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|Life and Death Medical Decisions |

| By Rabbi Joshua Flug |

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About this Packet

This packet was designed to be used as a multi-part series. It contains four shiur outlines with all of the sources. In addition, we included the basic sources with English translations. There are four shiurim in this packet:

1) Shoot or Don't Shoot- All of the shiurim deal with the concept of rodef. This shiur introduces the concept of rodef in an interesting way. It discusses the case of someone who security forces identify as a possible terrorist but they are not sure. If they decide to neutralize this person and he turns out to be an innocent civilian, they will have killed an innocent person. On the other hand, inaction can potentially lead to catastrophe. What should they do? [Note: a shiur outline is being prepared on the ethics of the swine flu outbreak. Many of the same sources are relevant to the discussion about whether someone with a contagious disease has the status of rodef for the purpose of forcing him into quarantine. This would be a good alternative to introduce the rodef concept.]

2) Abortion- This shiur outline was already sent out in October, but it is an important part of this series. It presents the basic discussion about abortion and contrasts the dispute in Halacha with the current secular approach.

3) Siamese Twin Separation- This shiur outline discusses the case of two Siamese twins who share a vital organ. If the twins remain together, they will not be able to live very long. However, there is the possibility of separating them allowing one of them to live a potentially long life while sacrificing the other.

4) Fetal Reduction- This shiur is an interesting application of the discussion of the previous shiurim. A woman is pregnant with multiple fetuses and if one or more are not aborted, it is possible that she may lose all of the fetuses. This shiur requires some knowledge of the abortion discussion and the Siamese twin discussion. There is no sheet with the English translation of basic sources because the basic sources are contained in the previous shiurim.

Table of Contents

|Shoot or Don't Shoot Shiur Outline and Sources |Page 3 |

|Shoot or Don't Shoot Basic Sources With English |Page 9 |

|Abortion Shiur Outline and Sources |Page 11 |

|Abortion Basic Sources With English |Page 20 |

|Conjoined Twin Separation Shiur Outline and Sources |Page 22 |

|Conjoined Twin Separation Basic Sources With English |Page 27 |

|Shmuel II with English (The Story of Sheva ben Bichri) |Page 28 |

|Fetal Reduction Shiur Outline and Sources |Page 29 |

Shoot or Don't Shoot?

I. Introduction- This shiur introduces the concept of rodef in an interesting way. It discusses the case of someone who security forces identify as a possible terrorist but they are not sure. If they decide to neutralize this person and he turns out to be an innocent civilian, they will have killed an innocent person. On the other hand, inaction can potentially lead to catastrophe. What should they do?

II. The concept of Rodef (Mishna-Sanhedrin) {‏1}

a. The Gemara states that in ordinary situations it is prohibited to kill one person to save the life of another. In fact, this is one of the three cardinal transgression in which one must give up his own life and may not kill someone else to save his own life. {‏2}

b. R. Chaim Soloveitchik (1853-1918) notes that the one exception to this rule is a rodef. If one person is pursuing someone else and is trying to kill him, it is permissible to kill the rodef. {‏3} R. Moshe Sokolofsky (d. 1931, a talmid of R. Chaim Soloveitchik) explains that there are two reason why this is permissible: {‏‏4}

i. In order to save the victim

ii. Because this is one of the aveiros that one may disable the violator before he violates the aveirah.

c. There are a number of differences between neutralizing the rodef to save the victim and neutralizing the rodef to save the rodef from a serious aveirah:

i. The Gemara states that if a rodef breaks something in his pursuit, he does not have to pay for it because he is chayav misah through his pursuit and we can't impose on him a monetary payment in addition. This exemption stems only from the fact that neutralizing him is a function of saving him from preventing an aveirah. {‏5}

ii. Chiddushei HaRan (1320-1380)- The ideal way of killing haba b'machteres (which is based on rodef) is using a sword because he is chayav sayaf. If that is not possible, you can use any means possible. {‏6} The explanation is that killing the rodef as a function of him pursuing an aveirah is a form of chiyuv misah and therefore, one should kill him with the proper misah of sayaf. If that is not possible, there is still an obligation to save the victim.

iii. The Gemara discusses whether a rodef must receive hasra'ah. {‏7} This is only applicable vis-à-vis neutralizing him to prevent the aveirah. To save the victim you certainly don't need hasra'ah.

iv. R. Sokolosfky discusses a rodef who plans to kill his victim via gerama (e.g. he plans to plant a bomb in the victim's car). Because he is not chayav misah for killing via gerama, neutralizing him is only warranted because it is to save the victim.

v. The most relevant difference in the context of medical decisions is the comment of the Vilna Gaon (1720-1797) that someone can be considered a rodef even if he has absolutely no intent of endangering someone else. If we have to choose between two lives and one is endangering the other, we neutralize the one who is endangering in order to save the other. {‏8}

1. Sometimes it is not clear who is endangering whom. This will be discussed in the section on Siamese twin separation.

d. Is there a difference between the actual victim and the third party who is attempting to save the victim?

i. Rivash (R. Yitzchak ben Sheshes, 1326-1408)- The whole question of whether you have to warn the rodef is only regarding other people. The victim has no obligation to warn the rodef. {‏9}

ii. R. Yehuda Rosanes (1657-1727, Mishneh L'Melech)- It's possible that the requirement to use minimal force when taking out the rodef doesn't apply to the victim. He is permitted to kill the rodef, even when there is an option to neutralize him without killing him. {‏10}

iii. Perhaps the explanation of these two ideas is that in an ordinary situation of rodef, it is not necessarily clear that the rodef is really a rodef. Perhaps he is really the one saving another victim from this person who appears to us as the victim. Therefore, we should try to warn him and we can't neutralize him lethally if there is another means of neutralizing him. However, the victim knows the whole story and that the rodef is a real rodef. Therefore, he doesn't need to warn, nor does he need to calculate how to neutralize him.

III. Safek rodef

a. There are a number of situations where it is not clear that the rodef is really a rodef:

i. Israeli security agents have faced numerous cases of a suspicious individual who may be a terrorist or may just be someone who is deranged. If you neutralize this person, you may be killing an innocent civilian. If you don't neutralize this person, he may end up reaking havoc, G-d forbid. What should one do?

ii. A rodef is pursuing someone with intent to kill, but it is not clear whether he will be successful in his pursuit. Is it still permissible to neutralize the rodef?

iii. According to the Acharonim that only allow abortion when the fetus is considered a rodef (see the shiur on abortion), what is the halacha in a situation where we are not sure if the fetus is a health risk to the mother?

b. There are two approaches to this question:

i. R. Yitzchak Shor (d. 1776)- One can argue that in principle, you can't choose one life over another. The only exception is when one of them is classified as a rodef. If you can't certainly classify him as a rodef, you return to the original principle that you can't choose one life over another. {‏11}

1. R. Chaim Ozer Grodzenski (1863-1940) adopts this position. {‏12}

2. R. Moshe Feinstein (1895-1986) has a similar position requiring "karov l'vaday" in order to abort a fetus that potentially threatens the life of the mother. {‏13}

ii. R. Yosef Babad (1801-1874, Minchas Chinuch)- One can argue that the mitzvah of saving a life already incorporates the concept of saving a life by neutralizing a life and therefore, the same way you can violate Shabbos to save a life, even when there are doubts involved, you can also violate lo sirtzach in order to save someone from a rodef, even when there are doubts involved. Minchas Chinuch writes that anyone who commits an act of negligence would be considered a rodef for these purposes. {‏14}

1. According to Minchas Chinuch, you could only treat a safek rodef as a rodef in situations similar to case 2 where the person is clearly out to cause harm but we are not sure of his ability to succeed.

2. R. Shmuel Vosner (b.1913) rules that a safek rodef is considered a rodef in a case of a fetus who may cause harm to the mother. Obviously, there is no negligence involved. {‏15}

3. R. Shlomo Zalman Auerbach (1910-1995)- The discussion about safek rodef is explicit in the sugya regarding haba b'machteres: {‏17}

a. The Gemara states that if there is any doubt as to whether the ganav is prepared to kill you, you may kill him. The only case where there is no doubt is when a son finds his father in the machteres. {‏16}

b. Since haba b'machteres is based on rodef, one must conclude that in any case of safek rodef, you are allowed to neutralize the rodef.

c. This case is clearly one where we don't know his intent. However, one can argue that there is negligence in getting into the machteres.

4. R. Tzvi Yehuda Kook (1891-1982)- You can't learn from haba b'machteres because the Torah specifically categorized him as a rodef. Regarding an ordinary rodef, the only time you can potentially categorize him as a rodef is when he has definite intentions to kill but you are not sure if he will succeed. {‏18}

1. מש' סנהדרין עג.

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2. סנהדרין עד.

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3. חידושי רבינו חיים הלוי הל' רוצח:א:ט

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4. אמרי משה ל:ט הגה

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5. סנהדרין עד.

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6. חידושי הרי"ן סנהדרין עב.

