Pikuach nefesh is a Jewish legal principle that the preservation of human life overrides virtually any other religious rule. When the life of a specific person is in danger, almost any mitzvah lo ta’aseh (command to refrain from doing a specific act) of the Torah becomes inapplicable.
The concept of pikuach nefesh is derived from the biblical verse “You shall therefore keep my statutes…which if a man does, he shall live by them” (Leviticus 18:5). From this verse, the Rabbis deduced that life takes precedence over all of God’s other commandments. They reasoned that the verse implies one should live by the commandments, not die by them. Therefore, if the only way to preserve life is to temporarily neglect a commandment, that commandment must be ignored.
The first mention of pikuach nefesh in the Talmud is found in Tractate Yoma which states: “the Sabbath may be violated for the sake of a sick person, even to undertake the slightest healing procedure for him.” From this source, the Talmud deduces that saving a life supersedes the laws of Shabbat. The rabbis expanded this principle to override most other commandments as well when life is endangered.
Pikuach nefesh applies to both life-saving actions and life-sustaining actions. It requires one to act to save someone whose life is in imminent danger, such as pulling a person out of a burning building on Shabbat. It also obligates provision of care to preserve the life of someone who is chronically ill, such as by allowing a kidney transplant to occur on Shabbat. Pikuach nefesh is so essential that if one sees a person drowning in a river or attacked by robbers, they are obligated to violate Shabbat to go save them.
However, pikuach nefesh does not necessarily permit all forbidden acts. It only allows one to override commandments between man and God, not interpersonal commandments that involve harming or stealing from others. Additionally, three cardinal sins – idolatry, sexual immorality, and murder – may not be violated even to save a life.
Pikuach nefesh applies not only to saving others but also oneself. A person must transgress any commandment, except for the three cardinal sins, to preserve their own life. However, one must sacrifice their life rather than transgress if they are being forced to directly kill someone else.
How much danger is required for pikuach nefesh to take effect? The preservation of life takes precedence over most commandments even for a remote chance of danger. But for violation of biblical prohibitions, imminent mortal danger is usually required. However, rabbinic prohibitions can be overridden even for a doubtful threat to life.
Pikuach nefesh also has limitations in certain end-of-life situations. While terminally ill patients must receive basic care, one is not obligated to pursue every life-sustaining measure if quality of life is severely compromised or the treatment has little hope of cure. Withholding futile interventions at the end of life can be justified by pikuach nefesh as well.
In summary, pikuach nefesh expresses Judaism’s infinite valuing of life. It teaches that saving a single human life is like saving an entire world. As Ecclesiastes 7:12 states, “Wisdom preserves the life of its possessor.” The allowance to temporarily break most commandments for the sake of life reflects the ultimate wisdom of putting preservation of life first.
Origins in Biblical and Talmudic Sources
As mentioned, pikuach nefesh is derived from Leviticus 18:5 which states one should “live by” the commandments. The earliest mention of suspending commandments to save a life is in Tractate Yoma of the Babylonian Talmud. Here the Sages state that the laws of Shabbat, including the prohibitions on cooking, kindling fire, and carrying items between domains, are superseded by the need to heal someone who is ill:
“The Sabbath may be violated for the sake of a sick person, even to undertake the slightest healing procedure for him.” (Yoma 8:6)
The Talmudic sage Rava further clarified that for purposes of pikuach nefesh, a doubtful danger to life is treated like a certainty:
“Any uncertainty about danger to life overrides anything other than the three cardinal transgressions.” (Yoma 82a)
The Scripture emphasizes the primacy of saving life in many places. Exodus 21:19 discusses the case where one person injures another in a fight. It rules that the assailant must pay for the victim’s loss of time and medical expenses “so that he may be thoroughly healed.” From this, the Sages deduced an obligation to proactively seek medical treatment to restore health.
Likewise, Deuteronomy 4:15 states God’s command to diligently protect one’s own life: “Take utmost care and watch yourselves closely.” This verse teaches we must be meticulous about safeguarding life.
Saving Oneself and Others
Pikuach nefesh applies equally whether saving one’s own life or the life of another person. It makes no difference whether the endangered person is a family member or stranger, adult or child, Jew or non-Jew.
The Talmud relates the story of a group of rabbis who were once traveling together when one of them went to gather wood to light a fire. In so doing, he negligently endangered his life and the others admonished him that “Your blood is redder than his – your life takes precedence over his life.” (Bava Metzia 62a) From this, the Sages taught one must save their own life before another’s.
