- Life is a gift from God, and man has the sacred duty to preserve it and accept medical treatment when he needs it. This obligation applies even when the preservation of life necessitates the violation of a different prohibition, aside from cases in which the principle of “Let him be killed and let him not transgress” is in effect1.
- It is the duty of every person to help those who are in life-threatening danger and save them. Doctors are commanded to heal patients and prolong their lives2.
הערת שוליים
- The sanctity of life is an important principle of Judaism. Fundamentally, the Torah prohibits bloodshed because man is created in the image of God. The Torah states: “Whoever sheds man’s blood, by man shall his blood be shed; for in the image of God He made man” (Genesis 9:6). The Sages likewise expounded: “ ‘And live by them’ (Leviticus 18:5), and not that one should die by them” (Yoma 85b). The Gemara learns from here that the majority of mitzvot are suspended in life-threatening situations. The obligation to preserve one’s life and health, including the prohibition against suicide, are extrapolated from the value of life itself. (Rambam Mishne Torah, Hilkhot Rotzeaḥ UShemirat Nefesh 2:2).The Gemara (Yoma 85a) even establishes that it is self-evident that we desecrate Shabbat even for ḥayyei sha’a. This is codified in Shulḥan Arukh, Oraḥ Ḥayyim 329:4; see footnote 40 above. This halakha, which stresses the value of life, informs our approach to treating a patient whose life is in danger: It is important to prolong someone’s life even when it is clear that he will soon die. See, e.g., Minḥat Shlomo, I, 91:24: “When it comes to ‘life,’ we have no way of measuring its significance and importance, not even through the parameter of Torah and mitzvot, since Shabbat is desecrated even for a sick old man afflicted with boils, and even if he is deaf and a completely mentally incompetent person (shoteh gamur), who cannot perform a single mitzva and his life is merely a burden and source of great suffering to his family, and causes them to neglect the study of Torah and performance of mitzvot […].” That said, it can be inferred that the value of life is not absolute, since there are three severe transgressions that one may not transgress, even if this means forfeiting his life, rather: “Let him be killed and let him not transgress,” (Yoma 82a). Other halakhic discussions also imply that the obligation to prolong life is overridden in certain situations; see below, footnote 56. We use the common accepted term the “sanctity of life” without entering into the halakhic or philosophical discussion of whether life has sanctity in and of itself. A possible definition of the “sanctity of life” is: “The normative attitude toward human life that demands giving the highest practical priority to preserving human life in the presence of any significant life-threatening danger, whether immanent or in the near future” (Encyclopedia of Medicine and Halakha, vol. 2, “A Terminally Ill Patient (a),” pp. 172).
- The number of sources that have been included in this essay, and the discussion of the nature of evidence that may be deduced from these sources, as well as the ethical significance of the absence of an explicit halakhic obligation to preserve one’s health is necessarily limited. For a comprehensive presentation of our position, see the position paper: “The Obligation to Seek Medical Treatment” (https://bit.ly/3BGnXTz). The obligation to protect one’s personal health is delineated by the Rambam in Mishne Torah, Hilkhot Deot, 4:1, as well as the rest of the chapter. The obligation to heal is codified in Mishne Torah, Hilkhot Nedarim 6:8, and in Shulḥan Arukh, Yoreh De’a 336:1. Though these obligations can be inferred from numerous rabbinic statements, it is difficult to find a clear and direct source for them (see Migdal Oz, Hilkhot Deot, chapter 4, who writes that the Rambam’s source is “statements of the Sages scattered throughout the Talmud […] and these are matters that are straightforward and necessary for all, and everyone agrees with them”). The primary sources cited by poskim in this discussion are: The permission to heal (“‘And he shall cause him to be thoroughly healed’ [Exodus 21:19] – from here we derive that permission is granted to a doctor to heal” [Berakhot 60a]) and the debate as to whether this forms the basis of the obligation to seek medical treatment; the obligation to desecrate Shabbat in order to save lives, and the debate as to whether the obligation to seek medical treatment can be inferred from this source; the verse, “And you shall take great care of yourselves [ve-nishmartem me’od le-nafshoteikhem]” (Deuteronomy 4:15), which primarily refers to being careful to avoid idol-worship, but is also cited by poskim as a source for the obligation to seek medical treatment; the obligation to restore lost property, which according to the Talmud includes the restoration of health; the obligation of a Torah scholar to refrain from living in a place that does not provide for one’s minimal needs, which includes the presence of a doctor; among others. As stated, none of these sources serve as a clear-cut obligation, and yet they are cited by poskim. Naturally, we must also recall the Ramban’s comment: “‘When a man’s ways please the Lord’ (Proverbs 16:7), he need have no concern with physicians” (Ramban’s Commentary on the Torah, Leviticus 26:11). On the basis of this statement, some poskim rule that one may refrain from seeking medical treatment in certain situations, but commonly accepted halakhic practice obligates one to seek medical treatment, as the Ramban himself writes elsewhere (Torat HaAdam, Sha’ar HaMiḥush, Inyan HaSakana [Chavel edition, p. 42]). The fact that there is no direct source that establishes this obligation can be explained in various ways, from the contention that there is no such obligation, to the claim that the indirect sources imply the existence of this obligation, to the suggestion that it is an axiomatic principle that does not require a source (we find many such principles in various areas of halakha, such as the lack of an explicit prohibition against eating human flesh, or harming another’s property). Rabbi Avraham Yitzḥak Kook (Iggerot HaReayah I, 89, p. 97) explains that fundamental moral principles are not formulated as an obligation in the Torah because: “One cannot imagine the great loss that human culture would have suffered if these lofty attributes had been established as fixed positive [commandments]”). It seems that several indirect sources establish that one is obligated to preserve his physical body, and it is a basic principle that need not be stated explicitly.
