Triage in halacha

[RabbiM]

The following case is taken from a presentation Monday afternoon by
Rav Akiva Tatz MD at Hackensack University Medical Center. Rabbi Tatz
is a surgeon turned Torah scholar who lectures widely around the
world. Years ago the largest trauma center in South Africa acquired a
very expensive state of the art ventilator. Since there was only one
available, the hospital ordered that it may only be used for
salvageable patients. Their reasoning was that if it were used for a
patient who was not salvageable, and then a patient came in whose life
could be saved, they could not (for practical reasons as well as legal
reasons) disconnect the hopeless patient in order to use it for the
salvageable patient, whose life would thereby be lost unnecessarily. A
young Jewish doctor asked a great rabbinical authority whether he is
obligated by halacha to use it for the first patient who needed it
rather than follow hospital guidelines, since we believe that even
"chayei sho'oh" must be preserved. The first halachic authority ruled
that the doctor should follow hospital guidelines, since the
statistical likelihood that a patient would need it is sufficient to
consider it as if the salvageable patient is already here and
deserving of a priority. The case was later referred to a Gadol in
Jerusalem who gave his opinion that as long as there is no patient
here now who is more salvageable we make the machine available for the
person who needs it now, even if that is counter to hospital policy.
The case was later referred to Rav Zilberstein in Bnei Berak and he
felt that the proper way to handle this would be to attach a bell and
timer to the ventilator which would turn it off every 30 minutes, and
an alarm would ring then and it would be started again. If the machine
was in use for a patient who was non-salvageable and another patient
who was salvageable arrived, the next time the machine switched off
automatically it would be disconnected and diverted to the other
patient.

I raise the following issue: Is it not permitted for the owner of
property to make decisions regarding that property for financial
reasons even though the fiscal policy will impact on life or death?
The proof is from the oft cited decision of Maharam MeRutenburg who
ordered that he should not be redeemed from imprisonment in order that
the community not be impoverished by the fine, and in order that other
rulers should not copy the practice of imprisoning Jewish leaders for
ransom. Clearly, the dungeon provided poor medical care and therefore
the decision not to be redeemed had consequences for Dinei Nefashos
and nevertheless his orders were followed. Couldn't the hospital argue
they are entitled to ration this expensive machine since they cannot
afford to buy many such machines. Even though the hospital is not
necessarily correct in devaluing Chayei Sho'oh they are entitled to
control their financial resources and therefore the doctor would not
be right in using the ventilator for non-salvageable patients.

Rabbi Avrohom Marmorstein