Pikuach Nefesh
Encyclopedia
The Hebrew term pikuakh nefesh (Hebrew פיקוח pikuakh "saving", of נפש nefesh "life") describes the principle in Jewish law
Halakha
Halakha — also transliterated Halocho , or Halacha — is the collective body of Jewish law, including biblical law and later talmudic and rabbinic law, as well as customs and traditions.Judaism classically draws no distinction in its laws between religious and ostensibly non-religious life; Jewish...

 that the preservation of human life overrides virtually any other religious consideration. When the life of a specific person is in danger, almost any negative commandment of the Torah
Torah
Torah- A scroll containing the first five books of the BibleThe Torah , is name given by Jews to the first five books of the bible—Genesis , Exodus , Leviticus , Numbers and Deuteronomy Torah- A scroll containing the first five books of the BibleThe Torah , is name given by Jews to the first five...

 becomes inapplicable.

Biblical source

The Bible
Bible
The Bible refers to any one of the collections of the primary religious texts of Judaism and Christianity. There is no common version of the Bible, as the individual books , their contents and their order vary among denominations...

 in Leviticus
Leviticus
The Book of Leviticus is the third book of the Hebrew Bible, and the third of five books of the Torah ....

 18:5 states "You shall therefore keep my statutes and my rules; if a person does them, he shall live by them: I am the . Ezekiel
Ezekiel
Ezekiel , "God will strengthen" , is the central protagonist of the Book of Ezekiel in the Hebrew Bible. In Judaism, Christianity and Islam, Ezekiel is acknowledged as a Hebrew prophet...

 20:11 also states this phrase. Nehemiah
Nehemiah
Nehemiah ]]," Standard Hebrew Nəḥemya, Tiberian Hebrew Nəḥemyāh) is the central figure of the Book of Nehemiah, which describes his work rebuilding Jerusalem and purifying the Jewish community. He was the son of Hachaliah, Nehemiah ]]," Standard Hebrew Nəḥemya, Tiberian Hebrew Nəḥemyāh) is the...

 9:29 also mentions this phrase.

Talmudic discussion

The Talmud
Talmud
The Talmud is a central text of mainstream Judaism. It takes the form of a record of rabbinic discussions pertaining to Jewish law, ethics, philosophy, customs and history....

 discusses a number of cases as examples in which biblically mandated laws can be disregarded for the sake of saving a human life (B.Yoma
Yoma
Yoma is the fifth tractate of Seder Moed of the Mishnah and of the Talmud. It is concerned mainly with the laws of the Jewish holiday Yom Kippur, on which Jews atone for their sins from the previous year...

 84b) All of these examples relate to Sabbath
Shabbat
Shabbat is the seventh day of the Jewish week and a day of rest in Judaism. Shabbat is observed from a few minutes before sunset on Friday evening until a few minutes after when one would expect to be able to see three stars in the sky on Saturday night. The exact times, therefore, differ from...

 prohibitions: rescuing a child from the sea, breaking apart a wall that has collapsed on a child, breaking down a door about to close on an infant, and extinguishing a fire to save a life. The Mishna there discusses when one is permitted to break his or her fast
Fasting
Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. An absolute fast is normally defined as abstinence from all food and liquid for a defined period, usually a single day , or several days. Other fasts may be only partially restrictive,...

 on the Day of Atonement
Yom Kippur
Yom Kippur , also known as Day of Atonement, is the holiest and most solemn day of the year for the Jews. Its central themes are atonement and repentance. Jews traditionally observe this holy day with a 25-hour period of fasting and intensive prayer, often spending most of the day in synagogue...

: "If one is seized by a ravenous hunger (ostensibly referring to something life threatening), he may be given to eat even unclean things
Unclean animals
Unclean animals, in some religions, are animals whose consumption or handling is labeled a taboo. According to these religion's dogmas, persons who handle such animals may need to purify themselves to get rid of their uncleanness.-Judaism:...

 until his eyes are lightened." (B.Yoma
Yoma
Yoma is the fifth tractate of Seder Moed of the Mishnah and of the Talmud. It is concerned mainly with the laws of the Jewish holiday Yom Kippur, on which Jews atone for their sins from the previous year...

