Acharei Mot-Kedoshim


Time and again in this coronavirus pandemic, our political leaders have said that social distancing is vital so as ‘not to overwhelm the NHS.’ In plain terms, that means that we want to avoid the nightmare scenario when there are insufficient resources to meet the needs of those who require critical attention. Agonising choices would have to be made as to who should be treated.

At the beginning of the pandemic, an article appeared in the New England Journal of Medicine spelling out some of the ethical challenges a pandemic might bring. When there are insufficient medical resources, how should the triage operate? Who are the ones who gets the treatment? The old? The young? What is the cut-off point? Under 75? Under 65? Those with the best chance of survival? Do we distinguish between those who are currently being treated, and those who are awaiting treatment? Would we, say, take someone off a ventilator in order to treat someone else with a much better chance of recovery?

The dilemma is captured in a famous debate that took place nearly two thousand years ago, recorded in the Talmud (Bava Metzia 62b)

Two people are travelling along the way, and one of them has in his possession a flask of water.  If both drink from it, they will both die.  However, if only one of them drinks, he will be able to make it out of the desert.

Ben Petura expounded, “It is better that both should drink and die that that one should witness the death of his fellow.”

Then Rabbi Akiva came and taught, “‘Your brother shall live with you’ (Vayikra 25:36) — your life comes first, before the life of your friend.

The analysis of this passage forms the basis of understanding Jewish teachings on triage. Is the moral course of action to save two lives even for a short time – i.e. share the water, like Ben Petura? Alternatively, do we look at the result that will be achieved? Is it therefore preferable to allow the person with the water to drink it all, giving him a chance of long-term survival – the view of Rabbi Akiva.

Normative Jewish law follows the view of Rabbi Akiva. Nevertheless, there is still a range of discussion on this issue. What if neither person has a bottle of water? Instead, a third person has a spare bottle. Who should he give it to?

A number of years ago, I discussed this question with Rabbi Professor Moshe Tendler, the son-in-law of the late Rabbi Moshe Feinstein (d. 1986) the leading halachic authority in America in the second half of the twentieth century. He told me that in the 1940s, his father-in-law was telephoned by the Chief Rabbi of Israel, Isaac Herzog, concerning a shortage of penicillin in Israeli hospitals. Rabbi Feinstein said that the doctor should give the medication to the first patient he came to who needed it.

On this basis, there would be no discrimination based on age or other health problems. Each patient is treated equally, irrespective of whether one is healthy or frail, young or old. It doesn’t matter whether one is a leading cancer specialist or top class footballer, prime minister or pop singer. The reasoning behind this approach is that every person is unique and has been created in the image of God. It is not up to us to decide whose life is worth more.

There are other approaches that are discussed in the halachic literature. It must be emphasised that most hospitals around the world today will take a utilitarian approach. The NICE guidelines in the UK in assessing critical care for adults suffering from Covid 19 will take into account age and frailty in deciding whether to prioritise a patient for limited critical care resources.

Can you imagine the agony a doctor must feel, when he knows he could treat someone who is very ill, but he is required by his protocols to prioritise another patient, because resources are limited? We can each make a contribution by abiding by the safety guidelines that have been drawn up. Stay home and save a life, so that critical care will be available to those who need it.

May the Almighty grant a refua shlema to all those who are unwell and may we be able to emerge from this crisis healthy and wise. Shabbat Shalom

Dayan Ivan Binstock