The Twins Dilemma - Rabbi Akiva Tatz

thank you okay let's take a look at one of the most amazing areas of Jewish Medical ethics which is relevant to everyone really try to show you the lucky fascination of this area and that is the question of having to kill somebody in order to save somebody right would you ever have to kill someone to save someone and the scenario that I'm thinking of is siamese twins right where you have children who are fused where the bodies are fused in such a way that if you if you took the life of one you might save one in other words a scenario where they're both going to die if nothing is done they will they'll both die but if you operate and separate them killing one you might save one okay that's a very rare situation I in my years of medical practice have never seen anything like that but the reason that we study it is because it is a key to understanding many halach issues that apply throughout medicine and world and well beyond so let's take a look at that subject and what I'd like to share with you is the analysis of a case that happened a few years ago in the United States in in New Jersey Jewish Family that gave birth to two little girls whose bodies were fused right so-called conjoined or siamese twins and they presented exactly such a dilemma how was that approached jewishly what are the principles that we that we learned from this case but let me just say a word or two about about Siamese twins in general so you know that you know that you have two different types of twin right you have twins that are so called fraternal twins where a pregnancy two pregnancies develop at the same time right any twins here any twins identical or not identical where's your other half his way ah right okay so you have two sets one type of tuning is where you have two pregnancies developing in England a few months ago a woman gave birth to two children one white and one black okay think about that so you can have two pregnancies developed at the same time however however sometimes what you get is one conception and at an early stage of cell development right you have 2 4 8 16 32 cells you get a cleavage of that embryo into two identical twits right they share obviously they're both boys both girls genetic feature appearance the same genetic features the same you can transplant organs from one to the other with no rejection problems and that is known as identical twinning when actually for everyone when that early ball of cells splits into two genetically identical herbs are they identical or are they mirror images a mirror image is like right and left hands right you cannot superimpose them on each other they only work as mirror images all identical twins the same or are they mirror images after all they split that way now listen listen carefully before you answer the question you should accuse me of asking an invalid question what's wrong with my question let's think come on let's learn to think together what's wrong with my question jewishly jewishly you may never ask a question that makes no difference in practice okay that means in the world of academics we ask questions that are academically interesting in Jewish study there has to be a practical difference or the Tamil would not discuss it but I didn't ask you that question for no reason there's a massive practical difference what's the Practical difference if identical twins are merry images or identical come on think the difference is this if they are identical they will be the same right if they mirror images one will have his organs where they should be and one will have his organs reversed the one will have his heart on the right side and organs reverse because can you see that I have my heart on my left but if I'm split from my twin this way his heart will be on the right that's very important when you're a surgeon when you cut someone you have to look for the appendix and it turns out to be here you're in big trouble so your homework question is do identical twins have a higher incidence of cytus inverses in other words reversed organs in one of the twins absolutely amazing question ask your Anatomy Professor right and you can really embarrass them because they were not but that is the that is the question so that's one of the questions and um but sometimes what happens is that at least this is one of the theories as they separate they do not disjoin completely and the bodies remain fused at some or other point of their anatomy and then you get what is known as conjoined or siamese twins right for example you have two American women black women who are about in the I think about their 40s who are joined by the tops of their heads okay the skulls are fused they spend 40 years walking around like this they sleep in two beds Head to Head they shower together they date together and they are very well adjusted one is a country and western singer and one is a nurse they were interviewed recently one of them said she dreamed she was separated from her sister she felt very lonely right so that's very well adjusted but sometimes you have situations for example they're two Russian women who are joined from the hips down in other words there's one pelvis and set of legs and two bodies from the waist up okay they walk perfectly coordinated on one pair of legs although each brain controls one side they do not get on well one is a chronic alcoholic and a sister has liver disease because when she drinks the sister gets drunk right and they they come to blows unfortunately nothing can be done by the way that raises amazing and moral questions for example if one of those girls would marry do you see the problem yes if one of them would marry first question is the man marrying them guilty of marrying two sisters not allowed in Judaism two in the intimate aspect of marriage in Jewish marital law Intimacy in marriage has to be extremely private you know in the Orthodox World you'll see people don't even hold hands or Embrace each other in public right although the intimate aspect of marriage