 83a)

Drawing the line

The principle of preservation of life, pikuach nefesh, has limitations. The individual whose life is to be saved must be a specific, identifiable individual, rather than an abstract or potential beneficiary.

The laws of preservation of life apply equally in saving the lives of a Jew or a Gentile, since a Gentile is just as much God's creation as a Jew. If one must choose between saving a Jew or a Gentile, and can only save one, the one who is more likely to survive given the circumstances must be saved. The rule of preservation of life does not apply when an animal's life is in danger, and halakha
Halakha
Halakha — also transliterated Halocho , or Halacha — is the collective body of Jewish law, including biblical law and later talmudic and rabbinic law, as well as customs and traditions.Judaism classically draws no distinction in its laws between religious and ostensibly non-religious life; Jewish...

 may not be broken to save the life of an animal.

Another question is what constitutes a life-threatening situation. Some situations are clearly life-threatening, such as one who is dying of a disease and will die without medical intervention, or one who is drowning and will not be able to escape the water without help from another. But in other situations, it may be unclear if a life is truly in danger.

For example, if a person is feeling "extreme pain," this may be tremendously uncomfortable, but will surely not be fatal, the actions one may take in violation of religious law are limited. It is preferable in these situations to receive help from a Gentile in any manner possible.

If one is in danger of losing a limb, mobility, eyesight, suffering the loss of some other function vital to one's future survival, or may be in danger of a new health problem developing that may ultimately shorten one's life, the situation is considered to be life-threatening.

Uncertainty

If it cannot be ascertained whether or not a situation is life-threatening, the situation must be considered life-threatening until proven otherwise, thereby allowing action to be taken.

It is of prime importance that if one believes a life may be in danger, and seconds may count, that persons involved not delay helping the victim out of fear of violating halakha, or in order to determine if such a violation is permissible according to halakha.

If one takes action in violation of halakha to save a life when s/he believes the situation is life-threatening, but later learns that there was no threat to a human life, s/he has not sinned, and must not feel guilty over having made such a mistake.

Who must help

In a life-threatening situation, when possible, it is necessary that the most qualified individuals available provide all assistance necessary during every moment of the situation. But when seconds count, there must be no delay in determining who is more qualified.

If there is a choice between a Jew and a Gentile who are equally qualified, and there is clearly plenty of time to decide, it is preferable that the Gentile provide the assistance. But if there is a choice between two Jews, and there is clearly plenty of time to decide, it is preferable that the more observant of the Jews break the halakha. This shows the importance of breaking halakha when a life is on the line, and that less observant Jews are not permitted to serve the purpose of breaking halakha during non-emergencies.

Organ donation

According to some halakhic rulers, Organ donation in Jewish law
Organ donation in Jewish law
Under Jewish law, organ donation raises some questions, and has traditionally been met with some skepticism. However, it has met increasing acceptance as medical transplantation methods have improved. In both Orthodox Judaism and non-Orthodox Judaism, the majority view holds that organ donation is...

 is one classic example of the obligation to violate a commandment because of Pikuach nefesh. Saving one's life can override the prohibition against desecrating a corpse. However, due to the limitation that a specific life must be in danger, a specific organ recipient must generally be identified before the organ is removed. Organ removal to organ banks for possible future use is generally prohibited by all Orthodox Judaism halakhic decisors
Posek
Posek is the term in Jewish law for "decider"—a legal scholar who decides the Halakha in cases of law where previous authorities are inconclusive or in those situations where no halakhic precedent exists....

.

