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Volume 38: Number 68

Fri, 21 Aug 2020

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Subjects Discussed In This Issue:
Message: 1
From: Micha Berger
Date: Thu, 20 Aug 2020 16:27:15 -0400
[Avodah] Vaccine Trials in Halakhah

Given the need for CoVID-19 vaccine challenge trials, I heard a number of
podcasts on the topics of testing or volunteering to be a test subject
for an experimental cure. But, it's hard to get people who are reading
an email digest to take time for an audio. So, here's a link to something
in text.


Here's the halachic section of the paper, minus all set-up and general
ethics discussion.

Chodesh Tov!
Tir'u baTov!

Micha Berger                 Good decisions come from experience;
http://www.aishdas.org/asp   Experience comes from bad decisions.
Author: Widen Your Tent                   - Djoha, from a Sepharadi fable
- https://amzn.to/2JRxnDF

    The Lehrhaus
    Signing Up for a COVID-19 Vaccine Trial
    By Sharon Galper Grossman and Shamai Grossman
    August 18, 2020
    Undergoing Dangerous Medical Procedures in Halakhah

    Halakhah's approach to dangerous medical procedures begins with Avodah
    Zara 27b, which permits a hayei sha'ah - a sick individual with a
    limited time to live - to seek the care of a pagan doctor, because
    while we worry that a Jew-hating doctor might kill the Jewish patient,
    he might also effect a long-term cure. However, if the sick individual
    is unlikely to die, he may not turn to the pagan. The Gemara's
    explanation as to why we permit the hayei sha'ah to risk his brief
    remaining time alive is, "le-hayei sha'ah lo haishinan" - we are not
    concerned about a risk to a short life because the pagan doctor might
    cure him.

    The Gemara derives this principle from the dilemma of the four lepers
    in II Kings 7:3-8. Banished from their city, which was struck by
    famine, they faced starvation. They saw a camp of Arameans possessing
    food, and were confronted by the following dilemma. If they were to
    enter the camp, the Arameans might kill them, yet they might feed them.
    Preferring possible immediate death from capture to certain subsequent
    death from starvation, the lepers entered the camp. There they
    discovered an abundance of food and survived.

    Tosafot (s.v. le-hayei sha'ah lo haishinan) questions the principle
    "le-hayei sha'ah lo haishinan." Doesn't Yoma 65a's permission to move
    stones on Shabbat to search for a hayei sha'ah buried underneath the
    rubble imply that we value even the briefest survival?  Tosafot answers
    that in both cases we act in the best interest of the patient,
    rejecting certain death for an uncertainty that might prolong life.
    Thus, in Avodah Zarah, we disregard hayei sha'ah because otherwise the
    patient will surely die. In Yoma, we desecrate Shabbat for the hayei
    sha'ah because if we do not remove the stones, he will also certainly
    die. Based on Avodah Zara 27b and the story of the lepers, Shulhan
    Arukh Yoreh De'ah 155:1 codifies the principal "le-hayei sha'ah lo
    haishinan,"  permitting a hayei sha'ah to incur the risk of death at
    the hands of a pagan doctor in the hope of a long-term cure. Numerous
    modern poskim[7] rule that a hayei sha'ah may undergo a risky
    medical procedure if it offers the chance of a long-term cure. Shevut
    Ya'akov 3:75 explains, "Since the patient will certainly die, we push
    off the certainty of death and opt for the possibility of cure."

    One source, however, seems to prohibit the hayei sha'ah from undergoing
    dangerous medical treatment. Sefer Hasidim 467 describes a special herb
    remedy with the potential to kill or cure within days of use, accusing
    the women who prepared it of shortening the lives of their patients.
    One might interpret his denunciation as a rejection of the principle
    "le-hayei sha'ah lo haishinan." Orhot Hayyim, Orah Hayyim 328:10
    dismisses this interpretation, explaining that Sefer Hasidim only
    prohibits the risky remedy because there is an alternative safe
    treatment. He argues that in the absence of an effective alternative
    even Sefer Hasidim would accept the risk. Applied to our case ,the
    absence of an effective cure for COVID-19 might justify engaging in a
    risky process to find a cure.

    Does the principle "le-hayei sha'ah lo haishinan" permit healthy
    volunteers like Sam to participate in a COVID-19 human vaccine
    challenge trial that injects half of the participants with a vaccine of
    uncertain benefit, exposing them to a lethal virus?  To answer this
    question, we must determine if hayei sha'ah applies to healthy
    volunteers who do not face the risk of immediate death, the level of
    medical risk one may incur to achieve hayei olam (long-term cure), and
    the level of benefit required to justify the assumption of such risk.
    In addition, we must establish whether the volunteers may endanger
    themselves, in the absence of any personal gain, purely for the benefit
    of others, and whether this principle applies to experimental therapies
    where the benefit of treatment is unclear. Finally, if Halakhah permits
    participation, is one obligated to volunteer?