However, if faced with a choice between passively allowing oneself to be killed versus actively killing another person, one must sacrifice their own life. The Talmud rules one must choose martyrdom over murder.
Notably, pikuach nefesh applies to saving non-Jewish lives equally. The Jerusalem Talmud in Tractate Sanhedrin explains:
“A non-Jew who studies Torah is like the Jewish high priest. Why? Because the ultimate purpose of Torah study is to preserve life. As the verse states, ‘It is your life and the length of your days’ (Deuteronomy 30:20).” (Sanhedrin 4:22)
Therefore, the high value Judaism places on life leads to an obligation to save any human life, without discrimination.
Overriding Laws of Shabbat
The laws of Shabbat provide a prime example of when pikuach nefesh takes precedence. As discussed, the Talmud in Tractate Yoma explicitly permits violation of Shabbat prohibitions to carry out medical treatment.
The Scriptures also mention suspended Shabbat observance to save a life. In Mark 3 and Luke 14, Yeshua heals individuals on the Sabbath and justifies his actions by arguing, “Which is lawful on the Sabbath: to do good or evil, to save life or to kill?” This follows the principle of pikuach nefesh.
Likewise, 1 Maccabees 2:29-41 praises Jews who chose to die in battle on Shabbat rather than refrain from defending themselves. They reasoned that although fighting on Shabbat is normally prohibited, defending lives took precedence.
The Mishnah expands on what is permitted on Shabbat to address health needs in Tractate Shabbat. It allows one to take any measures needed to save a person from danger, including:
– Removing debris to rescue someone from a collapsed building
– Extinguishing a fire threatening life or property
– Killing a dangerous animal
– Traveling to seek medical care from a physician
Moreover, not only are prohibitions suspended to provide urgent care, but even preventive healthcare is allowed. One may engage in habitual care necessary to keep someone alive, such as:
– Assisting people who are very ill or have disabilities
– Providing meals to sustain chronically ill people
– Allowing physicians to provide ongoing treatment
Shabbat restrictions are swept away when life is at stake.
Limitations and Exceptions
Despite the great leniency pikuach nefesh offers, it does not permit violation of all Torah laws. As discussed, the Talmud explicitly forbids violating the three cardinal sins of Judaism – idolatry, sexual immorality, and murder – even to save a life.
Additionally, while rabbinic decrees can be overridden for remote risks, biblical prohibitions usually require imminent mortal danger to be violated. For example, ingesting a small amount of non-kosher food is not permitted to prevent the common cold. But one may eat non-kosher food to prevent starvation if no kosher food is available.
Another limitation relates to end-of-life care. While ordinary basic care must always be provided, there are Talmudic debates around pursuing extraordinary life-sustaining interventions when quality of life is severely compromised. Some ethicists argue aggressive measures are not required by pikuach nefesh when treatment provides little benefit or cure. Withholding futile medical interventions is justified at the end of life.
In summary, pikuach nefesh expresses an extremely high but not absolute valuing of life in Judaism. The preservation of life is elevated above most other considerations, but there are exceptional cases where other values prevail. The exact boundaries of pikuach nefesh continue to be elaborated through rabbinic responsa interpreting how to apply it in diverse situations.
Modern Bioethics and Pikuach Nefesh
The Jewish commitment to preserving life has heavily influenced modern medical ethics. Pikuach nefesh is considered a predecessor to the bioethical principle of the sanctity of human life in secular healthcare systems.
For instance, the permissibility in Jewish law to violate Shabbat to provide medical care impacted the development of the U.S. healthcare system. When the first U.S hospitals were founded based on Judeo-Christian ethics in the 1800s, they were open seven days a week to care for patients. This represented a major divergence from European hospitals that closed on Sundays.
Some contemporary bioethical issues impacted by pikuach nefesh include:
Organ donation – Most rabbinic authorities encourage organ donation as an act of lifesaving. However, there is debate around whether brain stem death versus cardiac death determines the timing of organ harvest from a donor.
Abortion – Traditional Jewish thought opposes abortion but allows consideration of maternal health risks since the mother’s life takes priority. Many Orthodox rabbis only permit abortion where the mother’s life is directly threatened.
Euthanasia – Active euthanasia is strictly forbidden as an act of murder. However, passively allowing death by withholding extraordinary end-of-life measures is often deemed acceptable based on pikuach nefesh principles.