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7. סנהדרין עב:

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8. רמ"א וביאור הגר"א חו"מ ס' תכה

רמ"א סע' א: מי שמסכן רבים, כגון שעוסק בזיופים במקום שהמלכיות מקפידות דינו כרודף ומותר למסרו למלכות.

ביאור הגר"א ס"ק יא: מי שמכסן רבים- אע"פ שאין כוונתו לסכן.

9. ריב"ש ס' רלח

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10. משנה למלך הל' חובל ומזיק ח:יא

דהא דאמר דאם יכולין להציל באחד מאבריו של רודף שאין הורגין אותו שדין זה לא נאמר אלא באיש אחר הבא להציל אבל הנרדף אינו מדקדק בזה.

11. שו"ת כח שור א:כ

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12. אחיעזר ג:עב

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13. אגרות משה חו"מ ב:סט

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14. מנחת חינוך ס' רצו

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15. שו"ת שבט הלוי ה:קצג

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16. סנהדרין עב.-עב:

תנו רבנן אין לו דמים אם זרחה השמש עליו וכי השמש עליו בלבד זרחה אלא אם ברור לך הדבר כשמש שאין לו שלום עמך הרגהו ואם לאו אל תהרגהו תניא אידך אם זרחה השמש עליו דמים לו וכי השמש עליו בלבד זרחה אלא אם ברור לך כשמש שיש לו שלום עמך אל תהרגהו ואם לאו הרגהו קשיא סתמא אסתמא לא קשיא כאן באב על הבן כאן בבן על האב אמר רב כל דאתי עלאי במחתרתא קטילנא ליה לבר מרב חנינא בר שילא מאי טעמא אילימא משום דצדיק הוא הא קאתי במחתרתא אלא משום דקים לי בגוויה דמרחם עלי כרחם אב על הבן.

17. מנחת שלמה קמא ס' ז

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18. דעת כהן השמטות לס' פד

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1.

2. Sanhedrin 73a

The following people are saved (from transgression) by killing them: One who is pursuing another in order to kill him.

19. Sanhedrin 74a

What is the source for the prohibition against murdering someone in order to save one's own life? It is logical as we find in the case of the individual who appeared before Rabbah and said "The Mayor of the city told me that I must go and kill a certain individual and if I don't do so, I will be killed. Rabbah responded "Let them kill you and do not kill someone else. Who is to say that your blood is redder than the other individual? Maybe his blood is redder than yours."

20. R. Moshe Sokolosky (Rosh Yeshiva of Brisk d. 1931) Imrei Moshe 30:9

One can query regarding the permissibility to kill a pursuer: Is it because he has the status of someone who is punishable by death as we find by other murderers after they commit the act? [This is to say that] the pursuer is considered punishable by death by virtue of his pursuit and it is permissible to kill him before the act of murder. Alternatively, is the reason why it is permissible to kill the pursuer only to save the victim? … [Based on the above presentation] it is clear that there are two laws that allow one to kill the pursuer. The first is to save the victim. The second is because the pursuer has the status of someone who is punishable by death.

21. R. Moshe Isserles (1520-1572), Choshen Mishpat 425:1 and Vilna Gaon (1720-1797)

Rama- One who endangers the lives of many people, for example, one who is involved in counterfeiting in a place where the government is strict, he has the status of a pursuer and one may report him to the authorities. Vilna Gaon- Even if he has no intent to endanger others.

22. R. Yitzchak Shor (d. 1776), Ko'ach Shor 1:20

Regarding the law of the pursuer that is mentioned in the Mishna, the Talmud and the Codes, it seems clear that one cannot kill the pursuer unless it is clear that the pursuer wants to kill the victim. If there is a doubt whether the pursuer intends to kill the victim, one cannot kill the pursuer based on this doubt … I can prove this point logically. Why should one assume that the Torah gave a punishment to the pursuer that is more stringent than any other transgression? Regarding any other transgression, there is no punishment if there is a doubt whether a transgression occurred.

23. R. Yosef Babad, Minchat Chinuch no. 296

Although murder is not permitted in order to save a life, it is nevertheless permissible to kill a pursuer in order to save the victim. We see that the Torah permitted murder in order to save a life when there is negligence involved as in the case of the pursuer. Therefore, this type of murder is permissible for the purpose of saving a life in the same manner that one may violate other transgressions in order to save a life. Accordingly, even if there is a doubt as to whether someone's life is in danger, if the pursuer is negligent, the Torah permits murder and there is no difference between certain danger and questionable danger.

Abortion

I. Introduction- This shiur will provide a Jewish perspective on abortion. We will see that the arguments in the secular world supporting and prohibiting abortion do not necessarily reflect the Jewish arguments supporting and prohibiting abortion.

II. The difference between Noachide law and Jewish law

a. Gemara Sanhedrin- Regarding the seven mitzvot for B'nei Noach, the Gemara derives that a non-Jew is culpable for murder if he performs an abortion. {‏1}

b. Mishna Niddah- If you kill a one day old child you are chayav misah. {‏2}

i. The clear implication is that before the child is born, there is no chiyuv misah.

ii. Ramban (1194-1270) states this explicitly. {‏3}

c. Tosafos- There is a principle that there is nothing prohibited to non-Jews that is permissible to Jews. Doesn't abortion seem to contradict this principle? Tosafos answer that although there is no chiyuv misah if a Jew performs an abortion, it is nevertheless prohibited. {‏4} Tosafos can be understood in two ways:

i. There is no chiyuv misah but there is an issur d'oraisa

ii. There is no issur d'oraisa for a Jew to perform an abortion.

III. Is Abortion a biblical prohibition or a rabbinic prohibition?

a. Ramban- The reason why you are not chayav misah for abortion is that the fetus is not considered a nefesh. Implies that there is no biblical prohibition against abortion. {‏3}

b. Ran (1320-1380)- cites the Mishna {‏5} that if a woman is chayeves misah, we don't delay the execution and we actually kill the fetus before killing her.

i. Ran states that if we followed the opinion ubar yerech imo, we can say that the fetus is also chayav misah as is every other limb of her body. However, Ran notes that even if one follows the opinion ubar lav yerech imo, one still kills the fetus and since it is not yet born we are not concerned [for any prohibition that may be involved]. {‏6}

c. Rashi (1040-1105)- The Gemara discusses whether the laws of rodef apply to a child who is pursuing. The Gemara cites the Mishna {‏7} that states that if a fetus is causing complications in the delivery one may terminate the pregnancy. However, once the head is delivered, one may not choose the life of the mother over the fetus. The Gemara asks: isn't the baby nevertheless considered a rodef? The Gemara answers that the baby was naturally placed in this position and therefore he is not considered a rodef. {‏8}

i. Rashi- Even though the fetus is also in a natural position of endangering the mother, the reason why one may kill the fetus is not because he is a rodef but because he is not a nefesh. {‏9}

d. Rambam (1135-1204)- Implies that the reason why you can kill the fetus in utero is that he is considered a rodef. {‏10}

i. The fact that it is necessary to classify him as a rodef implies that otherwise, it would be prohibited to kill the fetus, even though the mother's life is in danger. This indicates that abortion is tantamount to murder and is not considered a rabbinic violation. This in fact is the opinion of R. Chaim Soloveitchik (1853-1918) and R. Moshe Feinstein (1895-1986).

1. R. Akiva Eger's (1761-1837) question- the reason to allow killing the fetus can't be because of rodef because if he was a rodef, even after birth he would be considered a rodef. Rather, the reason must be because a fetus is not a nefesh. How can Rambam categorize the fetus as a rodef? {‏11}

2. R. Moshe {‏12}

a. The fact that a personal was naturally positioned as a rodef does not make him any less of a rodef. However, when he didn't create the situation and only one can live and not the other, each one is considered a rodef after the other.

b. When you normally have two people who are pursuing each other, you can't take sides because "who is to say that his blood is redder than the other's." This is why you can't choose the life of the mother over the child once his head emerged.

c. Nevertheless, when the fetus is in-utero, the fetus is pursuing the mother and the mother is pursuing the fetus. Since the mother is a full life and the fetus is not yet a nefesh, one can choose the mother over the fetus.

3. R. Chaim as explained by R. Isser Zalman Meltzer (1870-1953)-similar idea {‏13}

a. Rambam applies the concept of rodef to luggage on a ship that is going to capsize if some of the load is not thrown overboard. {‏14}

b. In that case, one must choose between the luggage or the people. We view each group as a rodef after the other and the people are chosen over the luggage.

c. Similarly, the mother is a rodef after the fetus and the fetus is a rodef after the mother. Since the fetus has a lesser status, the mother's life is chosen.

4. Based on R. Moshe's and R. Chaim's explanations, in reality, it is biblically prohibited to kill a fetus and the only time we do so is when we are told to choose the life of the mother over the fetus.

ii. The alternative interpretation of Rambam is to assume that even Rambam agrees that the aborting a fetus is not retzicha.

