Trump's Shabbat Proclamation and America's Founding Promise
5 min read
12 min read
12 min view
5 min read
7 min read
Should we end of the life of one to save the other, or let both die?
In the 1970s a couple from New Jersey gave birth to conjoined twins (Siamese twins) who shared the same heart and other vital organs. If the twins would remain connected, the heart would not be able to support life for both of them and they would both eventually die. However, if the twins were surgically separated, the doctors concluded that one could survive while the other would die immediately. Thus, one of the most vexing questions in Jewish medical ethics was born. Should we remain passive and allow both twins to perish or should we be proactive and end the life of the weaker twin prematurely in order to save the other?
The question was brought to the greatest Torah scholar of the day, Rabbi Moshe Feinstein, a brilliant and exceedingly humble man who lived on Manhattan’s Lower East Side. After careful consideration, Rabbi Feinstein ruled that the twins should be separated since the long-term survival of one twin takes precedence over the life of the other. This bold ruling has been studied by Torah scholars all over the world ever since. In this article we will present an overview of the basis for this ruling.
The Talmud discusses a scenario of maternal-fetal distress during labor and differentiates if the baby was considered ‘born’ or not. If the head of the baby has not emerged, then the mother’s life takes precedence and may be terminated in order to save the mother. However, if the head already emerged, then both lives are equal and we cannot favor one over the other.
When Maimonides (Laws of Murder, 1:9) codifies this ruling, he explains it based on the concept of ‘rodef’, one who is pursuing another person to murder him. The Torah law is that the life of the pursued takes precedence over the life of the pursuer even if the pursuer is a minor. Based on this, Maimonides explains that the unborn fetus is considered a pursuer by endangering the mother’s life. Therefore, we may terminate its life in order to save the life of the mother. However, when the fetus is considered ‘born’ we cannot use the concept of ‘pursuer’ anymore because this is a natural phenomenon.
Many scholars are puzzled by the seemingly contradictory logic of Maimonides. Maimonides considers the unborn fetus to be a ‘pursuer’ and it is therefore permissible to terminate its life, but when the fetus is considered ‘born’ it is not deemed a pursuer. If a ‘born’ fetus endangering its mother’s life is considered a natural phenomenon and not a pursuer, then why is it considered a ‘pursuer’ when it’s unborn? Why is being born or unborn the criteria to determine whether the fetus is a pursuer? Aren’t these two lines of reasoning unrelated?
Rabbi Feinstein gave a fascinating analysis (Igros Moshe YD 2:60). He reasoned that in truth, the mother and fetus are both considered pursuers as they are each endangering the other’s life. So really it should be a stalemate. What would break the tie? If there is a reason to view one as a greater pursuer.
When the fetus is not considered ‘born’, its life does not have the full significance of a human life. Therefore, because the unborn fetus is pursuing a life more significant than its own, it is a greater pursuer than the mother who is pursuing the life of an unborn fetus, which is less of a life than her own. In short, while both mother and fetus are pursuers, the fetus is doing a greater act of pursual than the mother.
However, once the fetus is considered born then its life is equal to that of the mother’s, as such, both pursuers are equal and it is a stalemate and we cannot actively favor one life over the other.
The concept of determining the status of a pursuer relative to the significance of the life being pursued, was the primary basis of Rabbi Feinstein’s ruling regarding conjoined twins. The twins are both viewed as pursuers, each one endangering the other’s survival, albeit unintentionally. If both twins would have the same chance of survival if separated, then it would be a stalemate and we should not get involved. However, if one is stronger and more developed, it has a greater chance of survival and is being hampered by the weaker twin. As such, the weaker twin is considered a greater pursuer than the stronger one, as the weaker one is pursuing a full life whereas the stronger one is pursuing less of a life than its own. As such, it is permitted to end the life of the weaker twin in order to save the stronger one.
Another explanation goes as follows (See Bad Kodesh #52). The Talmud (Bava Metzia 62a) asks, if two people are traveling in the desert and one of them only has enough water for himself, must he share it with his friend, even though both will die of thirst, “he should not see the demise of his friend”? The Talmud contends that the owner of the water’s life takes precedence. He should drink his water and allow the other to perish. The ruling of the Talmud is understandable: a person is not obligated to proactively give up his limited supply of water and risk his own life for his friend.