in Judaism has to be very Dynamic but completely private well in this case you're not allowed to be intimate with one's wife when there's someone else present in this case the man would marry one of those girls he would never actually be alone with his wife because like her sister would always be hanging on you know she she'd been there right so that would be a problem and more interesting and more deep there's only one lower body so in the intimate aspect of marriage would there be adulterous element to the relationship do you understand because in that part of the body or two women did you see the question so they're very very amazing questions and all of these have been thought through halachly and some of them been tested legally and if you'd like to see actually the two American girls must be about 18 or 19 are the Hensley twins you can actually they've allowed themselves to be videoed through a day of the activities they have one body from the chest down and two necks and heads so you can see them how they comb each other's hair one sleeps when one's awake one's eating while one's sleeping each brain controls one side of the body they clap perfectly that you can walk with they balance on a bicycle even though each brain is controlling half the body they recently took their driver's test in Minnesota and they were required to take two drivers tests because each brain is controlling one hand right so and they drive their car there's two people driving the car and yet they control the car perfectly right so you can see all these I saw a case in England a few months ago two little four-year-old boys whose heads are fused at the side each child can see out of his eyes and each shot he can see out of his brother's eyes too right each boy can see out of his own eyes but the brains are cross-wired so he can see out of his brother's eyes and out of his owner but one of the problems right one of the problems is sometimes you have by the way the twins are usually very emotionally close to each other for example we are living now in London at Great Ormond Street is one of the largest series of separations of Siamese twins that be done in the world the surgeons they're very famous surgeon one in the best one of the best in the world he's a South African of course um he told us that many years ago they discovered that when they separate twins like this the kids get very distressed unless they nurse them in the same crib and if one child dies Unfortunately they found many years ago that if they nurse the surviving twin in a crib with a mirror it helps the child settle that's interesting right so they're unusual unusual closeness to each other but um one of the problems is this sometimes the bodies are fused in such a way that they share organs and in the case I'm thinking of that took place in 1978 or 79 these two little girls were born into an Orthodox Jewish Family in eastern United States small town in in New Jersey and what happened was their bodies were fused and the first doctor to examine them was struck to find that he could hear only one heartbeat and what turned out to be the case was that normal Limbs and normal bodies but their livers were fused and that was not a surgical problem there was enough liver tissue that could be cut to give each child enough liver tissue but the heart was fused so instead of being eight shape you know they're normal they're four chambers to the normal human at heart there should have been eight Chambers to this heart but there were only six it was an abnormally fused heart located more in the chest cavity of baby girl B they were not in the Press Dennis baby girl a and baby girl B and the heart was more in her chest if you'd like to look this up there was a Pulitzer prize-winning analysis of this published in the Philadelphia inquiry they did a famous uh analysis of this case with pictures and interviews very very well done by a non-jewish reporter who got the Jewish stuff very very very well and um you can you can look that up but what happened was the children were flown from where they were born to Children's Hospital of Philadelphia known as chop right children I actually had the honor of giving a talk on this case in that hospital to some of the doctors who'd been involved and some of the Muslim and Christian chaplains who'd been involved in this case as well and I'll tell you what they said about the case amazing amazing to see the the different approaches to this case but what happened was their children were flown there and they were examined and put under the care of Dr Elliot Coupe Dr Elliott Coop was a famous American doctor he became the Surgeon General of the United States he died only about a year ago and he is very famous among other things he happened to be a very religious Protestant Christian he was the kind of man who used to spend the entire night in the hospital reading the Bible before surgery the next day to prepare himself for surgery so you have a very Orthodox Jewish Family a Protestant Christian surgeon Children's Hospital is a Catholic institution and the case was heard in a high court in the United States and I'll tell you what the court case was about but it's an amazing opportunity to see how these different legal and ethical and religious systems look at the same problem and here's what happened Dr Coop examined the children and he said to the parents if we do nothing both your twins are going to die right the reason is that although the heart was good enough to keep the circulation of both twins going as they began to grow the heart would begin to fail right in medicine that's known as high output failure the heart cannot keep up the circulation of two growing twins in fact on the 21st day of their lives they went into heart failure and they needed to be put into intensive care and it was very clear that within two or three weeks they both would have died in fact in Colombia in South America two years before two twins like this had died and the surgeons in Philadelphia had the heart flown