Pikuach Nefesh: the Primacy of Saving a Life

Pikuach Nefesh:

the Primacy of Saving a Life

Elana Stein Hain

Where does the idea of Pikuach Nefesh (פיקוח נפש), the primacy of saving a life, come from in Jewish tradition? Why are we commanded to break Shabbat in order to save a life? What exceptions did the rabbis make to the principle of pikuach nefesh? The primacy of saving a life is an overriding value in Jewish law, and in a moment when our normal lives are disrupted, the ideas behind pikuach nefesh take on a new relevance.

Dr. Elana Stein Hain is Scholar-in-Residence and Director of Faculty at the Shalom Hartman Institute of North America, where she serves as lead faculty and oversees the content of lay and professional leadership programs. Elana also co-leads the Created Equal research team with Joshua Ladon.

Elana earned her doctorate in religion from Columbia University with a dissertation on the topic of legal loopholes in rabbinic law. She is an alumna of the Yeshiva University Graduate Program in Advanced Talmudic Studies (GPATS) and the Consortium in Jewish Studies and Legal Theory Graduate Fellowship. Elana served for eight years as a clergy member on the Upper West Side of Manhattan, at both Lincoln Square Synagogue and the Jewish Center, and taught at the Wagner School at NYU. She lives on the Upper West Side of Manhattan with her family.

Ayelet Hoffman Libson, Law and Self-Knowledge in the Talmud, p. 147

In sum, tracing the development of the rabbinic debate over fasting suggests that it is possible to identify three distinct models of how the rabbis related to the intersection of the sanctity of Yom Kippur and the risk to life. The mishnaic model relied on the experts’ authoritative decision, even when it contradicted the patient’s opinion that he was in need of food. The amoraicposition, by contrast, focused on the threat to life and emphasized that any doubt – raised by either patient or physician – is sufficient to be cautious and permit the patient to eat. The post-amoraic redactors diverged from this position, emphasizing instead the importance of the patient’s own knowledge in determining whether she should eat. I propose that there are two separate but interrelated transitions throughout this rabbinic conversation. First, there is a shift from the authority of experts to the autonomy of individuals. However, I believe we can also point to a second, subtler shift, occurring between the amoraic and post-amoraic periods. In contrast to the opinions of the earlier sages who understood the Mishnah as referring to medical knowledge alone, I offer a reading of a new perception in the post-amoraic layer, reinterpreting earlier sources so as to transition the discussion to a conversation about the religious-spiritual conception of fasting.

The correlation between fasting and atonement was not, of course, limited to one day per year. Rather, for both Jews and non-Jews in late antiquity, suffering constituted one of the central paradigms of religious understanding and conceptualization of the self. By delving deeper into the religious significance rabbinic Jews accorded to the connection between suffering, death and atonement, we will shed further light on the Talmudic dispute at hand, exploring the context in which suffering, knowledge and choice became inextricably intertwined.

The Shalom Hartman Institute is a leading center of Jewish thought and education, serving Israel and North America. Our mission is to strengthen Jewish peoplehood, identity, and pluralism; to enhance the Jewish and democratic character of Israel; and to ensure that Judaism is a compelling force for good in the 21st century.

Shalom Hartman Institute of North America

475 Riverside Dr., Suite 1450

New York, NY 10115

212-268-0300

[email protected] | shalomhartman.org