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Q&A

Can a terminally-ill patient give up his ventilator to save another?

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Last week I took a class on priorities in triage -- one ventilator, two people who will die without it, who gets it? We reviewed sources in talmud and later commentaries, some of which I remember from a class on self-driving cars and how they should be programmed in the case of impending accidents. The class then turned to two modern opinions.

R' Moshe Feinstein in Iggerot Moshe HM II:73 says, essentially, first come, first served, and once you have allocated a bed to one patient, even if he is terminally ill, you can't then reallocate it to somebody who is otherwise healthy and would live many years but for the immediate condition. (It sounds like he means even before you've hooked the person up to the ventilator -- you've just given him a bed so far.) R' Manashe Klein, on the other hand, in Responsa Mishneh Halakhot XVII:175, seems to be saying that you can take the terminally-ill person off of the ventilator in order to give it to someone healthier. He wrote this in response to a question from a doctor at a hospital that had the policy of not giving the ventilator (of which they had only one) to terminally-ill patients to begin with, lest a healthier person come in later and they would be unable to move it. If I am understanding correctly, R' Klein says that it is in fact permissible to remove the ventilator from the first person in order to give it to the second, and furthermore that a hospital can establish this as a condition of receiving treatment in the first place (that you must agree to this). I assume (but do not know) that he permits removal because it's passive, removing aid, and his fate at that point is in the hands of Heaven.

My question is about a patient in a hospital following R' Klein's policy. R' Feinstein says that the (first) patient has no obligation, "and perhaps he is even forbidden", to save the other patient's life at the cost of his own. According to R' Feinstein, the terminally-ill person might not be allowed to waive his right to treatment once started, though the text I have doesn't source that supposition. The class I took didn't take up this point.

Is a terminally-ill patient permitted to cede care he is already receiving to allow it to be applied to someone else (who is not terminally ill), as R' Klein indicates, or is he not, as R' Feinstein alludes to? What are the applicable sources?

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