up to United States that preserved heart in a bottle flown up so that they could study what was likely to be the abnormal enemy they might find if they're operated on these twins so it was very clear that if nothing were done the twins would die so Dr Coop said to the parents if we do nothing both these girls are going to die let me try to save one and what he proposed was separating the livers tying off the major vessels of baby girl Aid during surgery which means with his own hands he would kill her he would then carry her body over to a sterile surgical table that they would have ready in the operating room and then he would use her ribs to graft closure of the chest of baby girl Beach understand in other words where she was now missing a patch of tissue he would take a patch of chest wool from the sacrifice twin and stick Stitch it in to close the gap and leave the entire heart in the chest of baby girl be and hopefully that will be enough to keep her alive now you can imagine what an agonizing decision this is by the way by the way why was he talking about killing baby girl a I can think of at least four better options a heart transplant right what about a transplant transplant right put it transplant a heart into baby girl a isn't that obvious yes no yeah Okay the reason this wasn't done was because this case took place in 1986 in 1978 the first time heart was ever transplanted into a newborn was in 1986. don't forget heart transplantation already began in 1968 in a certain country of course we needn't uh need to mention where that was but um but by 1978 or 79 no one had yet tried to transplant a heart into a baby and therefore by the way you know the first time it was done very interesting the first time it was done was a baby born in California with heart disease baby was dying the surgeon was a famous chest surgeon called Norman Shumway he had no other option but a heart transplant and although it had never been done there was no other option what's the hardest part of transplanting a heart into a newborn they scoured the United States and they found a baby available for being a donor in Vermont but Vermont is three thousand miles away from California but there was no other hope so the higher the private jet in California they put one of the young surgeons in the jet in California flew him across the country to Vermont he cut out the heart of the donor child in Vermont put into a box of cold cardioplegic solution and they couldn't get the jet started they couldn't get the plane going they ended up scrambling United States Air Force supersonic fighter put this terrified young doctor in the back of a supersonic fighter with a heart in a box on his lap when they got back to California they resuscitate the doctor but they did and they saved the life of the baby in California right but back in 78 nobody had done this yet and therefore transplant was not an option second option to say baby girl a artificial heart right why didn't you leave the heart in baby girl B put an artificial heart into baby girl hey even today we don't have a fully implantable artificial heart not even for adults certainly not for children those very exciting research taking place but we don't have that third option for baby girl a any Veterinary students here animal Hut right so we use pig valves all the time in humans but if you try to use a pig heart or a baboon heart it's rejected in six to eight hours we haven't conquered that technology yet so that cannot be done and the fourth option of course is cloning your own tissues right growing hearts and organs from your own stem cells which is very exciting research but back in 1978 there was not yet not yet on the on the scene and therefore Dr Coop said we have only one option and namely apart from letting your twins die let me try to take the life of one to save the life of one the parents asked their rabbi the rabbi asked his rabbi and the question arrived on the doorstep of ramosha Feinstein was probably the greatest Authority in the world at the time he was in his 80s he later said it was the most difficult life and death decision that he was ever asked to make and he made hundreds if not thousands and what I'd like to share with you is some of the analysis that he went through in order to come to a halach understanding of what should be done okay question one that he asked was this are these two little girls two people or are they one why is that relevant that question if these two little girls are one person you're not killing someone you simply amputating part of a person in Judaism can you cut away the part of a person's body in order to save the person yeah you're obliged to right by the way do you have to cut away part of your body to save another person's life no no give you a case about 600 years ago a Jew in Turkey was accused of stealing by the sultan what's the Muslim punishment for stealing this Jew was sentenced to have his hand cut off he managed to escape and he fled to Egypt the Sultan in Turkey captured another Jew put him in jail and sent a message to the man in Turkey as in Egypt as follows he said if you refuse to come home I'll kill him come home I'll free him and cut your hand off refuse to come home I'll kill him you see the Dilemma so that man in Egypt went to the great rudbust great swaraji authority of David benzemery one of the greatest and he said to him Rabbi am I obliged to go home and have my hand cut off to Save a Life or may I remain here even though he will die do you have to give away part of your body to save a life amazing question right you should ask your local rabbis whoever you study with to study his answer which is amazing but I'll just tell you the bottom line he says that if a man would go and give his hand to Save a Life be incredible Mitzvah tremendous act of kindness a loud in Judaism but not obliged and this is the rationale we follow today with kidney transplantation when we ask someone for a kidney we say to them we need your kidney to save your brother's life we say it