Jewish Word | Pikuach Nefesh

In Chaim Potok’s 1969 novel The Promise, sequel to the better-known The Chosen, there’s a scene that piercingly illustrates the Jewish legal emphasis on saving a life. The main character, Danny Saunders, has left his Hasidic community to become a psychologist and is caring for a troubled teenager. He is spending Shabbat in his father’s strictly observant traditional home when his patient goes into crisis.

The phones in Reb Saunders’s house began to ring at ten minutes past two that morning. Danny was immediately awake… He found his father and his brother in the hall of the second-floor apartment, both of them in robes and skullcaps. They were staring at the phone…

“Answer,” Reb Saunders said. “If it is a mistake, let the sin be on my head.”…

The three of them stood around the phone, Danny explaining, his father and brother listening. He spoke rapidly, in Yiddish. Had it been any other night of the week, he would have told them nothing. But this was Shabbat. He would be traveling on Shabbat. He had to tell them.

Reb Saunders listened until he understood enough to enable him to make a legal decision. Then he broke in on Danny’s words. “Go!” he commanded. “Go quickly! Pickuach nefesh. Quickly! Quickly!”

Half a century later, the Jewish legal principle of pikuach nefesh, or saving a life, is front and center as the world struggles with the pandemic. In issues involving medical treatment, from quarantines and masks to vaccines and ventilators, pikuach nefesh remains a key aspect of Jewish practice and a frequently cited example of the larger Jewish principle of reverence for life.

In its simplest form, pikuach nefesh is the rule that any commandment, with a few clearly defined exceptions, must be set aside if fulfilling it would put a human life in danger. “Maimonides says you’re commanded to break the mitzvah—it’s not a choice,” says Rabbi Asher Lopatin, who has written widely on medical ethics and Jewish law. “Built into every mitzvah is the precedence of human life. It applies across the board, except for three commandments you can’t set aside—the prohibitions against idolatry, adultery and murder. You’re not allowed to protect your life by taking someone else’s.” (The rule also doesn’t apply if you are being forced by non-Jewish authorities to violate even a minor commandment as an example to shame other Jews. Rabbi Akiva, for instance, chose to teach Torah despite a Roman edict forbidding it, and was put to death.)

Pikuach nefesh applies broadly to many aspects of daily life. A person who is ill, for instance, may not fast on Yom Kippur. A starving person must eat non-kosher food if it’s necessary for survival. A person who refrains from riding in cars on the Sabbath must use an ambulance to get to a hospital if necessary. A prohibition against lashon hara, gossip, is waived if negative information must be shared to save someone from danger. A person who considers tattoos religiously objectionable must accept them if they’re needed as markers for radiation therapy.

Since the advent of COVID-19, the most obvious daily conflict for many religious communities has been between the requirements of daily prayer and the danger of gathering in groups.

Mainstream Orthodox authorities say pikuach nefesh is absolutely clear on this: Stay home. “Risking your life for a religious ritual doesn’t make you a martyr, it makes you a sinner,” says Micah Goodman, a philosopher affiliated with the Shalom Hartman Institute in Jerusalem. “You don’t score points with God by going to minyan. No ritual obligation is more important than your life.”

The well-known Talmudic dictum that “to save one life is as if you saved the whole world” is “a moral extension of this legal precept,” says Rabbi Daniel Nevins, dean of the rabbinical school at the Jewish Theological Seminary. Pikuach nefesh concerns, he says, “are prevalent in this pandemic in all manner of decisions, from canceling in-person programming to making emergency provision for online minyans, to allowing streaming on Shabbat, to triage decisions, to…brit milah [circumcision].”

Different denominations have approached the tradeoffs differently, some permitting “virtual” minyans to count, others canceling services. Early in the pandemic, Lopatin points out, mainstream Orthodox authorities agreed Jews should refrain from even central religious obligations, such as attending shul on the High Holidays: “The great poskim, or legal authorities, of central Orthodoxy all said, ‘Absolutely, miss a service, rather than put yourself at risk.’” Goodman says the refusal of some in Hasidic or Haredi congregations to follow this path may reveal a lack of trust in science and public authorities, while Lopatin suspects culture war considerations: “I’ve seen some rabbis come up with things I hadn’t heard of before, like religious reasons to keep your face uncovered,” which would imply that pressure to wear masks amounts to coercion from society to do something publicly un-Jewish. If true, this might supersede pikuach nefesh, he says, “but it’s not really the America we’re living in.”

The reach of pikuach nefesh and its boundaries has been disputed over the centuries. In the Middle Ages, sages debated whether the obligation to safeguard life extended to the lives of non-Jews as well as Jews. Modernity brought new questions: Does a threat to mental rather than physical health trigger pikuach nefesh? Some Open Orthodox rabbis who perform same-sex marriages say the higher suicide rate among LGBTQ youth constitutes a pikuach nefesh argument for inclusion. Pikuach nefesh also drove changes in the permissibility of organ donation, once considered forbidden.

As for vaccination, there are a few in Haredi communities who resist it, but “it’s pretty clear that not vaccinating yourself is against halacha,” Goodman says. Resistance to vaccines in Haredi communities, he suggests, is “not a problem of halacha but a problem of the collapse of truth because of social media,” with conspiracy theories obscuring medical consensus. Other commandments might justify requiring vaccination, such as “Do not stand idly by the blood of your neighbor” or even “Do not kill,” says Lopatin. Regardless, pikuach nefesh is having a moment in the spotlight.