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"He who has petzu’a daka (wounded testicles) or kerus shafcha (a severed penis) shall not enter into the kehal (assembly) of Hashem (Deut. 23:2)." A person who is a petzu’a daka or kerus shafcha, is forbidden to have marital relations with a woman who is a member of the "kehal of Hashem". This includes one’s wife. The Torah also prohibits seclusion with a woman with whom intercourse is forbidden. Therefore, if prostate surgery would cause a man to become a petzu’a daka or kerus shafcha, the Torah may require him to divorce his wife. DEFINITION According to the Gemara, Yevamos 75b, the terms petzu’a daka and kerus shafcha, denote a mauled or severed penis, testicle, or "cord of the testis". The Shulchan Aruch(1) defines the "cord of the testis" as the ducts in which the sperm matures, including the epididymis and the vas deferens. Injury to these ducts during their course through the scrotum would make one a petzu’a daka.(2) The Gemara(3) rules that injury to these organs "b’yidei shamaim (through divine agency)" would not cause one to become a petzu’a daka or kerus shafcha. DISCUSSION Almost all poskim agree that the prostate gland is not included among those organs whose damage would cause one to become a petzu’a daka or kerus shafcha. Therefore, this halacha is applicable only when a prophylactic vasectomy is performed. The Rambam(4) states that damage sustained to these organs through illness or physiological disorders is considered "b’yidei shamaim", and would not cause a person to become a petzu’a daka or kerus shafcha. This opinion is quoted by the Shulchan Aruch(5) and is accepted as halacha by many authorties.(6,7,8,9) When these organs are destroyed by disease and would disappear on their own, therapeutic surgical excision is also considered injury "b’yidei shamaim". However, most poskim would agree that prophylactic vasectomy as an adjunct to prostate surgery could not be categorized as "b’yidei shamaim". Even when surgery is deemed necessary to alleviate urine retention and to prevent serious renal complications, the vas deferens is not directly threatened by the disease process. Therefore, prophylactic vasectomy cannot be considered damage "b’yidei shamaim".(10) Recently, the medical justification of a prophylactic vasectomy has come into question. Some studies report that prophylactic antibiotics achieve similar results. Other studies suggest that there is no need for prophylaxis at all. In light of the halachic complications and the lack of evidence of medical necessity, The Torah Physician recommends that, a Jewish patient in need of prostate surgery should insist that a vasectomy not be performed. The patient should seek a surgeon who is willing to comply with this request. In addition, before the patient signs the surgery consent form, he should make sure that the form clearly states that he does not give his consent for a vasectomy. In the event that a vasectomy may be the best option medically, a halachic authority should be consulted. A patient who has had a vasectomy presents a complicated halachic problem. Each case must be addressed on an indidvidual basis by a competent halachic authority. ___________________________ 1Rav Yosef Karo, Shulchan Aruch,Even Haezer, 5:2. 2 Minchas Yitzchak, Vol. 2, 123:6. 3 Yevamos 75b, "Rav Yehudah said in the name of Shmuel, "a petzu’a daka b’ydidei shamaim is kosher." 4 Rambam, Mishnah Torah, Hilchos Isureii Bi’ah, 16:9. 5 Rav Yosef Karo, Shulchan Aruch, Even Haezer, 5:10. 6 Rav Shlomo Luria, Yam Shel Shlomo,Yevamos, 8:9. 7 Beis Chadash, Arba Turim, Even Haezer 5:3. 8 Beis Shmuel, Shulchan Aruch, Even Haezer, 5:12. 9 See also B’or HaGra, Shulchan Aruch, Even Haezer, 5:16. 10 For futher discussion as to what is considered "b’yidei shamaim" see Rav Eliezer Waldenberg, Tzitz Eliezer, vol. 10, no.25, ch. 24. "Neither shall you do this in your land (Lev. 22:24)" There is a second halachic consideration. There is a negative commandment not to make any person or animal a petzu’a daka or kerus shafcha. Anyone who castrates a person or an animal is in violation of the Torah. In addition, the recipient who makes himself available for castration has assisted in violating a negative commandment. There is some disagreement as to whether or not the recipient himself is in direct violation of the Torah. The HaFla’ah(1) held that there is a biblical injunction against allowing oneself to become a petzu’a daka. As explained earlier, a person only becomes a petzu’a daka or kerus shafcha if injury is sustained