is safe enough that Judaism allows it it's risky enough that you don't have to do it in other words it's up to you and that raises amazing stuff I'm not going to discuss this in detail this evening just to mention one point imagine you have a person dying of kidney failure and you say to his brother would you like to give your kidney let's say he does not wish to give it how can he say no with the whole family looking at him and saying how can you refuse how can they withstand the emotional pressure coercive emotional Prejudice is amazing amazing pressure the solution to that was proposed by Rabbi many years ago and it's now used throughout the world the non-jewish world and here's what they do they test the whole family and they see who matches they then interview the family individually and privately when the surgeons meet with a family member who matches best they say to them you are alone with us in this room you match if you agree we'll take your kidney and save your brother's life if you refuse we'll never disclose that you matched we'll falsify the record your family will never know you will have to live with a decision for the rest of your life but no one in your family will ever know will take will lie to take off from you isn't that amazing sometimes you can't do that because you need to know for example in the United States recently they've been doing a thing called cross transplants you know what that is that's amazing if this doesn't move you basically there's no hope for you let's say you have a mother who wants to give a kidney to a child but she doesn't match they look for another mother who's prepared to give a child to her kidney to her who also doesn't match and they asked Mrs a if she will give her kidney to Little B if Mrs B will give her kidney to little a and if they agree they sign the forms and they start the operation on both mothers at exactly the same moment so neither one can change your mind they extract their kidneys and they switch them and a few months ago in America they did 10. 10. Mrs a gave a kidney to Little B so that Mrs B would give a kidney to little C so that Mrs C gave a kidney to Little D in amazing 10 people got kidneys from somebody else's relative right that's called cross transplantation anyway that's some of what's going on but if you say that these two little twins are two people then you are not amputating part of a person what are you doing you're killing someone to save someone else what would you say these twins or two people or one most authorities have debated this case have felt that we should judge them as two people which makes our question much more difficult right okay here comes the second question stay with me carefully Rabbi finds to incent the following question to Dr Coop he said Doctor you are planning to operate in such a way that you save baby girl B and kill baby girl a could you reverse your decision could you reconnect the heart so that baby girl a survives and you kill B and Dr Coop said ask the Aged Rabbi why he wants me to perform the surgically impossible and to his dying day which is just a few months ago he maintained vehemently that there's no way that he could have changed the decision it was complicated enough like this and there was no way that they would guarantee that b would survive anyway and therefore he said no whenever Feinstein got that answer he said right you can go ahead and operate now what lay behind that question Robert Feinstein did not want him to say baby girl lay he was quite happy to say baby girl B where the heart was but what lay behind that question so stay with carefully with me and I'll try to explain we have a law in Judaism called rodaf rodaf means that if you listen well if you see somebody trying to kill someone else and the only way you can save the victim or rape by the way homosexual or heterosexual right but let's talk about murder it's complicated enough you're walking down the street you see a China kill B the only way you can save bees by killing a what do you do what do you do in Jewish law kill a allowed to or obliged to obliged obliged to if there's no way to say if you could shoot him in the foot you're not allowed to kill him is that clear but if there's only way to save the victim is by killing the aggressor that's what you do what's the commonest case of this law the commonest general case of killing a to save B in law self-defense when B is you if a is trying to kill you you can preemptively kill is that is that clear in all jurisdictions you can do that you can kill someone else to save your life preemptively right question two for homework you're walking down the street you see a trial and kill B and you instead of but you could shoot him in the foot but you kill him instead is that culpable as are you guilty of homicide for killing him because you didn't have to you could have injured him and part question two part B someone tries to kill you you could shoot him in the foot but you kill him are you guilty of murder because you killed him and you didn't have to but you acted in self-defense do you see the question okay think about that fascinating question for homework but that is the question of one person trying to kill another by the way this does not apply when two people trying to kill each other if you see a trying to kill B you can kill a to save B if you walk out into the street and you see two people with their hands over their gun happens in California all the time doesn't it that's a common scene in California um that is a situation where you may not intervene each one can kill the other one to save his life but you cannot kill one only if one is trying to kill him is this clear okay so why are we studying this law of roadev because maybe the babies are threatened maybe one of them is threatening the other one maybe they're threatening each other okay that's all over there by the way what's the commonest medical application of this law when a pregnant woman when the pregnancy threatens the life of the mother Judaism