1. Rabbi Yehoshua Falk (1555-1614, S'ma) quotes Rambam verbatim. S'ma notes that the reason why one may not kill the child once his head comes out is that he is not considered a rodef. Nevertheless, before it comes out, one may kill the fetus because it is not yet a nefesh. {‏15}

a. It is clear that S'ma that Rambam holds that even if the fetus is not categorized as a rodef, it is still permissible to kill it.

b. One must then question why Rambam uses the term "k'rodef"

2. R. Tzvi Hirsch Bishko (1740-1807, Tiferes Tzvi explaining S'ma) {‏16}

a. S'ma seems to consider the loss of a fetus a monetary loss and not a loss of life.

b. It is permissible to steal in order to save a life as long as you repay the property owner.

c. In the case of the fetus, killing the fetus to save a life would not be permissible since there is no way to repay the "owner" of the fetus.

d. However, once you classify the fetus as a rodef, it is now permissible to kill the fetus the same way it is permissible to cause monetary loss to an object that is considered a rodef (and there is no obligation to repay).

3. Teshuvos Geonei Basrai (a collection of teshuvos from various Acharonim) {‏17}

a. In reality, even if the fetus is not a rodef, he can be killed because he is not a nefesh.

b. The only reason why Rambam categorizes him as a rodef is so that you can use any method of killing him and you do not have to choose the most pleasant means of killing him.

4. A variation on Teshuvos Geonei Basrai

a. Rambam's formulation of the Halacha seems to focus on the prohibition against having mercy on a rodef.

b. Perhaps Rambam agrees that even if the fetus is not classified as a rodef that you can kill it to save the mother.

c. However, the Rambam is warning those who want to let nature take its course and be passive on the matter that it is actually prohibited to have mercy on a rodef and since the fetus is not a nefesh, he is similar to the luggage and one may not have mercy on him.

e. The approach of R. Shneur Zalman Pradkin of Lublin (1830-1902, Toras Chesed) click here to access the entire teshuva)

i. The whole discussion is contingent on whether you hold ubar yerech imo or lav yerech imo. {‏18}

1. According to Ran (cited above), if you hold lav yerech imo, you have to assume that the fetus is not a nefesh because there is no other way to explain killing the fetus of a woman who is chayeves misah.

2. Rambam is of the opinion that ubar yerech imo {‏19} and therefore the only reason why you kill the fetus is that the fetus as an appendage also participated in the act that is punishable by death. Ordinarily you cannot consider it a non-nefesh for the purpose of killing it.

a. One must still question Rambam's classification of the fetus as a rodef. If the fetus is considered is an appendage of the mother it should be permissible to remove that appendage to save the rest of the body even if the "appendage" is not a rodef.

b. Toras Chesed suggests that the case is one where the woman is already on the birthing stool. As such, it is no longer considered an appendage of the mother because it began to move down the birth canal. If this fetus were not considered a rodef, it would be prohibited to kill it to save the mother.

ii. If you hold ubar lav yerech imo, you can kill the fetus when there is a strong reason to do so. If you hold yerech imo, you can only do so for the health of the mother. {‏20}

iii. Toras Chesed's approach seems to be the opposite of the current pro-life vs. pro choice debate:

1. The pro-life advocates argue that the fetus is an independent entity and therefore, abortion is tantamount to murder.

2. The pro-choice advocates argue that the fetus is a limb of the woman's body and she can make her own choice what she wants to do with that limb.

a. It's important to note that Roe V. Wade did not accept this argument completely because it did not recognize an absolute right to perform an abortion.

3. Why then is the Torah view (according to Toras Chesed) the exact opposite?

iv. Understanding Ubar yerech imo through the discussion about kaparos (we mentioned this piece in the shiur about kapraos)

1. R. Shimshon ben Tzadok (d. 1312)- A male uses a rooster and a female uses a chicken for kaparos. {‏21}

2. Maharil (c.1365-1427)- A pregnant woman should use two birds, one for her and one for the fetus. {‏22}

3. Rama (1520-1572)- The reason why she uses a second bird is that the fetus may be a male. Therefore, she takes a female bird for herself and a male bird for the fetus. {‏23}

4. This implies that if we know that the fetus is female, only one bird is required.

5. The Vilna Gaon (1720-1797) explains the opinion of Rama based on the concept of ubar yerech imo. {‏24}

a. The Vilna Gaon asserts that most Rishonim are of the opinion that it is considered an appendage of the woman.

6. One must add to the Vilna Gaon's explanation:

a. Ostensibly, one should reach the opposite conclusion:

i. If ubar lav yerech imo, it is its own entity and one should perform a separate set of kaparos on its behalf.

ii. If ubar yerech imo, the kaparos that the mother performs should encompass the "additional limb" in her body and no additional kaparos should be required.

b. Why then does the Vilna Gaon explain that Rama holds ubar yerech imo?

c. Additionally, why is the additional set required only if the fetus is male and not female?

d. One must conclude that ubar yerech imo doesn't just view the fetus as a limb. Rather, the fetus is its own entity that is piggybacking off of the life force of the mother. The mother is sharing her "nishmas chaim" with the fetus.

i. If the fetus is a male, the mother's neshama needs a male kaparah in addition to her female kaparah.

ii. If the fetus is a female, one set of kaparos is sufficient.

iii. If one assumes ubar lav yerech imo, no kaparos are required for the fetus because there is no neshama in the fetus and it is not piggybacking off of the mother's life force.

i. We can now appreciate why according to Toras Chesed, abortion is a more serious violation if you hold ubar yerech imo:

1. If you hold ubar yerech imo, there is an actual life that you are ending by performing abortion. You are severing the body from its nishmas chaim.

2. If you hold ubar lav yerech imo, the fetus has no nishmas chaim.

1. סנהדרין נז:

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24. נדה מג:-מד.

תנוקת בת יום אחד מטמאה בנדה בת י' ימים מטמאה בזיבה תנוק בן יום אחד מטמא בזיבה ומטמא בנגעים ומטמא בטמא מת ... וההורגו חייב.

25. רמב"ן נדה מד: והא

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26. תוס' סנהדרין נט. ד"ה ליכא

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27. מש' ערכין ז.

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28. הר"ן חולין יט. ד"ה ולענין

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29. אהלות ז:ו

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30. גמ' סנהדרין עב:

אמאי (כשיצא ראשו אין נגעין בו) רודף הוא שאני התם דמשמיא קא רדפי לה.

31. רש"י שם ד"ה יצא ראשו

יצא ראשו - באשה המקשה לילד ומסוכנת וקתני רישא החיה פושטת ידה וחותכתו ומוציאתו לאברים דכל זמן שלא יצא לאויר העולם לאו נפש הוא וניתן להורגו ולהציל את אמו אבל יצא ראשו אין נוגעים בו להורגו דהוה ליה כילוד ואין דוחין נפש מפני נפש ואם תאמר מעשה דשבע בן בכרי הנה ראשו מושלך אליך דדחו נפש מפני נפש התם משום דאפילו לא מסרוהו לו היה נהרג בעיר כשיתפשנה יואב והן נהרגין עמו אבל אם היה הוא ניצול אף על פי שהן נהרגין לא היו רשאין למסרו כדי להציל עצמן אי נמי משום דמורד במלכות הוה והכי מפרש לה בתוספתא.

32. רמב"ם הל' רוצח א:ח-ט

אחד מבושיו, ואחד כל דבר שיש בו סכנת נפשות, אחד האיש שאחז את האשה, ענין הכתוב שכל החושב להכות חבירו הכייה הממיתה אותו מצילין את הנרדף בכפו של רודף, ואם אינן יכולין מצילין אותו אף בנפשו, שנ' לא תחוס עינך. הרי זו מצות לא תעשה שלא לחוס על נפש הרודף. לפיכך הורו חכמים שהעוברה שהיא מקשה לילד מותר לחתוך העובר במיעיה בין בסם בין ביד מפני שהוא כרודף אחריה להורגה, ואם משהוציא ראשו אין נוגעין בו שאין דוחין נפש מפני נפש וזהו טבעו של עולם.

33. תוס' רבי עקיבא איגר למש' אהלות ז:ו

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34. אגרות משה יו"ד ב:ס

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35. אבן האזל הל' רוצח א:ט

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36. רמב"ם הל' חובל ומזיק ח:טו

ספינה שחשבה להשבר מעובד המשוי ועמד אחד מהן והקל ממשה להשליך לים פטור שהמשא שבה כמו רודף אחריהם להרגם ומצוה רבה עשה שהשליך והושיעם.

37. סמ"ע תכה:ח

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38. שו"ת תפארת צבי או"ח ס' יד

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39. תשובות גאוני בתראי ס' מה

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40. יבמות עח.

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41. רמב"ם הל' שחיטה יב:י

מותר לשחוט את המעוברת עובר ירך אמו הוא. ואם יצא העובר חי אחר שחיטה והפריס על גבי קרקע אין שוחטין אותו ביום אחד ואם שחט אינו לוקה.

