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New York - Halachic Analysis: The Case Of Home's Refusal To Give CPR And The Noahide Laws

Published on: March 8, 2013 10:45 AM
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Shown is the main gate of Glenwood Gardens in Bakersfield, Calif., Monday March 4, 2013, where an elderly woman died after a nurse refused to perform CPR on her last week. The central California retirement home is defending one of its nurses who refused pleas by a 911 operator to perform CPR on an elderly woman, who later died. "Is there anybody that's willing to help this lady and not let her die," dispatcher Tracey Halvorson says on a 911 tape released by the Bakersfield Fire Department aired by several media outlets. (AP Photo/Gosia Wozniacka)New York - It is a case of mind-boggling immorality. The official policy of the “Glenwood Gardens” retirement home in Bakersfield, California, is that staff, even trained medical staff, may not engage in the saving of human life. Yes, you read correctly.

This immoral, depraved, and decadent policy may have resulted in the death of an 87-year-old retiree, when a nurse at that facility refused to give a woman CPR. Lorraine Bayless collapsed on Tuesday last week in the dining room of the Glenwood Gardens facility and was barely breathing. The nurse called 911 for help. She explained to the dispatcher that it was against the facility’s policy for staff to give CPR. The heroic dispatcher pleaded, “It’s a human being!” according to the 911 tape released by the Bakersfield Fire Department and aired by dozens of media outlets.

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911 dispatcher Tracey Halvorson continued her plea: “Is there anybody that’s willing to help this lady and not let her die?”

“Um, not at this time,” was the horrific response of the facility’s nurse. Bayless, 87, was declared dead at Mercy Southwest Hospital later that night.

The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse and his facility’s morally depraved policy. “In the event of a health emergency at this independent living community our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives,” Toomer wrote in a statement released to the media. “That is the protocol we followed.”

Glenwood Gardens is a subsidiary of Brookdale Senior Living, which operates long-term-care facilities in 36 states. Worse yet, the tape reveals that the nurse actually complained to someone else about the dispatcher’s moralization. “She’s yelling at me,” referring to dispatcher Halvorson, “and saying we have to have one of our residents perform CPR. I’m feeling stressed, and I’m not going to do that—make that call.” The dispatcher then asked the nurse if she was going to let the woman die. The nurse responded, “That’s why we called 911.”

All this brings up the question: Is there a halachic and moral obligation incumbent upon all humanity to save human life?

The answer is that the Torah obligates non-Jews to follow a set of halachic guidelines, known as the Seven Laws of Noah.

The Sefer HaChinuch points out that these are not just seven individual laws, but seven categories of laws. The Seven Laws are found in the Tosefta to Tractate Avodah Zarah (9:4) and are cited in the Babylonian Talmud (Sanhedrin 56a). They are (1) the obligation to believe in G‑d; (2) the prohibition against murder; (3) the prohibition against theft; (4) the prohibition against adultery and similar forms of immorality; (5) the prohibition against cursing G‑d; (6) the prohibition of the cruelty to animals involved in eating flesh from a live animal; and (7) the obligation to establish a just court of law to enforce the laws.

As mentioned earlier, these seven laws are categories, and the obligation to save the life of another person is a subcategory of the law against murder. The Talmud (Sanhedrin 72b) explains the moral obligation of defending the life of a victim from one who is pursuing him. There it states that the Torah obligates one to save the life of the victim—even if it may cause the death of the (potential) murderer pursuing that victim. This law and the associated verse—Bereishis 9:6, „שֹׁפֵךְ דַּם הָאָדָם בָּאָדָם דָּמו יִשָּׁפֵךְ כִּי בְּצֶלֶם אֱלֹקִים עָשָׂה אֶת־הָאָדָם“ —apply to non-Jews as well as Jews.

