Reprinted with permission from Medicine and Jewish Law, edited by Fred Rosner and published by Jason Aronson Publishers.
The main talmudic text dealing with the question of the determination of the moment of death is the following: “If a building collapses on a person [on the Sabbath]…they [may] dig to remove the rubble from him [to try to save his life]…but if he is dead, they leave him there [until after the Sabbath because it is forbidden to dig on the Sabbath]. How far does one check [to determine whether or not he is dead]? Until his nostrils; and some say, until his heart” (Tractate Yoma 85a). This ruling to check the nostrils to determine life or death is codified in Jewish law. The Talmud continues: “Rabbi Pappa said that the disagreement is when one examines from below to above, but [when] from above to below—since he examined him until his nostrils—he need [examine] no more” (Yoma 85a). This ruling is explicitly stated by Rabbi Joseph Karo in his Shulchan Aruch (a foundational Jewish legal code).
Maimonides states: “And when one comes to his nostrils and does not find any breath in him, then one may not dig any more, since he is undoubtedly dead.” Rabbi Shlomo ben Yitzchak, known as Rashi, similarly writes: “And if there is no vitality in his nostrils in that one does not find any wind [i.e., breath], he is undoubtedly dead, and [if it is on the Sabbath] one leaves him.” Rashi and Maimonides take pains to stress that in the absence of breathing the person is undoubtedly dead; one must leave him, and it is prohibited to dig any further on the Sabbath, even though any doubt regarding the saving of life overrides the Sabbath. Neither Rashi nor Maimonides, while interpreting the opinion that considers the sign of absent respiration from the nostrils as halakhically valid (i.e., valid according to Jewish law), mentions the heart as a criterion for determining death.
The talmudic text thus contains a disagreement as to which organ’s cessation determines the fact of death. According to one opinion, death is determined by observing the nostrils (i.e., respiration), and according to the other, by listening for the heartbeat. This latter version, however, is cited by only a very few talmudic commentators. However, the Jerusalem Talmud (Yerushalmi Yoma 8e) and most early talmudic commentators (rishonim) substitute the word navel for heart. Rabbi Moses ben Simon Margoliot, known as Penei Moshe, explains that even the rabbis who adopt the textual reading of “navel” are of the opinion that breathing is the decisive sign, and that the navel provides a sign similar to that of the nostrils. The examination of the navel refers to diaphragmatic breathing, which is perceived near the navel. Nonetheless, even the version “until his heart” is not in accordance with the final halakhic ruling, which is “until his nostrils.” Furthermore, according to the opinion of Rav Pappa, and to halakha, there is no disagreement over what is to be done when the rescuer first encounters the victim’s head in the rubble of the collapsed building; he is to remove the rubble until the victim’s nostrils are visible. If the heart is decisive in determining the moment of death, why did the talmudic sages not obligate the rescuer to remove rubble until the heart? And how did Maimonides determine that if there is no breath in the nostrils, he is “undoubtedly” dead?