Medical Halacha (Law) -  One Ventilator, Two Patients

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By Ira Somers on July 4, 2011 -- 5:56pm

One ventilator, 2 patients.
Rabbi Akiva Tatz from simpletoremember.com

The scenario: ER in Johannasburg: Young surgeon working in emergency room. Hospital Policy: you may not use a ventilator on a patient who is considered to be non-salvageable, i.e. mortally wounded. You must make do with other technology. WHY: In case you get another patient who needs the machine and you try to remove it from the first patient, the family might loudly object. (This was not a Jewish hospital.)

Jewish Law: If the first patient is put on the machine, then you can’t take him off it because that would be like killing the patient, regardless if it was to save someone else. So: If you put Person A on the machine and another patient comes whom the ventilator will save, you can’t switch.

In this hospital, it’s guaranteed that another patient (Jewish) will come in and need the machine within 1-3 hours. There is no doubt that another Jewish patient will come in and need the ventilator.
Question: Is the doctor obligated to follow the hospital’s instruction and not put Person A on the ventilator? Or must he ignore the rule and put Person A on the ventilator knowing statistically that another person will come in and need the ventilator? 

Two people who are equally ill, you treat the one who is closer. Two people who are equidistant from you, both are injured and in the same critical condition but one has another condition which is terminal, like a tumor, you treat the one without the tumor. 

When you pass over a life to save another, the one requirement is that it’s for a real person you’re saving. It’s called L’faneinu. This allows us to transgress almost all of Torah if we’re saving a life.

Post-mortem autopsies are against Jewish law if it’s to save a life in the future, ie let’s see how this disease spread to help others in the future. But it is okay if it will save a person right now.

If a person in the hospital has a disease that nobody has ever seen and the person starts flashing yellow stripes and then dies, you can’t open him up to find out why. But if a person in the next bed starts flashing yellow stripes, then you can open the first to find out how to save the living person. There has to be a real person who can be saved, that’s lifaneinu.

L’faneinu does not mean geographically right in front of you.  Nodiv (?) Yehuda of Prague says that it means there is a real, present person somewhere. A real live individual whose life might be saved.

8:00 am somebody wheeled into hospital, you see they’re not going to survive. You have this new machine that can prolong his life. You decide to hook him up but then somebody salvageable is wheeled in who needs it. Is that l’faneinu? Yes, you hook the second person up and not the first.
Scenario 2: Person comes into the hospital who is not going to survive but the machine can prolong his life. Then you get a call from an ambulance that is 10 minutes away with somebody who’s life the machine can save. Is that lfnaneinu? Yes
Scenario 3: Person comes into the hospital who is not going to survive but the machine can prolong his life. Then you get a call from a helipcopter that is 30 minutes away with somebody who’s life the machine can save. Is that l’faneinu? Yes
Scenario 4: Same situation except now, there is a statistical guarantee that in an hour or two or three, somebody will be brought in who the machine will save his life. Is that l’faneinu?

L’faneinu means you need a real person. So from experience working at this busy hospital, the doctor knows that there is a person eating breakfast right now who will soon step in front of a car or something and be brought to this hospital. Is a statistical l’faneinu l’faneinu? If you say it is not, use the machine on the first patient. If you say it is, wait for the second person.
The Rav who was consulted said it is l’faneinu and to wait for the second person. However, this rav later asked 2 others and got these answers:
1.  You treat the first person because it’s not l’faneinu.
2.  You attach a 30-minute timer with bell and after 30 minutes, the machine turns off and the bell rings. If the second person is not there, you restart the machine and the timer until it goes off again. If another patient arrives, when the bell goes off you switch the ventilator to him.

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