Thursday, February 01, 2007

Triage: A Case of Ladies Second?

The Mishnah in Horiyos (13a) states: A man comes before a woman in matters of life (le-hachayos) and to return a lost item, and a woman comes before a man for clothing and redemption from captivity.

The implication of the first item is that if a man and woman are drowning, one should save the man first and then the woman. This has practical implications in triage situations. When, for example, EMTs are called for two emergencies at the same time and have to decide which one to pursue, should they always take the call for man over the woman? Or when an ER doctor has to decide which patient to treat first, should he always take that man before the woman?

Two great recent posekim address this issue in different ways: R. Moshe Feinstein answers by limiting the rule in the Mishnah while R. Eliezer Waldenberg rejects it entirely.

R. Moshe Feinstein (Iggeros Moshe, Choshen Mishpat vol. 4 [I don't have the book in front of me right now so I can't name the exact responsum]) writes that the rule of the Mishnah only applies when all other things are equal. Thus, if both emergency calls are of equal distance, and both diseases are equally treatable, etc. Only then, in the rare case in which all things are equal, does the rule of the Mishnah apply.

R. Eliezer Waldenberg (Tzitz Eliezer 18:1) notes that the rule of the Mishnah is not mentioned in Mishneh Torah, Tur and Shulchan Arukh. Why? To answer this, he proposes a new interpretation of the Mishnah. He suggests that "matters of life (le-hachayos)" refers to feeding from charitable funds. Of course, he writes, when there is a literal case of life and death then we do not differentiate between people. However, when prioritizing limited charity funds and there is only enough food for one person, then according to the Mishnah the man receives priority over the woman. This ruling, however, is contradicted by a baraisa in Kesuvos (67b) in which it is stated that, when there are limited funds for food, women are given priority over men. Thus, R. Waldenberg suggests, the posekim followed the conclusion in Kesuvos which contradicted the ruling in the Mishnah.

Despite this approach being contrary to a Shakh and Taz, R. Waldenberg felt sufficiently confident in his ruling to utilize it in practical situations.

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