Since the obligation to save is even when it may cause the death of the pursuer, certainly, there is an obligation to save under other circumstances. Furthermore, Rabbi Dovid Parro in his monumental work Chasdei Dovid on the Tosefta writes (Korbanos 13:1) that each of the seven Noachide laws has an associated positive commandment, and the positive commandment of the law against murder is the obligation to save human life. The Chasdei Dovid writes, however, that one who neglects this obligation does not incur the death penalty.

How obligatory is the mitzvah of saving a life? The Netziv in his He’Emek Sheilah (Sh’lach 129:4) writes that a person is obligated to undergo any difficulty in the world to save the life of another. The Pischei Teshuvah (Y.D. 157:15) cites a debate between the Maharam Rikanti and the Radbaz as to whether one is obligated to sacrifice a limb to save another. The conclusion is like the view of the Radbaz that there is no obligation to do so.

What if the saving of the other’s life will incur an expense? Is there an obligation? Although the Yad Rama and Chavvos Yair seem to indicate that the obligation under such circumstances is similar to the view of the Radbaz, Rav Chaim Kanievsky in the work Mishnas Pikuach Nefesh (page 186) compiled by Rabbi Aryeh Lorenz (son of the late R’ Shlomo Lorenz) writes that there is an obligation of spending 20 percent of one’s financial holdings under such circumstances.

Applying all of this to the Glenwood Gardens nurse, let’s ask the following question: What if she could expect to be fired from her job if she chose to ignore the immoral policy of her employer? Would she still have had the obligation to save the life of the woman? Although technically one can answer that if losing her job would be greater than a loss of 20 percent of her assets she would be exempt, there are times when we must ignore the technical obligations and do what is right and proper. The Glenwood Gardens policy is horrifying and should be changed immediately. The moral fiber of this country is dependent upon the laws and policies that we implement—whether they be government policies or those of a corporation. At the same time, the actions of Tracey Halvorson, the 911 dispatcher, should be lauded and commended by anyone with the opportunity to do so.

he author can be reached at Yairhoffman2@gmail.com .



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Read Comments (39)  —  Post Yours »

1

 Mar 08, 2013 at 10:56 AM Anonymous Says:

this may be a shock to you but the official policy of the red cross is that if a patient is conscious you must get a verbal or any other kind of consent from them before treating them. even in a case of an emergency.

2

 Mar 08, 2013 at 11:04 AM kiri49 Says:

According to some; Sodom was not so barbaric, they just had lots of policies.

3

 Mar 08, 2013 at 11:06 AM DRE53 Says:

I understand the policy being in today's times where lawyers are out their to come up with ideas of how to sue.
A nurse isn't a licensed doctor and if somethingf goes wrong, the home will be sued and that's why they refrain from saving lives.
However, my question is: did the home clearly state there policy to all residents?

4

 Mar 08, 2013 at 11:14 AM sechelyoshor Says:

Maybe it's wiser not to air the halachos of this topic in public. If it were not for darchei sholom on Shabbos.... (fill in the rest of the sentence yourself)

5

 Mar 08, 2013 at 11:16 AM Wannashmooze Says:

Reply to #1  
Anonymous Says:

this may be a shock to you but the official policy of the red cross is that if a patient is conscious you must get a verbal or any other kind of consent from them before treating them. even in a case of an emergency.

False. Emergency situations have something called implied consent. Providers can care for patients within their scope of practice without consent in an emergency situation, even if the patient is conscious. I'm not sure what the red cross says, but that is the law.

This law applies to adults and children.

6

 Mar 08, 2013 at 11:32 AM Babishka Says:

CPR if done correctly breaks the ribs. My grandmother at 99 years old went into failure and in spite of a DNR, hospital techs performed CPR and broke all her ribs and then she died in horrible pain 2 weeks later.

7

 Mar 08, 2013 at 11:56 AM Truth Says:

Reply to #3  
DRE53 Says:

I understand the policy being in today's times where lawyers are out their to come up with ideas of how to sue.
A nurse isn't a licensed doctor and if somethingf goes wrong, the home will be sued and that's why they refrain from saving lives.
However, my question is: did the home clearly state there policy to all residents?