Futility judgments – Jewish law requires meticulous assessment of whether treatments offer a reasonable hope of cure versus simply prolonging the dying process. Aggressive interventions may not be obligated if they only extend futile suffering.
These examples demonstrate the relevance of pikuach nefesh to shaping modern healthcare practices and policies. The Jewish emphasis on preserving life continues to infuse the practice of medicine today.
Pikuach Nefesh Versus Kiddush Hashem
An interesting dichotomy in Jewish law exists between the principle of pikuach nefesh and the concept of kiddush Hashem, sanctification of God’s name. Kiddush Hashem involves martyrdom – sacrificing one’s life to sanctify God’s name in the world. This is in tension with the imperative to preserve life under pikuach nefesh. How are these concepts balanced?
Several examples illustrate the tension:
– As mentioned, one must choose martyrdom over murdering someone else even to save their own life. Allowing oneself to be killed rather than killing upholds kiddush Hashem.
– If faced with the demand to worship idols under threat of death, one must choose death, becoming a martyr for their faith. Death sanctifies God rather than the idolatrous act.
– During the Holocaust, Jews who chose to resist the Nazis and die fighting rather than be led “like sheep to the slaughter” invoked kiddush Hashem rather than take actions to prolong their lives.
Yet at the same time, pikuach nefesh obligations remained during the Holocaust. Efforts were still made to sustain lives in ghettos and concentration camps through preserving hygiene, sharing food, and resisting disease. Even at the brink of death, the impulse to keep fighting for survival persisted based on pikuach nefesh.
In conclusion, kiddush Hashem and pikuach nefesh provide complementary motivations in Jewish thought. Preserving life remains an imperative even in the darkest times. Yet kiddush Hashem calls us to affirm God’s presence in the world through our choices, especially when confronted with death. The two values exist in symbiosis, shaping when and how we live and die.
Pikuach Nefesh Versus Human Dignity
Another potential conflict arises between pikuach nefesh and considerations of human dignity. To what extent may the sanctity of life override a person’s dignity in how they live and die?
For instance, extremely invasive medical procedures may prolong someone’s life but severely compromise their quality of life in the process. Or dignity may be diminished by others seeing a person in a totally dependent state as death approaches.
Jewish thought stresses that saving a life does not justify all means. There are limitations to preservation of life if it excessively compromises someone’s basic dignity as a human being. As an example, the Talmud prohibits shaming someone else, comparing it to murder: “Whoever shames his fellow in public, it is as though he shed his blood” (Bava Metzia 58b). Causing profound humiliation, even to prolong life, violates human dignity.
Likewise, while ordinary care must be provided, excessively burdensome treatments need not necessarily be pursued if they offer little lasting benefit. As Rabbi Joseph Soloveitchik taught, when mortality looms, maintaining reasonable quality of life becomes paramount over merely extending a deteriorated existence.
Moreover, palliative care to relieve suffering may be provided even if it hastens demise, based on the principle of double effect. There is dignity in allowing natural death to occur versus aggressively prolonging the pain of a terminal illness.
In conclusion, while saving life remains an utmost priority in Jewish ethics, human dignity also matters. They exist in balance, not contradiction. Honoring dignity means considering not just quantity of life but the human experience of living. Sparing suffering and humiliation must temper how pikuach nefesh is applied.
Valuing Every Human Life
Pikuach nefesh expresses the immense value Judaism places on every human life. As taught in Mishnah Sanhedrin 4:5, “Whoever destroys a single life is considered by Scripture to have destroyed an entire world.” Therefore, tremendous priority is placed on preserving even one life.
This valuing of life extends to all people without discrimination based on ethnicity, religion, age, disability, or other characteristics. The duty to save a life applies equally to all. As Rabbi Akiva affirmed, human dignity derives simply from being created in God’s image: “Beloved is man for he was created in the image of God” (Pirkei Avot 3:14).
Moreover, life is treasured not merely as biological existence but as an opportunity to fulfill ultimate purpose. As Martin Buber wrote, “To be old is a glorious thing when one has not unlearned what it means to begin.” There is holy significance in living out one’s complete allotted time on earth.
For these reasons, pikuach nefesh charges us to view sustaining life as among our most sacred obligations. The chance for any person to experience their days to the fullest carries infinite weight. This reverence for the divinity within each human soul represents Judaism’s powerful teaching to the world. Saving a life affirms hope – hope for more beginnings, more dreams, and more candles lit against the darkness.