Shabbat and holidays

The laws of Shabbat
Shabbat
Shabbat is the seventh day of the Jewish week and a day of rest in Judaism. Shabbat is observed from a few minutes before sunset on Friday evening until a few minutes after when one would expect to be able to see three stars in the sky on Saturday night. The exact times, therefore, differ from...

 and the Jewish holidays may be suspended for the purposes of pikuach nefesh. The earliest known example of this took place in 167 BCE, when Mattathias
Mattathias
Mattathias ben Johanan was a Jewish priest whose role in the Jewish revolt against the Syrian Greeks is related in the Books of the Maccabees...

 and the Hasmoneans declared that it was permitted for their followers to fight on the Sabbath day to defend themselves from attack. One is allowed to travel in order to save another’s life, and medical care may be provided to critically ill patients (see Driving on Shabbat). According to Moshe Feinstein
Moshe Feinstein
Moshe Feinstein was a Lithuanian Orthodox rabbi, scholar and posek , who was world-renowned for his expertise in Halakha and was regarded by many as the de facto supreme halakhic authority for Orthodox Jewry of North America during his lifetime...

, it is permissible to travel to accompany a woman in labor to a hospital because the Talmud is especially solicitous of health with respect to pregnancy and childbirth. Shabbat laws can also be bent for a woman who has given birth in the last three days to make sure that she is comfortable and healthy.

One is allowed to drive a woman to a hospital on Shabbat to give birth, since birth can be life-threatening without medical supervision. Similarly, one may sign a consent form for surgery on Shabbat if the surgery will otherwise be delayed.

If one's close relative is transported to the hospital under emergency circumstances during Shabbat, one is allowed to drive or accept a ride to the hospital in order to provide company to their relative at the hospital, since this may be life-saving. One may also be needed at the hospital to sign potentially life-saving consent forms.

Telephone

If a medical emergency is known or suspected that warrants placing a phone call rather than transportation in a motor vehicle, the telephone may be used. If the situation has a lower level of urgency, the receiver shall be removed and the buttons pressed in an unusual manner. If the person involved is expecting a call to be returned to deal with the issue, answering the phone is permitted, and if another uninvolved person has placed the call, the person involved shall state that they are waiting for a call from the doctor (or similar).

Work

It is permissible for one whose profession it is to save lives (such as a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

, nurse, or emergency medical technician
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

) to work on Shabbat in order to save lives. It is permissible even for such a professional to use a telephone or pager to be alerted to his/her need for a life-saving act or to communicate life saving information, or to travel by any means necessary to the location where the potentially life-saving act will be performed.

It is another question if one who is facing hard economic times is permitted to work on Shabbat in order to make enough money to avoid starvation or homelessness or that of his/her relatives. This question may apply whether one needs the extra income that would be earned from working on Shabbat in addition to all other days, or if one must work on Shabbat in order to avoid losing his/her job/business. In such situations, the person involved must first search for all alternatives possible to working on Shabbat, and a rabbi shall be consulted regarding one's individual circumstances.

Fire

Extinguishing a fire on Shabbat or Yom Tov is forbidden under Jewish law. Extinguishing a fire or using the phone to call the fire department only in order to save one's property from damage is forbidden. However, it is still permissible do to so in most cases due to the danger caused to others unknown to the person who discovers the fire. Even if all people can escape a building, as long as the fire burns, there is a danger it can spread to other nearby buildings, thereby endangering the lives of others in them. Even in a rural area, where there are no other buildings nearby, there is the danger the fire can spread to a nearby forest, started a more devastating forest fire, which may endanger others. Only if it can clearly be established that no such risks are present is it forbidden to break Shabbat.

Non-kosher food

Non-kosher food may be eaten under the following circumstances:
  • If no kosher food is available to the person, and failure to eat the non-kosher food may result in starvation.
  • If a non-kosher food product specifically is needed to cure an illness.


If necessary for recovery, a patient may eat non-kosher foods
Kosher foods
Kosher foods are those that conform to the regulations of the Jewish Halakhic law framework, kosher meaning fit or allowed to be eaten. A list of some kosher foods are found in the book of Leviticus 11:1-47. There are also certain kosher rules found there...