Yes, they did have such a policy.

8

 Mar 08, 2013 at 11:59 AM Truth Says:

Reply to #6  
Babishka Says:

CPR if done correctly breaks the ribs. My grandmother at 99 years old went into failure and in spite of a DNR, hospital techs performed CPR and broke all her ribs and then she died in horrible pain 2 weeks later.

They should have honored the DNR, but your case is the exception rather than the rule. CPR saves lives, even in elderly. You seem like the poster that I fought with this about in a different Frum website.

9

 Mar 08, 2013 at 11:59 AM AskNoah Says:

From the 7-Mitzvot halacha sefer "Sheva Mitzvot HaShem," Vol.. 2, Prohibition of Murder and Injury, Ch. 7: "It is an obligation on every [Gentile] person to save another person from bodily or life-threatening damage ... [a Gentile] is obligated to spend money to save another person with the assumption that it will be paid back." (English translation: "The Divine Code", 2nd Ed.). By Rav Moshe Weiner, Jerusalem.

10

 Mar 08, 2013 at 12:11 PM Norden Says:

It will doubtless come as a terrible shock to many Jewish geriatrics but "DNR" (do not resuscitate) policies are standard practice in hospices and optional in old people's homes.

Sorry, Babishka, but what (or where) is your authority for stating that "CPR if done correctly breaks the ribs", please? You usually are the most sensible correspondent here on VIN.

Shabat shalom (uberiah!) to everybody.

11

 Mar 08, 2013 at 12:12 PM Truth Says:

Reply to #6  
Babishka Says:

CPR if done correctly breaks the ribs. My grandmother at 99 years old went into failure and in spite of a DNR, hospital techs performed CPR and broke all her ribs and then she died in horrible pain 2 weeks later.

R' Hoffman -" It is a case of mind-boggling immorality."

It is, but this is what all independent living facilities in the US do. Your anger should not be directed at the facilities. You know why? Because the State Govs. in all the States including Yours have made laws regarding suing which by far are absurd. The companies have no choice, but to make such policies like this one, if they are to survive financially. I was always told, if you point a finger at s/o - four point back to you.
Maybe not you directly, but it's the public that voted in these State legislators.
To illustrate, here in Jersey, they just passed another law protecting Volunteer Ambulance services from being sued because they "Mean Well". Well if they understand this -how come all Medical personell aren't protected, just because they are paid - don't they "Mean Well" too? What does this have to with whether you are paid or Not?
Yes, I agree that the Gov. in our country has no regard to the 7 Mitzvos of Bnai Noach! Sorry, it has nothing to do with companies that work in the Medical field.

12

 Mar 08, 2013 at 12:14 PM ST Says:

Reply to #6  
Babishka Says:

CPR if done correctly breaks the ribs. My grandmother at 99 years old went into failure and in spite of a DNR, hospital techs performed CPR and broke all her ribs and then she died in horrible pain 2 weeks later.

This is not true, CPR if done correctly does NOT break any ribs.

If the PT did have a DNR, then it most be present, the fact that she had one back home does not take away the obligation from the hospital staff.

In fact, the laws encourage bystanders to do CPR on any person found in cardiac arrest.

Interesting that you are so upset about the hospital doing what they are here for, which is trying to save people lives.

13

 Mar 08, 2013 at 12:16 PM Anonymous Says:

Reply to #1  
Anonymous Says:

this may be a shock to you but the official policy of the red cross is that if a patient is conscious you must get a verbal or any other kind of consent from them before treating them. even in a case of an emergency.

This has nothing to do with the red cross, this is law all over.

If a person is alert and oriented, they should be able to make their own decisions, no one should be able to force anyone to accept any medical treatment.

14

 Mar 08, 2013 at 12:18 PM ST Says:

Reply to #10  
Norden Says:

It will doubtless come as a terrible shock to many Jewish geriatrics but "DNR" (do not resuscitate) policies are standard practice in hospices and optional in old people's homes.

