Wednesday, February 29, 2012

Compartmentalization

I went to a funeral this afternoon, for a baby. I was never any good at compartmentalizing my emotions about this sort of thing and moving on - witness this old post - and I haven't gotten any better at it since leaving the shul rabbinate.

I know many people who have the same problem. Some of this is simply the strength of the emotion, but I think one reason people don't lock away their funeral emotions afterward is that it would feel wrong. It would feel like forgetting the death, it would feel disrespectful... and maybe it would feel like the experience didn't hurt me as much as it should have, as though I'm not connected enough to the people who are still grieving, who can't turn away. If you were really upset, you wouldn't be able to listen to that song, to laugh at that joke, to dance at that simchah. If it really touched you, you wouldn't commit the "turning away" Floyd sang about.

We need permission to move past grief, and this includes a permission only we can grant. So I went to a meeting tonight and couldn't let myself forget where I had been a few hours earlier. And now I'm supposed to be working on a shiur and I'm still at the cemetery.

It's good, even beautiful, that human beings can be so connected to each other; I cannot imagine how life without those connections could have meaning. But wow, does it hurt.

Walked past the sign my children made for my birthday, which is tonight, Zayin Adar is finally here. I don't feel the birthday... but I do feel the 40.

Do more

Just a line I came across this morning, and really liked:

The Talmud (Pesachim 112a) invokes a classic imperative:
הוי עז כנמר
Be bold like a leopard.

On this Rashi comments:
התחזק במצוה יותר משיכולת בידך
Strengthen yourself in a mitzvah beyond your abilities.

I find this compelling, and thought-provoking.

For further reading, I believe this ties into Beitzah 25b and Jewish boldness and Tosafot there on the caper bush; the Torah as עז in Zevachim 115b; and Sefer Chasidim 12, among other things.

Monday, February 27, 2012

Of Rabbis and Drinking

From my email-bag:

Would you say "enjoys a l'chaim" is something that would be helpful on a rabbi's skillset over "teetotaller"? Would you advise a, say, 26-year-old rabbi starting his career, who's neutral on spirits (groan), to develop a taste for it, as it will be helpful for his career?

I really, really, really don't want to answer "Yes" to these questions, but I suspect that is the correct answer.

I don't particularly enjoy drinking; any enjoyment I have in imbibing comes from the joy of doing something new, not from the drink itself. To the best of my knowledge, no one ever held that against me in my rabbinate... but I do think that rabbis who enjoy a drink will have an easier time socializing in certain settings.

Of course, every rabbi must know which situations are inappropriate for a drink:
1. Part of this goes back to my standard rants about inappropriate use of alcohol in the Jewish community; I do think we are much too free with alcohol, and this particularly bothers me in environments which include children. (For more on this, wait for the re-post next week of my standard Purim and Alcohol warning.)

2. And it's also a matter of people's comfort; a rabbi should realize that not everyone wants to see him drink, and to see him 'loosen up', in every setting.

But overall, I think a rabbi who knows 'when to say when' will socialize more easily, and therefore build relationships more easily, if he can enjoy a drink.

What say you?

Sunday, February 26, 2012

Class: Toxic treatments during pregnancy

I expect to present a shiur later today on "Toxic treatments during pregnancy".

Here are the vignettes:
1. Sarah, 40, is 20 weeks pregnant with her first child when she is diagnosed with lymphoma. Is Sarah obligated to have, permitted to have, or prohibited from having, chemotherapy treatments?

2. Susan, 26, is 32 weeks pregnant with her first baby. She enters labour, and the baby is in a "complete breech" position. The OB-GYN recommends a Caesarean section, but Susan is frightened by the prospect of surgery. May Susan refuse the Caesarean section?


The issue is actually not that complex in its most basic form - halachic authorities agree that the mother's life comes before that of the fetus. I do hope to shed some light on:
(1) Why the mother's life comes first, given that we normally do not kill one party to save another, and
(2) How we deal with complicating circumstances, such as cases in which the treatment is not likely to extend the mother's life, or where the mother wishes to continue the pregnancy without the toxic treatment.

Here are the source sheets I plan to use:

The status of a fetus in halachah

1. Mishnah Oholot 7:6

האשה שהיא מקשה לילד מחתכין את הולד במעיה ומוציאין אותו אברים אברים מפני שחייה קודמין לחייו יצא רובו אין נוגעין בו שאין דוחין נפש מפני נפש

If a woman is having trouble giving birth, we cut the fetus in her womb and produce it limb by limb; her life precedes. Once the majority of the fetus has emerged, we do not touch it; we do not push away one life for another.

