Home Hospice: A Kohen’s Dilemma – Part I

Palliative care provided through a home hospice program is a medical support service for patients with advanced terminal illnesses who choose to spend the final stage of their lives at home, surrounded by their loved ones. The goal of palliative care, including private home hospice services, is to maximize quality of life and comfort, prevent unnecessary suffering, and relieve physical pain, anxiety, and other symptoms associated with the illness and the patient’s condition.

Dr. Beth Popp specializing in Hospital Medicine at the Mount Sinai in New York recently presented the following question: A Kohen that his elderly mother-in-law is terminally ill, and her physicians have recommended that she receive palliative care at home. Is he permitted to bring her into his own home so that she can live there during this period?

On the one hand, there is no doubt that the support, care, and sense of closeness that her immediate family can provide in such an environment are of tremendous value. On the other hand, this raises a concern regarding the laws of Tuma that apply to Kohanim, since she is expected to pass away in the near future.

Among the issues that must be clarified is whether a Kohen may enter a house in which a terminally ill patient is present.

At the heart of this discussion lies the Halachic status of a Goses – a person in the final stages of life – with respect to Tuma. The Gemara (Nazir 43a) records a Machlokes about this issue:

The Chachamim taught: “[He shall not defile himself] ‘l’Heichalo’ (to profane himself)” – [this prohibition applies only] from when the person dies. Rebbi says: “[He shall become impure] ‘b’Mosam’ (in their death)” – only after death.

What practical difference is there between them? R’ Yocḥanan said: Their dispute only concerns the [correct] interpretation of the Pasuk. Reish Lakish said: The Nafka Mina concerns a Goses. According to the one who derives it from “l’Heichalo” the prohibition applies even to a Goses; according to the one who derives it from “b’Mosam” it applies only after death, but not while he is a Goses.

According to R’ Yocḥanan, the Chachamim and Rebbi agree that a Goses does not transmit Tuma because he is still alive. However, according to Reish Lakish, while Rebbi permits a Kohen to come into contact with a Goses, the Chachamim prohibit it even though there is no Tuma until death. They derive this Isur from the Pasuk, “l’Heichalo”.

The Rishonim disagree as to the interpretation of this Drasha. The Mefaresh (traditionally attributed to Rashi) on Nazir explains:

According to the one that derives it from l’Heichalo, it applies even to a Goses, because once he is a Goses, he is destined to become a corpse (a “Chalal”), for we maintain (Gitin 28a) that most Gosesim die (“Rov Gosesim l’Misa”), and the Pasuk says “Lo Yechalel”.

Tosfos (ibid.) offer a similar explanation:

The prohibition of “he shall not defile himself” is expounded as though it were linked to the word l’Heichalo [as if the Pasuk read, “He shall not defile himself to profane himself”] thus teaching that the prohibition applies even in the presence of a Goses.

              The Meiri similarly cites this ruling in the name of the Halachos Gedolos.

The Chochmas Adam (159:3) explains likewise:

A Kohen may not enter a house containing a Goses. Although the Goses does not yet convey Tuma, the Kohen violates the prohibition of “Lo Yechalel”, for he is commanded to safeguard the sanctity of his priesthood.

If the Torah prohibits a Kohen from remaining in a house with a Goses because he is “profaning” his priesthood by remaining in a place where he will almost certainly become impure – as “Rov Gosesim l’Misa” – perhaps the same should apply to any terminally ill patient whose death is anticipated imminently.

However, the Rosh in Nazir (ibid.) has a different approach. He interprets the Drasha from the word “l’Heichalo” as a reference to a Chalal – a corpse, even before death actually occurs. As he states: “From the moment he assumes the status of a corpse, since most Gosesim die.”

According to this view, the prohibition is not merely due to possible contact with Tuma, but because a Goses is already considered a Chalal. This leaves room to distinguish between a Goses and a terminally ill patient. Only a Goses, who has already entered the process of dying, is included in the Torah’s prohibition. A terminally ill patient, although death may be imminent, has not yet entered that process and therefore does not have the status of a Chalal.

Nevertheless, the Rosh’s concluding words (and the Mefaresh ibid.) that “most Gosesim die” suggest that the ruling is predicated on the principle of Rov. If so, one might argue that there is no practical distinction between a Goses and any other terminally ill patient whose death is all but certain.

Furthermore, the Gemara in Maseches Nazir (4b) seeks to prove that Shimshon became Tamei Meis from the Pasuk stating that “he struck” the P’lishtim. The Gemara rejects the proof: “Perhaps he merely left them Gosesim” – that is, he struck them to the brink of death, removed their garments while they were still alive, and thus remained Tahor. The Rishonim ask: a Nazir is forbidden to become Tamei even through contact with a Goses. Tosfos answer:

The Gemara does not mean actual Gosesim, as a Nazir may not touch a Goses. Rather, it means they were close to becoming Gosesim.

This answer makes it clear that the prohibition applies only to an actual Goses, not to someone merely close to that state, even if they are likely to die. The reason, as explained above, is that the Torah prohibited contact only with a Goses, in whom the process of death has already begun and is therefore considered a Chalal.

However, the Rosh offers a different answer:

It seems to me that one must distinguish between a Goses through natural causes and a Goses as the result of human action.

At first glance, the Rosh appears to reject Tosfos’ explanation that one who is merely close to becoming a Goses does not transmit Tuma. Indeed, the Gemara’s wording – “perhaps they were Gosesim” – does not suggest that it refers to those who had not yet reached that state. Had the Gemara meant that actual Gosesim were forbidden but those approaching that state were not, it should have said so explicitly.

The Rosh therefore explains that there are two kinds of Gosesim: One who is dying naturally and one whose condition was caused by human action. A Goses through natural causes transmits Tuma, even before the death process has fully developed, since most Gosesim die and it is all but certain that the Kohen will become impure.

However, this distinction is difficult to reconcile with the Rosh’s earlier explanation that the prohibition stems from the fact that a Goses is already considered a Chalal because most Gosesim die. If so, why should it matter whether that state resulted from human action or natural causes? This question is raised by the Keren Ora.^[1]

              Nevertheless, the Rosh’s distinction requires explanation.

It would seem that a Goses is only considered to have begun the process of dying if he became a Goses through natural causes (see Peirush haMishnayos, Kapach Edition, Ohalos 1:7). By contrast, a Meguyad – although hovering between life and death, and although most such victims die – is not yet in the process of death; rather, he is engaged in that struggle. Until the body has yielded and the process of dying has actually begun, he is not regarded as a dead person.

Accordingly, when the Rosh explains the prohibition in terms of “most Gosesim die,” that is not the primary reason. The decisive factor is that this individual has already entered the process of death. Since that is now his condition, and since most people in that state do die, it is already forbidden for a Kohen to come into contact with him.

At any rate, none of the other Rishonim adopt the Rosh’s distinction between two kinds of Gosesim.

To be continued…

[1] Incidentally, the Beis haLevi (3:29) asks how Reish Lakish knew to derive from the Pasuk that a Nazir may not become Tamei through contact with a Goses. Perhaps the Pasuk refers instead to a Meguyad – one mortally wounded by a sword – who is even closer to death than a Goses, as the Gemara states in Yevamos (120b, see Tosfos, Tosfos Yeshanim, and Ramban there). Perhaps this supports the Rosh’s distinction between a Goses through human action and one through natural causes. A Goses by human action is not included in the prohibition, which may be why Reish Lakish was compelled to derive a Goses from the Pasuk rather than Meguyad.