Sorry, Babishka, but what (or where) is your authority for stating that "CPR if done correctly breaks the ribs", please? You usually are the most sensible correspondent here on VIN.

Shabat shalom (uberiah!) to everybody.

Why would this be a shock? anyone dealing with geriatrics knows this.

Most doctors will discuss this with an elderly patient. Jewish people usually discuss this with their rav as well.

15

 Mar 08, 2013 at 12:20 PM Anonymous Says:

Reply to #3  
DRE53 Says:

I understand the policy being in today's times where lawyers are out their to come up with ideas of how to sue.
A nurse isn't a licensed doctor and if somethingf goes wrong, the home will be sued and that's why they refrain from saving lives.
However, my question is: did the home clearly state there policy to all residents?

Also, I think that what this senseless nurse did, was not let the dispatcher talk to any of the residence or other employees.
If she is scared that she may lose her job for doing CPR, OK. However why not let some other caring person do it?

16

 Mar 08, 2013 at 12:45 PM Kzler Says:

Reply to #3  
DRE53 Says:

I understand the policy being in today's times where lawyers are out their to come up with ideas of how to sue.
A nurse isn't a licensed doctor and if somethingf goes wrong, the home will be sued and that's why they refrain from saving lives.
However, my question is: did the home clearly state there policy to all residents?

Their rules have been written to avoid liability nothing else and avoid litigation and the h'll with the person . Funny we are so concerned with the fate of the unborn.

17

 Mar 08, 2013 at 12:58 PM shredready Says:

Reply to #4  
sechelyoshor Says:

Maybe it's wiser not to air the halachos of this topic in public. If it were not for darchei sholom on Shabbos.... (fill in the rest of the sentence yourself)

it is no secret anymore that halacha is all over the internet for all see.

18

 Mar 08, 2013 at 01:04 PM Shlomo2 Says:

I believe that Rabbi Hoffman misunderstands the halachic obligations in this case, perhaps because, like many, he is not aware of the efficacy of CPR on the frail elderly.
Chest compression is extremely violent; in the elderly and frail, it cracks ribs already with the first compression. By the end, perhaps all the ribs and likely the sternum will be cracked.
SHould the patient survive (only a tiny percentage will, in the nursing home population), she will likely spend the rest of her life intubated and heavily sedated in the hospital, in agony with each breath.
There is a difference between treatment that effects a cure and one which does not. In the case at hand, the woman was dying of organ failure and will soon afterwards die again
One need not know the patient’s wishes, as the majority of normal people would not want this.
That is why the dying are permitted to decline painful surgeries that will not cure them, but only add to their pain as it prolongs their dying process.
I refer Rabbi Hoffman to “End of Life Issues in Halacha: DNR, Feeding Tubes, and Palliative Care
Rabbi Y. Dovid Kaye”
http://goo.gl/cdGdX

19

 Mar 08, 2013 at 01:20 PM Anonymous Says:

Correct me if I'm wrong but when CPR is necessary isn't the patient already unconcious? The argument regarding consent would then be a moot point.

20

 Mar 08, 2013 at 01:38 PM Not true? Says:

Reply to #12  
ST Says:

This is not true, CPR if done correctly does NOT break any ribs.

If the PT did have a DNR, then it most be present, the fact that she had one back home does not take away the obligation from the hospital staff.

In fact, the laws encourage bystanders to do CPR on any person found in cardiac arrest.

Interesting that you are so upset about the hospital doing what they are here for, which is trying to save people lives.

You're saying that the story she's telling about her grandmother is not true , that her grandmother's ribs were not cracked by CPR, and her grandmother did not die two weeks late in horrible pain?

Anyone who doubts this should Google CPR +frail +elderly.

21

 Mar 08, 2013 at 01:56 PM Anonymous Says:

I would be careful with this issue. I can infer that it is and obligation to donate organs to save lives, perhaps?