2. Mishnah Erchin 1:4

האשה שהיא יוצאה ליהרג אין ממתינין לה עד שתלד ישבה על המשבר ממתינין לה עד שתלד

We do not delay a woman's execution until she gives birth. Once she sits on the birthing table, we wait for the birth.

3. Talmud, Sanhedrin 57b

משום רבי ישמעאל אמרו אף על העוברין מאי טעמיה דרבי ישמעאל דכתיב שפך דם האדם באדם דמו ישפך איזהו אדם שהוא באדם הוי אומר זה עובר שבמעי אמו ותנא קמא תנא דבי מנשה הוא...

"They cited R' Yishmael as saying a Noachide is liable even for killing a fetus." Why? Bereishit 9:6 says, "One who spills the blood of man in man, his blood will be spilled." What is the blood of man in man? This is a fetus inside its mother. The first sage was from the yeshiva of Menasheh [which read the verse, "One who spills the blood of man, in man his blood will be spilled"].

4. Tosafot Niddah 44a איהו

ומיהו אפשר דדוקא היכא דאמו חיה לא מיחייב הורגו עד שיצא ראשו שתלוי קצת בחיות אמו אבל היכא דמתה חייב משום דכמונח בקופסא דמי

Perhaps the non-liability of one who kills a fetus in utero applies specifically while the mother is alive, but where the mother has died one would be liable, for it is as though the fetus was in a box.

5. Ran Chullin 19a בדפי הרי"ף

לאו משום עובר ירך אמו הוא אלא שכיון שהיא מחוייבת מיתה אין מענין את דינה. ולולד כיון שלא יצא לאויר העולם לא חיישינן תדע שאילו נגמר דינה להריגה וילדה אין הורגין את הולד משום דעובר לאו ירך אמו הוא ולא עליו נגמר הדין

We don't believe that the fetus is [liable as] part of the mother; rather, she is liable for death, and we don't oppress her judgment. Since the child has not yet emerged, we are not concerned for it. We see this in the fact that we don't executed the child if she does give birth after the verdict; the fetus is not part of the mother, and it is not his verdict.

6. Rambam, Mishneh Torah, Hilchot Melachim 9:4

בן נח שהרג נפש אפילו עובר במעי אמו נהרג עליו

If a Noachide kills a life – even a fetus in utero – he is executed for it.

7. Talmud, Sanhedrin 59a

"לבני נח ולא נשנית בסיני לישראל נאמרה ולא לבני נח" אדרבה מדלא נישנית בסיני לבני נח נאמרה ולא לישראל ליכא מידעם דלישראל שרי ולנכרי אסור

"Any mitzvah conveyed to Noachides and not repeated at Sinai applies to Jews, not Noachides." Just the opposite – if it was not repeated at Sinai then it is only for non-Jews! Nothing is permitted for Jews and prohibited for non-Jews.

8. R' Moshe Feinstein, Igrot Moshe Choshen Mishpat 2:69

וברמב"ם פ"א מהלכות רוצח ה"ט מפורש עוד יותר דהריגת עובר הוא רציחה ממש, שהרי כתב טעם על מה שבמקשה לילד מותר לחתוך העובר שבמעיה כדי להציל את האם מפני שהוא כרודף אחריה להורגה והוא מהדין דחייבה תורה לכל ישראל להציל הנרדף אפילו בנפשו של רודף אפילו כשהרודף הוא קטן ואף כשרודף באונס, הרי דסובר דאף שפטור הוא עכ"פ לענין האיסור כרציחה ממש שלכן היה אסור להורגו אלא מחיוב הצלה אף בנפש הרודף

It is even more clear in the Rambam that killing a fetus is murder, for he based the permission to cut a fetus to save a mother on the fetus's status as a pursuer… This shows that he believed that the exemption is only from the crime of murder, but one still may not kill it other than to save a pursued party.

Justifications for pursuing chemotherapy

9. Talmud, Sanhedrin 74a

ההוא דאתא לקמיה דרבה ואמר ליה אמר לי מרי דוראי זיל קטליה לפלניא ואי לא קטלינא לך אמר ליה לקטלוך ולא תיקטול מי יימר דדמא דידך סומק טפי דילמא דמא דהוא גברא סומק טפי

Someone came to Rabbah and said, "My mayor told me to kill Ploni, and he would kill me if I didn't do it." Rabbah said, "Let them kill you; do not kill. Who says your blood is redder? Perhaps that man's blood is redder."

10. R' Avraham Yeshayah Karelitz, Chazon Ish on R' Chaim on the Rambam, Hilchot Rotzeiach 1:9

יש לומר כיון דהא דשפיכות דמים ייהרג ואל יעבור הוא מסברא – מאי סברת דדמא דידך סומק טפי – לא שייך זה בעובר

One could say that since the reason why one must be killed rather than commit murder is one of logic - "Why do you think your blood is redder" - and is not relevant regarding a fetus.

