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Pikuach Nefesh: The Jewish Value of Saving a Life

The primacy of human life is a fundamental principle of Jewish law and a core value of Jewish tradition.

One of the most basic principles in Jewish law is that human life comes first. Almost any religious commandment can be broken in order to save the life of a human being.  

While the Torah goes to great lengths to tell us how important some of the commandments are, the start of the Torah foreshadows that saving human life will be more important: “And God created man in His image, in the image of God He created him.” (Genesis 1:27) Clearly, the life of a human being is special and unique, and as would become clear later in the Torah, demands preservation beyond anything else.

This idea, known as pikuach nefesh, is derived from two main sources. One, preferred by the 12th century scholar Maimonides, is the verse in Leviticus 18:5: “You shall keep My laws and My rules, by the pursuit of which man shall live.” The talmudic sage Rabbi Akiva comments that the verse says “by the pursuit of which man shall live” — not “shall die.” Built into every mitzvah – with some exceptions – is the precedence of human life. Keep the Sabbath — but if you have to violate its laws to perform life-saving surgery or get someone to the hospital, do it.

Many rabbis, Maimonides included, apply this principle only to the life of a fellow Jew. In a sense, they are saying that a Jew should never do a commandment that puts another Jew at risk. Over the centuries, the rabbis have successfully resorted to roundabout explanations so that by now there is now a consensus that the lives of non-Jews must be saved as well. But the core of this first understanding is the idea that pikuach nefesh is basically a Jewish concept embedded in commandments that apply only to Jews.

This read of pikuach nefesh tells us clearly that commandments are not about restrictions on life — though they might restrict our actions to some extent — nor are they about pulling us back from life. Rather, the mitzvot are supposed to enable us to live in the image of God to the fullest extent possible, to be an integral part of life in this world. If a mitzvah even runs the risk of stopping us from living, it is pushed away by pikuach nefesh, the ultimate concern for life. This understanding pushes us to reflect on our own lives: Are we life affirming? Are we acting in a way that celebrates the God-infused life we have been given?

The second source, preferred by the 13th century sage Nahmanides, is also from Leviticus: “the stranger and the citizen shall live with you.” According to the Talmud, this verse tells us that we have a positive commandment to preserve life, even if it means violating other ritual or ethical commandments. As opposed to being a built-in exception to every commandment, this source tells us that saving lives is a positive commandment on its own.

Nahmanides is clear that this applies to gentiles as well as Jews. We are all human beings created in the image of God. Whether Jewish or not, citizen or stranger, the commandment of saving a life is preeminent.

This community-minded understanding of pikuach nefesh teaches us that not only are we to celebrate mitzvot as affirming of our creation in the image of God, but also as vehicles to affirm that others are created in the image of God as well. Our tradition aims to create a society which celebrates the creation of all of humanity. Nahmanides’ interpretation ask us: Are we creating a society on the principles of pikuach nefesh, where everyone is looking out for the life, safety and well-being of the “stranger and the citizen” around us?

Of course, nothing in Judaism is so simple – nor should it be. So there are exceptions to pikuach nefesh. The Talmud tells us that a person cannot kill another person to save their own life. Adultery and idolatry are also excluded; according to most authorities, a person must give up their life rather than violating these prohibitions. The Talmud also tells us that if the violation would be public — and especially if it’s a time when the ruling authorities are seeking to get Jews to violate the Torah’s commandments — you must give up your life rather than commit even the smallest infraction.

There is one other important exception to saving life as declared by Rabbi Akiva: If the choice is between saving your own life or someone else’s, save your own first. If you are in the desert and have only one bottle of water, and you need it all to survive, drink the water — even if it means your friend gets stuck without any water and dies.

All of this was hotly debated in the medieval period because the basic idea of never having a commandment come at the expense of human life was so central. Our tradition just cannot conceive of it in a normal world. In the late Middle Ages, Rabbi Menachem Meiri said that while the Talmud seemed to exclude many non-Jews from the laws of pikuach nefesh, had it known of the civilized societies of Meiri’s era (and ours), it would have been more explicit that everyone living in civilized society, Jew or non-Jew, is covered by the law of pikuach nefesh. Their lives must be saved, even if that meant violating almost all of the central commandments of Judaism.

Meiri understood that pikuach nefesh is not a loophole. It is a way to view the sanctity of human life as central to our tradition, our society and our commandments.

Rabbi Asher Lopatin is the founder and spiritual leader of Kehillat Etz Chayim in Detroit and the founder of the Detroit National Center for Civil Discourse. He is the former president of the rabbinical school Yeshivat Chovevei Torah.

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