42. תורת חסד אהע"ז ס' מב

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43. תשב"ץ קטן ס' קכה

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44. מהרי"ל הל' ערב יום הכיפורים ס' ב

אמהר"י סג"ל אשה מעוברת תקח שתי כפרות האחד בשביל העובר.

45. רמ"א או"ח תרה:א

ונוהגין ליקח תרנגול זכר לזכר, ולנקבה לוקחין תרנגולת (ב"י בשם תשב"ץ), ולוקחין למעוברת ב' תרנגולים אולי תלד זכר.

46. ביאור הגר"א או"ח תרה:א

דקיימא לן עובר ירך אמו הוא דרבי יוחנן דסבירא ליה בתמורה כ"ה א' עובר לאו ירך אמו הוא אתותב שם וכן הסוגי' בספ"ב דגיטין וכן ברפ"ה דב"ק פרה שהזיקה גובה מולדה מ"ט כו' וכן במתניתין דערכין ז' א' וע' רש"י שם ד"ה אין ממתינין כו' ובגמרא שם פשיטא גופה היא כו' ועיין תו' דב"ק מ"ז א' ד"ה מ"ט כו' וכ"פ הרא"ש שם ובת"ה נ"ג א' ובמשמר' הבית שם דלא כרא"ה ור"ת וע' תוס' דסנהדרין פ' ב' ד"ה עובר כו'. ומ"א כת' משום דשני גופים מתכפרים בכפרה אחת כמ"ש במנחות בכל הקרבנות לבד ממנחה שנא' נפש ואינו נרא' דלא דמי לנדבה.

1. Sanhedrin 57b

One who slaughters a man, by a man shall he be put to death. What is a man within a man? This is a fetus in his mother's womb.

47. Ramban (Nachmanides 1194-1270), Niddah 44b, s.v. VeHa

That which it states in the Mishna that one is culpable (for death) for killing a baby, that only applies to a one-day old baby. However, one is not culpable for a fetus because it is not considered a living person.

48. Tosafot, Sanhedrin 59a, s.v. Leka

Regarding (the termination of) fetuses where non-Jews are culpable and Jews are exempt, even though they are exempt from death, it is nevertheless prohibited.

49. Mishna Erchin 7a

If a (pregnant) woman is sentenced to death, we do not wait until she gives birth.

50. Ran (R. Nissim of Gerona c. 1320-1380), Chullin 19a, s.v. Ul'Inyan

That which it states in Tractate Erchin that a woman who is sentenced to death, we do not wait until she gives birth, this is not because we consider the fetus an extension of the mother, but rather since she is culpable for death, we don't delay her judgment and regarding the fetus, since he has not yet reached the outside world, we are not concerned (about him).

51. Mishna Ohalot 7:6

A woman who is having labor complications, one may cut the fetus in-utero and remove the fetus limb by limb because her life supersedes the life of the fetus. If majority of the fetus came out (some versions state "if his head came out), one may not touch him because one cannot choose one life over another.

52. Sanhedrin 72b

If his head came out, one may not touch him because one cannot choose one life over another. Why should this be? Isn't he considered a pursuer? This is different because he is in a natural disposition of endangering her life.

53. Rashi (1040-1105) ad loc., s.v. Yatza

Regarding a woman who is having labor complications and in danger, the beginning of the Mishna states that the midwife extends her hand and cuts (the fetus) and removes it limb by limb because as long as it has not entered the world, it is not considered a living person and one kill it in order to save the mother. However, once its head came out, it is considered fully born and one cannot choose one life over another.

54. Rambam (Maimonides 1135-1204)

Whether (she hits him) in his private area or any other place that can be life threatening, whether the striker is a man or a woman, the point of the verse is that anyone who intends to hit his friend a strike that can kill him, we save the victim by neutralizing the hand of the pursuer. If we can't save (by neutralizing the hand), we even save the victim with the life of the pursuer as it states "you shall have no pity." There is even a negative commandment prohibiting having mercy on the life of the pursuer. Therefore, the rabbis ruled that if a pregnant woman is having labor complications, it is permissible to cut the fetus in-utero -whether it is with a chemical or whether it is by hand- because the fetus is like a pursuer (who is pursuing) after her to kill her. And if this happens once his head comes out, one may not touch him because one cannot choose one life over another.

Conjoined Twin Separation

I. Background- Conjoined twins often share some vital organs Let's take the following case: "A pair of conjoined twins, A and B, in the ICU share certain vital organs including the heart. If there is no medical intervention, A will die within the next few weeks and will pull B down with her. There will be no possibility of saving B by this stage. If, on the other hand, doctors operate before A's demise, (re)allocating certain organs (including the heart) to B, then B will have some chance of surviving into old age. Obviously, A will die almost immediately." Source: Med Law Rev. 1997 Summer; 5(2):149-71. What should one do in this situation?

II. Are conjoined twins considered one entity or two entities?

a. The Gemara presents an interesting discussion about conjoined twins: {‏1}

i. Plimo asks what the Halacha is regarding tefillin for someone with two heads. Rebbe chastised him for asking such a ridiculous question.

ii. Someone then came to the Beis Medrash announcing that his wife just gave birth to a boy with two heads and he wanted to know how many selaim he must give for pidyon haben. The Gemara concludes that he must give ten selaim because pidyon haben depends on the gulgoles (skull).

1. One can understand that the conclusion of the Gemara is that we treat it as one person with two heads and that is the reason why you have to give two sets of pidyon haben.

2. It is possible that even you consider them two beings, you still give two sets of pidyon haben because the petiras rechem occurred on both of them.

iii. R. Ya'akov Reischer (1661-1733, Shevus Ya'akov)- When there are two distinct bodies and they are only attached at the head, they are certainly considered two beings. {‏2}

iv. If they are considered one being, it is much less problematic to separate them because it is similar to severing a limb in order to save the rest of the body.

III. Choosing to terminate one life in order to save the other

a. Ostensibly, you can never choose one life over another.

b. However the Tosefta has a more subtle approach to this issue: {‏3}

i. If there are a group of people and a terrorist demands to either turn over one person to be killed or he will kill the whole group, one may not turn anyone over.

ii. If they specify one person, as in the case of Sheva Ben Bichri {‏4‏0}, they can turn over that person.

iii. The Talmud Yerushalmi cites a dispute regarding the case where they specify one person: {‏5}

1. According to Reish Lakish the only case where it is permissible to turn over the individual is when that person is chayav misah.

a. According to R. Yochanan anytime that they specify one person, you can turn over that individual.

iv. Rashi questions the validity of handing over Sheva Ben Bichri: {‏6}

1. He initially suggests that the reason why they were allowed to hand him over was because he was going to be killed regardless of whether they handed him over.

2. He then suggests that the reason why they were allowed to hand over was because they specified him.

v. Halacha L'ma'aseh:

1. R. Yosef Karo (1488-1575) notes that we should follow R. Yochanan's opinion because we normally follow his opinion when he disputes Reish Lakish. He also cites Rabbeinu Shimshon (c. 1150-1230) and Ran (1320-1380) who rule in accordance with R. Yochanan. {‏7}

2. Rambam (1135-1204) follows Reish Lakish's opinion. {‏8}

3. Rama (1520-1572) seems to side with R. Yochanan's opinion but quotes Reish Lakish's opinion as a yesh omrim. {‏9}

c. The Analysis of R. Moshe Feinstein (1895-1986): {‏10}

i. Rav Moshe's original teshuva is about two shuls in Russia where under the threat of the government, one of them had to close down. In that teshuva, he analyzes the opinions of R. Yochanan and Reish Lakish and lays the groundwork for his more famous ruling regarding separation of conjoined twins.

ii. Why should the fact that one person is specified or chayav misah affect the rule that you can't kill one person to save another?

1. When there are two people in situations where only one of them can live, we don't view both of them as non-rodfim, rather each one is considered a rodef, albeit accidentally, after the other one.

2. Because each one is a rodef, we can't choose one arbitrarily over the other one.

3. However, if there is a legitimate way to choose between the two, you can choose one life over the other.

4. In the case of Sheva Ben Bichri, he was going to die regardless and if they didn't hand him over, they were going to die as well. Therefore, he was considered a rodef after their opportunity to live a long life and they were a rodef after his chayei sha'ah (the few moments longer that he would have lived if they didn't turn him over). Because their stakes were chayei olam and his stakes were chayei sha'ah, we can legitimately choose one over the other.