    Defining Hayei Sha'ah

    The discussion permitting dangerous medical treatment assumed that the
    individual had the status of hayei sha'ah - a terminal illness with a
    limited time to live. Can we interpret hayei sha'ah more broadly, and
    can we apply this understanding to human vaccine challenge trials
    involving healthy volunteers? Rishonim and early Aharonim do not define
    hayei sha'ah precisely. Their interpretation of the term ranges from a
    life expectancy as short as one to two days to longer than a year (see
    Table 1). Though these poskim debate the exact duration of life
    required to satisfy the halakhic definition of hayei sha'ah, they view
    a hayei sha'ah as an individual with an illness that compromises his
    life expectancy. At first glance, these poskim would not classify Sam,
    a healthy young volunteer, as a hayei sha'ah.

    However, Tiferet Yisrael Yoma, Yakhin 8:3, expands the definition,
    permitting a healthy individual to undergo smallpox vaccination, which
    causes death in one in 1,000 individuals, to attain long-term immunity.
    He dismisses the small risk of immediate death from vaccination so as
    to prevent future lethal infections and broadens the definition of
    hayei sha'ah to include situations where the cause of death is not
    present, but is only a statistical possibility. He bases this ruling on
    Beit Yosef Hoshen Mishpat 426, which, citing the Yerushalmi Terumot,
    chapter eight, obligates a person to place himself in a possible danger
    to save his friend from a certain danger. So for example, if someone
    sees his friend drowning in the sea, he must jump in to save him though
    he risks drowning during his attempted rescue. Tiferet Yisrael reasons
    that if a bystander is obligated to incur possible risk to rescue his
    drowning friend from a possible danger, a healthy individual may accept
    possible immediate peril to save himself from a possible future danger.

    Rabbi J.D. Bleich applies Tiferet Yisrael's definition of hayei sha'ah
    to healthy carriers of the BRCA mutation who act to reduce their high
    risk of cancer by opting for prophylactic surgery.[8] Though the
    cancer has not yet developed, they may incur the immediate risk of
    surgery to increase their life expectancy.[9] Even if we consider
    a genetic predisposition or a statistical probability a present danger,
    it is unlikely that unafflicted carriers of such a mutation will die
    within twelve months. By permitting a healthy individual to assume a
    one in 1,000 risk of immediate death to prevent a future lethal
    smallpox infection, Tiferet Yisrael suggests that Halakhah recognizes
    the importance of disease prevention, equating it with treatments for
    active life-threatening disease. His halakhic analysis and assessment
    might permit a healthy volunteer such as Sam to participate in a
    COVID-19 human vaccine trial to achieve immunity from COVID-19.
    However, such a trial involves substantial risk without proven
    benefits.  In addition, because Tiferet Yisrael bases his position on
    the Yerushalmi which obligates an individual to endanger himself to
    save someone who faces certain danger, Tiferet Yisrael might even allow
    Sam to participate in the absence of any personal benefit, for pure
    altruism to save humanity.

    Defining a Permissible Level of Risk

    Aharonim debate the exact level of risk the hayei sha'ah may incur.
    Ahiezer 2:16:6 cites Mishnat Hakhamim to permit a dangerous treatment
    for a safek shakul - a risk of death less than or equal to 50%. If the
    risk of death exceeds 50%, the hayei sha'ah may not receive the
    treatment. This is also the opinion of Tzitz Elieze r 10:25:5:5. If the
    majority of physicians endorse treatment, Ahiezer permits a risk
    greater than 50% and does not define the upper limit of permitted risk.
    Because any COVID-19 human vaccine challenge trial would receive the
    prior approval of an overseeing body of physicians, Ahiezer might
    permit participation for a risk higher than 50%. Beit David Yoreh De'ah
    II:340 permits a hayei sha'ah to receive a treatment that causes death
    in 999 out of 1,000 patients. In 1961, Rav Moshe Feinstein, Iggerot
    Moshe Yoreh De'ah 2:58, permitted a treatment in which the odds were
    more than 50% that it would cause death. However, in 1972 (Iggerot
    Moshe Yoreh De'ah 3:36), he modified his position, permitting only a
    safek shakul. He concludes that a hayei sha'ah who seeks medical
    treatment with a greater than 50% risk of death may rely on the more
    lenient position of Ahiezer and receive the dangerous therapy.

