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of the adrenaline’s effects is to produce prolonged contrac-
tion of the blood vessels and it regulates the heart rate. If
in extreme situations this effect is very prolonged and the
cardiac arteries are not in good condition, it is liable to cause
a blockage in the heart, which leads to the death of the tissue
[this can sometimes happen even when the arteries are in
good condition]. When a tissue’s oxygen supply is interrupt-
ed it decays i.e. it ceases to be living tissue. Blockage of the
cardiac muscle is obviously liable to lead to disturbance of
the heart rate and even to death [e.g. ventricular tachycardia
or fibrillation].

In addition, love of women, if it is prolonged, usually
expands the heart but unrequited love leads to depression.
Nowadays, antidepressants can be given in such situations
and also in situations of stress, in order to offset conditions
that cause the secretion of adrenaline. These drugs stop the
contraction of the blood vessels.

Thus, in light of these physicians’ comments, since this condition
can be treated medically, it is not considered piku’ach nefesh and it
is therefore straightforward that in this case a shoteh should not be
allowed to have relations with his sister’s daughter.4



Separating Mentally Ill Brothers when this Might

Lead One of them to Commit Suicide

Question: A person has two mentally unstable brothers, one of
whom is younger and the other older, who share the same accommo-
dation. The older of the two cooks, does laundry and takes care of the

4. See too further, siman 285, ‘Response to Question Two,’ regarding sinning on
one’s own in order to prevent suicide.

412 1 Medical-Halachic Responsa of Rav Zilberstein