special prosthetics in Halacha

{for the Halachic perspective on steroid use – see responsum #4599}

Special Prosthetics in Halachic Perspective

Classic Prosthetics in Halacha

Regular limb prosthetics are a known Halachik subject since ancient times[1], as were artificially made permanent teeth[2]. The discussion varies in topic, for example:

a. The possibility of moving with them on Shabbat, specifically the issue of level of dependency on the prosthetic limbs and how much they are considered inseparable from the person using them[3].

Issues of Laws of Purity are considered: Are the prosthetics tools or garments, with regard to impurity (Tum'a)?[4] ; are prosthetics a problem (Haziza) when worn during ritual bathing (Tvila)[5]?

b. The status of a paraplegic Cohen, normally banned from work in the Temple or Birkat Cohanim in the synagogue, is deliberated[6] in case of a prosthetic leg.

c. Technological advancements in composite materials, computation and bio-engineering have produced a myriad of new prosthetic solutions for the disabled. Some of these solutions rely heavily on technological systems that are constantly evolving[7]. Let us examine some examples of the new generation of special prosthetics and their Halachic status:

1. Hearing:

The use of artificial sense aids – namely hearing aids, has also received ample discussion in the response of the past decades, by the great Poskim of the previous and present generation.

Technological evolution brings the hearing aid closer to what is today referred to as "special prosthetics”. Renewed discussion on the issue of hearing aid followed the introduction of the Cochlear Implant (CI) sometimes described as a bionic ear. What sets this hearing aid apart from previous technologies is that it bypasses the damaged auditory organs in the ear. Cochlear implants do not amplify sound, but work by directly stimulating any functioning auditory nerves inside the cochlea by an induced electric field.

The Halachic debate is whether to see the Cochlear Implant as an expanded version of the previously known hearing aid[8], or to treat this kind of technology on a different basis from the old hearing aids[9], where the main consideration was internal functionality of an external machine, namely electricity. According to the latter view, This is not an external microphone but a supplementary ear or hearing faculty altogether[10].

The Cochlear implants are not the cutting edge of hearing implants. New developments[11] enable direct access to the auditory nerve thereby replacing the entire ear (external and internal)[12]. Perhaps this kind of implant will be considered as fully replacing the ear and not just supplementing it with enhanced volume.

2. Eyesight

Innovation in neurological science enables completely blind people to see even with physiologically damaged ocular faculties[13]. This is possible through direct stimulus of the visual centers in the brain[14], or an electronic replacement of the retina[15].

The Halachic ramifications of this artificial sensory replacement has recently been explored[16], touching subjects like the function of a judge, a Cohen, reliance on observed phenomena and the performing Mitzvot in general.

3. Bio-Mechanical prosthetics, Body-Computer Interface (BCI)[17]

Research in neurology and computing has produced a bio-mechanical interface[18] between machine and the human body and brain. This allowed manipulation of robotic limbs directly through the brain[19], as in regular limb movement.

Body-Computer Interface and Brain-Bomputer interface (BCI) technologies have recently been discussed Halachically. The preliminary discussion[20] lays out the wide Halachik scope – covering ritual and legal performance, responsibility for actions etc.

More focused attention is given[21] to a specific topic – the use of body-computer interface on Shabbat.

Expansion of the human body

Both the BCI and the bionic-eye discussions make a point of the merging between man and machine to the point of inseparability. The issue of a machine becoming a part of the person it is connected to has been brought up in the case of a pacemaker and it's reuse after death[22].

For example, the degree of the prosthetic (or its component's) merging with the body plays a central role in the considerations for and against its use on Shabbat[23]. So the connection between the body and the machine has direct Halachic ramifications, making the use of the artificial limb or organ a human action, and its integrity is as important as the body's own health and dignity.

We must qualify this Halachic regard for the special prosthetic and its role as an expansion of the body, with a limitation on the topics: Halacha does not decide whether use of a special prosthetics is illegal in a competition: that is up to the rule-makers of the sport.

Halacha can treat a prosthetic as an integral part of the body, but that would not define the legibility to compete in sport at a specific competition class. For example, a Halachik analysis may conclude that a paraplegic Cohen equipped with bio-mechanical limbs that function smoothly with his body, can perform the technical sacrificial duties; even if such a ruling would be made, it would not reflect on the legality of his participation in a marathon.

To sum up:

Competitive sport has an autonomous legal structure that Halacha does not breach unless it is a matter of clear mortal danger, in which case even other Halachic considerations are superseded. That aspect of the discussion was addressed in the section dedicated to steroid use.

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[1] "מקל" – טושו"ע או"ח שא יז. ובלשון המקרא 'מחזיק בפלך' (רש"י שמו"ב ג כט); "סמוכות" במילוי צמר גפן – שבת סה ב. וראה תוס' שם ד"ה הקיטע; שבת סו א. רש"י שם ד"ה ואם; "כיסא של קיטע"- שבת שם, וברש"י שם ד"ה סמוכות.

[2] שבת סד ב, וברש"י שם ד"ה שן, ששיניים תותבות היו מוכרות כבר בזמן התלמוד, והיו עשויות מזהב.

[3] לגבי מקל של חיגר: טושו"ע או"ח שא יז; שמירת שבת כהלכתה, פי"ח סי"ג.