    How does Sam's participation in a COVID-19 human vaccine trial compare
    to the risks that these poskim cite? They address situations where the
    person is terminally ill and faces imminent death, but do not define
    the level of risk a healthy individual may incur. However, Tiferet
    Yisrael permits a healthy individual to undergo vaccination against
    smallpox with a risk of death of one in 1,000. For all adults age 20-29
    infected with COVID-19, including those with comorbidities, virologists
    estimate a 1.1% risk of complications requiring hospitalization and
    0.03% risk of death,[10] an approximation that might either
    overestimate or underestimate Sam's true risk.

    Sam, who suffers no comorbidities, might be at the low end of the
    participation risk. Furthermore, because Sam lives in an area with a
    large number of COVID-19 cases, he is already at high risk of
    infection; participation only minimally increases this. Should he
    become infected, he will receive state-of-the-art care, which might
    reduce his complications. In addition, if researchers identify an
    effective treatment, that treatment would further diminish his
    participation risk. With appropriate risk minimization (e.g., careful
    titration of viral dose, early diagnosis, and optimal medical care),
    Sam might face little, if any, additional risk related to experimental
    infection. Alternatively, Sam's risk of death might be higher than
    estimated because the vaccine or the strain of virus injected might
    increase the severity of infection or the incidence of lasting harm. In
    addition, because the virus is so new and follow-up of those infected
    limited, the long-term risks of COVID-19 infection are unknown and
    might be greater than anticipated. Even if Sam's risk from
    participating is higher than estimated, his danger of death is still
    well below the 50% threshold that the above poskim use and the 0.1%
    risk that Tifferet Yisrael permits for healthy individuals undergoing
    smallpox vaccination.

    Definition of Hayei Olam - What Benefits Justify Risk?

    The above discussion, which explored a hayei sha'ah's acceptable
    level of risk with regard to medical treatments, assumed that the
    goal of treatment is to achieve hayei olam, a long-term cure. Poskim
    disagree about whether one may undergo a dangerous therapy for any
    other purpose, such as prolonging life in the absence of a complete
    recovery or the relief of pain and symptoms. Iggerot Moshe Yoreh
    De'ah 2:58 and 3:36 prohibits risky treatment that merely prolongs
    life in the absence of complete recovery. Rav Bleich offers a
    different perspective.[11] Quoting Ramban's Torat ha-Adam,[12]
    which derives from the phrase, "le-hayei sha'ah lo haishinan"
    the principle that "we are not concerned with possible [loss of]
    hayei sha'ah in the face of more life (hayei tuva)," Rav Bleich
    interprets "hayei tuva" to mean more life, and concludes that Ramban
    would permit dangerous medical treatment to achieve a longer period
    of hayei sha'ah, even in the absence of a cure. Iggerot Moshe Yore
    De'ah II:36 prohibits dangerous treatment for pain relief alone. Rav
    Yaakov Emden, Mor u-Kezi'ah 328, writes that surgery for pain relief
    is not "hutar le-gamrei," categorically permitted, suggesting that
    under specific circumstances it might be allowed. Tzitz Eliezer 13:87
    permits morphine for a dying patient, although morphine might hasten
    his death, because nothing torments man more than intractable pain.
    Thus, Tzitz Eliezer would argue, a hayei sha'ah may undergo dangerous
    treatment not just to achieve hayei olam but also to achieve hayei
    tuva, longer life or pain relief.

    What is the benefit to Sam of participating in the human vaccine
    challenge trial? Will participation give him hayei olam, hayei tuva, or
    some other non-life prolonging benefit?  First, vaccination itself or
    infection with or without vaccination might yield hayei olam -- a
    long-term cure and permanent immunity to COVID-19, akin to Tiferet
    Yisrael's smallpox vaccine. However, it is possible that the vaccine or
    infection will only provide temporary immunity. Here, participation
    will not achieve hayei olam, but only hayei tuva, but revaccination to
    boost his immunity could yield hayei olam. Second, because Sam lives in
    a high-infection zone, he faces a real risk of becoming infected even
    if he does not participate. Participation guarantees Sam priority in
    the allocation of medical resources and the best medical care should he
    become infected. By participating, Sam decreases his risk of
    complications and death from infection. Better care could improve his
    medical outcome and increase his chances of surviving COVID-19, thus
    facilitating hayei olam. Furthermore, if he develops immunity, he can
    no longer infect his family. The possibility of achieving long-term or
    short-term immunity to COVID-19, better treatment if infected, and
    relieving anxiety over infecting others are direct benefits to Sam for
    participating in the trial.

