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problem of maintaining medical confidentiality in all its various as-
pects.]

2. Are we obligated to provide expensive treatment to such a per-
son, when he endangers the public, including the medical staff, in
various ways, considering that he will die within a short time if his
dialysis treatments are stopped?

3. Should a kidney become available for transplant into such a per-
son, should he receive it, in view of the enormous shortage of kidneys
available for transplant and the extremely long waiting list?

Dr. David Jonathan Van Dyke, Spe-
cialist in Internal Medicine, Kidney
Disease and Blood Pressure, Petach
Tikvah

ɳ Response

This young criminal should not receive the gift of a kidney because he
is considered a rodef (a pursuer). It is clear in maseches Pesachim (49b)
that there is a type of person whom it is permitted to kill even on Yom
Kippur that falls on Shabbos. Tosfos (ibid. s.v. v’yaish) explain that
this refers to a person whose killing is viewed as piku’ach nefesh [of
the public], “for he is a robber and is suspected of murder, otherwise
how would it be permitted to kill him on Yom Kippur which falls out
on Shabbos, when even a gentile may not be killed...?”

The case described in the above letter, where while undergoing
treatment by the physicians he performed an indecent act using
threats and had previously stolen and robbed and performed indecent
acts – a criminal of this type resembles the kind of person mentioned
in the gemara and by Tosfos above, whom it is permitted to kill and to
whom it is certainly forbidden to extend help and a donated kidney.

The Shulchan Aruch (Choshen Mishpat 425:4) also writes,“A per-
son who was pursuing a close relative [in order to sin with her] and
others were chasing after him to save her, and she said, ‘Leave him
alone…’… we do not listen to her. Instead we frighten him and pre-

276 1 Medical-Halachic Responsa of Rav Zilberstein