22

 Mar 08, 2013 at 02:21 PM DavidCohen Says:

The halachic discussion is an important one. But the outrage over this case is completely misplaced as the patient had signed a DNR as has now been confirmed by the family. Tying this conversation into mass hysteria does the subject a disservice.

23

 Mar 08, 2013 at 02:50 PM 5towner Says:

Actually there was no DNR signed as the institution readily admitted.

24

 Mar 08, 2013 at 03:08 PM JOTHEPROFESSOR Says:

Reply to #3  
DRE53 Says:

I understand the policy being in today's times where lawyers are out their to come up with ideas of how to sue.
A nurse isn't a licensed doctor and if somethingf goes wrong, the home will be sued and that's why they refrain from saving lives.
However, my question is: did the home clearly state there policy to all residents?

There is no liability in suchy a case; there are specific laws protecting people who render eme5rgency aid.

25

 Mar 08, 2013 at 04:13 PM Wannashmooze Says:

Reply to #12  
ST Says:

This is not true, CPR if done correctly does NOT break any ribs.

If the PT did have a DNR, then it most be present, the fact that she had one back home does not take away the obligation from the hospital staff.

In fact, the laws encourage bystanders to do CPR on any person found in cardiac arrest.

Interesting that you are so upset about the hospital doing what they are here for, which is trying to save people lives.

Wrong. Im a Doctor I have seen many cases where CPR was performed correctly and ribs were broken.

26

 Mar 08, 2013 at 05:24 PM ComeOn Says:

Reply to #8  
Truth Says:

They should have honored the DNR, but your case is the exception rather than the rule. CPR saves lives, even in elderly. You seem like the poster that I fought with this about in a different Frum website.

CPR in a non hospital setting is successful 5% of the time.
It is not as "life saving" as you may think. And before you say that it 100% saves the 5%, please remember that the victim had a DNR because even of the 5% that live, the elderly and frail ones are usually in severe pain due to broken ribs or other reasons.
The victim's family was thankful that the home did not try to revive her.

27

 Mar 08, 2013 at 11:07 PM RobertS Says:

We can argue mitzvot and Halacha all we want but it's moot because the goyim and writers of civil law do not feel obligated to keep any aspect of Jewish law. This is not EY; the majority here are goyim. You think this is a bad situation? Just wait for worse treatment under ObamaCare.

28

 Mar 09, 2013 at 07:14 PM Anonymous Says:

Reply to #8  
Truth Says:

They should have honored the DNR, but your case is the exception rather than the rule. CPR saves lives, even in elderly. You seem like the poster that I fought with this about in a different Frum website.

Unfortunately, it's not the exception. CPR has the potential to break ribs in a young person, kal v'chomer in an elderly woman (many of whom have brittle bones).

29

 Mar 09, 2013 at 07:20 PM 1ROYTOVOLAM Says:

who is roy tov

30

 Mar 09, 2013 at 07:24 PM Kzler Says:

Reply to #27  
RobertS Says:

We can argue mitzvot and Halacha all we want but it's moot because the goyim and writers of civil law do not feel obligated to keep any aspect of Jewish law. This is not EY; the majority here are goyim. You think this is a bad situation? Just wait for worse treatment under ObamaCare.

ObamaCare is decent and menschlich. Wait till Paul Ryan gets his claws into Medicare. The current inflation rate in medical care outpaces the national inflation and we are facing anticiatory instability in medical care because of Paul Ryan and his cohorts. Doctor's are reprimanded and dismissed from hospital staff because of not [producing enough admissions, [procedures are performed not for the benefit of the patient but for the profit margin of the hospital, procedures performed by incompetent doctors, ceiling on malpractice which leaves open the patient to unnecessary invasive procedures without fear of payment of damages. The salaries of hospital CEO is exorbitant, obscene and gained on the results of incurable ailments, inoperable cancer and malpractice. We suffer from an ethical decline it is not to save a patient but figured out by highly paid lawyers which is more important the life of a human or the liability incurred and halocha is as far away from it as the moon is from the earth. It is greed and again greed pure ands simple

31

 Mar 09, 2013 at 08:16 PM Shlomo-1 Says:

1) CPR may crack ribs even when practiced well
2) Many nursing homes and assisted living centers have policies in place to not routinely perform CPR. The survival rate is very, very low in that population and many have DNR orders in place.
3) The person involved was not a nurse.
4) CPR does not "save lives." It only buys time to get a defibrillator and then trained personnel to the scene.

