Rabbi Heller's Blog

The debate currently going on surrounding America's health care system is extremely heated. The legislation that just passed the House of Representatives has not yet been fully studied, and both it and the legislation that it would replace, are extremely complex. Our Jewish tradition as well, has wrestled for centuries with the life or death questions of how people are cared for, but we can condense the discussion to a basic question. Are we our brothers’ keepers? To what extent are we obligated to expend our limited resources to save the life of another? A famous teaching of Rabbi Akiva (Talmud Bava Batra 62a) seems to offer one view.
“If two people were traveling and one of them had a flask of water in his hand. If both of them drink, they would die; and if one of them drinks, he would reach settlement.
Ben Petora expounded: It is better [in such a case] that both of them drink and die rather than one of them see the death of his fellow.
[This was the accepted view] until Rabbi Akiva came and taught: "The life of your brother is with you" (Vayikra 25:36) [this means] your life takes precedence over the life of your fellow.”
Some have tried to read this text to limit our obligation. After all, Rabbi Akiva says that we don’t have to share our water in the desert, even if it means that another person will die! However, the issue is that Rabbi Akiva is speaking about the case where one is risking one’s own life to save another. If there is only enough medicine to save one person, one does not need to give up one’s dose, and one’s life, so that another can be saved. Indeed, there are times when triage forces us to decide which patients will get priority in treatment.
On the other hand, if you can save a life without risking anything other than your wallet, then a very different principle applies. This week’s Torah portion, Kedoshim, states, “You may not stand idly by your neighbor’s blood" (Leviticus 19:15). The Talmud (Sanhedrin 73b) interprets this verse to mean that one must extend one’s self to save one’s neighbor from danger, even if it means expending resources by hiring others to assist. Individuals and society have an obligation to ensure that the sick receive medical care.
It is worth noting that our tradition does place limits on this ruling:
1. The person being saved is required to pay back what is spent on saving him or her, to the extent possible. (Rabbeinu Asher, commenting on the text in Sanhedrin above).
2. There is a general principle that one should not spend more than 20% of one’s net worth on any one Mitzvah. Some (including Rabbi Yoseph Shalom Elyashiv) have suggested that this applies even to this Mitzvah of saving the life of another. So we have an obligation to save the lives of others, but there may be limits to how far we can go. Interestingly enough, our country currently spends about 18% of its Gross National Product on medical care.
One of the most important Jewish medical ethicists of the last 100 years, Rabbi Eliezer Waldenberg, wrote: “It has been enacted in every place where Jews live that the community sets aside a fund for care of the sick. When poor people are ill and cannot afford medical expenses, the community sends them a doctor to visit them and the medicine is paid for by the community fund.”
As a nation, America has some tough choices to make as to how medical care is provided fairly and ethically. There may be limits to what we can spend, as a society and as individuals. Continued thought is necessary as to how we maximize the efficiency and effectiveness of the care that is offered. Jewish ethics does not tell us what kind of healthcare payment system is best, but it does tell us whatever system we choose must do as much as possible to ensure lifesaving treatment is within reach for everyone.