5. Reish Lakish agrees in principle to this explanation but does not allow the terrorist to choose one person arbitrarily. If the person that is singled out is not arbitrarily singled out, you can choose one over the other when they are on different levels.

d. Rav Moshe's psak regarding the conjoined twins

i. The facts as presented in Assia "Baby A and Baby B were joined from the shoulder to the pelvic area, sharing one liver and one six-chambered heart. The wall between the four essentially normal chambers belonging to Baby B and the stunted two-chamber heart belonging to Baby A was too thin to be divided; the twins, therefore, could not each be given a heart. Even if it were possible, a two-chambered heart could not have supported Baby A for long. In addition, Baby A had a circulatory defect that would eventually kill her. The doctors could only help Baby B, by giving her the entire six-chambered heart. This procedure would end the life of Baby A. On October 6, 1977, Rav Moshe Feinstein asked his son-in-law Rabbi Moshe D. Tendler to call the surgeon in charge of the case, Dr. C. Everett Koop, and instruct him to proceed with the surgery – in other words, to end the life of Baby A in a procedure that might save the life of Baby B." Source: .

ii. A more detailed exposition of the case can be found in Rabbi Tendler's article about the case: .

iii. Based on R. Moshe's previous teshuva, it makes sense that he permitted separating the twins at the expense of Baby A's life:

1. Baby A had no chance to survive long term regardless of any procedure. Baby B had a chance of long term survival.

2. As such, Baby A is a rodef after the chayei olam of Baby B, while Baby B is a rodef after the chayei sha'ah of Baby A.

3. This is similar to the case of Sheva ben Bichri and therefore, you can terminate the life of Baby A in order to prolong the life of Baby B.

1. מנחות לז.

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55. שבות יעקב א:ד

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56. תוספתא תרומות ז:כג

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57. שמואל ב פרק כ

(א) וְשָׁם נִקְרָא אִישׁ בְּלִיַּעַל וּשְׁמוֹ שֶׁבַע בֶּן בִּכְרִי אִישׁ יְמִינִי וַיִּתְקַע בַּשֹּׁפָר וַיֹּאמֶר אֵין לָנוּ חֵלֶק בְּדָוִד וְלֹא נַחֲלָה לָנוּ בְּבֶן יִשַׁי אִישׁ לְאֹהָלָיו יִשְׂרָאֵל: (ב) וַיַּעַל כָּל אִישׁ יִשְׂרָאֵל מֵאַחֲרֵי דָוִד אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי וְאִישׁ יְהוּדָה דָּבְקוּ בְמַלְכָּם מִן הַיַּרְדֵּן וְעַד יְרוּשָׁלִָם: (ג) וַיָּבֹא דָוִד אֶל בֵּיתוֹ יְרוּשָׁלִַם וַיִּקַּח הַמֶּלֶךְ אֵת עֶשֶׂר נָשִׁים פִּלַגְשִׁים אֲשֶׁר הִנִּיחַ לִשְׁמֹר הַבַּיִת וַיִּתְּנֵם בֵּית מִשְׁמֶרֶת וַיְכַלְכְּלֵם וַאֲלֵיהֶם לֹא בָא וַתִּהְיֶינָה צְרֻרוֹת עַד יוֹם מֻתָן אַלְמְנוּת חַיּוּת: (ד) וַיֹּאמֶר הַמֶּלֶךְ אֶל עֲמָשָׂא הַזְעֶק לִי אֶת אִישׁ יְהוּדָה שְׁלֹשֶׁת יָמִים וְאַתָּה פֹּה עֲמֹד: (ה) וַיֵּלֶךְ עֲמָשָׂא לְהַזְעִיק אֶת יְהוּדָה וַיּוֹחֶר מִן הַמּוֹעֵד אֲשֶׁר יְעָדוֹ: (ו) וַיֹּאמֶר דָּוִד אֶל אֲבִישַׁי עַתָּה יֵרַע לָנוּ שֶׁבַע בֶּן בִּכְרִי מִן אַבְשָׁלוֹם אַתָּה קַח אֶת עַבְדֵי אֲדֹנֶיךָ וּרְדֹף אַחֲרָיו פֶּן מָצָא לוֹ עָרִים בְּצֻרוֹת וְהִצִּיל עֵינֵנוּ: (ז) וַיֵּצְאוּ אַחֲרָיו אַנְשֵׁי יוֹאָב וְהַכְּרֵתִי וְהַפְּלֵתִי וְכָל הַגִּבֹּרִים וַיֵּצְאוּ מִירוּשָׁלִַם לִרְדֹּף אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי: (ח) הֵם עִם הָאֶבֶן הַגְּדוֹלָה אֲשֶׁר בְּגִבְעוֹן וַעֲמָשָׂא בָּא לִפְנֵיהֶם וְיוֹאָב חָגוּר מִדּוֹ לְבֻשׁוֹ ועלו וְעָלָיו חֲגוֹר חֶרֶב מְצֻמֶּדֶת עַל מָתְנָיו בְּתַעְרָהּ וְהוּא יָצָא וַתִּפֹּל: (ט) וַיֹּאמֶר יוֹאָב לַעֲמָשָׂא הֲשָׁלוֹם אַתָּה אָחִי וַתֹּחֶז יַד יְמִין יוֹאָב בִּזְקַן עֲמָשָׂא לִנְשָׁק לוֹ: (י) וַעֲמָשָׂא לֹא נִשְׁמַר בַּחֶרֶב אֲשֶׁר בְּיַד יוֹאָב וַיַּכֵּהוּ בָהּ אֶל הַחֹמֶשׁ וַיִּשְׁפֹּךְ מֵעָיו אַרְצָה וְלֹא שָׁנָה לוֹ וַיָּמֹת ס וְיוֹאָב וַאֲבִישַׁי אָחִיו רָדַף אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי: (יא) וְאִישׁ עָמַד עָלָיו מִנַּעֲרֵי יוֹאָב וַיֹּאמֶר מִי אֲשֶׁר חָפֵץ בְּיוֹאָב וּמִי אֲשֶׁר לְדָוִד אַחֲרֵי יוֹאָב: (יב) וַעֲמָשָׂא מִתְגֹּלֵל בַּדָּם בְּתוֹךְ הַמְסִלָּה וַיַּרְא הָאִישׁ כִּי עָמַד כָּל הָעָם וַיַּסֵּב אֶת עֲמָשָׂא מִן הַמְסִלָּה הַשָּׂדֶה וַיַּשְׁלֵךְ עָלָיו בֶּגֶד כַּאֲשֶׁר רָאָה כָּל הַבָּא עָלָיו וְעָמָד: (יג) כַּאֲשֶׁר הֹגָה מִן הַמְסִלָּה עָבַר כָּל אִישׁ אַחֲרֵי יוֹאָב לִרְדֹּף אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי: (יד) וַיַּעֲבֹר בְּכָל שִׁבְטֵי יִשְׂרָאֵל אָבֵלָה וּבֵית מַעֲכָה וְכָל הַבֵּרִים וַיִּקָּהֲלוּ וַיָּבֹאוּ אַף אַחֲרָיו: (טו) וַיָּבֹאוּ וַיָּצֻרוּ עָלָיו בְּאָבֵלָה בֵּית הַמַּעֲכָה וַיִּשְׁפְּכוּ סֹלְלָה אֶל הָעִיר וַתַּעֲמֹד בַּחֵל וְכָל הָעָם אֲשֶׁר אֶת יוֹאָב מַשְׁחִיתִם לְהַפִּיל הַחוֹמָה: (טז) וַתִּקְרָא אִשָּׁה חֲכָמָה מִן הָעִיר שִׁמְעוּ שִׁמְעוּ אִמְרוּ נָא אֶל יוֹאָב קְרַב עַד הֵנָּה וַאֲדַבְּרָה אֵלֶיךָ: (יז) וַיִּקְרַב אֵלֶיהָ וַתֹּאמֶר הָאִשָּׁה הַאַתָּה יוֹאָב וַיֹּאמֶר אָנִי וַתֹּאמֶר לוֹ שְׁמַע דִּבְרֵי אֲמָתֶךָ וַיֹּאמֶר שֹׁמֵעַ אָנֹכִי: (יח) וַתֹּאמֶר לֵאמֹר דַּבֵּר יְדַבְּרוּ בָרִאשֹׁנָה לֵאמֹר שָׁאֹל יְשָׁאֲלוּ בְּאָבֵל וְכֵן הֵתַמוּ: (יט) אָנֹכִי שְׁלֻמֵי אֱמוּנֵי יִשְׂרָאֵל אַתָּה מְבַקֵּשׁ לְהָמִית עִיר וְאֵם בְּיִשְׂרָאֵל לָמָּה תְבַלַּע נַחֲלַת ה': וַיַּעַן יוֹאָב וַיֹּאמַר חָלִילָה חָלִילָה לִי אִם אֲבַלַּע וְאִם אַשְׁחִית: (כא) לֹא כֵן הַדָּבָר כִּי אִישׁ מֵהַר אֶפְרַיִם שֶׁבַע בֶּן בִּכְרִי שְׁמוֹ נָשָׂא יָדוֹ בַּמֶּלֶךְ בְּדָוִד תְּנוּ אֹתוֹ לְבַדּוֹ וְאֵלְכָה מֵעַל הָעִיר וַתֹּאמֶר הָאִשָּׁה אֶל יוֹאָב הִנֵּה רֹאשׁוֹ מֻשְׁלָךְ אֵלֶיךָ בְּעַד הַחוֹמָה: (כב) וַתָּבוֹא הָאִשָּׁה אֶל כָּל הָעָם בְּחָכְמָתָהּ וַיִּכְרְתוּ אֶת רֹאשׁ שֶׁבַע בֶּן בִּכְרִי וַיַּשְׁלִכוּ אֶל יוֹאָב וַיִּתְקַע בַּשּׁוֹפָר וַיָּפֻצוּ מֵעַל הָעִיר אִישׁ לְאֹהָלָיו וְיוֹאָב שָׁב יְרוּשָׁלִַם אֶל הַמֶּלֶךְ: (כג) וְיוֹאָב אֶל כָּל הַצָּבָא יִשְׂרָאֵל וּבְנָיָה בֶּן יְהוֹיָדָע עַל הכרי הַכְּרֵתִי וְעַל הַפְּלֵתִי: (כד) וַאֲדֹרָם עַל הַמַּס וִיהוֹשָׁפָט בֶּן אֲחִילוּד הַמַּזְכִּיר: (כה) ושיא וּשְׁוָא סֹפֵר וְצָדוֹק וְאֶבְיָתָר כֹּהֲנִים: (כו) וְגַם עִירָא הַיָּאִרִי הָיָה כֹהֵן לְדָוִד:

58. תלמוד ירושלמי תרומות ח:ד

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59. רש"י סנהדרין עב: ד"ה יצא ראשו

ואם תאמר מעשה דשבע בן בכרי (שמואל ב, כ) הנה ראשו מושלך אליך דדחו נפש מפני נפש התם משום דאפילו לא מסרוהו לו היה נהרג בעיר כשיתפשנה יואב והן נהרגין עמו אבל אם היה הוא ניצול אף על פי שהן נהרגין לא היו רשאין למסרו כדי להציל עצמן אי נמי משום דמורד במלכות הוה והכי מפרש לה בתוספתא

60. בית יוסף יו"ד ס' קנז

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61. רמב"ם הל' יסודי התורה ה:ה

נשים שאמרו להם עובדי כוכבים תנו לנו אחת מכן ונטמא אותה ואם לאו נטמא את כולכן יטמאו כולן ואל ימסרו להם נפש אחת מישראל, וכן אם אמרו להם עובדי כוכבים תנו לנו אחד מכם ונהרגנו ואם לאו נהרוג כולכם, יהרגו כולם ואל ימסרו להם נפש אחת מישראל, ואם יחדוהו להם ואמרו תנו לנו פלוני או נהרוג את כולכם, אם היה מחוייב מיתה כשבע בן בכרי יתנו אותו להם, ואין מורין להם כן לכתחלה, ואם אינו חייב מיתה יהרגו כולן ואל ימסרו להם נפש אחת מישראל.

62. רמ"א יו"ד קנז:א

עובדי כוכבים שאמרו לישראל תנו לנו אחד מכם ונהרגנו לא יתנו להם אחד מהם אלא א"כ יחדוהו ואמרו תנו לנו פלוני. ויש אומרים דאפילו בכה"ג אין למסרו, אא"כ חייב מיתה כשבע בן בכרי.

63. שו"ת אגרות משה יו"ד ב:ס

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1. Menachot 37a

Plimo asked of Rebbe "One who has two heads, on which one should he place the tefillin?" He responded "either leave or you will receive excommunication." Subsequently, a person came and said "A child was born to me who has two heads, how much must I give to the Kohen?" The older gentleman (Rebbe) came and taught him "You must give the Kohen ten sela'im" …

64. Talmud Yerushalmi Terumot 8:4

It was taught: Caravans of people were traveling on the road. A group of gentiles approached them and said "give us one person from your group and we will kill him and if not we will kill all of you." Even if it means that everyone must die, one may not hand over one Jewish life. If they specified one of them such as in the case of Sheva ben Bichri, he may be handed over and they are not required to give up their lives. R. Shimon ben Lakish said "This only applies if he was sentenced to death like Sheva ben Bichri." R. Yochanan said "Even if he is not sentenced to death like Sheva ben Bichri."

65. R. Yosef Karo (1488-1575), Beit Yosef, Yoreh De'ah no. 157

The implication is that the Halacha follows R. Yochanan and this is what it seems to be the opinions of Rabbeinu Shimshon in his commentary on the Mishna and Rabbeinu Nissim in Tractate Yoma … However, Rambam in the fifth chapter of Hilchot Yesodei HaTorah ruled in accordance with Reish Lakish and one must understand why because we ordinarily follow R. Yochanan against Reish Lakish. It is possible (that he felt) that the simple meaning of the text (of the Tosefta) follows Reish Lakish.

66. R. Moshe Isserles (Rama, 1520-1572), Yoreh De'ah 157:1

If gentiles say to the Jews "Give us one of you and we will kill him," one may not hand over any individual unless they specified an individual and said "Give us Ploni." And there are those that say that even in this situation, one may not hand him over unless he was sentenced to death like Sheva ben Bichri.

67. R. Moshe Feinstein (1896-1985), Igrot Moshe, Y.D. 2:60

The reason why R. Yochanan permits handing him over when he was singled out - even though there is still temporary life which one is culpable for- is that regarding long term life, only he is the pursuer and not them. Reish Lakish who disagrees and prohibits even when an individual is singled out can be understood in two ways: 1) He is of the opinion that he cannot be considered a pursuer when he has no intent to pursue … 2) He also agrees that [he can be considered a pursuer] but when he is specified, we cannot consider him a pursuer based on the fact that the gentiles decided to kill him because he is not sentenced to death and they just chose him arbitrarily … There is an important difference between the two approaches for if we follow the first approach, we must conclude that according to Reish Lakish, he must specifically be sentenced to death like Sheva ben Bichri. If we follow the second approach, even if he wasn't sentenced to death but they chose to kill him for a specific complaint they have against him, it would also be permissible to hand him over.

שמואל ב פרק כ

|1 Now there happened to be there a base fellow, whose name was Sheba, the son of Bichri, a Benjamite; |(א) וְשָׁם נִקְרָא אִישׁ בְּלִיַּעַל וּשְׁמוֹ שֶׁבַע בֶּן בִּכְרִי אִישׁ יְמִינִי |

|and he blew the horn, and said: 'We have no portion in David, neither have we inheritance in the son |וַיִּתְקַע בַּשֹּׁפָר וַיֹּאמֶר אֵין לָנוּ חֵלֶק בְּדָוִד וְלֹא נַחֲלָה לָנוּ בְּבֶן|

|of Jesse; every man to his tents, O Israel.' 2 So all the men of Israel went up from following David, |יִשַׁי אִישׁ לְאֹהָלָיו יִשְׂרָאֵל: (ב) וַיַּעַל כָּל אִישׁ יִשְׂרָאֵל מֵאַחֲרֵי |

|and followed Sheba the son of Bichri; but the men of Judah did cleave unto their king, from the Jordan|דָוִד אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי וְאִישׁ יְהוּדָה דָּבְקוּ בְמַלְכָּם מִן |

|even to Jerusalem. 3 And David came to his house at Jerusalem; and the king took the ten women his |הַיַּרְדֵּן וְעַד יְרוּשָׁלִָם: (ג) וַיָּבֹא דָוִד אֶל בֵּיתוֹ יְרוּשָׁלִַם וַיִּקַּח|

|concubines, whom he had left to keep the house, and put them in ward, and provided them with |הַמֶּלֶךְ אֵת עֶשֶׂר נָשִׁים פִּלַגְשִׁים אֲשֶׁר הִנִּיחַ לִשְׁמֹר הַבַּיִת וַיִּתְּנֵם |

|sustenance, but went not in unto them. So they were shut up unto the day of their death, in widowhood,|בֵּית מִשְׁמֶרֶת וַיְכַלְכְּלֵם וַאֲלֵיהֶם לֹא בָא וַתִּהְיֶינָה צְרֻרוֹת עַד |

|with their husband alive. 4 Then said the king to Amasa: 'Call me the men of Judah together within |יוֹם מֻתָן אַלְמְנוּת חַיּוּת: (ד) וַיֹּאמֶר הַמֶּלֶךְ אֶל עֲמָשָׂא הַזְעֶק |

|three days, and be thou here present.' 5 So Amasa went to call the men of Judah together; but he |לִי אֶת אִישׁ יְהוּדָה שְׁלֹשֶׁת יָמִים וְאַתָּה פֹּה עֲמֹד: (ה) וַיֵּלֶךְ |

|tarried longer than the set time which he had appointed him. 6 And David said to Abishai: 'Now will |עֲמָשָׂא לְהַזְעִיק אֶת יְהוּדָה וַיּוֹחֶר מִן הַמּוֹעֵד אֲשֶׁר יְעָדוֹ: (ו)|

