This document discusses parameters for permitting risky medical treatments when life is in question. It explores how long "chayei sha'ah" or imminent death is considered, how much risk is acceptable, and how to define success. Regarding risk, an operation is only permitted if chances of life and death are equal, not if death is most likely. Success is defined as regular life without the illness, or a situation requiring lifestyle changes but allowing many years of life.

1. NATIONAL JEWISH INSTITUTE
FOR CONTINUING PROFESSIONAL EDUCATION
AND
INSTITUTE FOR CONTINUING
PROFESSIONAL DEVELOPMENT
AT TOURO COLLEGE

2. MEDICINE, CULTURE AND
ETHICS
PARAMETERS OF RISK

3. ROLLING THE DICE
RISKY AND EXPERIMENTAL
TREATMENTS

4. WHEN LIFE HANGS IN THE BALANCE

5. CRITERIA FOR RISKY TREATMENTS
Patient will surely die
Complete cure is possible
Most physicians agree
Rabbinic authority agrees
– Rabbi Ya’akov Reischer

6. DEFINING THE PARAMETERS
1 2 3
How long is How much risk is How do we define
chayei sha’ah? acceptable? success?

7. HOW LONG IS CHAYEI SHA’AH?

8. HOW LONG IS CHAYEI SHA’AH?
Despite the fact that the boundary
marking the transition from chayei sha’ah
to long term life expectancy is not clearly
delineated, it is logical to assume that as
long as we know that the illness is
already terminal, regardless of how much
time will pass until death arrives, it is
considered chayei sha’ah.
Rabbi Avraham Yitschak Hakohen Kook
(1865-1935), Mishpat Kohen 144:3

9. HOW LONG IS CHAYEI SHA’AH?

10. HOW LONG IS CHAYEI SHA’AH?
“It does not state clearly the
definition of chayei sha’ah. It is
clear that a life expectancy of one to
two years is not considered chayei
sha’ah, because if so, what is chayei
olam?
Ultimately everyone is mortal, and
what difference is there between one
year or two years, or 100 years, since
no one can live forever? Are we to
categorize all life as chayei sha’ah?

11. HOW LONG IS CHAYEI SHA’AH?
Nor does it appear correct to
say that chayei sha’ah only
refers to a situation in
which the person will die
from the specific illness
[that he is seeking a cure
from] and not from other
ailments; for what
difference should it make
what illness will cause his
death? . . .

12. HOW LONG IS CHAYEI SHA’AH?
[Rather it would appear that] just
as a tereifah is defined as an ill
person who will not live more
than twelve months, so
too, anyone whose illness will not
let him live for more than twelve
months is considered to be in the
category of chayei sha’ah.
However, if the illness will cause
death after twelve months, this is
not chayei sha’ah but chayei olam.
Rabbi Shlomo Kluger (1783-1869), cited
by Darchei Teshuvah, Yoreh De’ah 195:6

13. HOW LONG IS CHAYEI SHA’AH?
tereifah
ravaged / mauled
may die within a year

14. HOW MUCH RISK IS ACCEPTABLE?
However, this [permission to
operate] is only if the chances
of life and death as a result of
the surgery are equal, but not
if, in the majority of cases, the
patient will die as a result of
the operation.
Rabbi Eliezer Waldenberg (1915-2006),
Tsits Eliezer, vol. 10, 25:5

15. HOW MUCH RISK IS ACCEPTABLE?
In a situation when we have
otherwise given up hope, we
disregard chayei sha’ah, even
for a remote possibility that
the patient will be healed.
Rabbi Chaim Ozer Grodzinski (1863-
1940), Achiezer, Yoreh De’ah 16:6

16. HOW DO WE DEFINE SUCCESS?
Regular life is life without the illness that in
the natural course of events, will allow one to
live like any normal person.
Obviously this includes situations where the
patient is expected to be totally healed. . . but
it even includes the more common
situation, in which the patient is weak after
surgery and needs to attend carefully to many
things, such as a proper diet, avoiding
excessive exertion, and often, taking various
medicines in order to avoid a relapse.

17. HOW DO WE DEFINE SUCCESS?
This too, is considered like
the life of a normal
person, since there are many
weak people who need to be
careful about these
matters, and it is possible for
them to live for many
years, just as long as healthy
people, and sometimes even
longer . . .

18. HOW DO WE DEFINE SUCCESS?
If, however, the surgery will only help in that the
patient will be able to continue in his ill state for a
long period of time instead of a short one, and
there is also the possibility that the surgery could
cause immediate death, then, since, even if the
surgery were to be successful, the patient would be
prone to die from this illness at any time, even
though the surgery would create the possibility for
him to go on in this dangerous state for a long
time, it is likely, in my humble opinion, that one
should not permit the surgery.
Rabbi Moses Feinstein (1895-1986),
Igrot Moshe, Yoreh De’ah 2:36

19. APPLYING THIS TO TOM?
Wife’s
Smoke? opinion?
Experts
Drink? concur?
Risks of
Terminal? surgery
Lifestyle
changes?