. In the Babylonian Talmud, Chapter 82a of Tractate Yoma
Yoma
Yoma is the fifth tractate of Seder Moed of the Mishnah and of the Talmud. It is concerned mainly with the laws of the Jewish holiday Yom Kippur, on which Jews atone for their sins from the previous year...

 mentions pregnancy cravings for non-kosher food (the passage discusses a pregnant woman who craves pork on Yom Kippur
Yom Kippur
Yom Kippur , also known as Day of Atonement, is the holiest and most solemn day of the year for the Jews. Its central themes are atonement and repentance. Jews traditionally observe this holy day with a 25-hour period of fasting and intensive prayer, often spending most of the day in synagogue...

) as the paradigmatic example of a presumed life-threatening situation where a person is allowed to eat non-kosher food (and is permitted to eat it on Yom Kippur
Yom Kippur
Yom Kippur , also known as Day of Atonement, is the holiest and most solemn day of the year for the Jews. Its central themes are atonement and repentance. Jews traditionally observe this holy day with a 25-hour period of fasting and intensive prayer, often spending most of the day in synagogue...

).

Fasting

On Yom Kippur, the fast preferably may only be broken if one is advised by a physician not to fast, and then consults a rabbi regarding the physician's advice. The general practice though, is to eat only as much as is necessary in order to satisfy one's needs. If one is advised by a physician not to fast, but is unable to consult a rabbi, one should eat in accordance with the physician's advice.

If one senses they may have a health problem that may be aggravated by fasting, but no physicians or rabbis are available to give advice, they should use their own judgment, and is permitted to refrain from fasting. In such cases, one must not delay eating in order to speak with the appropriate authority, or feel guilty for eating in this situation.

One who must eat on Yom Kippur is required to eat only as much as is necessary to avoid aggravating a medical condition priority over prayer. All blessings normally recited before and after eating are recited as usual.

Fasts other than Yom Kippur are viewed more leniently. Anyone who feels unable to fast is permitted to break the fast without attempting to consult a physician or rabbi.

On all fasts, one who is taking a medication for any reason is permitted to use food or water as necessary to aid in taking the medication. If the medication has instructions to consume food or beverage with the medication, s/he is not permitted to fast, and s/he need not further consult a physician or rabbi.

A person who becomes severely dehydrated during any fast shall consume sufficient fluids to restore his/her body to normal hydration levels.

Waiting for the proper time to eat

Rabbinical law prohibits eating at certain times even on non-fast days, such as prior to daily morning prayer, the recitation of kiddush
Kiddush
Kiddush , literally, "sanctification," is a blessing recited over wine or grape juice to sanctify the Shabbat and Jewish holidays.-Significance:...

 on Shabbat or Yom Tov, and between the ending of Shabbat and Havdallah. In particular, these laws are to strictly be followed by adult males and should be followed by adult females who are not pregnant or nursing. While it is optimal to wait out these shorter periods of time rather than eating, even for one whose medical condition demands frequent eating, there are exceptions:
  • A pregnant woman or a woman who is nursing a baby who has a craving shall eat without delay. For all other women and for boys yet to have reached bar mitzvah age, these laws are treated more leniently.
  • One who must take a medicine at a specific time may consume any food or drink necessary in order to consume the medicine or that must be eaten with the medicine.
  • A person who is severely dehydrated may consume fluids as necessary to restore his/her body to normal hydration levels.
  • A person who lacks the strength to perform the necessary service without nourishment may eat the minimum amount necessary to perform the service with kavanah
    Kavanah
    Kavanah or Kavannah is the mindset often described as necessary for Jewish rituals ....

    .