|Sheba the son of Bichri do us more harm than did Absalom; take thou thy lord's servants, and pursue |וַיֹּאמֶר דָּוִד אֶל אֲבִישַׁי עַתָּה יֵרַע לָנוּ שֶׁבַע בֶּן בִּכְרִי מִן |

|after him, lest he get him fortified cities, and escape out of our sight.' 7 And there went out after |אַבְשָׁלוֹם אַתָּה קַח אֶת עַבְדֵי אֲדֹנֶיךָ וּרְדֹף אַחֲרָיו פֶּן מָצָא לוֹ |

|him Joab's men, and the Cherethites and the Pelethites, and all the mighty men; and they went out of |עָרִים בְּצֻרוֹת וְהִצִּיל עֵינֵנוּ: (ז) וַיֵּצְאוּ אַחֲרָיו אַנְשֵׁי יוֹאָב |

|Jerusalem, to pursue after Sheba the son of Bichri. 8 When they were at the great stone which is in |וְהַכְּרֵתִי וְהַפְּלֵתִי וְכָל הַגִּבֹּרִים וַיֵּצְאוּ מִירוּשָׁלִַם לִרְדֹּף אַחֲרֵי |

|Gibeon, Amasa came to meet them. And Joab was girded with his apparel of war that he had put on, and |שֶׁבַע בֶּן בִּכְרִי: (ח) הֵם עִם הָאֶבֶן הַגְּדוֹלָה אֲשֶׁר בְּגִבְעוֹן |

|thereon was a girdle with a sword fastened upon his loins in the sheath thereof; and as he went forth |וַעֲמָשָׂא בָּא לִפְנֵיהֶם וְיוֹאָב חָגוּר מִדּוֹ לְבֻשׁוֹ ועלו וְעָלָיו |

|it fell out. 9 And Joab said to Amasa: 'Is it well with thee, my brother?' And Joab took Amasa by the |חֲגוֹר חֶרֶב מְצֻמֶּדֶת עַל מָתְנָיו בְּתַעְרָהּ וְהוּא יָצָא וַתִּפֹּל: (ט) |

|beard with his right hand to kiss him. 10 But Amasa took no heed to the sword that was in Joab's hand;|וַיֹּאמֶר יוֹאָב לַעֲמָשָׂא הֲשָׁלוֹם אַתָּה אָחִי וַתֹּחֶז יַד יְמִין יוֹאָב |

|so he smote him therewith in the groin, and shed out his bowels to the ground, and struck him not |בִּזְקַן עֲמָשָׂא לִנְשָׁק לוֹ: (י) וַעֲמָשָׂא לֹא נִשְׁמַר בַּחֶרֶב אֲשֶׁר בְּיַד |

|again; and he died. And Joab and Abishai his brother pursued after Sheba the son of Bichri. 11 And |יוֹאָב וַיַּכֵּהוּ בָהּ אֶל הַחֹמֶשׁ וַיִּשְׁפֹּךְ מֵעָיו אַרְצָה וְלֹא שָׁנָה לוֹ |

|there stood by him one of Joab's young men, and said: 'He that favoureth Joab, and he that is for |וַיָּמֹת ס וְיוֹאָב וַאֲבִישַׁי אָחִיו רָדַף אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי: |

|David let him follow Joab.' 12 And Amasa lay wallowing in his blood in the midst of the highway. And |(יא) וְאִישׁ עָמַד עָלָיו מִנַּעֲרֵי יוֹאָב וַיֹּאמֶר מִי אֲשֶׁר חָפֵץ |

|when the man saw that all the people stood still, he carried Amasa out of the highway into the field, |בְּיוֹאָב וּמִי אֲשֶׁר לְדָוִד אַחֲרֵי יוֹאָב: (יב) וַעֲמָשָׂא מִתְגֹּלֵל בַּדָּם|

|and cast a garment over him, when he saw that every one that came by him stood still. 13 When he was |בְּתוֹךְ הַמְסִלָּה וַיַּרְא הָאִישׁ כִּי עָמַד כָּל הָעָם וַיַּסֵּב אֶת עֲמָשָׂא מִן|

|removed out of the highway, all the people went on after Joab, to pursue after Sheba the son of |הַמְסִלָּה הַשָּׂדֶה וַיַּשְׁלֵךְ עָלָיו בֶּגֶד כַּאֲשֶׁר רָאָה כָּל הַבָּא עָלָיו |

|Bichri. 14 And he went through all the tribes of Israel unto Abel, and to Beth-maacah, and all the |וְעָמָד: (יג) כַּאֲשֶׁר הֹגָה מִן הַמְסִלָּה עָבַר כָּל אִישׁ אַחֲרֵי יוֹאָב |

|Berites; and they were gathered together, and went in also after him. 15 And they came and besieged |לִרְדֹּף אַחֲרֵי שֶׁבַע בֶּן בִּכְרִי: (יד) וַיַּעֲבֹר בְּכָל שִׁבְטֵי יִשְׂרָאֵל |

|him in Abel of Beth-maacah, and they cast up a mound against the city, and it stood in the moat; and |אָבֵלָה וּבֵית מַעֲכָה וְכָל הַבֵּרִים וַיִּקָּהֲלוּ וַיָּבֹאוּ אַף אַחֲרָיו: |

|all the people that were with Joab battered the wall, to throw it down. 16 Then cried a wise woman out|(טו) וַיָּבֹאוּ וַיָּצֻרוּ עָלָיו בְּאָבֵלָה בֵּית הַמַּעֲכָה וַיִּשְׁפְּכוּ סֹלְלָה |

|of the city: 'Hear, hear; say, I pray you, unto Joab: Come near hither, that I may speak with thee.' |אֶל הָעִיר וַתַּעֲמֹד בַּחֵל וְכָל הָעָם אֲשֶׁר אֶת יוֹאָב מַשְׁחִיתִם לְהַפִּיל|

|17 And he came near unto her; and the woman said: 'Art thou Joab?' And he answered: 'I am.' Then she |הַחוֹמָה: (טז) וַתִּקְרָא אִשָּׁה חֲכָמָה מִן הָעִיר שִׁמְעוּ שִׁמְעוּ אִמְרוּ |

|said unto him: 'Hear the words of thy handmaid.' And he answered: 'I do hear.' 18 Then she spoke, |נָא אֶל יוֹאָב קְרַב עַד הֵנָּה וַאֲדַבְּרָה אֵלֶיךָ: (יז) וַיִּקְרַב אֵלֶיהָ|

|saying: 'They were wont to speak in old time, saying: They shall surely ask counsel at Abel; and so |וַתֹּאמֶר הָאִשָּׁה הַאַתָּה יוֹאָב וַיֹּאמֶר אָנִי וַתֹּאמֶר לוֹ שְׁמַע דִּבְרֵי |

|they ended the matter. 19 We are of them that are peaceable and faithful in Israel; seekest thou to |אֲמָתֶךָ וַיֹּאמֶר שֹׁמֵעַ אָנֹכִי: (יח) וַתֹּאמֶר לֵאמֹר דַּבֵּר יְדַבְּרוּ |

|destroy a city and a mother in Israel? why wilt thou swallow up the inheritance of the LORD?' 20 And |בָרִאשֹׁנָה לֵאמֹר שָׁאֹל יְשָׁאֲלוּ בְּאָבֵל וְכֵן הֵתַמוּ: (יט) אָנֹכִי |

|Joab answered and said: 'Far be it, far be it from me, that I should swallow up or destroy. 21 The |שְׁלֻמֵי אֱמוּנֵי יִשְׂרָאֵל אַתָּה מְבַקֵּשׁ לְהָמִית עִיר וְאֵם בְּיִשְׂרָאֵל לָמָּה|

|matter is not so; but a man of the hill-country of Ephraim, Sheba the son of Bichri by name, hath |תְבַלַּע נַחֲלַת ה': וַיַּעַן יוֹאָב וַיֹּאמַר חָלִילָה חָלִילָה לִי אִם |

|lifted up his hand against the king, even against David; deliver him only, and I will depart from the |אֲבַלַּע וְאִם אַשְׁחִית: (כא) לֹא כֵן הַדָּבָר כִּי אִישׁ מֵהַר אֶפְרַיִם |

|city.' And the woman said unto Joab: 'Behold, his head shall be thrown to thee over the wall.' 22 Then|שֶׁבַע בֶּן בִּכְרִי שְׁמוֹ נָשָׂא יָדוֹ בַּמֶּלֶךְ בְּדָוִד תְּנוּ אֹתוֹ לְבַדּוֹ |

|the woman went unto all the people in her wisdom. And they cut off the head of Sheba the son of |וְאֵלְכָה מֵעַל הָעִיר וַתֹּאמֶר הָאִשָּׁה אֶל יוֹאָב הִנֵּה רֹאשׁוֹ מֻשְׁלָךְ |

|Bichri, and threw it out to Joab. And he blew the horn, and they were dispersed from the city, every |אֵלֶיךָ בְּעַד הַחוֹמָה: (כב) וַתָּבוֹא הָאִשָּׁה אֶל כָּל הָעָם בְּחָכְמָתָהּ |

