Is One Obligated to Take into Account Low Level Side Effect Risks in Child Immunizations? Part 2. Shomer Ptaim Hashem

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1 Cheshvan 5773 October 2012 Dear friend, The 15th Annual Jerusalem Yarchei Kallah took place August 8-14, 2012, and was successful both in participation and halachic content. As in all previous Yarchei Kallah Gedolai hador shared with us their knowledge regarding both theoretical and practical concerns pertaining to a variety of contemporary bioethical issues. The Rav visited the Panama community but was recalled to Jerusalem with news of his Mother s z l serious medical condition. She passed away at the age of 102 after a long life of doing chessed for Am Yisroel especially concerning the enormously important mitzvah of hachnoses kallah, of assuring creating homes in the joy of Torah and ensuring the growth of our people. May she be remembered by all for a blessing and a role model for all whose aspirations all firmly rooted in the Torah. The Rav plans traveling to the communities in Chicago and Switzerland. For additional information please visit our web site Is One Obligated to Take into Account Low Level Side Effect Risks in Child Immunizations? Part 2 Shomer Ptaim Hashem In Tractate Avodah Zara (30b) "R' Eliezer asserts that one may eat grapes or figs at night and need not fear (that a venomness snake had previously bitten into them) for it is written in Psalms (116:6) Shomer Ptaim Hashem- Hashem protects the simple." The Rabbis prohibited drinking uncovered water in vicinity in which poisonous snakes are common. This prohibition is limited only to liquids; it does not include solid foods. The Tosfot Rid to Avodah Zara (30b) clarifies that "One may eat figs and 1

2 grapes at night and need not fear that a poisonous snake had bitten into them. Even though this may happen, one need not be concerned as this is indeed an infrequent occurrence. However it is common that they drink liquids (from open containers)." Hence we may conclude that a rare yet hazardous event should not be seen as a cause for apprehension. Tractate Niddah (31a) teaches "that if one has relations with his pregnant wife on the 90 th day since conception, it is as if he were killing the fetus. Argues Abaye, based on the principle of shomer ptaim Hashem one may act normally and not be apprehensive." This principle also appears in Ketuvot (39a), Yevamot (71a) and Shabbat (129b) 1. Consequently with respect to inoculations and their rare side effects, given that the overwhelming numbers of those vaccinated suffer no ill effects, one should not be concerned regarding their children being vaccinated: the halachic principle of shomer ptaim Hashem is inherently invoked. Additionally, as mentioned above (Bulletin 14, part 1), there is a mitzvah that commands us to safeguard our health. Hence vaccinating one's children can be defined as being osek b'mitzvah (currently engaged in the performance of a mitzvah). The Gemara in Pesachim (8b) maintains that performing a mitzvah involving an infrequent risk to life brings into play the rule of shluchei mitzvot einan nizokin (messengers of mitzvot are not injured). Thus when performing a mitzvah, one need not entertain any apprehension concerning infrequent risk. The Gemara's source for this rule is Shmot (34:24) where the Torah guarantees that no harm will befall people or their home properties or belongings while performing the mitzvah of aliya l'regel (going up to Jerusalem) for one of the holidays. This includes their cows grazing in the fields or chickens running free. The present author would reason that if cows and chickens are guaranteed against harm, then even more so one's children for whom the mitzvah of safeguarding their health is being accomplished via the inoculation. 1 See Rapo Yerape, Chapter 15, by this author for further insights regarding this topic. 2

3 A dissenting opinion is voiced by Avnei Nezer (Orach Chaim, 454) who understands the rule in the previous paragraph known as shluchei mitzvot einan nizokin applies only to the person himself and not to his child. He discusses the rule as it pertains to a baby about to have a brit mila but for whom a small risk might be present. He concludes that the rule is applicable only to the one performing the mitzvah but not to its beneficiary. In opposition to the Avnei Ezer's view, the Chatam Sofer (Yore Deah 243) posits that indeed the rule applies also to the baby. Community Immunity 2 It may be argued from the intersection of the principle of shomer ptaim Hashem and the community immunity model that given a vaccinated community, it might be unnecessary to inoculate any particular child. The likelihood of that child contracting a contagious disease from a community of vaccinated children would be minimal. Why then would any parent be obligated to vaccinate his child? Perhaps it is even prohibited in that the child will be administered a seemingly unneeded injection which may cause pain and unwanted side effects such as low-grade fever, stuffy nose or sore throat. Concerning the definition of danger, there are five relevant issues raised by the Rambam concerning this topic which we will now present and analyze. The first Rambam (as presented in part one of Bulletin 14) is a general decree which speaks of life threatening dangers 3 Hence one might conclude that only in lfe threatening danger does the Torah demand safeguarding one's health. 4 2 Also known as Herd Immunity. "When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines such as infants, pregnant women, or immunocompromised individuals get some protection because the spread of contagious disease is contained. This is known as 'community immunity'." Department of Health and Human Services, National Institutes of Health, National Institute for Allergy and Infectious Diseases. 3 The Rambam in Laws of Murder and Guarding One's Life (11:4) states: "Similarly, there is a positive commandment to remove all obstacles that are hazardous to life, as it is written (Deut. 4:9) 'Take heed and care diligently for your lives.' If one neglects to eliminate hazardous impediments, but instead leaves them, he has transgressed the negative commandment of 'Do not retain (objects that result in the loss of) blood (i.e., death) in your home (Deut. 22:8). 3