to the testicle, penis, or vas deferens inside the scrotum. Thus, with the exception of a prophlylactic vasectomy, neither the surgeon nor the patient is in violation of this injunction. ______________________________ 1 Ha Fla’ah, Nesivos la Sheves, Even HaEzer 5:7. "Giving another ‘a cup of roots’ to drink in order to sterilize him is forbidden (Shulchan Aruch, Even HaEzer, 5:11)." "A cup of roots" was a drug used in the time of the Gemara for sterilization. The Beis Shmuel(1) wrote that even for medicinal purposes the use of "a cup of roots" is forbidden. This includes cases where sterilization was an incidental outcome and not the goal of treatment. It also is forbidden to patients who have already fulfiled the mitzvah of procreation. The Chazon Ish(2) wrote that the prohibition against using "a cup of roots" constitutes a rabbinic injunction against any form of sterilization, even if it does not make one a petzu’a daka or kerus shafcha. Since one of the sequella of a TURP is retrograde ejaculation, the patient is essentially sterile. Thus, according to the Chazon Ish, the TURP procedure itself violates a rabbinic decree. However, the Chazon Ish concluded, that since there is a danger to the patient’s health if the procedure is not performed, the surgery is permissible and the patient is permitted to marry. Rav Moshe Feinstein(3) argued with the Chazon Ish. Rav Feinstein wrote that the rabbinic prohibiton against using "a cup of roots" was specific to that form of medicinal sterilization. The prohibition was enacted because the relative safety and availability of the drug led to its abuse. Rav Feinstein held that prostate surgery cannot be compared to medicinal sterilization. Therefore, there is no rabbinic prohibition against it. There is another problem. The Vilna Gaon(4) implies that any form of sterilization is in direct violation of the Torah. This would include prostate surgery. According to this opinion, both the patient and the surgeon would be in violation of the Torah. Since the patient is at risk, he would in any case be permitted to undergo surgery. However, a Jewish surgeon would not always be permitted to perform the operation. The patient should always choose the most highly qualified surgeon available. However, if he has a choice between two equally qualified surgeons, he should give preference to the non-Jewish physician. 1 Beis Shmuel, Even HaEzer, 5:13. 2 Chazon Ish, Even HaEzer, 12:7. 3 Rav. Moshe Feinstein, Igeres Moshe, Even HaEzer, vol. 4 no.29, sec. 1. 4 B’or HaGra,Shulchan Aruch, Even HaEzer, 5:28. "And Hashem Blessed them and said to them, ‘Be fruitful and multiply’ (Gen. 1:28)." The first mitzvah given in the Torah is the command to procreate. According to the mishnah in Yevamos,(1) in order to fulfill this mitzvah, a person must father both a son and a daughter. The Rambam(2) ruled that this mishnah is according to halacha. Therefore, even if someone has fathered six sons, he still has yet to fulfill the mitzvah of procreation. Since one of the outcomes of prostate surgery is retrograde ejaculation, the patient is functionally sterile. Therefore, unless he has already fullfilled the mitzvah of procreation, he will no longer be able to do so in a natural fashion.. However, none of the poskim commented that this mitzvah is a consideration in prostate surgery. Presumably the reasoning is as follows: A person in need of prostate surgery is at risk for significant medical complications if the surgery isn’t performed. Since circumstances force him to have the surgery performed, he is not voluntarily nullifying his ability to fulfill this mitzvah and therefore is not held culpable. _____________________________ 1 Yevamos 61b 2 Rambam, Mishnah Torah, Hilchos Ishus, 15:4. SUMMARY The major halachic problem encountered with prostate surgery is not due to the surgery itself, but to the prophylactic vasectomy that sometimes accompanies the procedure. A vasectomy usually makes the patient a petzu’a daka. Thus, it is questionable if such a patient may stay married to his wife. There is a second problem of the prohibition against sterilization. Although most opinions agree that this is not a problem for the patient since his health is at risk, there is some question as to whether it is permissible for a Jewish urologist to perform the surgery. A Jewish urologist, in any case, should consult a competent halachic authority to get clear guidelines as to when he is permitted to perform a transuretheral prostatectomy.
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Editor's Note