Autopsies and Dissection
AUTOPSIES AND DISSECTION.
Respect for the dead, and the utmost reverence for the human body after death are enjoined by both Jewish law and custom. The rabbis deduce the prohibition of the desecration of the corpse (nivvul ha-met) as well as the duty of the reverent disposal of the body by burial as soon as possible after death from Deuteronomy 21:22, 23. Mutilation of the body, whether for anatomical dissection or for post-mortem examination, would appear to violate the respect due to the dead and is consequently to be forbidden. Reverence for the corpse (kevod ha-met) must yield, however, to the superior value of life and its preservation. In fact, the duty of saving and maintaining life (*pikku'aḥ nefesh), which includes even cases of a doubtful nature, overrides all but three commandments of the Torah. Hence the question of the permissibility of the dissection of human bodies for the study of medicine, and of autopsies for the purpose of establishing the cause of death and for the development of medical research revolves therefore round the interpretations of the two principles: nivvul ha-met and pikku'aḥ nefesh. For while any tampering with the corpse comes under the former category and is therefore prohibited, it can be argued that as a result of dissections and autopsies the lives of others can be saved or prolonged, and hence the prohibition of nivvul ha-met would be overridden by the prime commandment of pikku'aḥ nefesh.
In the Bible there would appear to be two clear instances of the dissection of the body of a deceased person: the embalming of Jacob (Gen. 50:2–3) and of his son Joseph (ibid., 26). According to all evidence the process of *embalming as practiced by the ancient Egyptians consisted of disemboweling the body and filling the cavity with certain unguents. The view was put forward in a question addressed to Ezekiel *Landau (see below), that this act should be permitted since it was performed out of the principle of respect for the dead, and what is done out of respect for the dead cannot be considered as nivvul ha-met, which is essentially disrespect for the dead. This principle is explicitly laid down in the Talmud to justify certain cases of postponement of burial so that proper respect may be shown to the dead (Sanh. 47a), and it has been advanced again as an argument in favor of permitting autopsies.
In the Talmud there are two noteworthy references to the possibility of autopsies, each for different reasons. One (Ḥul. 11b) clearly states that an autopsy may be performed on the victim of a murder in order to establish whether he was viable at the time of the assault. Were he not, no charge of murder could be laid against the assailant. This case would come within the framework of permissibility of pikku'aḥ nefesh. Such a consideration, however, does not apply to the second instance. The question was raised, in an actual incident, whether the corpse of a boy could be exhumed for examination to ascertain whether he was a major or a minor at the time of death, the question of the disposition of an estate being involved. In this case the exhumation was forbidden, but only because it would have had to be performed by relatives, who stood in a special category with regard to the deceased, and because of the possibility of changes having taken place in the corpse after burial, thus rendering the examination inconclusive. The whole discussion, however, suggests the possibility of the examination of a body for reasons not connected with pikku'aḥ nefesh (bb 154a–b). There are in the Talmud various instances of the dissection of human bodies for anatomical research (cf., e.g., Bek. 45a), but in all these instances it would appear that the corpses of non-Jews were employed.
It was not until the 18th century, when human bodies began to be used systematically for medical research as a regular practice, that the permissibility of autopsies for medical research and saving lives became a practical question of halakhah. A query addressed from London to Ezekiel Landau, of Prague, inquired as to the possibility of performing an autopsy on the body of a Jew, in order to reveal the cause of death and thus find a cure for others suffering from the same malady. The questioner gave his reasons for permitting this, citing, inter alia, the embalming of Jacob. Landau dismissed his arguments but conceded that, should there be at the time of death, in the same hospital, another patient suffering from the same symptoms, so that the autopsy could immediately help, it could be permitted on the grounds of pikku'aḥ nefesh. Strictly limited though this permission was, it was the first clear, recorded ruling permitting autopsies in the interest of the living, and all subsequent discussions on the subject have used it as their starting point (responsa Nodabi-Yhudah, Mahadurah Tinyana, yd 310).