11. R' Yisrael Lipschitz, Tiferet Yisrael to Oholot 7:6, בועז י

ספק נפל הוא ואין לו חזקת חי עדיין כל זמן שהוא ברחם אמו ובכה"ג ודאי דמא דידך סומק טפי

The child might not be viable, and it has no standing as 'alive' as long as it is in utero. In such a case your blood certainly is redder.

12. R' Shlomo Zalman Auerbach, cited in Nishmat Avraham Choshen Mishpat 425:1:7

צ״ע דמ״מ עכשיו שהאמא חולה, הרי העובר ממש רודף אותה

This requires examination; right now, when the mother is ill, the fetus is pursuing her.

13. Rambam, Mishneh Torah, Hilchot Chovel uMazik 8:15

ספינה שחשבה להשבר מכובד המשוי ועמד אחד מהן והקל ממשאה והשליך בים פטור, שהמשא שבה כמו רודף אחריהם להרגם

If a boat is rupturing due to the weight of its burden, and one of the people present lightens its burden, throwing it into the sea, he is exempt from liability; the burden was like a pursuer, coming to kill them.

14. Rambam, Mishneh Torah, Hilchot Ishut 21:11

פסקו לה מזונות הראויות לה והרי היא מתאוה לאכול יתר או לאכול מאכלות אחרות מפני חלי התאוה שיש לה בבטנה הרי זו אוכלת משלה כל מה שתרצה ואין הבעל יכול לעכב ולומר שאם תאכל יתר מדאי או תאכל מאכל רע ימות הולד מפני שצער גופה קודם.

If a court assessed payment for appropriate food for a [nursing] woman, and she wants to eat more or to eat different foods because of a craving in her belly, she may eat from her own funds as she chooses and the husband cannot protest that she is eating too much, or that she will eat a bad food which will harm the child. Her pain precedes.

Complications

15. R' Yitzchak Zilbershtein, Chemotherapy for a Pregnant Mother, Techumin 23 pg. 217

להערכתנו, מחלתה המפושטת של החולה הינה בעלת סיכוי נמוך לריפוי (5-10%) והרווח הנוסף מטיפול משולב יכול להגיע ל-10% מהסיכוי הבסיסי (כלומר 0.5-1%). מאידך גיסא, לעובר, שכבר ניזוק מטיפול כימי וקרינתי, יש סכנה גבוהה למומים כבר בשלב זה (להערכתנו כ-30%) והמשך טיפול יעלה את הסיכון למומים בעוד 10-20%.

In our opinion, the metastasized illness of the patient has a low (5-10%) chance of healing, and the added benefit of integrated treatment could achieve 10% over the base chance (meaning 0.5-1%). On the other side, the fetus – already harmed by chemotherapy and radiation – has an elevated risk of defects at this stage (30% in our opinion) and continued treatment would elevate the risk for defects by another 10-20%.

16. R' Yisrael Meir Kagan, Shaar haTziyyun 331:17

אם עבר ומלו, אף דעביד איסורא בזה אפילו הכי מותר עתה לחלל

If they transgressed and circumcised [without medicine present], then even though they violated the law, one still may violate Shabbat…

17. R' Eliezer Waldenberg, Tzitz Eliezer 9:51:3 סיכום יז

אשה שחולה במחלה מסוכנת שעומדת למות ממנה וההריון שהרה בו אם תמשיך בו יקרב מיתתה והאשה מתחננת שלא לסדר לה הפלה ולא איכפת לה אם זה יקרב מיתתה ובלבד שישאר אחריה זכר, יש מקום להתיר להיות בזה שב ואל תעשה.

If a woman is dangerously ill and stands to die from her illness, and continuation of her pregnancy would hasten her death, and she pleads not to abort and she does not care about this hastening her death so long as she can leave behind a 'memorial', there is room to permit this, and not act.

Refusing a Caesarean Section

18. Rav Shlomo Elyashiv, cited by R' Yitzchak Zylbershtein, cited in Nishmat Avraham Orach Chaim 330

חייבת להוסיף קצת בסכנה ולעבור ניתוח קיסרי כדי למלאות את שעבודה ללדת ובפרט שכיום רבות הן הנשים שעוברות ניתוחים קיסריים

She is obligated to add a little risk and undergo the Caesarean section to fulfill her obligation to give birth, and especially today when many women undergo Caesarean sections.