    However, it is possible that participation will provide no benefit,
    direct or indirect, to Sam. Sam's ultimate motivation for
    participation, like that of the thousands of volunteers who have come
    forward to participate in these trials, is altruism, helping to
    discover an effective vaccine that will save millions of lives. May one
    undergo a dangerous treatment in order to save others?

    Incurring Risk to Save Others

    Citing Talmud Yerushalmi Terumot, chapter eight, Beit Yosef Hoshen
    Mishpat 426 obligates one to place himself in a possible danger to save
    the life of someone facing certain danger. In Shulhan Arukh, Rav Yosef
    Karo and Rama omit this requirement. Sema Hoshen Mishpat 426:2 explains
    that Shulhan Arukh and Rama follow Rambam, Rif, Rosh, and Tur, who also
    omit this obligation. Pithei Teshuvah Hoshen Mishpat 426:2 suggests
    that they omitted this obligation because it contradicts Talmud Bavli
    (Niddah 61a and Sanhedrin 73a) and Jewish law typically follows Talmud
    Bavli. Radbaz 3:627 (53) was asked if a foreign government demands that
    a Jew undergo removal of a limb, a procedure presumed not to endanger
    his life,  to save the life of another Jew, may one do so.  He answers
    that one who consents acts with midat hasidut, a degree of piety, but
    if amputation will endanger his life, he is a hasid shoteh, acting
    illogically by violating the commandment va-hai bahem (which Sanhedrin
    74a understands to mean that mitzvot are to live by and not die by).
    Similarly, in in Radbaz 5 Lilshonot ha-Rambam 1:582 (218), he addresses
    whether one is obligated to save the life of a fellow Jew, he explains
    that if the rescuer faces a safek mukhra - a certain danger - he has no
    obligation to act. But if the odds are greater that he will save his
    friend without endangering himself, failure to rescue transgresses lo
    ta'amod al dam rei'ekha.

    Tiferet Yisrael bases his teshuvah permitting a healthy volunteer to
    undergo smallpox vaccination on Talmud Yerushalmi and Beit Yosef Hoshen
    Mishpat 426, which obligate a person to place himself in danger to save
    a drowning friend. Tiferet Yisrael reasons that if one may endanger
    himself to rescue his friend from danger, he may certainly assume risk
    of vaccination to save himself and achieve long-term immunity. In fact,
    Iggerot Moshe Yoreh De'ah 2:174:4 permits one to accept a possible
    danger if it will save someone else from a definite danger. Tzitz
    Eliezer 13:101 rules that one may participate in experimental therapy
    and donate blood to benefit others if physicians determine that
    participation is risk-free. We consider such participation a mitzvah.
    In this situation, however, physicians cannot determine the risk of
    Sam's participating in the human vaccine trial and cannot claim that
    the trial is without risk.

    In Yehaveh Da'at 3:84, Rav Ovadia Yosef prohibits treatment with a risk
    greater than 50% based on Radbaz's classification of a rescuer who
    endangers himself for a safek shakul as a hasid shoteh. Rav Ovadia
    Yosef states that the majority of Aharonim, including Eliyah Rabba
    328:8, Netziv ha-Emek She'eilah Re'eh 147:4, Aruh Ha-shulkhan 426,
    Mishpat Kohen 143-2, Heikhal Yitzhak Orah Hayyim 3, and Iggerot Moshe
    Yoreh De'ah 1:145, support this position. However, he permits kidney
    donation and even considers it a mitzvah, because the risk to the donor
    is low; according to the physicians with whom he consulted, 99% of
    donors recover fully from the operation. Interestingly, like Rav Ovadia
    Yosef, ethicists point to kidney donation as a model for determining
    the level of risk one may accept to benefit others[13,14] and consider
    the risk of death from participation in a COVID-19 human vaccine trial
    equivalent to the risk of death from kidney donation.[15] Because the risk
    of death from participating in this trial is significantly less than 50%
    and is comparable to the risk of kidney donation, Halakhah would seem
    to permit Sam's altruistic enrollment to save others from certain death
    from the virus. In fact, Sam's participation, which has the potential to
    save not just one life, like a kidney donor, but millions, is not only
    permitted but meritorious. One might even argue that Sam is obligated
    to participate based on lo ta'amod al dam rei'ekha.