Exceptions

There are some Jewish laws that may not be violated, even when a life is in danger. In these cases, a life must be sacrificed rather than a halakha be broken. These include:

Defaming God's Name

Sins that involve Chillul Hashem
Chillul Hashem
Desecration of the Name meaning desecration of the names of God in Judaism, is a term used in Judaism particularly for any act or behavior that casts shame or brings disrepute to belief in God, any aspect of the Torah's teachings, Jewish law, or the Jewish community.-Hebrew Bible:The source for...

 (the defamation of God's name) may not be committed even to save one's life. These include idolatry
Idolatry
Idolatry is a pejorative term for the worship of an idol, a physical object such as a cult image, as a god, or practices believed to verge on worship, such as giving undue honour and regard to created forms other than God. In all the Abrahamic religions idolatry is strongly forbidden, although...

, blasphemy
Blasphemy
Blasphemy is irreverence towards religious or holy persons or things. Some countries have laws to punish blasphemy, while others have laws to give recourse to those who are offended by blasphemy...

, or denial of God's existence. Forbidden violations include:
  • Worship of any god other than Hashem
  • Bowing to any god other than Hashem for show just to please the enemy, or other signs of pretending to worship such a god, even if one's intention is not to worship
  • Violating any negative commandment in submission to a persecuting enemy whose purpose is to stand against God
  • Construction of such a god for oneself or others to worship, or support of such worship
  • Entry into a building where a god other than Hashem is being worshipped. It is for this reason that one may not enter a church during services, even to save a life. Entering a church when services are not going on has lesser restrictions.
  • Recitation or printing God's Holy Name in vain
  • Destruction of God's Holy Name from a printed sheet of paper or parchment
    Parchment
    Parchment is a thin material made from calfskin, sheepskin or goatskin, often split. Its most common use was as a material for writing on, for documents, notes, or the pages of a book, codex or manuscript. It is distinct from leather in that parchment is limed but not tanned; therefore, it is very...

     except in the performance of rituals prescribed in the Torah
  • Pretending God does not exist in order to avoid persecution

Murder

Any act that intentionally causes the death of another person (considered to be an act of murder), that injures a person so the potential for death from the injuries is high, or that otherwise creates a dangerous situation that will very likely put one or more lives at risk, is not permitted for the preservation of life. Forbidden examples are:
  • Harvesting organs from the body of a person who is clearly alive
  • Live organ donation, where the risk of death to the donor is extremely high. If the risk is low, the donation is permitted.
  • Driving at a very high speed in order to reach a hospital if a crash with an innocent motorist is almost assured

Exceptions

An exception in which killing another person is permitted is the case of a rodef
Rodef
A rodef , in traditional Jewish law, is one who is "pursuing" another to murder him or her. According to Jewish law, such a person must be killed by any bystander after being warned to stop and refusing...

(aggressor), who may be killed in order to save the life of oneself or another. This permits self-defense and wartime killings in Judaism. Also, abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...

 is permitted in Jewish law if the unborn fetus is endangering the mother's life, because the fetus is considered to be a rodef. The "rodef" assertion is also used to permit the separation of conjoined twins
Conjoined twins
Conjoined twins are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and a smaller fraction of...

 when it is likely or even certain that one will die as a result of the operation if this is necessary to save the other.

Biblically-sanctioned executions may be performed, though they are not performed today.

Life for a life

While one is not permitted to automatically give up one's life in order to save the life of another (an act of suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

, forbidden in Jewish law), one may risk his/her life to save the life of another. It is, however, forbidden to place one's own life at more risk than the other person is already in.

One may not put another's life in danger, especially against that person's will, in order to save his/her own life or that of another.

Scholars have long questioned whether or not stealing is permitted in order to save a life. Most have concluded that stealing sustenance from a poor person is prohibited under life-threatening circumstances, since the life of a poor person who loses even a small portion of his/her sustenance is considered to be endangered. Also, operating a business or similar operation that intentionally robs or defrauds the poor of all or any part of their sustenance is strictly forbidden, even to save a life. Robbing or defrauding a large business, organization, or the government is forbidden if the poor will suffer as a result of the business, organization, or government losing these funds. If a business suffers the loss of money due to fraud or theft, it may pass the losses onto customers by raising its prices, and as a result, the poor may have to spend more. The government, if cheated, may raise taxes, even to the poor, or cut services from which the poor benefit.

