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THE DETROIT JEWISH NEWS

46 Friday, January 24, 1986

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HOTEL MIAMI BEACH

When Medicine And
Jewish Law Clash

The dispute in Israel is over performing
autopsieS and organ transplants

BY NEHEMIA MEYERS

Israeli Correspondent

"There is no reason for a clash
between medicine and Jewish
Law," says Dr. Mordechai
Halperin, an M.D., Ph.D. and or-
dained rabbi who heads the
Schlesinger Institute for Medi-
cal-Religious Research at Jeru-
salem's Orthodox-oriented
Sha'arei Zedek Hospital.
Perhaps Halperin is right in
\ -theory, but a clash does exist,
particularly in regard to, autop-
9 / - -
sies and transplants.
Jewish religious w holds
that the body of ead person
must be treated with utmost re-
spect, must be buried quickly
and in its entirety and, finally,
must not be exploited. All these
factors mean that an autopsy,
says Dr. Halperin, cannot be
performed unless there is a
reasonable and immediate pro-
spect that it will result in the
saving of human life.
Dr. Halperin is of the opinion
that not only religion, but also
civil rights are involved in this
issue. "After all," he argues,
"just as a persep's body belongs
to him while heAs still alive, it
Should not become public pro-
perty when he dies.
Halperin does not believe that
the dissection of cadavers is still.
essential in the 20th century for
the training of medical students
or that autopsies are always nec-
essary in order to ascertain
whether a physician has diag-
nosed a particular illness cor-
rectly. "In any case," Halperin
holds, "many autopsies are per-
formed only to supply data for
scientific papers."
At his own hospital, autopsies
are few and far between, per-
haps no more than 10 or 20 a
year, though post mortem biop-
sies are permissible and quite
common. Each full-scale autop-
sy done at Sha'arei Zedek, inci-
dentally, requires the approval
of both a senior physician and
the hospital's rabbi.
Autopsies at most other med-
ical institutions are not nearly
as rare, but they have substan-
tially declined in number since
the passage of the Anatomy and
PathologyLaw in 1981 (a result
of pressure from the religious
parties). Before that time the
authorization of three doctors
was sufficient for an autopsy to
be performed. Now it must be
approved in writing by the next
of kin and can be blocked — no
matter what the next of kin may
say — by almost any relative,
even a distant cousin. As a re-
sult, autopsies are performed on
an average of only 10% of the
deceased, and in Jerusalem hos-
pitals, where Orthodox pressure
is greatest, the percentage is
even lower.
This decline is particularly
significant where medical
schools are concerned, says
Prof. Hahn Lichtig,. who teaches
pathology at the Haifa Tech-
nion's Faculty of Medicine.

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"Prior to the passage of the
law," he notes, "fourth-year
students participated in bet-
ween six and seven autopsies a
year; last term, however, they
did not participate in a single
one. And whether a student
later becomes a. general practi-
tioner, surgeon or researcher,
textbooks, photographs and
tests on preserved organs are
poor compensation-for the real
thing."
Pathologists here admit that
Israel is not the only country
where the number of autopsies
has dropped in recent years; the
U.S., for one, has experienced a
similar trend, though in hospi-
tals there, on the average, twice

The dispute in
Israel is over
performing
autopsies and organ
transplants.

as many post mortems are per-
formed as at Israeli medical in-
stitutions, Also it should be
mentioned that the debline in
the United States stems primar-
ily from economic factors, (post
mortems are expensive and
don't bring in income to a hos-
pital) rather than religious ones.
Israeli pathologists like Dr.
Nina Hurwitz of Kaplan Hospi-
tal continue to stress the impor-
tance of autopsies as a means of
"quality control" in medicine.
For while opponents of autop-
sies argue that new diagnostic
aids like the CAT Scanner lessen
diagnostic errors, she points out
that the percentage of discrep-
ancy between clinical and path-
ological diagnosis has, in fact,
not changed in the last 40 years.
Moreover, Dr. Hurwitz de-
clares, post mortem biopsies are
an inadequate substitute for a
complete autopsy.
. Turning to a related issue, the
Kaplan Hospital pathologist
emphasizes the importance of
autopsies in throwing light on
new forms of old diseases (influ-
enced by modern drugs) and on
entirely new diseases like AIDS.
Problems also arise from the
viewpoint of. Jewish law where
the removal of organs for trans-
plants is concerned, says Dr.
Mordechai Halperin of Sha'arei
Zedek. For instance, organs are
sometimes removed from a per-
son's body when he has a flat '
EEG ("brain death"), even while ,
his heart is still beating. Jewish
law, he explains, holds this to be
equivalent to "murder" because
there are cases where patients
with a flat EEG have subse-
quently recovered.
"As a rabbi." he adds, "I
would agree with removing a
liver for transplant purposes