The problem became an acute and practical one with the establishment of the Medical School of the Hebrew University in Jerusalem. It was obvious that bodies would have to be made available for the study of anatomy and that the cause of medical research would necessitate autopsies. Chief Rabbi A.Y. *Kook, usually liberal in his approach, entirely forbade the use of Jewish bodies for such purposes (Da'at Kohen, 199), but in 1944, his successor, Rabbi I.H. *Herzog, and Ẓevi Pesaḥ *Frank, chief rabbi of Jerusalem, reached an agreement with Dr. H. Yasski on behalf of the Hadassah Hospital, permitting autopsies in the following cases: (1) when the civil law demanded it in cases of crime and accidental death; (2) to establish the cause of death when it was doubtful; (3) in order to save lives; and (4) in cases of hereditary disease. The authority to perform such autopsies was made conditional upon the signatures of three doctors. All organs dissected were to be handed over for burial after the necessary examinations had been performed. This agreement was the basis for the Law of Anatomy and Pathology passed by the Knesset in 1953.
The Sephardi Chief Rabbi B.M. *Ouziel devoted two responsa to the halakhic basis of the question (Mishpetei Uziel (1935), 1:28 and 29; cf. 11 (1952), no. 110). Arguing that dissection of the body for anatomical study and autopsies in the interests of the advancement of medicine did not constitute nivvul ha-met, Ouziel ruled that "the essence of the prohibition of nivvul ha-met is that it refers specifically to cases where there is a deliberate intention to desecrate a body or to treat it with disrespect without any advantage to others. Whenever others can benefit, however, and most certainly when there is a possibility of thereby saving life, the prohibition does not apply. Anyone with a knowledge of the development and progress of medicine will not for a moment doubt the benefits which accrue from autopsies and dissections. Autopsies are of inestimable value in establishing the cause of the ailment and its effect upon other organs of the body. In addition, where the preservation of life and the interests of the living are concerned, there is neither nivvul ha-met nor desecration of the body."
Other rabbinic authorities (e.g., Rabbi I. *Jakobovits), taking modern developments into account, suggest that autopsies, especially in cases of heart disease and cancer, not only belong to the category of pikku'aḥ nefesh in a general way, but are even sometimes imperative, especially in connection with determining the effects of new medicines. "As it is the duty of the rabbi to prevent autopsies where no pikku'aḥ nefesh is involved, so is it his duty to insist on it where there is the slightest possibility of it being of benefit" (R. Isaac Arieli, in: Torah she-be-al Peh (1964), 66).
In 1965, following allegations of widespread abuse of the safeguards contained in the Law of Anatomy and Pathology, certain Orthodox circles in Israel agitated to have the law amended by reverting to the strictly limited permission given by Ezekiel Landau. A ruling to this effect was issued under the signatures of the two chief rabbis (Y. *Nissim and I.Y. *Unterman) and the heads of yeshivot.
Although from the halakhic point of view the objections that apply to autopsies also apply to dissection for the purpose of anatomical study, enough people bequeath their bodies for this purpose so that the religious opposition has been confined largely to autopsies, despite the fact that the halakhic permission for such bequests is doubtful. Similarly, there has been a universal consensus of opinion permitting autopsies in the case of violent or accidental death or where crime is suspected. In such cases the talmudic precedents quoted above would apply. Most of those who oppose autopsies made an exception in the case of corneal transplants which restore sight to a blind person. In this specific instance Rabbi Unterman stated that the deceased would consider it an honor for his eye to be used for such a purpose, thus overcoming the prohibition of nivvul ha-met., In the same responsum, Rabbi Unterman put forward the interesting view that an organ from a deceased person is "revived" when successfully grafted on to a living person and ceases to be regarded as part of a corpse. Though resistance to transplants remains widespread, there has been a tendency to greater leniency, as in the case of heart transplants where the position has shifted from total opposition to conditional consent.
M. Greiber, Nittu'aḥ Metim le-Ẓorkhei Limmud ve-Ḥakirah (1943); I. Jakobovits, Jewish Medical Ethics (1956), 144–56; idem, Jewish Law Faces Modern Problems (1965); I.Y. Unterman, Shevet mi-Yhudah (1945), 317–22; Torah she-be-Al Peh (Proceedings from the Sixth Annual Conference on Oral Law, 1964), 39–73, 81–86; K. Kahana, Nittuḥei Metim ba-Halakhah (1967), bibliography of Hebrew works.
[Louis Isaac Rabinowitz]