Lashon hara
Lashon hara
The Hebrew term lashon hara is a term for gossip. It also refers to the prohibition in Jewish Law of telling gossip....

 is symbolically considered an act of murder, and therefore may not be spoken to save a life. However, most cases in which bad word must be spoken against a person in order to save a life are productive, and thereby do not constitute lashon hara.

Torturing or persecuting another person is forbidden, since a person who has undergone such trauma has been "murdered" for whom s/he is. An exception is one who is seemingly tortured by medical treatment performed to save his/her life.

Forbidden relationships

Engaging in individual sex acts or entering long-term relationships forbidden according to the Torah are not permitted if failure to do so would place one's life on the line. This includes adultery
Adultery
Adultery is sexual infidelity to one's spouse, and is a form of extramarital sex. It originally referred only to sex between a woman who was married and a person other than her spouse. Even in cases of separation from one's spouse, an extramarital affair is still considered adultery.Adultery is...

, incest
Incest
Incest is sexual intercourse between close relatives that is usually illegal in the jurisdiction where it takes place and/or is conventionally considered a taboo. The term may apply to sexual activities between: individuals of close "blood relationship"; members of the same household; step...

 (acts with one's blood relatives mentioned in the Torah as constituting a forbidden relationship), sexual relationship between a Jew and a gentile
Gentile
The term Gentile refers to non-Israelite peoples or nations in English translations of the Bible....

, or marriage between a kohein and a woman forbidden to a kohein.

Forbidden sex acts that are only rabbinically prohibited are permitted in order to save a life. Also forbidden forms of sex with one's spouse, such as niddah
Niddah
Niddah is a Hebrew term describing a woman during menstruation, or a woman who has menstruated and not yet completed the associated requirement of immersion in a mikveh ....

 violations, are also permitted in order to save a life.

Other behaviors that directly lead to a violation of a prohibited sex act are also forbidden in order to save a life. For example, violations of yichud
Yichud
The prohibition of yichud , in Halakha is the impermissibility of seclusion of a man and a woman who are not married to each other in a private area. Such seclusion is prohibited in order to prevent the two from being tempted or having the opportunity to commit adulterous or promiscuous acts.The...

 laws prohibiting long-term seclusion with a member of the opposite sex would be forbidden. It is therefore forbidden to live with a member of the opposite sex forbidden under yichud laws if the alternative is life-threatening homelessness.

Rape

If one is raped by physical force, one is not considered to have transgressed, since the victim has no control over the act. Even if the victim is capable of fighting back but fails even to attempt to do so, no violation has occurred. But scholars have questioned if one who is threatened with a weapon to submit to a forbidden sex act is required to give up his/her life rather than submitting. Most scholars have concluded that due to the trauma one is experiencing during such an event, the act is considered involuntary, and even if s/he submits to the act, s/he is forgiven.

Contemporary examples

A ZAKA
ZAKA
ZAKA , is a series of voluntary community emergency response teams in Israel, each operating in a police district . These organizations are officially recognized by the government...

 delegation, a rescue team made up of ultra-orthodox Jewish men worked in the Haitian capital of Port-au-Prince soon after the 2010 Haiti earthquake
2010 Haiti earthquake
The 2010 Haiti earthquake was a catastrophic magnitude 7.0 Mw earthquake, with an epicentre near the town of Léogâne, approximately west of Port-au-Prince, Haiti's capital. The earthquake occurred at 16:53 local time on Tuesday, 12 January 2010.By 24 January, at least 52 aftershocks...

. They took time out to recite Shabbat prayers and continued to work throughout Shabbat.
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