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Medical Awareness and Halacha: Is it Obligatory?

By BJLIfe/Rabbi Yair Hoffman

Posted on 02/15/18

Recently, a tragic loss has affected the Five Towns/Far Rockaway community in the passing away of a wonderful and remarkable person – Rabbi Yehuda Harbater z”l.  Rabbi Harbater was a beloved individual who was both a talmid chochom as well as a person who gave heart and soul to Yeshiva Darchei Torah – a Yeshiva that is close to everyone’s heart.  He performed his job beautifully, and the tragedy of his loss is felt by thousands.


His tragic passing was on account of something called “sepsis”, an illness and word that 40% of Americans have never heard of.  In his case, everything was done correctly and he was placed on anti-biotics as soon as possible.  However, regarding many other people who are at risk for this disease, more can certainly be done. 


What follows is a discussion as to whether or not we are halachically obligated to be medically aware.   But first a discussion of some very serious diseases.


Prostate cancer kills some 27,000 people a year.  Breast cancer kills some 41,000 a year.  AIDS death rates amount to some 6700 per year.  But more people die of sepsis each year in the United States than all three of these illnesses combined.  Every year in the United States, 270,000 people die from sepsis.  It is the eleventh leading cause of death in the United States, according to the Center for Disease Control.


There are two main areas where sepsis deaths and its effects can be minimized:  1] Raising awareness of sepsis so that it can be treated quickly and more effectively and 2] Reducing and preventing the infections tha lead to sepsis.


The CDC actually recommends family members of someone who is ill - to ask the following question to doctors:  “Could it be sepsis?”


Awareness of sepsis by both medical practitioners as well as family members can significantly reduce the mortality of this disease.  For every hour that treatment of sepsis is delayed, the mortality of the disease is increased by an astounding 8%.  As many as 80% of sepsis deaths could be prevented with rapid diagnosis and treatment.


PREVENTATIVE


Everyone, of course, is aware of the obligation to tend to medical needs.  Most of us have heard of the Mitzvah of “veNishmartem me’od b’nafshosaichem (Dvarim 4:9) – the Mitzvah of protecting our health and well-being. The question is what is the halachic obligation for taking preventative measures?  Are we obligated in both the concepts of medical awareness as well as prophylactic preventative measures?


I would like to suggest, based upon a number of sources that we, in fact, are.  This would be particularly true for the disease known as sepsis.  The general import of the Pasuk in Shmos 23:25 – vehasirosi machala mikirbecha – generally indicates that it is a good thing to have disease entirely removed from within our midst.  This point is made by the author of Siach Shaul (page 267) – who was a leading dayan in Eretz Yisroel and a student of Rav Isser Zalman Meltzer zt”l. 


The Igros Chazon Ish (Vol. I #136) writes:  When I am to myself, I calculate the natural hishtadlus in that which pertains to health as a Mitzvah and an obligation.”


We find regarding Yaakov Avinu (Bereishis 28:11) that he placed the stones around himself in a circle before he went to sleep.  Rashi explains that it was in order to protect himself against animals.  We therefore find that it is necessary to take protective measures. 


OTHER MITZVOS


Many people are unaware that there is actually more than the one Mitzvah of VeNishmartem.  There is also a not-so-well-known second Mitzvah.  The verse later on (Dvarim 4:15), “Rak hishamer lecha” is understood by most Poskim to actually comprise an actual second Mitzvah (See Rav Chaim Kanievsky Shlita in Shaar HaTeshuvos #25) – to take special care of one’s health. There is very often a third Mitzvah, “V’Chai Bahem - And you shall live by them” (VaYikra 18:5).


So we see that there are, in fact, three Mitzvos involved in the matter. 


SEPSIS – WHAT IS IT?


Essentially, sepsis is the immune system in the body over-reacting and attacking everything and anything – organ after organ, system after system.  It causes more damage to the body than it does to the underling infection.  Imagine, for example, instead of a sprinkler system in the house to put out a fire, the doorway to Niagara Falls opens up.


Doctors and researchers haven’t yet figure out what causes the over-reaction.  It is also very tough to identify at the outset.  Even top doctors often fail to see it in time.  This is because it looks like a normal illness when it first presents.  There is a fever, a high heart rate, low blood pressure, overall pain.


HOW TO DIAGNOSE IT


There is something called SIRS or the systemic inflammatory response syndrome – which is the most effective way to diagnose sepsis.  If two of any of the following four criterion apply to someone with an infection – evaluate immediately for sepsis and anti-biotic should be given within 180 miuntes.



  • If the body temperature is below 96 or above 100.

  • If the heart rate is above 90.

  • If the respiratory rate is above 20 per minute

  • If the white blood count is either below 4000 or above 12,000. 


A KOL KOREH ON SOMETHING THAT IS LESS OF AN ISSUE


There is also a fascinating issue in regard to this disease.  Colorectal cancer is a serious illness and many many people over the age of fifty make sure to get a colonoscopy every five years.  Not only is this the recommendation that every doctor makes to his or her patients, but the Gedolei Yisroel even signed a Kol Koreh to that effect two years ago.  That is correct – there is a halachic Kol Koreh that was signed by Gedolim to get colonoscopies every five years.


This author would like to suggest that since the Gedolei Yisroel signed a Kol Koreh about taking pre-emptive measures regarding colo-rectal cancer – certainly one should do so regarding an illness that kills people at ten times the rate of colo-rectal cancer.


WHAT MORE CAN BE DONE SPECIFICALLY


There is an Israeli company that has developed a rapid detection CBC – where the white blood count can be measured immediately – just like the testing strips of a diabetic.  If this can be pushed along that would go a long way in saving lives. 




The author can be reached at yairhoffman2@gmail.com