CHOOSING WHICH PATIENT TO SAVE Solomon B. Freehof

QUESTION: The head of a clinic in Boston asked, following a forum session at the last Biennial Convention of the Union of American Hebrew Congregations in Montreal (November, 1967):"What guidance can Jewish tradition give us in the excruciating, ethical dilemma of selecting one patient over many others to keep him alive by means of a mechanical kidney machine? Since such facilities are extremely limited, many patients must be rejected and are certain to die. The same question may also be raised with reference to the very limited supply of organs for transplantation. On what basis can a conscientious doctor make the decision as to which patient is to live or die?"*

ANSWER: Solomon Landau, in a responsum embodied in the collection of his father Ezekiel Landau ’s responsa(Noda biYehudah, vol. II,#74), was asked whether a man sought by the government as a criminal Should be turned over or not. He says at the outset:"It is difficult to make a decision in matters which involve the life of a human being." Such a decision is always a difficult one in any decent tradition, religious or social. The question asked here by the physician of the clinic is especially difficult to decide on the basis of Jewish traditional literature. Obviously, there were in those days no such remarkable inventions, or the means for the preservation of vital organs, as there are today. In those days, when a person was dying, they would discourage any i ficial attempt to keep him alive for another hour or so, because a man has a right to die when the time comes(cf. Ran to Nedarim 40a). But nowadays it is possible, in the case of moribund patients, to effect what often amounts to a cure. So there is no real precedent for the problem in the traditional literature.

: Nevertheless, there are quite a number of somewhat different discussions which involve the question of choosing one person to live or another person to die. In the discussion of these various dilemmas there may perhaps be found an ethical principle, or at least an ethical mood,