(Vol. LXXVII, 1967, pp. 78-81)
QUESTION: The USSR for thirty-five years has been using the blood of the recently deceased for the benefit of patients who need transfusions. This blood is usable for transfusions for up to three months; then the plasma can be extracted and frozen and be good for five years. What is the attitude of Jewish legal tradition to this procedure?
ANSWER: From the point of view of Jewish legal tradition, which in many ways expresses Jewish ethical feelings, there are many objections to this procedure insofar as it applies to the bodies of deceased Jews and insofar as the blood is to be used for the benefit of Jewish patients. The objections are as follows:
1. The blood is deemed an integral part of the body, and it is a duty to bury the entire body of the deceased, including the blood. Thus, if a body of a murdered man or a slain soldier is found with his blood soaked into the earth around him or into his clothes, the blood-soaked objects must be buried with the body.
2. It is forbidden for the living to derive any benefit from the bodies of the dead. This objection is often applied to the planned use of cornea and bone from a bone bank, etc.
3. It is especially forbidden by Jewish law to eat blood. This is a Biblical prohibition and is the reason for the thorough soaking and salting of meat before it may be eaten.
The first legal principle concerning the duty of burying the entire body--limbs, eyes, blood, etc.-- applies as a general rule. However, if it is demonstrable that certain parts of the body are a remedy for a sick person who is in grave danger, then the necessities for healing would constitute an exception, as it also constitutes an exception to point 2 above, namely, not to have any benefit from a dead body. It is, therefore, necessary to go into the question of the legal status of healing, as to what may be used for healing the sick.
The laws are based upon the verse Leviticus 18:5: "Observe My commandments which a man shall do and live by them." From this verse the conclusion was drawn that whenever life is endangered, the rule is that the ritual and Sabbath laws are suspended (in fact, all laws are suspended, except those involving idolatry, murder, and immorality). In this spirit, the long chain of legal tradition is finally codified in the Shulchan Aruch, Yoreh De-a 155. There the law can be generally stated as follows: If a patient is not dangerously sick, he may use anything which is forbidden by Rabbinic law (i.e., by secondary laws), except idolatrous spells, etc. If a patient, however, is dangerously sick, then he may use even things prohibited by Biblical law (which is primary). Thus, the principle is that anything at any time may be used for the benefit of a patient who is gravely sick. The Sabbath must be violated in his behalf, food must be given to him on Yom Kippur, and all forbidden foods are permitted to him. But if he is not gravely sick, these permissions are, as has been mentioned, somewhat restricted.
How this works out can be seen in a responsum of Judah Lev Zirelson, the famous rabbi of Kishinev (Lev Yehuda, #45). He was asked the question: What should one do when the doctor recommends for a patient with anemia to eat liver (which is full of blood) cooked in butter? (Here, then, there are two prohibitions: the blood itself and the meat with butter). He answers: "If the patient has an ordinary tendency to anemia, the doctor should be asked whether there are not other more acceptable remedies, but if it is pernicious anemia, then the patient not only may take the remedy, i.e., the blood and the meat with butter, but it is his duty to take it, since the saving of life is primary."
More specifically with regard to the use of blood is the responsum of Jacob Reischer, Rabbi of Metz (16th-17th centuries). He says that the people of his community use as a remedy for various sicknesses (not necessarily grave ones) dried goat's blood, and he says that this is permissible because the blood has been so dried up that it has become like another substance. A similar responsum, and more modern, is by David Hoffman, the great German legal authority of the past generation (Melamed Leho-il, Yoreh De-a 34). He was asked whether a man may take medicine made from blood which has been chemically broken up and is in a new form. He answered that the blood may be used, since it has now been so changed that it can be considered as another substance.
There was a number of secondary elements involved in the question. First, there is the long discussion in the legal literature as to whether the prohibition of getting benefit from a dead body is to be deemed a special restriction applying only to the bodies of Jews (for whose burial there are other special requirements, i.e., Jewish cemeteries, shrouds, etc.), or whether the prohibition of benefiting from a dead body also applies to the bodies of non-Jews. At least half of the authorities say that this is only a special Jewish requirement, like other special religious requirements that apply only to Jewish bodies. Since, therefore, the overwhelming majority of bodies would not be those of Jews, this special religious prohibition of "benefiting from the dead body" would not generally apply.
An additional special consideration involves the method by which the material is taken into the body of the patient. The law makes a distinction between "the way things are enjoyed" ("kederech hana-atan") and "the way things are not enjoyed" (cf. Yoreh De-a 155.3). If, for example, forbidden food is given to a patient in a way that he enjoys it as food, it would be frowned upon. But if it is taken in a way that there is no enjoyment, it is permissible. A transfusion of blood involves no direct eating or enjoyment from eating and is therefore permissible as far as that consideration is concerned.
Of course, the special difficulties in this question are due to the procedure practiced in the USSR with bodies of the dead. If it were not for that fact, it would be a rather simple problem. A well-known Orthodox authority, the late Hillel Posek of Tel Aviv, editor of the rabbinic magazine Haposek (in #96-97, ninth year, responsum 1082), gives a general and unrestricted permission to blood transfusions. He says that in the first place, the prohibition against the consumption of blood is essentially a prohibition against eating the blood of cattle or birds; it does not apply to the blood of fish or any other animals, including man. Of course, because it may seem like forbidden blood, then if a person's teeth or gums are injured and some blood appears on the bread he is eating, he may not eat that bread; but that is only because of the appearance of the blood. However, the unseen blood (that may be sucked from the gums and swallowed) is not forbidden. This law is clearly stated in the Shulchan Aruch, Yoreh De-a 66.10. Maggid Mishnah (Don Vidal), in his commentary to Maimonides' laws of forbidden foods (2, #3), says that such blood is absolutely permitted.
Then Hillel Posek comments further that whatever prohibition there is, is only a prohibition because of appearance--that the blood looks like forbidden animal blood, hence it may not be eaten or swallowed, as the legal phrase is, "in the way of enjoyment." But if the blood is inserted in the veins, etc.--which is not by way of enjoyment--there is no prohibition at all against this procedure, even with regard to sick people who are not in danger. But this general permission applies to blood taken from living people. Hillel Posek had not known--as the present writer did not know--of the practice of the USSR of taking the blood from the dead; hence, the limitations which are mentioned above.
To sum up, the general attitude of Jewish law would be as follows. There would be some hesitation about using the blood from Jewish bodies because of the special requirements with regard to their burial and the prohibition against benefiting from them. But this is only a general hesitation, because it is overridden by the outright permission to use any valuable remedy for a patient who is in danger. For such a patient the blood can be used. If the patient is not in danger, then the blood plasma--which changes the appearance of the blood and its original form--may be used.
Solomon B. Freehof