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Health Care in Jewish Law

Concepts and Sources

From "Judaism and Health Care Reform," a United Synagogues Position Paper, April 1993

Hatzalat Nefashot – The Saving of Human Life: It is a positive commandment to save the life of a person in danger from illness. This duty falls under the general obligation of saving life, which is grounded in a number of biblical verses, including ‘thou shalt not stand idly by the blood of your fellow," (Lev. 19:16) and " And your fellow shall live by your side," (Lev. 25:36). So great is the mitzvah of saving life, that nearly all other religious obligations are subordinated to it: we violate the Sabbath to save a person’s life (Pikuah nefesh doha et ha-shabbat, Yoma 85b), and there is a general principle in Jewish law that danger to life and health is of greater concern than ritual matters (Hamirah sakanta mi’issura, Hullin 10a). [See Encyclopedia Talmudit, Vol.10, s.v. Hatzalat Nefashot, pp. 242-251; Shulan Arukh, Yorh Deah sec. 336 and Maimonides, Commentary to Mishnah Nedarim 4:4]

Shemirat Ha-briyut – Preventive Care: In addition to requiring a response to illnesses when they occur, Jewish law also requires that we make all attempts to stay well. In Deuternomy, God tells the Jewish people, "take utmost care and watch yourselves scrupulously." The Talmud derives from these verses that a person must scrupulously guard his/her physical health (Berak-hot 32b), and this ruling was codified by Maimonides (Hikhot Rotzeah 11:4) and the Shulhan Arukh (Hoshen Mishpat 427:8). Maimonides understands this obligation to include both positive aspects, such as regular exercise and the seeking out of proper medical care, as well as negative ones, such as refraining from damaging one’s body through the consumption of harmful food or drugs. [Hilkhot Deot, 4:1ff; see also Rabbi David Golinkin’s ruling that smoking is prohibited by Jewish law in Moment Magazine, Oct. 1991, pp.14-15]

Tzedaka – communal Obligations to Meeting Basic Human Needs: Just as the Jewish community recognizes an obligation to provide for such basic needs as food, clothing, and shelter through the collection and distribution of communal funds, so too, have Jews long insisted that no person be denied access to basic health care on account of inability to pay. While physicians are not required to provide their services for free ("A physician who takes nothing is worth nothing" –Baba Kamma 85a), communal subsidies matched by reduced rates for poor patients have been the norm. [Shulhan Arukh, Yoreh Deah 249:16; see also Responsa Ramat Rahel of Rabbi Eliezer Y. Waldenberg, sections 24-25]

Bikkur Holim – Visiting the Sick: Judaism recognizes that illness affects the whole person, presenting threats not only to the body, but also to one’s mental state and financial ability. Bikkur holim – the mitzvah of visiting the sick – ensures that the needs of the sick are attended to in all of these areas, creating a communal support system to complement the work of the medical doctors. [Shulhan Arukh, Yoreh Deah 235-238; Maimonides, Hilkhot Eivel 14:4-5; Berakhot 5b, Nedarim 39b-40a, and Sotah 14a]

Distribution of Scarce Resources: We have seen that Judaism places a premium on human life and mandates the creation of structures to provide every member of society with access to adequate health care. In situations of scarcity, Jewish insistence on the intrinsic and fundamentally precious value of human life makes triage difficult. Consequently, the rationing of scarce resources in the classical texts is often decided on procedural grounds (e.g., first come, first served) rather than substantive considerations (e.g., who is worthier of being saved). [Maimonides, Hilkhot Yesodei HaTorah 5:5-7; Bava Metziah 62a]

 
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