Life is described in the Bible as a combination of body and soul. Similarly, death is the departure of the soul from the body and not when the death process has begun. If the death process has begun and there is at least a small chance that the person may die, he is considered a "gosses." A "gosses" is considered alive pertaining to all halachic legal matters, even if he is in a coma. Even when in a coma he is atoning for sin, since he is not well.

There are three different types of death described in the Talmud. The Chasan Sofer adds that to be sure, one should wait until he sees a deathly appearance and a cold body.

The first type of death is irreversible respiratory arrest. However, the continuation of breathing after he has suffered irreversible cardiac arrest is meaningless because his breathing is no longer a "breath of life" (Genesis: chapter 7) since the oxygen can no longer be absorbed by the body through blood circulation. These two events of death are described in Talmud Yoma (page 85). There is, however, disagreement as to whether the methods used in those days to determine total cardiac arrest were as reliable as the feather by the nose test to determine total cessation of breathing. Rashi there says, "sometimes life is not in the heart but is felt in his nose." He does not say sometimes there is no life in the heart but there is life due to breathing. This would imply that one can be a "gosses" although his heart has stopped.

The definition of irreversible respiratory or cardiac arrest is to be understood with the perspective that the "doctor may heal the sick." Therefore, the medical expert must decide if- with all the medicine and medical equipment available to him, can he resuscitate the heart so that it can function on its own. If he cannot effect the heart to function on its own, and he must transplant another in its place, then the new one becomes his own heart in all respects. If a heart transplant is not the solution, however, and the heart can be replaced with a mechanical heart, this pump is not considered part of the human system. Therefore, it is only done if he will retain or regain consciousness, because consciousness in itself is generally a sign of life. However, as long as he is breathing with it he is alive.

There is a difference between the heart and the lungs. The heart itself is a muscular pump, and if it does not pump on its own it is not functioning. The lung is not a pump. There is a separate muscular partition between the chest and abdominal cavities called the diaphragm which causes the lungs to react like a bellows by inflating and deflating it. Therefore, even if the lungs cannot intake air on their own, they are considered functioning on their own if- when fed oxygen by means of a respirator they will function normally by absorbing the oxygen and feeding it to the blood. This is comparable to the way medicine enables an organ to function on its own. Furthermore, there are, unfortunately, people who are afflicted with severe cases of neurological diseases such as Guillian- Barre, Botulism, and Myasthenia-Gravis, and are totally unable to breath on their own, to the same degree as a brain- dead person. However, there is no hospital that would refuse him a respirator so that he can sit up and write. Even if he is in an irreversible coma, but so long as the lungs are functioning on their own with the help of a respirator, and the lungs, with the assistance of the heart, are sending life- sustaining oxygen throughout his body, he is a "gosses, and he is "halachicly" legally considered alive.

The third type of death is mentioned in Talmud Chulin (page 21) and explained in the Rambam's Mishneh Torah in the laws of Tumas Mess (chapter 1, law 15) and in the laws of Avos Hatumah (chapter 2, law 1). If one was decapitated or cut in half along the stomach, including the inner organs, he is considered dead even though he is still alive. The explanation is such; if he has been decapitated he is worse than one whose neck has been cut from the spinal cord most of the way forward. He can no longer breathe since the nerves controlling the breathing have been severed. If so, why mention decapitation? The answer is that decapitation and being cut in half is a third type of death where the human or animal form no longer exists and the spirit cannot exist in a shape that is not the form it was intended for. Therefore, the Rambam concludes that- although immediately after being severed in half at the stomach he is still breathing and his heart is still pumping for about one to two minutes until he bleeds to death and he appears to be alive, nevertheless this is an event of death and he is halachicly dead. Therefore, even if you could attach a heart lung machine to a decapitated person, he is still dead. This includes the head even if it is possible to attach a machine to the head to enable it to use its senses. It is to be compared to a head that was decapitated, immediately afterwards it can open and close its eyes, but it is dead.

Recently, a new scientific definition of death was added to the hospital codes and to the laws of some governments. It says that death is also an irreversible process, and when it has begun, and if the patient is in an irreversible coma and his quality of life is nil, he is dead. The guidelines for the President's Commission Criteria of brain death are as follows. An individual with irreversible cessation of all functions of the entire brain including the brain stem, is dead. Cerebral and brain stem functions are absent. The cause of coma is established and is sufficient to account for the loss of brain function. The possibility of recovery of any brain function is excluded. The cessation of all brain functions persists for an appropriate period of observation and/or trial of therapy.

The tests for brain stem functions are done by BAEP and SSEP test. These tests are done externally and have a 5% inaccuracy, and possibility that there is a small amount of electrical activity entering the body. Others theorize that it is this amount of electrical activity that is keeping the heart functioning, especially for those hearts that need a pace-maker after the transplant. In any event, there is still electrical activity within the brain cells. There may be many functions within the brain. The only mental functions that can be fairly reliably tested for are brain stem activity related to bodily muscular function. Some do testing to see that there is no blood flow into part of the brain.

