In this episode of Refuah & Psak, Rabbi Shlomo Brody speaks with Dr. Jonah (Yonah) Rubin, Ematai medical advisory board member and pulmonary and critical care physician at Mass General Hospital, about the medical and halachic complexities surrounding DNI (“do not intubate”) orders. Dr. Rubin explains the full spectrum of oxygen support, from nasal cannula and high-flow systems to BiPAP and, when necessary, invasive mechanical ventilation, highlighting how intubation serves as a bridge to recovery rather than a cure. They discuss scenarios where intubation may be futile (“a bridge to nowhere”), the potential need for tracheostomy in prolonged cases, and the factors that determine whether and when to extubate, including the distinction between clinical and palliative extubation. Rabbi Brody outlines key halachic perspectives and together they offer practical guidance for families and rabbis, such as asking whether the patient is likely to be successfully extubated, understanding prognosis and possible outcomes, and keeping the decision-making process dynamic, recognizing that new crossroads for choice often emerge during a patient’s course of care.

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