19. R' Shlomo Zalman Auerbach, cited in Nishmat Avraham Orach Chaim 330

אין על האשה כל חיוב להכניס את עצמה לסכנה של ניתוח קיסרי כשהיא מפחדת מהניתוח כדי להציל את עוברה, ומה שהיא מחוייבת משעבודה לבעלה הוא להכניס את עצמה לסכנה של הריון ולידה רגילה כי כך קבלה על עצמה ועל דעת זו התחתנה.

The woman has no obligation to introduce herself into the risk of a Caesarean section when she fears the surgery, in order to save her fetus. Her obligation to her husband is to introduce herself to normal pregnancy and birth, for that was what she accepted, marrying on that condition.


Thursday, February 23, 2012

Are all midrashim to be taken literally?

Several weeks ago I came across interesting 13th century comments recorded in the Shiltei Giborim [on the Rif] to Avodah Zarah 20. These comments address the question of whether midrashim are intended to be taken literally. You can find a text of the Hebrew - corrected from manuscripts - on-line here, along with some very important footnotes.

Here's a quick translation of the Shiltei Giborim's words:

Know and understand that there are three paths in midrash:

1) Some [midrashim] exaggerate, as Chullin 90b says, "The Torah spoke words of emptiness, the prophets spoke words of emptiness, the sages spoke words of emptiness," such as in Deuteronomy 1:28 "great, fortified cities in the heavens," and Kings I 1:40 "the earth split due to their voice."

There are many of these, like the words of Rabbah bar bar Chanah in Bava Batra 73b; these were exaggeration, for people speak thus.

2) Some of the midrashim present miracles, in which Gd demonstrates His might and displays amazing and shocking deeds, as in Daniel 10:7, "And I, Daniel alone, saw the vision, and the people with me did not see, etc." And Yonah ben Amitai who was swallowed by the fish and spat out. And many others like this.

Many of these are found in the words of the sages, such as Bava Batra 58a regarding R' Bena'ah marking caves, and Bava Batra 58a with a magician digging in the caves of the dead. All of those were miracles, as were performed and revealed to the prophets, but not for other people.

There are many of these, like the deeds of Rabbah bar bar Chana, things which are shocking which Gd showed His pious people who believe in Him wholeheartedly.

3) In some of the midrashim the sages intend to analyze Scripture with any means possible, relying on Tehillim 62:12, "Gd said one thing; I heard two." And so Yirmiyah 23:29, "For My words are as fire; this is the word of Gd. And they are like a hammer, splitting stone." They learned from this that one sentence may lead to many meanings, as explained in Sanhedrin 31a.

Do not be shocked by this; you often see that even a normal person speaks a complex message with two facets, and certainly words of wisdom spoken with Divine inspiration. Along these lines the sages analyze a passage in any way they can analyze it, saying (Shabbat 63a), "The passage does not depart from its simple meaning," which is the essence, and regarding all of the midrashim which are drawn from it, some of them are of the essence and close to the literal read and some of them have a small hint [in the text].

You see what one of the sages taught in Taanit 5b, "Yaakov our ancestor did not die." One sage replied to him, "Did the eulogizers eulogize him and embalmers embalm him and buriers bury him for nothing?" And he responded, "I am analyzing the passage." Meaning: I know he died, but I intend to analyze the passage in any way it can be analyzed, and if the midrash cannot be as it sounds, the passage still offers a hint that one could say "he did not die" as Berachot 18a says, "The righteous live even in their death," for their names and memory and deeds live eternally.

A similar case is seen in Shabbat 30b, in which the exegete taught, "Israel will produce cakes and fine clothing," as it is written, "There will be pisat bar in the land." [See Rashi there, for the connection between pisat and cakes and clothing.] A student mocked him, noting that Kohelet 1:9 says there is nothing new under the sun! To which he replied, "Come and I will show you an example of these items in this world." He went out and showed the student mushrooms. The sage was informing him that the midrash could be explained in a manner which was close to it; the original verse was teaching that the Creator would provide great goodness in the world.

Similar statements occur in other midrashim

They said in Yerushalmi Nazir 7:2, "Are the midrashot amanah? Learn them and receive reward." It is explained that the sages did not state the midrashim as matters of faith [emunah] and as the essence, but to increase the meanings of the text and analyze all of its facets, such that they might include a hint. Links to text and hints are among the paths of Torah study, regarding which it is said, "Learn them and receive reward."

Regarding one who mocks their words it is said (Divrei haYamim II 36:16), "And they mocked the messengers of Gd… and made light of His prophets." In various places we find that they were punished for mocking the words of the sages. Learn from the student who mocked the words of the sage who was analyzing Yeshayah 54:12, "And I will make your windows of gems," and they showed him from heaven, for the honour of that sage, that the words of the sage were accurate and one should not mock them, and the student was punished. (Sanhedrin 100a)