rules that the babies are deaf on the mother and therefore you can terminate the pregnancy only while she's pregnant once the head is born or half the body is born in the world then you cannot kill the child to save the mother then have equal claims to life but while the mother is pregnant The Birth has not begun then in Jewish law the mother's life takes precedence by the way this was a Catholic Hospital the Catholics rule exactly the opposite when a mother and child are fighting for survival in Catholic law they try to save the child and let the mother die the reason is don't ask me questions about this I have enough trouble keeping up with Jewish law but I'll tell you what the priests told me in that hospital they told me that according to Catholic uh understanding child is born in a state of sin and unless they're being baptized to be saved by the grace of Christianity they go to a very bad place in the Hereafter the mother has already been baptized so she's guaranteed a place in heaven so it's better to let her die and save the child to baptize the child my father was a doctor before me my father came from South Africa to study medicine in England my father told me there were times when he was attending a woman in labor in a very Catholic maternity hospital in Dublin when the father walked over and said to him doctor if my wife's labor becomes obstructed I want you to save the baby and let my wife die these were not cases of difficult marriages you understand they were cases of Catholic law in Judaism absolutely not we take the life of the fetus in order to save the life of the mother so that is the situation but it can get very complicated for example in 1973 here in Israel there was a case of some Israeli soldiers in the Sinai being fired upon by other Israelis you know you would call this Friendly Fire mistaken identity and what happened was there was a group of Israeli soldiers in one position and they were being fired upon rocket fire and mortified by another group of Israelis who couldn't see who it was and they could not communicate at a distance was a third group of Israeli boys who saw what was happening and could not communicate with either group and in this third group were some religious soldiers who knew the law of radith and they said look if a is trying to kill B and the only way you can save bees by killing a we ought to kill them in a tragic situation they had a terrible argument about it on the battlefield and they did not fire in the end people died in the first group when these soldiers got home they went to see Revelation great Rabbi in Jerusalem and they said what should we have done he said there's no way you'd been allowed to fire these soldiers are doing what they ought to be doing in Wartime under genuine case of mistaken identity that's called they are pursued from Heaven you're definitely not allowed to intervene question three for homework why is this not like the fetus fetus threatens the life of the mother innocently we kill the fetus soldiers threaten the life of the soldiers innocently we don't kill the soldiers do you see the problem okay think about that it's worth a whiskey right interesting question so those are some of the laws of relief right why are we just debating riddiff because maybe we could see our way clear to killing baby girl a if she's a reader from baby goby and we need one final law and then we can close the circle what happens if the relative is one of a group for example we're sitting in this room and suddenly the building is surrounded by non-jewish terrorists and they give us an ultimatum give us one Jew to kill the rest of you can go free or we kill everyone or one woman to rape or we rape them all okay but let's deal with murder again are we allowed to give a person to die and think about it if we don't everyone's going to die what's Jewish law say absolutely not absolutely not although many people will die that's his problem we are not allowed to kill somebody in order to save money however what happens if they name the person they want they specify the person we won finkelmovich got a problem with him send him out to Die the rest of you can go what would you say think about it the in the first case the problem is who are we to make the selection why should we kill you or you or you in the second case Finkle moment is a dead man anyway why do we all have to die do you see that okay so the answer to that fascinating discussion the Jerusalem talmud I'm not going to go into the detail but who's a law student here anyone law students keep your wits about you the talmud says that once there was a man called who attacked King David what's the Jewish punishment for attacking the Jewish King absolutely execution but he managed to escape and he hit in the town of Avil you have David's General surrounded the town with his army and he gave the people of the Town such an ultimatum he said if you don't give me bin bakery or kill him I'll wipe you all out what happened was a very old lady called Sarah was Usher climbed up on the ramparts began debating the case with you had him killed threw his head over the wall and she saved the whole city so the talmud says you see from this case that if the person is named because it was named that's called if the person is named you could kill him to save everyone what's wrong with that proof he wasn't only named he was guilty how can you prove from this case so talmud says there's a fascinating debate in atonement one opinion is that Chevron Bakery was killed because he was named the other opinion because named unguilty the other opinion that he was just happened to be guilty but that's not necessary and there's an argument down to this day the rambam rules that you cannot kill such a person but there are great Jewish authorities for example the the rashboard of SoMo Bernard was the rabbi Barcelona in the 14th century many debate many talk about it somehow that you could kill such a person even if he's not guilty but at least he's designated look at a and b if