Pikuach Nefesh’s Applications in Bioethics (By Isaac Shim)

One key distinction between Judaism and Christianity, aside from the belief in a Messiah, is the comprehensive set of Levitical laws that followers of Judaism are required to observe. Among these laws, one principle stands above all: Pikuach Nefesh. This moral directive is rooted in Leviticus 19:16, which instructs, "Do not do anything that endangers your neighbor’s life." Pikuach Nefesh is considered one of the most important Jewish obligations, and it permits the breaking of other laws to preserve human life. How does this principle apply to issues like abortion, euthanasia, or triage in disasters—topics that are already deeply controversial? Should this concept have limitations, or should it be followed universally?

This is a challenging question, as it’s not easily answered. In the context of abortion, exceptions are often made when the mother's life is at risk. Dr. Fred Rosner argues that “An unborn fetus in Jewish law is not considered a person (Heb. nefesh, lit. “soul”) until it has been born. A fetus is regarded as a part of the mother’s body and not a separate being until it begins to egress from the womb during parturition (childbirth). In fact, until forty days after conception, the fertilized egg is considered as ‘mere fluid’.” Thus, if abortion is necessary to save the mother, it is seen as upholding Pikuach Nefesh. However, the issue becomes more complex when dealing with other modern medical situations, such as euthanasia.

Euthanasia is typically performed to alleviate suffering. Although this is a contentious issue for many, and not only is it forbidden in Judaism, it also can be perceived as directly conflicting with Pikuach Nefesh. The patient is essentially committing suicide, and the physician who performs the procedure could be seen as committing murder. But is it morally right to preserve life at the cost of immense suffering? Reform Rabbi Peter Knobel argues that if a person suffers to the extent that they can no longer live in the image of God, "Active euthanasia is permitted when the person has waived his/her right not to be killed and it is consistent with the person’s biography." While euthanasia does violate Pikuach Nefesh, it might be considered morally justifiable to relieve someone of extreme pain.

Consider a Jewish doctor treating a cancer patient who is on a BiPaP machine around the clock, suffering immensely, and wishes for relief from the pain. If the doctor adheres strictly to Pikuach Nefesh, they may choose to prolong the patient’s life, even at the expense of continued suffering. In contrast, a doctor not bound by Jewish law might consult with the patient and, with their consent, consider euthanasia as a way to end the suffering. Forcing the patient to endure unbearable pain to maintain life could be seen as morally wrong by most people. After all, aren't the Jewish laws designed to guide people toward living a morally righteous life?

Let’s delve deeper into another modern medical dilemma: triage in disaster situations. Triage occurs when there is an overwhelming number of patients and not enough medical personnel to treat everyone effectively, which is common after disasters. Medical professionals then categorize patients into groups: those who are unsalvageable (likely to die even with treatment), those urgently in need (requiring immediate care to survive), and those less urgent (who can wait for treatment without severe consequences). The triage process is already controversial in itself due to its perceived unfairness in its categorization of those in suffering. However, in such situations, it aims to prioritize those who can be saved with the resources available. Attempting to treat every patient equally might inadvertently cause more deaths. It may seem blunt, but expending resources on those who are beyond saving could result in the loss of more lives. With the goal being to save as many lives as possible, making difficult decisions about whom to treat is, I believe, compatible with Jewish law.

Ultimately, the primary consideration should be what is morally right. Deuteronomy 6:18 instructs, "Do what is right and good in the Lord’s sight." Pikuach Nefesh, the prioritization of saving life, exists for this reason. However, this principle must have limitations in certain situations. Yes, placing limits upon Pikuach Nefesh means going against traditional Jewish legal thought; nonetheless, if following Pikuach Nefesh results in causing unnecessary pain, exceptions should be made. What is most important, even for followers of Judaism, is living a morally righteous life.