From AJWS Education Module on The Global HIV/AIDS Pandemic (November, 2005)
Jewish tradition is unequivocal on the value of human life, to the extent that each human being is equated with an entire verse, as it says:
|Therefore man was created singly, to teach you that whoever destroys a single soul of Israel, Scripture accounts it as if he had destroyed a full world; and whoever saves one soul of Israel, Scripture accounts it as if he had saved a full world. [Moreshet translation]||
לפיכך נברא אדם יחידי ללמדך שכל המאבד נפש אחד מישראל מעלה עליו הכתוב כאילו איבד עולם מלא וכל המקיים נפש אחת מישראל מעלה עליו הכתוב כאילו קיים עולם מלא
Because each person is the potential progenitor of all his or her descendants, the loss of any one person deprives the world not only of that person, but of all his or her potential descendents. For Jews, there is no greater tragedy than the loss of a human being and the generations that he or she would have brought into the world.
Integrally linked to this infinite valuation of human life is a corresponding intense obligation to protect life. We find:
This Divine charge forbids us to be passive if our fellow human beings are in mortal danger.
And what is phrased in the Torah as a negative prohibition becomes a positive obligation, where is says:
These few exceptions, in a legal system filled with seemingly infinite obligations and prohibitions, simply underscore the absolute priority accorded to saving lives.
The implications of pikuach nefesh in the context of the HIV/AIDS Pandemic are obvious and straightforward. We cannot remain passive or disinterested while millions of people are at immediate risk of death. And while there may have been some ambiguity about this question in the early days of the pandemic when treatment options were unclear, the existence now of effective treatments to prolong the lives of people living with AIDS makes our obligations clear. We must do all that is in our power to insure that HIV positive people receive adequate medical care and treatment and that effective prevention programs are employed to reduce as much as possible the rate of new infections. Each person killed by HIV/AIDS is an entire universe and we cannot stand idly by and accept that loss with indifference.
Beyond saving lives, there is an additional Jewish obligation to anticipate potential dangers and protect against them. This principle is derived from two separate verses in Deuteronomy. In the first, Deuteronomy 4:9, we find a requirement that people take care to protect themselves from danger: "Protect yourself and guard yourself."
The Shulkhan Arukh extrapolates from this verse an obligation to protect others:
|And so too any obstacle that endangers life, it is a positive commandment to remove it and to be very careful around it as it is said, “Protect yourself and guard yourself." (Deuteronomy 4:9) And if he did not remove and set aside these obstacles that are dangerous, he violated the positive commandment and also violated the commandment, “Do not bring bloodguilt upon yourself” (Deuteronomy 22:8). [AJWS translation]|
Rambam builds on this narrow case to create a more universal and wide-ranging obligation:
|Both the roof and any other object of potential danger, by which it is likely that a person could be fatally injured, such a well or a pit on his property, whether or not there is water in it, require that the owner build a barrier at least ten handbreadths high or make a cover for it so that no one will fall in and die. And so regarding any situation which has mortal danger, one has a positive commandment to remove the danger and guard it and be very careful with it as it says, "Be careful" and "Guard your soul" (Deuteronomy 4,9) and if one does not remove it but leaves those obstacles allowing potential danger, one transgresses a positive commandment and negates a negative commandment “Thou shall not spill blood.” [AJWS translation]||
אחד הגג ואחד כל דבר שיש בו סכנה וראוי שיכשל בו אדם וימות כגון שהיתה לו באר או בור בחצירו בין שיש בהן מים בין שאין בהן מים חייב לעשות להן חוליה גבוהה עשרה טפחים או לעשות לה כסוי כדי שלא יפול בה אדם וימות. וכן כל ג מכשול שיש בו סכנת נפשות מצות עשה להסירו ולהשמר ממנו ולהזהר בדבר יפה יפה שנ' (דברים ד' ט') השמר לך ושמור נפשך, ואם לא הסיר, והניח המכשולות המביאין לידי סכנה, ביטל מצות עשה ועבר על לא תשים דמים.
Now the charge is that every person has an obligation to anticipate and remove "any obstacle which could cause mortal danger." Again, the implications in the context of HIV/AIDS are clear. To the extent that lack of access to resources- education, condoms, clean needles, money, refrigeration for AIDS drugs, food, clean water, etc.- is a life-threatening challenge for people living with AIDS, or for people at risk for AIDS, we are bound to work to rectify the situation and make those resources available.
Finally, Jewish tradition articulates an obligation to maintain social relationships with people suffering from illness. This reflects a deep understanding of the kind of social isolation that the ill can experience- not only are they often limited from social activity and restricted to home by their illness, but the stigma and fear of contamination that accompany illness may keep the community from maintaining connections and providing critically important emotional, physical, and psychological support.
This value is enshrined in the Babylonian Talmud where visiting the sick is included among a short list of ethical actions.
|R. Hama son of R. Hanina further said: What means the text: "You shall walk after God" (Deuteronomy 13)? Is it, then, possible for a human being to walk after God; for has it not been said: "For God is a devouring fire" (Deuteronomy 4)? But [the meaning is] to walk after the attributes of the Holy One... The Holy One, blessed be God, comforted mourners, for it is written: "And it came to pass after the death of Abraham, that God blessed Isaac his son" (Genesis 25), so do you also comfort mourners. [Soncino translation]||ואמר רבי חמא ברבי חנינא, מאי דכתיב( דברים יג) אחרי ה' אלהיכם תלכו? וכי אפשר לו לאדם להלך אחר שכינה? והלא כבר נאמר (דברים ד) כי ה' אלהיך אש אוכלה הוא! אלא להלך אחר מדותיו של הקב"ה, מה הוא מלביש ערומים, דכתיב( בראשית ג) ויעש ה' אלהים לאדם ולאשתו כתנות עור וילבישם, אף אתה הלבש ערומים; הקב"ה ביקר חולים, דכתיב( בראשית יח) וירא אליו ה' באלוני ממרא, אף אתה בקר חולים; הקב"ה ניחם אבלים, דכתיב( בראשית כה) ויהי אחרי מות אברהם ויברך אלהים את יצחק בנו, אף אתה נחם אבלים|
The text puzzles at R. Dimi's claim that one who does not visit the sick person cause him/her to die, but then arrives at a remarkable conclusion. The crime in failing to visit and care for the sick person is not an act of killing. It is an act of profound indifference to human life. "He who does not visit the sick prays neither that he may live nor die."- he is indifferent and to the rabbis, indifference to human suffering is perhaps even worse than active malevolence.
Among these three values discussion here, bikur cholim is perhaps the one most directly linked to HIV/AIDS. Because it is an infectious and (thus far) chronic illness, and because it remains ruthlessly lethal, and because it has historically struck already vulnerable populations, AIDS carries a history of stigma and social discrimination that we must transcend if we are to respond to the pandemic and its victims with compassion and solidarity.