you could kill either one could you make such a choice no but when Rabbi Feinstein got the answer there's no way to save a the only one we can save is B maybe we can say that a is designated to die she's threatening B and not the reverse and maybe she's like the fear is threatening the mother and possibly that's enough for us to allow allow us to kill a in order to save B let me tell you what happened in the case in fact Robert Feinstein took 11 days of thinking about this together with his family he has a son-in-law as a professor biology as a grandson who's an internist in Natalia hospital and they got together to give Ramos the medical and Technical input so he could he had the luxury of 11 days because the hospital Was preparing surgery over time the nurses the Catholic nurses refused to take part even though the Catholic priest authorized surgery and the reason was they felt emotionally unable to go to an operating room where they would see a child killed you know almost no one ever dies in an operating room you can almost always get them out into recovery you know where someone else's someone else's problem right to see a child killed by the surgeon absolutely you know horrendous and so the hospital had to put together a team of Volunteers in the end in order to to do the surgery and they were unprecedented just for the medical students I'll share this with you they decided to use two separate teams of anesthesiologists in the end can you see the problem two little newborn heads each team controlling the respiratory function of their twin and anything they did to the respiratory function of their twin remains separate but anything they do to the circulation affects the other child as well because although they're separate lungs there's one circulation they don't teach you that in medical school right not even you not even at UPenn right and therefore this was a completely unprecedented situation and it took a long time to sort out but eventually hit it some of the questions Robert Feinstein one of the young Rabbi said to Robert Feinstein what if two people are coming down by a parachute and one man's parachute fails to open so he grabs his friend's leg but due to his weight the parachute begins to rip is the man with the parachute on his back allowed to kick his friend off to a certain death is the Perry is the heart like the parachute another question they asked him was imagine you have two people two people walking through the desert one of them has a bottle of water there's enough water in the bottle that if he drinks it he'll get back to civilization right why you want to do that these days beats me but you know if you did but if you share the water with your friend you'll both die in other words you'll both live another day or two and then both die is it better to share the water and both die a day later or to let him die today you drink it and survive in the long term so we rule according to Rebecca's opinion that that the one who has the water drinks it the one who has the water drinks it okay that's how we rule is the heart like the bottle of water question four for homework what happens if neither one owns the water you land in a helicopter with a bottle of water there's two people dying in the desert do you flip a coin and give it to one so that one survives or do you then share it so that both live a little longer in other words the question is is ownership the reason that the person who has it drinks it is it because it's my water or is the logic it's better to have one person survive in the long term rather than two but before I tell you the outcome I must share with you an incredible incident that occurred in the courtroom Dr Coop insisted on a court hearing to authorize surgery why because he was concerned that under Philadelphia Under Pennsylvania law somebody might charge him with homicide for killing baby girl a so he wanted to be protected himself in the hospital against a charge you understand so he wanted so a three-judge panel was convened on Thanksgiving Day that year and a team of lawyers argued precedent in front of the judges to convince them that they should allow surgery most of the examples they gave the judges were things known as Lifeboat ethics you know people in a Lifeboat there wasn't enough food for everyone so they starved someone they threw someone overboard there have been cases where they at someone in a famous case in British law where there were three men about 100 years ago in the South Atlantic Shipwrecked three of them were left alive in a Lifeboat the first the captain the first officer and a young 19 year old Cabin Boy called Robert Parker after 17 days without food the two older men decided to kill him and eat him okay they killed him with a pocket knife and at him Raw and survived weather got back to England they admitted what they'd done and they were charged with murder and tried in England for murder look it up it's an incredible case it's a major precedent in British and American maritime law that is called the case of Robert Parker absolutely and that is um that's a famous case in the end the judges allowed surgery and surgery went ahead but an amazing incident occurred in the courtroom and listen carefully to this the lawyers at one point argue that surgery should be allowed because in Pennsylvania 1978 the definition of death was secession of spontaneous heartbeat when the heart stops beating the patient has died so they argued like this of course surgery should be allowed you're going to leave the Hut beating in the Chester baby girl B if no heart stops beating nobody's dying Isn't that cool do you know what this means if you don't like someone hack their heart out keep a ticking in your lab cut up the rest of them in small pieces no problem if not stop eating nobody's dying this is what you call a loophole and in a secular democracy when people make up the laws they go along you get weird things like this in Torah which comes from another world you don't get this one of the great rabbis of