|man to his tent. And Joab returned to Jerusalem unto the king. 23 Now Joab was over all the host of |וַיִּכְרְתוּ אֶת רֹאשׁ שֶׁבַע בֶּן בִּכְרִי וַיַּשְׁלִכוּ אֶל יוֹאָב וַיִּתְקַע |

|Israel; and Benaiah the son of Jehoiada was over the Cherethites and over the Pelethites; 24 and |בַּשּׁוֹפָר וַיָּפֻצוּ מֵעַל הָעִיר אִישׁ לְאֹהָלָיו וְיוֹאָב שָׁב יְרוּשָׁלִַם אֶל|

|Adoram was over the levy; and Jehoshaphat the son of Ahilud was the recorder; 25 and Sheva was scribe;|הַמֶּלֶךְ: (כג) וְיוֹאָב אֶל כָּל הַצָּבָא יִשְׂרָאֵל וּבְנָיָה בֶּן |

|and Zadok and Abiathar were priests; 26 and Ira also the Jairite was chief minister unto David. |יְהוֹיָדָע עַל הכרי הַכְּרֵתִי וְעַל הַפְּלֵתִי: (כד) וַאֲדֹרָם עַל הַמַּס |

| |וִיהוֹשָׁפָט בֶּן אֲחִילוּד הַמַּזְכִּיר: (כה) ושיא וּשְׁוָא סֹפֵר וְצָדוֹק|

| |וְאֶבְיָתָר כֹּהֲנִים: (כו) וְגַם עִירָא הַיָּאִרִי הָיָה כֹהֵן לְדָוִד: |

Fetal Reduction

I. Introduction- In certain cases of multifetal pregnancies of three or more, the physicians may assess that if the number of fetuses is not reduced, the chance of survival for all of the fetuses is very small. Does one sacrifice one or more of the fetuses in order to save the rest of them. A good article with some basic information can be found here:

II. This question will partially depend on one's approach to abortion:

a. If abortion is not considered retzicha, there is more flexibility to consider terminating one life to save the others.

i. Rambam (1135-1204) applies the rodef principle to inanimate objects {‏1} so the rodef principle may be still be relevant here, but with lower stakes.

ii. Rav Asher Weiss: {‏2}

1. The source for the prohibition against abortion is the Torah's allowance to save a fetus in order that he may observe many more Shabbasos. If you can violate Shabbos for this cause, you certainly cannot terminate its life.

2. Therefore, the nature of the prohibition is goal oriented and if terminating some of the fetuses will lead to the other fetuses observing many more Shabbasos, you can do so.

b. If abortion is considered a form of retzicha, the question is really can you kill one person in order to save others?

i. When one of the fetuses has no chance of long term survival and his presence is threatening the survival of the others, it is similar to the conjoined twins discussion.

ii. When all of the fetuses are equally healthy, does this compare to the case of the terrorists demanding to turn over one victim at random?

1. R. Moshe ben Avraham Tzvi (d. 1681, Tiferes L'Moshe)- The only prohibition of handing over a person to the terrorists is when it is random. If you take a lottery and one person is chosen through a lottery, there is no prohibition to hand over one of them. {‏3}

a. R. Avraham Yeshaya Karelitz (1878-1953, Chazon Ish) questions this ruling- If that's true, why does the Tosefta state that they should all die? Why not simply suggest that they perform a lottery? Chazon Ish admits that if they all agree to perform a lottery and the loser will hand himself over that it permissible as long as he does it voluntarily. {‏4}

b. According to Tiferes L'Moshe you can entertain performing a lottery to decide which fetus will be terminated. According to Chazon Ish, you can't perform a lottery. Even Tiferes L'Moshe's suggestion is difficult to implement because medically, they can only terminate certain fetuses.

2. R. Yitzchak Zilberstein adds another dimension to the discussion: {‏5}

a. He quotes a number of Acharonim who imply that the case of handing over the individual is one where there is a possibility that some of the people will escape and some will die. If it is clear that all of them will die, you can hand over one of them.

b. Furthermore, he suggests that Tiferes L'Moshe's suggestion to perform a lottery is only in such a case where it is known that everyone is going to die.

c. Therefore, if the physicians assess that there is no chance of survival for all of the fetuses, it is permissible to terminate one of them.

3. Chazon Ish's grenade dilemma: {‏6}

a. Chazon Ish discusses a case of an arrow (or more likely a grenade) that is headed towards a group of people and will kill all of them. Can one send the grenade somewhere else where it will only kill one person?

b. Chazon Ish claims that this is not the same as handing over one person to the terrorists because in this case, the act is, in principle a life-saving act, whereas handing over one person is an act of cruelty.

c. Chazon Ish nevertheless leaves it as an open question because in reality, it is an act of murder when you throw the grenade to the other side and kill the lone individual.

d. R. Moshe Shternbuch- Regarding fetal reduction, one can consider terminating one of the fetuses as an act of saving the lives of the others as opposed to an act of cruelty. {‏7}

4. Even if the rodef discussion is applicable to fetuses, the "terrorist discussion" is not.

a. R. Eliezer Waldenberg (1915-2006, Tzitz Eliezer)- Since a fetus is not considered a nefesh, you can hand over one fetus to save the others. {‏8}

i. One would have to add that even Rambam who invokes the rodef discussion to a fetus still does not consider the fetus a full-fledged nefesh (as per R. Moshe's teshuva and R. Chaim- see the abortion shiur).

b. R. Moshe Shternbuch- The only time that you don't hand over one of the people is in a case where killing him would be considered yehareg v'al ya'avor. This is not true regarding killing a fetus. {‏9}

III. Halacha L'Ma'aseh

a. R. Shlomo Zalman Auerbach (1910-1995) and R. Yosef S. Elyashiv (b. 1910) are both cited in Nishmas Avraham as allowing fetal reduction in certain situations. The explanation is not that extensive and Nishmas Avraham seems to base the criteria primarily on how many fetuses there are. {‏10}

b. R. Tzvi Kushelevski- All of the heteirim have their difficulties and therefore it is difficult to be lenient. {‏11}

1. רמב"ם הל' חובל ומזיק ח:טו

ספינה שחשבה להשבר מעובד המשוי ועמד אחד מהן והקל ממשה להשליך לים פטור שהמשא שבה כמו רודף אחריהם להרגם ומצוה רבה עשה שהשליך והושיעם.

68. קובץ בית הלל חוברת ו' תשובת הרב אשר וייס

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69. תפארת למשה הע' ליו"ד קנז:א

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70. חזון איש סנהדרין ס' כה

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71. מאמרו של הגר"י זילברשטיין אסיא טבת תשמ"ט

ומסתבר שבאופן זה מותר להטיל גורלות מי יהיו השלושה שיוטלו לים. ומה שתמה ה"חזון איש" אם כן למה יהרגו כולם, יטילו גורלות? הרי כתבו ה"יד רמה", ו"מהר"ם חלואה", וה"לחם משנה" ו"חסדי דוד" במשניות אהלות, שלא בטוח שהאחד שימסרו ודאי ייהרג, כי שמא יצליח להימלט, אבל כאשר ברור הדבר שייהרג מותר למוסרו. אך מדברי ה"חזון איש" הנ"ל נראה דגם כשברור שכולם ייהרגו אסור.

72. חזון איש סנהדרין ס' כה

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73. תשובות והנהגות ג:שנח

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74. ציץ אליעזר כ:ב

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75. תשובות והנהגות ג:שנח

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76. נשמת אברהם חו"מ ס' תכה

בשאלה של ששיה אמר לי הגרש"ז אויערבאך זצ"ל שמותר לגרום להפלה חלק מהעוברים כדי להציל האחרים. במקרה אחר באשה עם רביעיה דעת הרופאים שלא תוכל להמשיך עם הריונה עקב האגן הקטן והתיר הגאון זצ"ל שיפילו אחד או שנים מהעוברים לפי הצורך. הסביר לי הגאון זצ"ל שבמקרה של הריון בסיכון גבוה עקב ריבוי עוברים כל אחד מהעוברים יש לו דין של רודף ולכן מותר לרופא להרוג חלק מהם בזריקה בבחירת אותם לפי שיקול רופאי שהריגתם יגרום לסיכוי הקטן ביותר של הפלת כולם. והוא זצ"ל גם הסכים שמותר לעשות זאת אחרי ארבעים יום (מבחינת רפואי הזמן האופטימי לבצע דילול הוא בין תשע לשתים-עשרה שבועות של הריון).

ואמר לי הגרי"ש אלישיב שליט"א שכיון שהרופאים אומרים שיש סכנה ברביעיה שתפיל את כולם, מותר לדלל. מאידך ידוע לי שהגאון שליט"א אסר דילול בשלישיה.

77. עטרת שלמה חוברת י' מאמר הגר"צ קושלבסקי

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