    Rav Asher Weiss in Minhat Asher 3:122 cites Ta'anit 18b as proof that
    an individual may endanger himself to save the community, and in doing
    so performs a great mitzvah. According to Rashi, Turyanus, a Roman
    official, accused the Jews of murdering the emperor's daughter. He
    threatened mass execution unless the guilty party confessed. To save
    the community, Lilianus and Pappus, falsely do so. Turyanos executes
    them and spares the community. Rav Weiss concludes that an individual
    who gives his life to save the community has a direct path to the
    Garden of Eden. He states that when a nation is at war, there are
    unique rules of pikuah nefesh, the obligation to save a life. To win,
    the nation requires the self-sacrifice of not only its soldiers, but
    all those who fill  essential, life-saving roles, such as police
    officers, fire fighters, security guards, and physicians. In the midst
    of a pandemic that has infected 13,000,000 and led to the death of
    500,000 worldwide, one may reasonably conclude that we are at war with
    COVID-19, and that Sam and the other volunteers for a human vaccine
    challenge trial are voluntary conscripts.

    Though Halakhah permits one to undergo risky treatment to achieve a
    long-term cure, poskim, including Tiferet Yisrael Yoma 8:3, do not
    obligate participation.  If the chance that the treatment will succeed
    is greater than 50%, Iggerot Moshe in Yore De'ah 3:36 and Choshen
    Mishpat 2:74:5  Rav Bleich explains that assuming risk for a long-term
    cure is permitted but not obligatory, because we trust a person to do
    what is reasonable to safeguard his body from danger. For those who are
    risk averse, undertaking a dangerous treatment or participating in a
    human vaccine trial would be unreasonable, while for the less
    conservative, such as Sam, the risk is acceptable.

    Experimental Therapy in Halakhah

    The discussion about dangerous medical treatment applies to therapies
    with known medical benefits. How does Halakhah approach risks incurred
    for experimental therapy with no proven benefit? Ttitz Eliezer 13:101
    limits participation in experimental treatment to trials that are
    risk-free. Rav Moshe Dov Welner in ha-Torah ve-haMedinah, VII-VIII
    (5716-5717), 314, prohibits participation in clinical trials that lack
    scientific basis. He addresses a situation where the physician has no
    idea how to treat a disease and decides to experiment on a dying
    patient because the patient will die anyway. He calls such a physician
    a terrorist. The scientific reality surrounding human vaccine trials is
    vastly different than this extreme example. While the exact benefits of
    participation - such as whether the vaccine confers immunity and
    whether it will eradicate COVID-19 - are unknown, these trials employ
    vaccines that have already shown promise in preliminary trials and
    undergone extensive review by governmental and international agencies
    that have approved their scientific merit as potential vaccines. Such
    trials would not qualify as acts of desperation, implemented because
    the patient is dying anyway.

    Minhat Shlomo 2:82:12 permits participation in medical research,
    classifying the battle against disease as a milhemet mitzvah, a
    necessary war. Today we do not have a king or beit din to declare a
    milhemet mitzvah against disease and obligate the healthy to take
    dangerous medicines to help find a cure. He writes that because
    recognized experts, our contemporary equivalent of a beit din or king,
    take great care to execute these studies, one may participate. He
    explains that participation qualifies as holeh lefanenu, the presence
    of an actual sick person before us, which is considered a fundamental
    halakhic requirement for defining a situation as pikuah nefesh. In Noda
    be-Yehuda Yoreh De'ah 280, Rav Yehezkel Landau prohibited autopsies
    because they are for the benefit of future patients, not those who
    appear before us now, and thus fail to meet a strict definition of
    holeh lefanenu.[16]  Rav Shlomo Zalman Auerbach explains that
    those autopsies were performed exclusively to increase the physician's
    knowledge, so are not comparable to experimental therapy. Rav Auerbach
    believes that contemporary medical research qualifies as holeh lefanenu
    because those sick with these diseases are before us, and the
    treatments to be tested are before us. He considers participation in
    clinical trials safek hatzalat nefashot - possibly life-saving - and
    not merely an academic exercise to increase scientific knowledge.

