ורפאורפא ירפירפאא Th e Journal of Torah and Medicine of the Albert Einstein College of Medicine Synagogue and RIETS Volume IV ורפאורפא ירפירפאא Th e Journal of Torah and Medicine of the Albert Einstein College of Medicine Synagogue and RIETS Volume IV EDITORS Rabbi Raphy Hulkower, MD Rabbi David Shabtai, MD EXECUTIVE EDITOR Rabbi Tzvi Sinensky Rabbi Yair Hindin EDITORIAL ADVISOR Rabbi Edward Reichman, MD ASSOCIATE EDITORS Avi Friedman Sefi Lerner Daniel Poliak Menachem Yondorf EDITORIAL MANAGER Peter Kahn THE MICHAEL SCHARF PUBLICATION TRUST OF THE YESHIVA UNIVERSITY PRESS NEW YORK Copyright © 2012 Yeshiva University All rights reserved Th e Michael Scharf Publication Trust of Yeshiva University Press New York ISBN 13: 978-0615739496 Available at Amazon.com Verapo Yerape welcomes new submissions and letters to the editor. Contact the journal at [email protected] Contents Foreward by the Dean of RIETS vii Foreward by the Dean of AECOM ix Bone Marrow Donation in Halakhah Rabbi Asher Bush 11 Are Two Heads Really Better Th an One? Halakhic Issues Relating to Conjoined Twins and a Two-Headed Person Rabbi Edward Reichman, M.D. 35 Hormonal Birth Control Th erapies and Vesatot Rabbi Tzvi Sinensky 60 Medical Care for a Child on Shabbat Ariella Nadler, M.D. 79 May Physicians Strike? Ephraim Meth 93 But the Earth He Has Given to Mankind? Toward a Th eology of Synthetic Biology Peter Kahn 104 Metzitzah Ba-Peh Under the Microscope: An Ancient Rite from a Modern Perspective Daniel Poliak 129 Prayer and the Terminally Ill Patient Yehuda Turetsky 136 Surgical Placebo in Jewish Law Yehuda Salamon, M.D. 152 Eat, Drink, and be Merry, for Tomorrow We Die Is there an Obligation to Maintain Good Health? Jonathan Ziring 172 Body Ownership and Non-Altruistic Organ Donation Ari Friedman 193 Th e Ownership and Market of Human Tissue R. Dr. A. Yehuda Warburg 207 To Tell or Not to Tell: Th e Obligation to Disclose Medical Information to a Potential Spouse Rabbi Netanel Wiederblank 234 Donation after Cardiac Death: Myth or Reality? A Secular and Ethical Analysis Rabbi Yonah Bardos, M.B.E. 249 Halakhic Perspectives Rabbi David Shabtai, M.D. 272 Foreword by the Dean of RIETS We are excited to present this fourth volume of the Verapo Yerape journal, under the editorship of: Rabbi David Shabtai, MD, a member of the Bella and Harry Wexner Kollel Elyon at the Rabbi Isaac Elchanan Th eological Seminary (RIETS) at Yeshiva University; Rabbi Raphy Hulkower, MD, a resident at the Albert Einstein Col- lege of Medicine and RIETS graduate; Rabbi Yair Hindin, rabbi of the Einstein synagogue and RIETS graduate; Avi Friedman, Men- achem Yondorf, Sefi Lerner, Daniel Poliak, and Peter Kahn, students of the Albert Einstein College of Medicine and members of the Ein- stein synagogue. We also express our appreciation for the eff orts of the previous rabbi of the Einstein synagogue and previous editor of this journal, Rabbi Tzvi Sinensky. Th e Verapo Yerape journal is an important contribution to the world of medicine and halakhah, which has been a burgeoning fi eld of scholarship in recent years. During this past year, Dr. Shabtai published his groundbreaking volume, “Defi ning the Moment,” containing a meticulous analysis of the Talmudic sources relating to the debate regarding the precise defi nition of the moment of death according to Jewish law. Th ese issues are not only interesting from an academic perspective, but are of crucial relevance in terms of their practical applications. Th ere are many contemporary questions that will require expertise in both medicine and halakhah during the years ahead. As new technologies and treatments develop, and new opportunities and challenges emerge in a multiplicity of medical fi elds, from the use of stem-cells and the practice of freezing embryos, to the parame- ters of genetic engineering, it is crucial that we develop our resources and talents to approach each issue thoroughly and sensitively from the standpoint of Jewish law and ethics. Navigating the sources is not always an easy endeavor. To cite a case in point, with respect to end-of-life care, there is a funda- mental tension captured by the Talmudic sources between the notion of prolonging life even for the most minute moment (Yoma 85a) and the notion of praying for “the celestial forces to vanquish the earthly forces” (Ketubot 104a) in order to enable a person to pass tranquilly vii from this world when physical life in this universe is no longer bear- able. Many rabbinic authorities grapple with these tensions and of- ten resolve them in diff erent ways, with important ramifi cations. It is the goal of those who have produced the present volume and the other volumes in this series to explore and elucidate these sources for the benefi t of scholars, professionals and laypeople alike. Recently, RIETS formed a