32

 Mar 09, 2013 at 08:34 PM Kzler Says:

I was starved and taken to the SS Wache in Pelzer Hasag in Czenstochau beaten and resulted in broken ribs. Better broken ribs than tachrichim and 6 ft under

33

 Mar 09, 2013 at 10:13 PM Kzler Says:

Reply to #31  
Shlomo-1 Says:

1) CPR may crack ribs even when practiced well
2) Many nursing homes and assisted living centers have policies in place to not routinely perform CPR. The survival rate is very, very low in that population and many have DNR orders in place.
3) The person involved was not a nurse.
4) CPR does not "save lives." It only buys time to get a defibrillator and then trained personnel to the scene.

I daven in a stibl and there is a defribillator on the wall and someone who can use it. It depends on your outlook on human life and not your holiness

34

 Mar 10, 2013 at 12:07 AM lazerx Says:

shev v'al ta'aseh is different, states the gemora. Here the person did nothing. It is hard to believe that she would be chaiyev on this tragic death. However to claim she is a decent person, I would not claim this either.

35

 Mar 10, 2013 at 08:29 AM five townser Says:

The article said that she is not chayav - just that she was mechuyav to do it

36

 Mar 10, 2013 at 09:27 AM chavaz Says:

Something that has been overlooked in all the prior posts-You don't perform CPR on someone who is still breathing as it clearly said she was (on the 911 dispatcher's recording). What should have been done, if it was available, was to put oxygen on her and to position her with her upper body elevated. If someone has died, i.e. stopped breathing and no heart rate, one is not under any obligation to try and bring them "back". Also, isn't there a halacha that says if a person is near death you are not supposed to touch them in fear that you might hasten their demise?

37

 Mar 10, 2013 at 01:36 PM Truth Says:

Reply to #31  
Shlomo-1 Says:

1) CPR may crack ribs even when practiced well
2) Many nursing homes and assisted living centers have policies in place to not routinely perform CPR. The survival rate is very, very low in that population and many have DNR orders in place.
3) The person involved was not a nurse.
4) CPR does not "save lives." It only buys time to get a defibrillator and then trained personnel to the scene.

4. Not true. While a defib is important and needed in V. Tach & V. fib - CPR has been proven to save lives. I had an argument with a Shlomo on the other Frum site. Stop with your nonsense already.

38

 Mar 10, 2013 at 01:41 PM Truth Says:

Reply to #36  
chavaz Says:

Something that has been overlooked in all the prior posts-You don't perform CPR on someone who is still breathing as it clearly said she was (on the 911 dispatcher's recording). What should have been done, if it was available, was to put oxygen on her and to position her with her upper body elevated. If someone has died, i.e. stopped breathing and no heart rate, one is not under any obligation to try and bring them "back". Also, isn't there a halacha that says if a person is near death you are not supposed to touch them in fear that you might hasten their demise?

"If someone has died, i.e. stopped breathing and no heart rate, one is not under any obligation to try and bring them "back"."

Every Poisek that I know of holds that CPR is a Chiyuv of "Lo Saamod", even though they are clinically dead. Ever hear of something called "Megaleh Ponim B'torah Shelo K'halacha? If you make up your own Halachos it's called "Megaleh Ponim, etc."!

39

 Mar 10, 2013 at 05:28 PM pinay Says:

Reply to #21  
Anonymous Says:

I would be careful with this issue. I can infer that it is and obligation to donate organs to save lives, perhaps?

The issue with organ donation is that brain death does not equal halachic death and you cannot kill one to save another.

40

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