לגבי קיטע ורגל תותבת: שו"ת בנימין זאב, ח"ב סי' רח; שו"ת אגרות משה, חאו"ח ח"ד סי' צ; ילקוט יוסף, שבת, כרך ד סי' שכח ספ"ט. וראה בס' שולחן שלמה ח"א סי' שא סקי"א(א); שמירת שבת כהלכתה, פי"ח סט"ו. למרות שבשו"ע או"ח סי' שא סע' טו נפסק לאיסור, הדין שונה בתותבות שבימינו.

[4] שבת סו א; רמב"ם כלים כה יט.

[5] עין מלאכותית: שו"ת מהרי"א אסאד חיו"ד סי' רכט; שו"ת שואל ומשיב מהדו"ת ח"ג סוסי' קח; יד שאול יו"ד סי' קצח; שו"ת כוכב מיעקב סי' קלא; שו"ת הר צבי חיו"ד סי' קסא; שו"ת אגרות משה חיו"ד ח"א סי' קד; שו"ת מנחת יצחק ח"ג סי' פב; שו"ת באר משה ח"ב סי' נו; שערי טבילה סי' לט;

שינים תותבות – רוב הפוסקים מקילים בתותבות קבועות: שו"ת מהרי"א אסאד חיו"ד סי' רכט; דרכי תשובה יו"ד סי' קצח סקע"ה; טהרת ישראל סי' קצח ספ"ז; שו"ת בנין ציון החדשות סי' נז; חכמת אדם כלל קיט, בבינת אדם שער הנשים אות יב.

האבני נזר (חיו"ד סי' רנט) מחמיר אם רוב התותבות הפכו לקבועות, וחולק עליו בשו"ת אמרי יושר ח"ב סי' קצג.

[6] שו"ת אגרות משה, חאו"ח ח"ב סי' לב

[7] These systems are also developed for the general consumer-market, and are becoming household brands, see for example: <http://www.thinkartificial.org/artificial-intelligence/whole-body-computer-interfaces/>

[8] In the sense that it does not heal an organ or returns functionality to it , thereby becoming a healing of a mal-condition. This view is that the Cochlear implant is an external machine aiding the person. See R. Gavriel Toledano, in an answer in the IRP database, and a subsequent article in Assia 82-83.

[9] ד"ר ישראל ברמה ; שתל הקוכלארי והגדרת החרש בהלכה ; תחומין כרך כד עמ' 173.

[10] The main argument for this position is the bypassing of the damaged receptors in the ear.

[11] John Middlebrooks, Russell Snyder ; Enhanced Hearing Replacement Using a Penetrating Auditory Nerve Array ; The Journal of the Association for Research in Otolaryngology (JARO) ; January 30, 2007

[12] See Science central Report, 07.26.07.

[13] See 'Bionic' eye gives blind people some sight ; The Guardian, Tuesday April 22 2008

[14] Detailed examples and sorces available at http://www.artificialvision.com/ . This is actually achieved with by extracting shape information from visual to-auditory sensory substitution. See A. Amedi, et al ; Shape conveyed by visual-to-auditory sensory substitution activates the lateral occipital complex ; Nature Neuroscience, Vol. 10, No. 6, pp. 687 – 689, June 2007 (doi:10.1038/nn1912).

This research was also featured in the New Scientist print edition of May 26, 2007, with an article titled "<a href="http://www.newscientist.com/article/dn11934-how-the-brain-can-hear-shapes.html" target="thevoice" title="A device that turns visual data into sound triggers part of the brain associated with sensing shape - it might help the blind ">How the brain can hear shapes", p. 22.

[15] See Gislin ; Virtual technologies aid in restoring sight to the blind ; Communications Through Virtual Technology:Identity Community and Technology in the Internet Age

Ed. G. Riva & F. Davide, IOS Press: Amsterdam, 2001; Chap 15.

[16] שלומי רייסקין ; "עיניים חשמליות" – האם נחשבות כ'ראיה'? ; תחומין כ"ו, הוצאת מכון צומת תשס"ו ; עמ' 419-426.

[17] Not to be confused with Brain-Computer Interface that can help in treating damaged brains. For example: Electronic chip, interacting with the brain, modifies pathways for controlling movement ; University of Washington ; Public release date: 24-Oct-2006. The wide range of applications is described in: <a href="">.

[18] See: Gopal Santhanam et al ; A high-performance brain–computer interface ; Nature Vol. 442 13 July 2006

[19]See : Meel Velliste et al ; Cortical control of a prosthetic arm for self-feeding ; Nature Vol. 453 19 June 2008

[20] שלומי רייסקין ; ממשקי מחשב-מוח (BCI) ; אסיא עט-פ, עמ' 5-16 (2007(.

[21] ישראל בלפר ; ממשקי אדם מכונה בשבת ; אסיר פג-פד, (2008), עמ' 67-90.

[22] הרב ד"ר פנחס טולידאנו, הוצאת קוצב לב מגופו של נפטר; תחומין י"ב ,385-388 . נשמת אברהם יורה דעה סימן שמט, סעיף ג.

[23] רייסקין, שם, עמ' 417-418. בלפר, שם.