    Human Vaccine Challenge Trials

    Recently, Rav Asher Weiss[17] directly addressed the
    permissibility of participating in such trials. Reiterating his
    position in Minhat Asher 3:101 that one may endanger oneself to perform
    an essential communal role such as serving as a police officer, rescue
    worker, or even judge who risks death threats, he permits young,
    healthy individuals to participate in COVID-19 human vaccine challenge
    trials in controlled environments because the risk of complications or
    death is low, especially for those who are young and lack
    comorbidities, and the trial can potentially save thousands of lives.
    He notes the concerns of Noda be-Yehuda[18] and Hatam
    Sofer,[19] who prohibited autopsies because such procedures
    failed to satisfy their halakhic definition of holeh lefanenu.  Rav
    Weiss explains that even if we do not define participation as pikuah
    nefesh, overriding biblical and rabbinic prohibitions, it is a mitzvah
    since it will save millions of lives. This social good permits Sam to
    assume the small risk of participation. Furthermore, one cannot
    extrapolate from the autopsies of the Noda be-Yehuda to contemporary
    scientific reality. It is highly unlikely that autopsies performed two
    hundred years ago affected medical care. He writes, "verifying the
    efficacy of a vaccine would not be categorized as a benefit in the
    distant future, but rather as a great mitzvah that is, in fact,
    halakhically considered to be possibly life-saving." He rejects Rav
    Auerbach's classification of medical research as milhemet mitzvah
    because this designation obligates participation in medical research,
    and Rav Weiss believes that participation is not obligatory. Only wars
    fought against enemy armies qualify as milhamot mitzvah, not public
    dangers such as wild animals and diseases, to which only the laws of
    pikuach nefesh apply.


    The halakhic decisions cited above, including perhaps even Radbaz,
    would seem to permit Sam's participation in a COVID-19 human vaccine
    challenge trial, because a healthy individual may incur a small risk of
    death, comparable to the risk permitted for other acts of altruism such
    as kidney donation to achieve long-term immunity.  In addition, the
    potential benefit to society is immeasurable, preventing the death and
    suffering of millions by halting the spread of this pandemic and ending
    the physical, psychological, and economic devastation of prolonged
    social distancing.

    Table 1
[Okay, I couldn't pass the summary table of who defines chayei sha'ah
 as how long to the digest. So, go check the URL for yourself! Skipping
 to the foonotes. -micha]
    [7] Shvut Yaakov 3:75, Pithei Teshuvah Yoreh De'ah 339:1, Gilyon
    Maharsha Yoreh De'ah 155:1, Binat Adam 73, 93, Binyan Tziyyon 111,
    Tiferet Yisrael Boaz, Yoma 8:3, Ahiezer 2:16:6, Iggerot Moshe Yoreh
    De'ah 2:58 and 3:36, and Tzitz Eliezer 4:13, all permit a hayei sha'ah
    to undergo risky medical treatment for cure.

    [8] Bleich, J.D., "Survey of Recent Halakhic Periodical
    Literature: Hazardous Medical Procedures," Tradition, 37, no.3 (2003):
    76-100, [241]https://www.jstor.org/stable/23262430 .

    [9] Bleich, J.D. "Genetic Screening: Survey of Recent Halachic
    Periodical Literature," Tradition, 34, no.1 (2000): 63-87,
    [243]https://www.jstor.org/stable/23261641?seq=1 .

    [10] Verity, R. et al, "Estimates of the Severity of Coronavirus
    Disease 2019: A Model-based Analysis," Lancet Infect. Dis. March 30,
    )30243-7/fulltext .

    [11] Bleich, J.D., "Survey of Recent Halakhic Periodical
    Literature: Hazardous Medical Procedures," Tradition, 37, no. 3 (2003):

    [12] Kol Kitvei ha-Ramban, II, 38.

    [13] Miller, G.,  Joffe, S., "Limits to Research Risks," J. Med.
    Ethics 35, 445 (2009).

    [14] Resnik, D., "Limits on Risks for Healthy Volunteers in
    Biomedical Research," Theor. Med. Bioeth. 33, no. 2 (April, 2012): 137.

    [15] Verity, R. et al, "Estimates of the Severity of Coronavirus
    Disease 2019: A Model-based Analysis," Lancet Infect. Dis. March 30,

    [16] For a more detailed discussion of the definition of holeh
    lefanenu in Covid-19, see our earlier Lehrhaus essay,

    [17] Rav Asher Weiss, "Experimental Treatments for Coronavirus,"
    Mosaica Press (2020): 5-7.

    [18] Noda be-Yehuda Yoreh De'ah, 210.

    [19] Hatam Sofer Yoreh De'ah, 336.

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Message: 2
From: Chana Luntz
Date: Thu, 20 Aug 2020 22:43:28 +0100
[Avodah] uncovered hair in home in front of relatives.

