Sunday, January 6, 2008

Class: Autopsy

Gd-willing, I'll deliver a basic class on Autopsy issues this coming Tuesday, at Lehigh Valley Hospital (Cedar Crest). We'll be in Education Room 2.

Here are some useful sources, whether you'll make it or not:

Talmud, Chullin 11b [In the context of a discussion of how we know, biblically, that we work with majorities in adjudicating cases]
Rav Kahana said: We may deduce it from murder cases: The Torah said to kill the murderer, but perhaps the victim was a tereifah! It must be that we follow the majority. And if you will say we do examine the body, that would degrade it. And if you will say the loss of a life should override degrading the body, we would still have to be concerned that there might have been a wound in the spot where the sword entered [and so investigation is impossible - and yet, we kill the alleged murderer].

Talmud, Bava Batra 154a-b
The following once happened in Bnei Brak: A male sold his father’s property, and later died. Family members later objected that he had been a minor at the time of his death [and therefore at the time of the sale, which would invalidate the sale].
They asked Rabbi Akiva about examining the body. Rabbi Akiva replied: “You are not permitted to degrade his body. Further, signs of puberty change after death.”

In this case, the property was held by the purchasers, and the family was protesting. This is logical, for he said to them, “You are not permitted to degrade his body,” and they were silent. If the family was protesting, that is why they fell silent. If the purchasers were protesting, why would they have fallen silent? They could have said, ‘We paid him money, let him be degraded!’
But this may not be proof; perhaps Rabbi Akiva said to them, “First, you are not permitted to degrade him. Further, if you will say he took your money and so let him be degraded, there is still the point that signs of puberty change after death.”

Talmud, Erchin 7a
Rav Nachman said, citing Shemuel: If a woman sits on the birthing table and dies on Shabbat, we bring a knife and cut open her belly and produce the child.

There are also a few actual autopsies mentioned in the gemara; see Bechoros 45a and Niddah 30b, for example.

Teshuvos: Nodeh b'Yehudah 2:Yoreh Deah 210; Chasam Sofer Yoreh Deah 336; Binyan Tzion 1:170-171, 3:103; Har Tzvi Yoreh Deah 278; Tzitz Eliezer 4:14; Sridei Eish 2:92; Igros Moshe Yoreh Deah 2:151; Minchas Yitzchak 5:9; Mishpitei Uziel I Yoreh Deah 28-29

There are many more teshuvos, of course (see Steinberg's Encyclopedia of Jewish Medical Ethics under "Autopsy" for a nice collection), but those were particularly useful.

Here's a quick rundown of the major issues:

Reasons to prohibit
Honor of the deceased / Degradation of the body
Paining the soul when the body is disgraced
Delaying burial
One may not benefit from a corpse

Reasons to permit
Saving a life
The deceased forgives his honor

And, finally, a popular set of practical guidelines for autopsies, when the autopsies are halachically required:
1. In all instances, every effort should be made to expedite the release of the body as quickly as possible.

2. The entire autopsy should be performed in a body pouch.

3. The autopsy procedure should be as minimal as possible:
Avoid incision whenever possible.
Samples for pathology should be as small as possible.

4. Replace all organs in their proper place; e.g. brain in suitable small plastic bag in the skull.

5. All instruments should be wiped clean with a cloth and the cloth should be placed in the body pouch.

6. Suture all incisions as tightly and leak proof as possible.

7. All blood or articles of clothing containing blood that are not needed for pathological or evidence purposes should be sent along with the remains to the funeral home.

8. When possible the entire body and especially the genitalia should be kept covered at all times.

9. A member of the Sacred Society or designate thereof or a Rabbi will be permitted to attend the autopsy upon request.

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