the last century said a beautiful thing he said in a democracy that people make the law in Judaism the law makes the people isn't that beautiful okay let me tell you what happened and I'll and I'll finish with that surgery went ahead in fact a team of doctors opened the chest to the children separated their livers Dr Coop insisted on being the one to tie off the vessels of baby girl a terrible terrible moment obviously she died immediately the heart continued beating although they weren't sure that it would he carried the body of baby gold a over to the sterile table they never needed her ribs they were able to get the chest of bee closed with a breast tissue in the normal place and all the anatomy correctly disposed without needing ribs from baby girl a and he handed the body of baby girl a back to the family the same day so they could bury her right before Sunset and people present said was an incredible experience to see how the Jews and non-jews went along with the halachic requirements as laid out by an elderly Sage among the Jewish people and that in fact is what happened in this case life begins at conception but you only get what's called a yetzer ra at Birth Bar Mitzvah right so a fetus is certainly a living human being that's why you can break Shabbos for example to save a pregnancy no matter which stage yes so obviously in this case like you couldn't ask baby her opinion but like in all these yes yes like let's say someone like volunteered and said okay like I'll be the one that gets killed okay so the answer is like this you don't not only volunteer you'd have to actually do it if a crowd of people are threatened and you ran out of the room to give your life to save money that's an incredible act tremendously uh meritorious and allowed not obliged of course but allowed but if you say look take me and kill me we couldn't do that you'd have to actually give your life to save everyone else 1950 ish a man was driving his car down the Carmel Mountain in have you been in a very steep Mountain the brakes failed actually this was an Israeli car never used the brakes before just use the whole you know they might cause in Israel they don't have breaks they just give them horns you know do you notice that anyway this fellow was driving down the mountain his brakes failed and he found himself careening towards a bus stop in which 10 people were standing listen carefully he's about to kill 10 people he could not stop but he could turn but unfortunately only to a place where one person was standing what should he have done again do nothing wipe out 10 people turn kill one innocent person one bystander save ten what should he have done okay listen to this I don't know what he did but afterwards they went to ask the khazonish great rabbinic Authority in benebra what should the man have done and the Khazana says and he writes about this he says I think he should have turned and killed the man they said Rabbi doesn't that contradict what we learned this evening wait listen we learned that if 10 people are about to die and you could kill one to save them may you do that no way so how come you could kill this one to save the ten and let me point out they're exactly parallel situations I'm not looking here for practical differences they're exactly parallel let me make that clear there are 10 people in front of my car out of control okay it's not my fault someone sabotaged the brakes if I do nothing 10 people die if I turn and kill one person disconnected from the scene he's standing under a tree thinking deep philosophical thoughts about uh life and death if I kill him I save 10 should I do that yes scenario number two 10 people about to wipe out by terrorists one guy innocently sitting under a tree thinking Deep Thoughts the terrorists say tats he has a high-powered rifle shoot that guy in the head and 10 people live am I allowed to shoot him no way why they're exactly the same situations come on what's the difference you're not allowed to do that in her analysis you may never introduce a dart from the outside we are dealing with a lab situation all the variables are frozen guaranteed there are two parallel situations with all the certainties and that's exactly the same the same guy in both scenarios the same innocent person standing under the tree in the first case I shoot him dead with a gun to save 10 people in the second case I run him down with my car it's exactly the same person in the car most I'm not killing those cars out of control no fault of mine in both cases if I do nothing to die and I can kill one to save 10 they're exactly the same here's your clue stay tuned I'm going to give you two other cases that bear the same relation but I think more clearly okay here it comes you stand in my Railway track railroad track Express train is coming down the line it's going to fly past you and wipe out five people standing on the line if you pull the points quickly you you cause the track to Veer the train goes down a new line where there's one person standing and he'll die again you stand there do nothing train flies past you kills five people act quickly change the track train goes on to new line kills one person if you think you should pull the points and change the track raise your hand more than 90 percent of westerners agree with you that you should pull the points scenario number two you're a doctor in a hospital you've got five people dying of organ failure they need transplants desperately the nurse walks in and says Doctor there's a young man in the waiting room come to visit his mother let's cut his throat take five of his organs and save five lives anything well we should do that it's exactly the same exactly the same and if you don't like blood if you don't like blood rig up believer that you pull that does something that cuts his throat take his organs say five people how come in the case of the train you told me to pull the lever kill one person to save fight in the case of the people in the hospital you said no they're exactly the same foreign