4 The second Rambam (Laws of Murder and Guarding One's Life, 12:4) is derived from the Rambam s interpretation 5 of the Yerushalmi (Terumot 8:3) and informs that: "It is prohibited to insert coins in one's mouth for the dry spittle of a mukeh shechin (one who suffers from boils) or that of a leper may have adhered to them." In his third statement the Rambam (ibid, 12:5) declares that "A person should not place his hands under his armpits for it is conceivable that he touched a leper or a poisonous substance which may enter into the bloodstream through absorption via the armpit. (This results from) one s not paying attention to what he touches." The fourth reference (ibid, 12:5) warns that "One should not place cooked food under a bed for a harmful object may fall unseen onto it." It should be stressed that this statement does not refer to a life threating hazard, instead to harm that might ensue to the person who subsequently eats the cooked food. Finally (ibid, 6) the Rambam declares that "a person should not pierce an etrog or radish with a knife for (fear that) someone may fall on the blade and perish." One might posit a contradiction between the first and fourth statements of the Rambam above. The instance of an object falling on the food (statement four) while under the bed deals with the case of possible harm to the one who consumes the food. The Rambam declares that eating the cooked food is prohibited even though not necessarily jeopardizing life.thus differing from the first statement. The source of the Rambam is the Yerushalmi (Terumot 8:3). Says Rav Ami, one should be wary (of those situations) of which other people are also wary. The Yerushalmi provides four examples which form the basis of the Rambam s positions. This author understands that the Rambam s first ruling concerns circumstances which may lead to life-threatening consequences. Hence every individual is obligated to be wary of them notwithstanding the sensitivity or lack thereof concerning the consequences (e.g., smoking)of the community. An exception to this rule (according to the Rambam s interpretation of the Yerushalmi) is that even if the case under 4 Support for this can be identified from the fact that these laws are derived from the section of the Rambam Guarding One s Life and not his Health. 5 Statements two to five of the Rambam are all derived from this Yerushalmi. 4

5 consideration is not life threatening, when a community is wary concerning some specific situation, an individual must conform and also exercise caution. An additional example of this principle can be understood in Avodah Zorah (30b) concerning a certain vegetable[shachalayim] that is steeped in wine. In Israel there was no concern about a snake drinking from the mixture. However, abroad people were indeed wary of the possibility that a snake drank of the mixture, and as such it was prohibited for them to drink of it. The Gemorra is telling us that since abroad wariness exists, even though it should be permitted (as it was in Israel), however since the community was wary then each individuals is likewise obligated to conform. This would answer the above question on the Rambam. That when a community is wary regarding a harmful situation this obligates the individual even if not life threatening. The Ra avad (Laws of Murder and Guarding One s Life 12: 5, 6) argues with statements three, four and five of the Rambam. Regarding statement three the Ra avad opines that the Yerushalmi (Trumot 8:3) in reality speaks of either a piece of meat or bread (being placed under the armpits), this being prohibited due to the detrimental outcomes to health emanating from the sweat in the armpits which will contaminate the food and directly endanger the person. With reference to the fourth ruling of the Rambam, the Ra avad disagrees and states that it is prohibited because of a ruach ra a (a malevolent spirit under the bed). Finally the Ra avad disagrees with the fifth position of the Rambam and declares that the reason one should not pierce (the etrog or radish)is for use as a knife handle this stems (not from the possible death of someone) but from disgracing food. This author suggests that their argument revolves around those parameters which compel one to be wary regarding those situations, even though rare, which others are also wary of. Evidently the Rambam understands that even if a small possibility exists that harm may emerge from some event or condition (even though presently not prevailing) it is prohibited. This is exemplified by placing one's hand under his armpits which is currently a non-extant danger, but which may develop into one in time. Similarly, placing food under a bed is in itself a neutral act, one which may 5

6 however lead to a hazard if something falls on it. Lastly, sticking a knife in food, although currently not causing harm, may do so if someone falls on the pierced fruit. Nevertheless since people are wary of such circumstances, one should avoid them. On the other hand the Ra'avad understands the Yerushalmi as pointing to a presently extant but low probability danger. For example, although the likelihood of the spittle of a leper or body sweat being present on a coin is slight, nevertheless since a dimension of existing danger, which if present, would harm a person, since people are wary of such situations, one must also be wary. This clarifies the Ra'avad's dispute with the Rambam's ruling requiring the scenario of placing bread or meat (which will be eaten) under the armpit. The ruach ra a that is present on the food under the bed. Concerning the obligation of inoculating a child, the Rambam would rule that since there are people who are wary of the consequences, the child should be inoculated. However according to the Ra avad, since there is currently no extant danger, one would not obligated to inoculate the child. The Shulchan Aruch (Yore Deah 116:5) combines the interpretations of both the Rambam and the Ra avad. Therefore one would be obligated to innoculate ones child. 6