reasons to act as if he is dead. In fact, it seems to me that only reasons of saving the lives of others, or preventing extremely severe suffering of the person himself.
This rule can be applied to the situations you raised as follows:
1. Regarding organ harvesting: since here there is a very good reason, it is justified in my understanding to harvest organs in order to save the life of another person. Life without consciousness is worth much less than full life (and the proof is that many people are willing to define such a state as death). However, harvesting organs from the dying that are not needed to save life (if there is such a case at all; at the moment I’m speaking hypothetically) probably has no justification, because from my perspective the donor is not really dead.
All this is said only on condition that the donor agrees, of course, since his consent is required even for donations after full death.
I do not know how brain death is measured. But if there is a clear way to know that the state is one of irreversible absence of consciousness, that is a good criterion in my opinion.
[I am now thinking about a hypothetical case—I do not know if there is a way to know this—of a person who lost his sanity to such a degree that he has no consciousness at all. He is like an animal. Would you be willing to regard him as dead for this purpose? I recoil from that, but I have no good explanation of how that differs from a state of brain death. Perhaps this is a slippery slope in sense 1 from my previous letter.]
2. Regarding disconnecting from machines: maintaining the body as alive is, in my opinion, obligatory so long as there is no real and concrete need for the equipment or the manpower to save the life of another concrete person. A general cost-benefit consideration cannot be made when it comes to taking life. Financial savings also do not justify killing, even if this is not full killing (taking partial life). Of course, when there is a concrete need to save the life of a specific person, that is exactly like the situation regarding organ harvesting.
All these considerations are meant for the doctor’s decisions in an individual case. Considerations of a public system (the systemic rules that guide doctors) may be different, and there even a non-concrete need is a legitimate consideration (decisions about financial savings in a public system are equivalent to life-saving considerations). Therefore, in the health basket, resources are allocated according to broader considerations.
_____________
I wrote a Torah article on the matter. Its main point is the claim about the irrelevance of the moment of death. Beyond that, it mainly contains a Torah discussion. In any case, if you want to read it, here is the link:

תרומת איברים[1]

Vladimir:
Thank you very much for your reply.
I read the Torah article carefully, both because dealing with ethical/value issues in the Jewish tradition interests me personally, and for practical reasons of the implications of these halakhic rulings for my work as a physician in practice (after all, the Dying Patient Law and the regulation regarding organ donation in this country are to a very large extent derived from those rulings). I have a clarifying question—if according to Jewish law the measure of the value of life is the ability to fulfill commandments, then the absence of consciousness (as I suggested in our previous correspondence) is an excellent marker from a halakhic perspective as well and not only intuitively, since clearly one cannot fulfill commandments without consciousness. The implication is that in principle, from a halakhic point of view, one could move from determining “brainstem death” (which is the accepted practice today, stemming from the fact that halakhic decisors in our time decided that brainstem death may be determined as actual death in light of the absence of spontaneous breathing in those states) to determining “brain death” as death of the hemispheres where consciousness is “concentrated.” What do you think?

Michi:
I completely agree. Except that this is not a criterion for determining a state of death, but for the value and worth of life. That is exactly what I wrote.

Vladimir:
Have you tried to promote this approach practically through any channels in Israel?

Michi:
Unfortunately not. I don’t know how to do that. One of the members of the management of Shaare Zedek (which, as is known, is a hospital run in a religious manner and faithful to Jewish law) read the article and spoke with me enthusiastically about it. But he told me there is no chance they would adopt the approach and policy I proposed, even though I am offering a halakhic solution to a problem that troubles everyone there. Their halakhic policy is to stick to recognized halakhic decisors and consensus opinions, both because of the personal approach of the hospital administration (which is made up of people with a conservative religious outlook), and because of fear of public criticism from the religious and Haredi public and various boycotts.
Incidentally, my impression is that Prof. Steinberg also takes such an approach (I get the impression that he mainly summarizes and applies opinions of well-known halakhic decisors and expands from sources and other opinions from around the world. He is a great scholar, but does not take independent positions of his own. That is the way of most of the religious/rabbinic ethics people I know).

The criterion should be according to the average person, not according to medical equipment or medical knowledge.
Life and death are the concern of nature, not of technological industries whose goal is to make money from problems and distress.

And that means that if a person is in such a state that the average ignorant idiot from the street cannot bring him back to life, then someone who does intervene to save him is forbidden to do so for any compensation whatsoever.