Answers Beyond Death: A Jewish Ethical and Legal Analysis of Conducting Autopsies Today

Abstract

In lieu of an abstract, here is a brief excerpt of the content: When doctors tell relatives of the deceased that the “cause of death” is unknown and an autopsy must be performed, these relatives often turn to their rabbi seeking guidance. The automatic response may be to encourage the family to try to avert the procedure, but that advice comes with a series of attendant, if generally unspoken, no’s. No, they cannot learn why their loved one died. No, they cannot be at peace, knowing that it was not a rare disease that others in their family might have. No, they cannot have a medical answer to provide for all of those “How did he die?” shivah scenarios. Is there any room in Judaism today to permit conducting an autopsy? Taken one step further, can performing an autopsy be considered an ethical act? An autopsy is not a pleasant procedure. Just the initial description of the lengthy step-by-step protocol in Finkbeiner, Ursell, and Davis’ Autopsy Pathology: a Manual and Atlas give a sense of the graphic examination: After you have completed the external examination, place a block under the shoulders to extend the neck . . . The incision is roughly Y-shaped and most easily made with a sharp scalpel. It begins at the shoulders, anterior to the acromial processes and sparing the top of the shoulders. The upper limbs of the incision penetrate to the ribs and meet at the level of the xiphoid process . . . We prefer to direct the upper limb incision medial to the breasts, believing that this results in less chance of fluids inadvertently leaking from the closed body after the autopsy. 1 No wonder Maurice Lamm, in his book The Jewish Way in Death and Mourning, half-encouraged his readers to skip his own chapter on the topic. 2 Nevertheless, a review of the literature documenting such protocols is a must. Both Manual and Atlas and The Jewish Way in Death and Mourning are helpful to understand autopsies with precision, in order that we may perform an accurate ethical and legal analysis of the status of the autopsy in the view of Judaism. Many people have a strong negative visceral reaction to the idea of an autopsy. Even from the description above, we visualize a gory post-mortem surgery—a surgery that regards the body as a scientific objective and no longer human. Relatives of the deceased often experience denial and shock, even in the moments following a long-awaited and anticipated death. It is during those moments that medical professionals raise the question or suggestion of autopsy. In some cases, when the cause of death is unknown, there may be a secular legal mandate for said autopsy, providing little room for thought or discussion. Regardless, post-mortem surgical procedures on our beloved are implicitly off-putting, especially when the procedure is generally known throughout the bereaved community as a result of popular culture, particularly televison. A decision as to whether or not an autopsy is ethical and halakhically permitted necessitates a conversation about the sanctity of life. In Judaism specifically, life is most precious. Because the body is a vessel for life, we honor and respect this vessel even after death with as much care as we would give to a living person. However, with regard to autopsies, there are two opposite and separate trajectories of sanctity-of-life arguments. First, one may argue that performing an autopsy is a noble, honorable act because it has the sanctity of life as its catalyst: one might be saving a life by performing an autopsy. 3 Different discoveries and new evidence gleaned from the autopsy could prevent future early deaths of both relatives and other patients with similar conditions. The other argument is diametrically opposed to the first: performing the autopsy is a direct affront to the sanctity of life; the vessel that held life is no longer treated as sacred when it is ready and open to the examiner’s scalpel. There are three potential Jewish ethical and legal difficulties with performing...