Gosses/Saving a Life

Dear Rabbi, My question is about the complex situation which can arise when somebody is in the presence of a dying person. Since I was in that situation recently and after checking relevant sources I wasn't able to decide what are the proper actions in this case I am writing down also the situation and after that my questions. I took care of my elderly friend and colleague since he was bedridden because he hadn't family member in the city and I was in his neighbourh. After two weeks of hospitalization he was taken home at Friday in a very weak condition, because he didn't want to remain in the hospital anymore and even refused to eat properly there, although he also ate very little in the last months at home as well. I was there when he was placed in his bed and I remained there for about an hour but went home to Sabbath preparations and went back to him at the evening. He was sleeping when I arrived, therefore I started to read, but after a I while he woke up and drank some juice from a bottle. He started to cough, presumably due to some fluid misswallowing. That happened several times earlier, and I knew that it is common when somebody is drinking regularly in lying position. But the cough didn't stop but it turned into a kind of noise where some fluid is blocked in the windpipe, therefore I went to him to help, and said that he should cough a bit forcefully in order to remove the misswallowed fluid. He tried to do it and I elevated the head of the bed with my hand to help to get the fluid out (it was a motorized bed with movable parts), but it didn't help. He also said that he had nausea but wasn't able to vomit, so I was waiting beside him and tried to elevate his upper body and patting him on his back to help freeing the windpipe. Then he said that I should call the emergency because he cannot breathe so I called them and told the situation and when the assistant asked if he was breathing, I saw that not anymore, so the assistant said that I should immediately start resuscitation because within a few minutes it is possible to save his life. So I moved him to the floor and started the chest compression for about ten minutes when the emergency unit arrived and they tried to his resuscitation for about another 20 minutes when they stopped finally. After the confirmation of death, the leader of the unit told me that he hadn't shown the signs of life when they arrived. After the incident I looked for the description of the case of a dying person, mainly in the Shulchan Aruch and in the book Care of the Critically Ill, Responsa of Rav Moshe Feinstein. After checking these sources, I have encountered with the concept of goses, where the main signs are that every time the individual breathed in and out you could hear the phlegm in the bronchial tubes. And the main point of the halacha (as I understood) that you shouldn’t do anything, not even touching the sick person. But in my case several conditions appeared which were not discussed in the halacha and in the responsa I read. I know that this is not a reversible situation but I would like to know what should somebody do in similar cases when he is alone and no professional help is available expect emergency call. My questions are: 1., Are you allowed to use the motoric function of a bed to change the position of a patient on Shabbath when under normal condition it is not life saving but useful for the comfort of a bedridden patient? (Since he had been drinking in bed for over a year and had often coughed afterwards, therefore I didn’t know that this case can be dangerous). 2., If somebody knows what goses means and are able to confirm its signs as well, then is he not allowed to touch him when he is assuming, that some action can help him? (Like elevating his upper body to ease breathing or similar). 3., I think you should call the emergency service when he asks for it, even if he definitely in the state of goses. (?) 4., When the emergency service responds and you see that the patient is no longer breathing and they say that you should start his chest compression, what should you do? Based on the halacha, he had already died and you cannot touch him, but if you refuse to do what the emergency person says, it could be a criminal offence (failure to provide assistance). In my case I thought that he only fainted and it is possible to rescue him, because I though that the main problem was some fluid blocked in the windpipe. 5., My last questions are more general. I assume that many people are not aware about the state of goses or not able to properly determine its signs, therefore they try to do something in such case (at least to call the emergency). It is written that this state can continue up to three days. Are these dying people left without medical intervention even nowadays, when if somebodies’ condition is worsening, usually he is transferred in the intensive care unit? If somebody didn’t follow the halacha in such a situation because of lack of proper knowledge, what should he do afterwards? Is there any halachic literature dealing specifically with such case (touching a goses)?

Shalom!

Thank you for your question.

Allow me to begin by emphasizing that anything must be done to save a life and by the sound of your story, you did everything right.

Regarding your individual questions:

1. you have to first know if he is a cholae sheysesh bo sakanah (life-threatening situation) and not lifting him from his bed could endanger his life then either a non-Jew can be asked to do this or done be'shinuy (abnormal way) if both options are not possible then one may do it himself. If he is not a choleh sheyesh bo sakanah (not life-threatening )then it is only permitted if it is done by a non-Jew. or a shinuy.

2. 3. This was not goses. Anyone who is able to talk/communicate is not a gosses. Yes, you must call the ambulance service for help on Shabbat if there is a possible danger to life.

4. CPR and the like should be attempted since one isn't sure when a person has properly died.

5. The status of gosses nowadays is unlike what it was in the past. It is a case-by-case basis. There is no one single definition. A doctor and a rabbi must decide together when a patient has the status of gosses.