Peku’ach Nefesh (saving a life)

The principle of pekuach nefesh (pronounced pe-koo-ach ne-fesh) is usually translated into English as ‘saving a life’ and is known to every observant Jew. It provides essential guidance on the question of when, and under what circumstance, may another mitzvah (‘commandment’) be broken or disregarded, and in particular, whether one is required to give up one’s life rather than break a mitzvah.

The principle is based on two verses in the Torah as interpreted in the Oral Law.

The first of these Torah verses is Exodus 31: 16 which states ‘Wherefore the Children of Israel [the Jewish people] shall keep the Sabbath to observe the Sabbath throughout their generations for a perpetual Covenant.’ The rabbis understand this as meaning that Jews should observe the Sabbath in a manner that allows it to continue to be observed, or, as succinctly put in the Talmud (Yoma 85b) ‘Desecrate one Sabbath on his behalf so that he will observe many Sabbaths’ (better to violate one Sabbath in order to stay alive and be able to observe many more in the future).

The second Torah verse on which the principle is based is Leviticus 18: 5 which states ‘You shall keep My laws and My rules, by the pursuit of which man shall live. I am the Lord your God.’ The simple comment made on this verse in the Talmud (also Yoma 85b) is ‘And you shall live by them, and not that you shall die through them.’

As Rabbi Benjamin Blech writes (Understanding Judaism, Jason Aronson Inc, 1991, at p.104), ‘If it is clear that observance of a specific mitzvah will spell certain death, then clearly in that particular instance God would not want us to fulfill the law, but rather to opt for the greater good and choose life. Violating a mitzvah, when not to do so means death, is therefore not an option but a duty.’

Important Exceptions to the Principle

As a general rule, a Jew is required to take all necessary action to preserve human life. However, there are 3 important exceptions – 3 mitzvot which may never be broken even if someone’s life is at stake. These 3 mitzvot are:

  1. Idolatry – worshipping a god other than God
  2. Murder – causing another person’s death
  3. Forbidden sexual relations.

For example, if someone is threatened with being killed unless they kill someone else, then the principle of pekuach nefesh does not apply and it is considered better to allow oneself to be killed than to kill someone else. Over the course of Jewish history, many Jews have been killed rather than commit one of the 3 transgressions listed above. Jews who have died in such a way are said to have died al kiddush HaShem (‘sanctifying the name [of God]’).

Further Discussion of the Principle

Judaism cares not only about life, but also about a person’s health and well-being. Thus, a serious threat to someone’s life or well-being may be enough for the principle to apply even if it will not directly lead to their death. Common sense needs to be applied to determine if the threat is sufficiently serious – clearly trivial medical issues do not warrant the principle being applied, but serious medical issues do. Where it is not clear if the principle applies, a rabbi should be consulted for guidance.

The principle of pekuach nefesh also applies when it is the life, health or well-being of another person that is at risk. Hence the principle allows someone to transgress a mitzvah in order to assist another person if that other person’s health, well-being or life is at stake.

Examples of the Principle in Action

A common example would be if someone is taken ill on Shabbat (the Jewish Sabbath) – may medical help be summoned, even though this would require using a telephone or driving a vehicle (both actions normally forbidden on Shabbat)? The answer depends on the particular circumstances. For example, if an adult suddenly collapses and the cause is unknown or reasonably suspected to be a serious medical matter, then without doubt medical help may and should be summoned (e.g. the cause may be a heart attack or stroke, both of which require immediate medical treatment. Even the reasonable possibility of one of these causes is sufficient – it does not matter if the cause turns out to be less serious as we do not take chances with what may be serious medical issues). On the other hand, a mild headache would not of itself justify breaking Shabbat – whilst perhaps annoying, a mild headache does not usually have a severe impact on one’s health or well-being.

With a young child, greater leniency is shown. For example, if a 1-year-old starts crying persistently on Shabbat and appears to be in pain, medical assessment and help should be sought. Relevant factors include that such a young child cannot provide a proper, detailed description of their symptoms and proper medical examination and assessment is therefore required.

Another common example would be an adult who has diabetes and controls it through diet, including eating small, frequent meals to regulate their blood sugar levels. Such a person should not fast on Yom Kippur (Day of Atonement) even though fasting on this day is commanded in the Torah (fasting could result in them going into a diabetic coma, a potentially life-threatening condition). Similarly, there are some adults who react badly to fasting on Yom Kippur (which involves not eating or drinking at all for 25 hours), for example they develop severe headaches, are unable to stand, and/or pass out. Such individuals are often exempted from fasting on the basis of pekuach nefesh, but should consult a rabbi who can guide them appropriately.

Doctors and nurses are allowed to work on Shabbat as the nature of their work is providing medical care to others, which falls under the umbrella of pekuach nefesh.

If a man’s wife goes into labour on Shabbat, he is allowed to drive her to the hospital as giving birth is potentially dangerous and medical care is required. However, the man is not allowed to drive home afterwards if it is still Shabbat as he has no medical need to be at home – his options are to either remain at the hospital until Shabbat ends, or to walk home.

In March 2020 during the COVID-19 pandemic, the Sydney Beth Din (rabbinical court) on 17 March issued a notice urging all synagogues to immediately at the minimum enforce social distancing guidelines and preferably to stop holding synagogue services altogether without waiting for a government directive to do so. The notice was explicit in attributing this advice to the highly infectious nature of the life-threatening COVID-19 virus and the importance of the mitzvah of pekuach nefesh, and stated ‘we believe there is a halachic [Jewish legal] imperative to act now’. The effect was that synagogues throughout Sydney immediately stopped holding prayer services, shiurim (group study sessions), and other group activities.