The diver is not suffocating his friend, he is simply saving himself with something that is rightfully his. It is not an act of murder but a rightful act of self-preservation.
Let us now consider the following scenario: two buddies go diving together, each with their oxygen tanks. Deep underwater, one diver’s oxygen tank fails and in desperation he grabs the mouthpiece of his fellow diver. Can the diver take back his own mouthpiece? Can he actively put his own life ahead of the other diver? An important argument could be made: The diver is not suffocating his friend, he is simply saving himself with something that is rightfully his. It is not an act of murder but a rightful act of self-preservation.1
In this story of the conjoined twins, they shared a six-ventricle heart, unlike the normal human heart which has four ventricles. It seemed from the anatomical structure of the double heart, that the four ventricles belonged to stronger twin, and it was fused with the underdeveloped two ventricle heart of the weaker twin. According to this, in essence the weaker twin was ‘using’ the heart of the stronger twin to survive.
As such, the question of separating the weaker twin from the stronger twin is similar to the case of the divers. Just as we do not view the act of taking back one’s rightful mouthpiece as an act murder but an act of self-preservation, so too the act of separating the weaker twin from the stronger twin is not murder but preventing the weaker twin from using a heart that doesn’t belong to him.
In summation, there are two rationales to allow the separation of the twins: fist, the weaker twin is considered a pursuer because he is endangering a life greater than his own. Second, the weaker twin is using a heart that doesn’t belong to him, so the act of separating is not an act of murder but of legitimate self-preservation.
May God create every child healthy and well so these conundrums can remain only theoretical.
I believe this decision had to be made by former Surgeon General Everett Koop and the parties involved were Jewish. The cut was made by him and one life was saved. Though a devout Christian the family had Rabbis in it whom he consulted.
If the weaker twin can be considered the greater rodef because it is pursuing a life greater than its own, why would the same not apply to the mother of the baby whose head just emerged? This baby is clearly a weaker life form than the mother.
Or conversely, if the only-head-born baby is NOT considered less of a life form, surely this case cannot be used when discussing the conjoined twins, one of which is weaker but both of which are fully born?
Nice summation of this complicated issue. I looked up your reference in Igros Moshe (YD 2:60) and did not see the teshuva. Are you sure that's right?
The teshuva is discussing a different question dating back to when Rav Moshe was still in Russia. However, his son, Rav Dovid zt"l, told me that this was his primary rationale in the case of the conjoined twins that took place years later.
Your missile example reminded me of a different question: You are the engineer of a train. Ahead of you are three people tied to the tracks, but you can divert the train where only one person is tied to the tracks. Do you do nothing, letting 3 die, or take action, and 1 dies?
Most would say 1 dies, 3 live. But what if that 1 person was your mother ?
while the conclusion is clear enough, the arguments seem to be founded more on twisting a precedent to fit, than on plainly considering the facts.
there is no “rodef” in the case of two babies, who neither asked to be born, nor to be conjoined. the example of sharing water or air is closer, but still, there is no intention on the part of either baby, so it isn’t a question of who “deserves” to be saved.
based on competent medical knowledge, which is better than it was in rambam’s day, or even rav feinstein’s, if you do nothing, they both die, and only if you save the stronger twin will one of them have a chance to live.
it’s a sad decision, but it is to “choose life”, as best we can.
In the instance of the 6 ventricles it is being assumed that the stronger twin was the owner of four ventricles when it is not knowable and possible four belonged to the weaker twin.
The decision belongs with the parents after receiving all facts, both religious, and medical.
It is also assumed that if both twins remained conjoined that they would die instantly at the same time, but this is unlikely to ever be true, even if we are talking about just seconds of separation between deaths. Here in lies the leaning towards recognizing each twin, even when conjoined, as separate souls.
This should be the motivation to humanely give each twin their "own" life, even if it means one twin must leave this earth early.
Stay safe. Be well.
As a practical matter, if the second twin would die seconds after the first, it would likely be medically impossible to intervene and remove the dead twin before the living twin succumbed. Obviously, each case is different and requires a discussion between the family, medical team, halachic authority, and attorneys.
The comment is not advocating to have the twins remain conjoined.
Thank you for writing such a clear and interesting article.