rabbinic advisory board, com- prised of Roshei Yeshiva from RIETS, to advise individuals with respect to Halakhah and Hospice issues, with a particular focus upon a new initiative undertaken at Calvary Hospital to provide hospice care to members of the Jewish community. Th is initiative was spurred through the persistent and compassionate eff orts of Dr. Edward Burns, Executive Dean at the Albert Einstein College of Medicine, and is a wonderful example of the manner in which our medical school personalities at AECOM and our Jewish law experts at RIETS can work together for the benefi t of the broader commu- nity. It is our hope that we will receive the necessary support from those who are interesting in supporting these endeavors to create an Institute of Medical Halakhah at RIETS in the near future. We are indebted to President Richard M. Joel and Rosh HaYeshiva Rabbi Dr. Norman Lamm who have provided the leader- ship and encouragement necessary to bring our eff orts to fruition. I also congratulate the editors and contributors of this volume, stu- dents in both RIETS and Einstein, for their top-notch scholarship and concomitant commitment to Torah values and ideals. We also recognize the constant and critical support of Dr. Edward Reichman, Editorial Advisor to the journal, Dr. Jeff rey S. Gurock of the Mi- chael Scharf Publication Trust of the Yeshiva University Press, and, of course, Dr. Edward Burns. As always, we are grateful to Michael and Fiona Scharf for their benefaction which allows us to publish this journal of Torah and Science. I am confi dent that you will enjoy the articles in this vol- ume, both in terms of their scholarly substance and in terms of their Torah U’Madda synthesis. Rabbi Yona Reiss Max and Marion Grill Dean of RIETS 7 Marcheshvan 5773 viii Foreword by the Dean of AECOM Th e vision of Torah U’Madda, while an ideal of human be- havior, is rarely realized. Th e conventional approach of religious and secular curricula presented sequentially in most yeshivot perpetuates the duality of these philosophies rather than their intertwined es- sence. Th e mere fact that science, business and the humanities are taught by faculty attempting to bring the messages of universalism to their subject matter by defi nition excludes a Torah based perspective. Similarly, the classic literature of the Tanach, Mishnah and Talmud are taught diligently in a milieu of historical classicism that rarely en- gages modernity. Th ere are, of course, noteworthy exceptions which must be lauded. Th e fi eld of Jewish medical ethics and law is one of these notable areas. Here is where the interplay of genetics, cloning, organ transplantation and medical economics with Gemara, Shulhan Arukh and teshuvot fl owers. A steady crop of books from distinguished Rab- bis is published regularly, but these are the works of true world class experts. I am so proud that the members of the Albert Einstein Syna- gogue, Congregation Birkat Shmuel, named after Rabbi Dr. Samuel Belkin, the Yeshiva University President who built the Albert Ein- stein College of Medicine have successfully published four volumes of Verapo Yerape. Th is magnifi cent fusion of timeless Torah and fu- turistic madda is a highly successful series that is both scholarly an eminently practical. More importantly, it proves that our students and their highly regarded mentors have truly synthesized the essence of the Torah U’Madda dualism into a single entity of kiddush Hash- em. Nowhere but here. Edward R. Burns, M .D. Executive Dean and Professor of Medicine Albert Einstein College of Medicine of Yeshiva University ix RABBI ASHER BUSH Bone Marrow Donation in Halakhah Introduction On December 1, 2011, the Ninth U.S. Circuit Court of Appeals ruled that in certain cases, bone marrow donors may be paid.1 Th is is in striking contrast to all other organ donations, regarding which federal law prohibits payments for organs. Th ose laws were enacted in order to protect vulner- able poor people from feeling pressure to sell their vital organs and possibly risk their lives in the process. Th e court ruled that the newer Peripheral Blood Stem Cell (PBSC) form of marrow donation, which takes the cells from the blood itself and not the bones, more closely resembles donations of blood plasma, which by law may be done for money. Th is ruling does not impact the older type of marrow donation, wherein the mar- row is removed directly from the bones; it remains a crime to compensate donors for that process.2 1 Flynn v. Holder. For a full clarifi cation of the medical ramifi cations of this ruling, see “Selling Bone Marrow-Flynn vs. Holder,” New England Journal of Medicine 366:4 (2012): 296-7. 2 Th e National Organ Transplant Act makes it illegal to buy or sell organs for profi t; the penalty for breaking this law is a fi ne of $50,000.