<< Private: The Biur Halachah writes that although originally it was
permitted for married women to uncover their hair in the privacy of their
homes, in more recent times "the prevailing custom in all places is for
women to cover their hair, even in the privacy of their own homes.... Since
our ancestors, in all localities, have adopted this practice, it has taken
on the full force of Jewish law and is obligatory...."
Rabbi Moshe Feinstein disagrees with this ruling and writes that "[covering
hair when in private] is praiseworthy, but not required."
Can anyone tell me where this igros moshe is? >>

See Igeros Moshe Even HaEzer Chelek 1 siman 48 and also (and particularly)
Igeros Moshe Orech Chaim chelek 5 siman 37:12:

????? ???? ???? ????, ???? ?????.  ??????? ????? ??? ??? ?? ????.   ?????
???? ?????? ???? ??? ????? ????? ???? ???? ?????.   ?????? ???? ????? ?????
?????? (???? ?"? ?"?), ??? ?? ????? ????? ?????? ???? ?????? ?????? ???????.
???? ?????? ?? ??? ??????? ?????? ?? ??? ?????? ??????.
The covering of the head before her husband is not necessary. Since the
prohibition of uncovering the head is only in the marketplace.  And even at
the time of her period, there is no prohibition in her house before her
husband and children.  And there is a hidur to do like Kimchit (Yoma 47a)
but we have not heard that there are any modest like this and even in the
earlier generations.  And in the time of the Tanaim the married women were
not accustomed so except for individuals like Kimchit.

Note specifically *but we have not heard that there are any modest like
this, and even in the earlier generations*.  A reasonably translation of
this is surely: neither Rav Moshe's wife, nor his mother did this.

<<Answer: It is permissible to uncover your hair in your own home in the
presence of your father, husband and son.

Where it is customary and not considered offensive, a woman may uncover her
hair in front of her brother in the privacy of her own home.

Is this leniency known/relied upon? Is this what people are doing out there

I think it depends on your community.  In a modern orthodox community in
which most women are not covering their hair when they go out in a public
place either, I suspect many if not most of the few women who do cover their
hair when they go out absolutely rely on this position, and sometimes more
lenient ones inside their homes (ie only cover their hair when they go out,
as per the pshat of the mishna & gemora in Ketubos as referred to by Rav
Moshe, and not when in their home regardless of who is there).  In the
Satmar community where they shave their heads, no, I am pretty sure no women
are relying on this leniency.   Within the communities on the spectrum
between these two poles, I suspect it varies, getting more likely as you
move towards the more "modern" end and less likely as you move towards the
more charedi and certainly Chassidic end.  But Rav Moshe never having heard
of it in his and in previous generations is a notable data point.





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Message: 3
From: <mco...@touchlogic.com>
Date: Thu, 20 Aug 2020 20:04:40 -0400
Re: [Avodah] uncovered hair in home in front of relatives.

Thank you for your comments

RCL wrote... Note specifically *but we have not heard that there are any
modest like this, and even in the earlier generations*.  A reasonably
translation of this is surely: neither Rav Moshe's wife, nor his mother did

True; although I would like to hear what the Feinstein children testify
about their mothers hanhaga..

RCL wrote... Answer: It is permissible to uncover your hair in your own home
in the presence of your father, husband and son.

R moshe as quoted only mentions husband/children.
Where/how do we expand this to her brother?
if it was bc of the simple pshat of the Mishna & gemora in Ketubos, then
everyone should be ok inside (not just brother/family)

and if the heter is based on inside - is uncovered hair allowed when
swimming w husband/children alone (but outside)?
(it is illogical to suggest that there is a continual obligation to cover
her hair outside, even when a permissible situation such as alone or only
with other women)


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Message: 4
From: Chana Luntz
Date: Fri, 21 Aug 2020 01:56:42 +0100
Re: [Avodah] uncovered hair in home in front of relatives.

RMC writes:

<<RCL wrote... Answer: It is permissible to uncover your hair in your own
home in the presence of your father, husband and son.>>

Actually, this wasn't me, this was the yoetzet website you quoted.

<<R moshe as quoted only mentions husband/children.
Where/how do we expand this to her brother?
if it was bc of the simple pshat of the Mishna & gemora in Ketubos, then
everyone should be ok inside (not just brother/family)>>

I assume that the reasoning behind the website's psak is based on with whom
she is allowed to have yichud.  Rav Moshe also doesn't specifically mention
father, and yet the logic of the website including father as automatically
on the same page as husband and children would seem to be driven by the
unity of halacha regarding yichud.  The yichud status of brothers is a bit
more complex, as a certain level of yichud is allowed, but not completely,
and hence they would seem the logical extension to question, and one could
understand a view that, to the extent yichud is allowed, so should this be.




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Message: 5
From: Akiva Miller
Date: Fri, 21 Aug 2020 06:06:29 -0400
Re: [Avodah] birchat hanehenin

R' Joel Rich wrote:
> I'd love to understand why there seem to be 3 statuses -
> machshava balma (random thought?) which has no halachic significance,
> amira (specific oral articulation) which is completely binding and
> amen/specific machshava (really imho 2 separate items) which are somewhat
> indeterminate (not welcome in a brisker world?)