According to halacha, if a person is in an irreversible process of death he is a "gosses" and is alive. The brain- dead person does not fit into any of the three definitions of death discussed previously. His heart and lungs are functioning on their own, even though he needs a respirator. He is far from being decapitated. There is still electrical activity in his brain cells. The head still has much to do with the body because you can tell the temperature of the body through the head by inserting a thermometer under the tongue.

It is the decision of all major "poskim" (professional experts in Jewish law) that one who is brain dead is a "gosses."

A "gosses" is a person who is so weak that there is at least a small chance that he may die now. Therefore, moving his arm or causing him psychological anguish could shorten his life. We may move him for medical procedures only if the chances to keep him alive longer by moving him outweigh the chances of shortening his life by moving him.

The practice of euthanasia and mercy killings and the doing away with unproductive people all preceded the establishment of the death camps of Europe, and all this with rather sophisticated technology. Technology does not improve human nature, but the study and practice of the Torah does improve human nature.

Hearts, livers, lungs, and pancreas for the transplants are removed from brain dead persons. An acceptable method would be to have an organ- removal operating room always ready to accept donors who are dead due to irreversible cardiac arrest. This would enable the immediate removal of the organ before it deteriorates. Any side complications can be reversed with a little research. If, by waiting after death for signs of death, the organ will deteriorate, causing the chances of survival to drop, then we wait for biblical death and do not wait for signs of death, as explained previously.

At the present time the halachic legal justification and guidelines for heart, liver, lung, and pancreas transplants are as follows. The operation must be done by an experienced team. The overall survival rate of these teams for heart and liver are eighty percent for the first year and sixty- five percent over a six- year period. The survival rate for lung transplants vary from 40 to 80 percent for the first year, and from 40 to 60 percent for the next few years. The large variations are due to the nature of the illness and the health of the patient. The individual must be assessed as having a survival rate of at least sixty percent. The patient must not hire those removing the heart, liver, lung, or pancreas from a brain- dead person by paying them any amount prior to the organ removal. The procedure today is that he is billed after the organ removal upon receipt of the organ. This constitutes encouraging such deeds. However, they would do the deed anyway even if he would not undergo the operation, due to the great demand for such organs. Therefore, he is permitted to undergo the transplant operation to save his life.

Cornea, skin, and bone transplants are usually not done to save a life. They can be removed from a body that has suffered irreversible cardiac arrest. Today, most kidney transplants are done for convenience, and not because this is the only way to keep the recipient alive. The patient who needs the kidney to save his life has precedence over others and may choose from the numerous kidneys available in the kidney transplant bank. It is therefore, prohibited to degrade the Jewish body by removing an organ, and it is similarly prohibited to donate an organ. Degradation of the Jewish body is only permitted when it is clearly needed to save a life at that moment and there are no other alternatives.

High risk procedures are only permitted if the odds are that he has only one or two days to live. He then has a choice to risk it or not. (See Talmud Avodah Zoroh page 27, Rashi and Ron.)

As far as using extraordinary means or heroic methods to keep a terminally ill person alive, the Chofetz Chayim in his Mishna Berura (chapter 329) reminds us of the guidelines in deciding what is forbidden or what is permitted as far as Biblical laws are concerned. One cannot give his own reasons for the law and decide the law on the basis of these reasons. Therefore, if one is required to desecrate the Sabbath so that the life of a terminally ill person should be extended for any length of time, one cannot differentiate between one type of medical procedure or another. Furthermore, whenever there is a question whether to extend or not to extend a life, we always extend it, unless there is strong proof otherwise. This is true even if he is in pain, because we cannot play G-d and decide that he has suffered enough. It is permitted to give him pain- killing drugs. If he is a "gosses" the pain may shorten his life and we give him pain- killing drugs.

The Bais Yosef and Bach in the Tur (chapter 339) explain that the prohibition not to let one die refers to medical efforts and not to spiritual matters. Therefore, although one must do everything medically to keep a suffering terminally ill person alive, he may pray at the head of the terminal patient for mercy and if G-d will not heal him will G-d be merciful to take him. Likewise, one is permitted to stop a banging sound, or remove salt from his tongue, which are spiritual remedies for extending the time of the departing soul in the body.

For this same reason we cannot give our own reasons to differentiate between a fertilized egg to say that it is permitted to abort, and a fetus of four months old to say that is forbidden to abort. So long as the fertilized egg has potentiality of life, it is forbidden to abort him. Talmud Sanhedrin (page 72) says that only if the mother's life is in danger are we allowed to abort the unborn, but if his head has left the womb we do not kill one to save another since it is nature and an act of heaven that is causing her death and not the child's free will.

Furthermore, we see from here that it is a Biblical prohibition to abort an unborn child. For if not, why is it only permitted to abort to save a life?

If, however, one has to risk his own life to save a life, he is not required to do so even if the odds are that he will not die as a result. He is permitted if he so chooses, as long as the odds are that he will not die as a result, and the odds are that he will save the person's life. If, however he works as a fireman or policeman and he is required to attempt to save people even though there is only a small chance they will survive, he is permitted to take a small risk to keep his job.