I would appreciate your help.
Peace and blessings
My name is N., I graduated from medical school about a month ago, and I live in Lod.
I am currently studying the subject of Pikuach Nefesh on Shabbat, and in particular, I am currently dealing with the question of Pikuach Nefesh.
Since I heard a lesson from you in the past that touched on this area, I would like to present to you a question that is troubling me, and I would appreciate it if you could refer me to relevant sources if possible:
How can one combine the halakhic thinking of pikuach nefesh, which is characterized by a binary of 0 and 1, i.e. there is or there is not pikuach nefesh, with today’s medical thinking that speaks in percentages – statistics show that a certain situation is at X% danger/mortality, etc. And even the simplest situations have a certain percentage of dangerous complications.
Is it possible to describe a boundary line beyond which a certain percentage will be called a life-saving doubt?
Thank you very much,
Great evening
Hello N.
It seems to me that there is a confusion between two levels in your words. The difference is not between medicine and halacha, but between reality and the normative teaching that concerns it.
Everyone understands that dangers are not measured in binary logic (1 or 0) but in continuous logic (probability). Medical science deals, among other things, with dangers, and it is no wonder that it measures them in the language of probabilities. But a normative system such as Halacha or law must end with the bottom line, permissible or prohibited. Therefore, there is no escape from drawing a line on the continuum of chances and risks, beyond which the situation will be defined as pikuach nefesh and below which – not. On this subject, you can read in my article here:
https://mikyab.net/%D7%9B%D7%AA%D7%91%D7%99%D7%9D/%D7%9E%D7%90%D7%9E%D7%A8%D7%99%D7%9D/%D7%94%D7%9C%D7%9B%D7%94-%D7%95%D7%9E%D7%A6%D7%99%D7%90%D7%95%D7%AA-%D7%9E%D7%94%D7%99-%D7%9E%D7%95%D7%9E%D7%97%D7%99%D7%95%D7%AA-%D7%94%D7%9C%D7%9B%D7%AA%D7%99%D7%AA/
Therefore, Halacha is not binary in its view of reality. It is binary in its normative instructions in relation to reality. Its view of reality is exactly like the medical view, since it does not deal with reality, just as medicine does not deal with norms.
If you are looking for a line in the sense of a number (dangerous is a risk of 70% or more), you will not find such a line in any normative system. Neither in halakhah nor in law. They speak in the language of reasonable risk, great risk, and small risk. The judge/arbiter in the field must decide, given the circumstances, under which category the case he is discussing falls. For example, there are sayings in halakhah such as “God protects the foolish,” which say that if it is a risk that reasonable people would take, then halakhically it is not a dangerous situation (such as smoking, car accidents, etc.), regardless of the objective chance of losing a life.
In conclusion, there is no basis for comparing Halacha and medicine, since the former deals with norms and the latter with facts. It is true that there are many rabbis, doctors, and people who confuse the two fields and make nonsense statements because they do not understand this difference. For example, I have met doctors who think that in a committee for terminating a pregnancy, the decision should be made by a doctor (and protest against the presence of a rabbi on the committee, for example), and you could not be more foolish than that (see my articles above). For example, psychiatrists think that defining a disease is a medical-clinical question and you could not be more mistaken than that (see my articles above, and in the links that will be cited immediately).
You can see an example of this in the debate I had with Prof. Yoram Yuval in columns 25 and 26 on my website (and in the original). You can see it here:
https://mikyab.net/%D7%A2%D7%9C-%D7%A1%D7%98%D7%99%D7%99%D7%94-%D7%9E%D7%95%D7%9E%D7%97%D7%99%D7%95%D7%AA-%D7%95%D7%A2%D7%A8%D7%9B%D7%99%D7%9D-%D7%AA%D7%92%D7%95%D7%91%D7%94-%D7%9C%D7%9E%D7%90%D7%9E%D7%A8%D7%95/
And continue here:
https://mikyab.net/%D7%A2%D7%9C-%D7%A1%D7%98%D7%99%D7%99%D7%94-%D7%9E%D7%95%D7%9E%D7%97%D7%99%D7%95%D7%AA-%D7%95%D7%A2%D7%A8%D7%9B%D7%99%D7%9D-%D7%AA%D7%92%D7%95%D7%91%D7%94-%D7%9C%D7%9E%D7%90%D7%9E%D7%A8%D7%95-2/
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