It seems to me that what you're really asking is: How/why does "Shomea
k'oneh" work?

Why is it that if I listen to someone say something, and we both have the
correct "specific machshava", it is considered "as if" I had said it
myself? And, just as importantly, to what *extent* is it considered as if I
said it myself?

As an illustration of this principle, R' Danny Schoemann cited the Kitzur
in 127:3
> Similarly, regarding the fasts on Monday, Thursday and Monday
> following Pesach and Sukkos. If you answer Amein after the Mi
> shebeirach ... and you intended to fast, this is sufficient...
> Nevertheless, if you change your mind, and do not wish to fast,
> you may [eat], since you did not expressly commit yourself.

I'd like to offer another illustration: If a person is saying Shemoneh
Esreh when the shul is at Kaddish or Kedusha, Mechaber 104:7 writes that
"He should be quiet and pay attention to the shatz, and it will be like he
is answering." And the Mishne Berura 104:28 explains: "It will be like he
is answering for the purpose of being thereby yotzay for Kaddish and
Kedusha, but nevertheless it is not considered a hefsek."

The halacha of Shomea K'oneh seems to allow us to have it both ways: We
have *effectively* said something, yet not *actually* said anything.

[Email #2. -micha]

Addendum to what I wrote a few minutes ago:

I know that Shomea K'Oneh is effective even when one does not actually
respond "Amen". After all, a precise translation of the phrase would NOT be
"listening is like answering Amen", but is rather "mere listening is like
repeating it yourself."

And yet, I seem to recall that there are some specific cases where the
halacha differs depending on whether the person actually said "Amen" aloud,
vs where he merely listened with all the correct intentions. Does anyone
else know of such cases?

Akiva Miller

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Message: 6
From: Marty Bluke
Date: Fri, 21 Aug 2020 07:33:33 +0300
[Avodah] Blowing shofar with a mask on the end

To prevent the spread of COVID see

What are the halachic implications of putting a mask on the end of the
shofar? Does it affect the sound?
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Message: 7
From: Zev Sero
Date: Fri, 21 Aug 2020 07:57:08 -0400
Re: [Avodah] Blowing shofar with a mask on the end

On 21/8/20 12:33 am, Marty Bluke via Avodah wrote:
> To prevent the spread of COVID see 
> https://www.timesofisrael.com/put-a-face-mask-on-your-shofar-so-it-wont-blast-virus-to-worshipers-experts/
> What are the halachic implications of putting a mask on the end of the 
> shofar? Does it affect the sound?

The OU says it doesn't appear to.


9. Shofar: An appropriate precaution during shofar blowing would be to 
place a surgical mask over the wider end of the shofar, as this does not 
appear to alter the sound of the shofar blast. Some may point the shofar 
out an open window or door, or near and towards the front wall or aron 
kodesh, facing away from the congregation. A single shofar should not be 
used by multiple people, and no barrier should be placed between the 
shofar and the mouth of the one blowing the shofar. Poskim have 
addressed when and how much to sound the shofar where the time in shul 
is seriously limited

Zev Sero            Wishing everyone a *healthy* and happy summer
z...@sero.name       Seek Jerusalem's peace; may all who love you prosper

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Message: 8
From: Micha Berger
Date: Fri, 21 Aug 2020 15:07:00 -0400
Re: [Avodah] Blowing shofar with a mask on the end

On Fri, Aug 21, 2020 at 07:33:33AM +0300, Marty Bluke via Avodah wrote:
> https://www.timesofisrael.com/put-a-face-mask-on-your-shofar-so-it-wont-blast-virus-to-worshipers-experts/

> What are the halachic implications of putting a mask on the end of the
> shofar? Does it affect the sound?

As Zev already posted, the OU considers it permissible if the mask does
not affect the sound.

But I don't know how they are publishing a single answer without
specifying which kind(s) of masks they experimented with.

The typical shul can judge for itself whether the mask changes the sound
of the shofar. (Although maybe if you have a piano tuner or someone else
with sensitive hearing in the minyan, you need them to say they don't
hear a difference if they personally wish to be yotzei.)

But it's unlikely that every shul has the resources to measure the
resulting potential virus spray given their choice of mask / cloth to use.

Some of the other solutions -- such as pointing the shofar away from
the congregation and toward a nearby window -- may be more safer choices.

Chodesh Tov!

Micha Berger                 The purely righteous do not complain about evil,
http://www.aishdas.org/asp   but add justice, don't complain about heresy,
Author: Widen Your Tent      but add faith, don't complain about ignorance,
- https://amzn.to/2JRxnDF    but add wisdom.     - R AY Kook, Arpelei Tohar


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