We are Free – to Save a Life

Last week’s wonderful conversation about Jewish tradition when approaching questions of life and death brought together so many important issues, and some that have been on my mind for a long time. The questions at hand often relate to the conflicting ideas of freedom and responsibility, especially in light of the current conflicts around mask wearing and the “re-opening” of our economies and gathering places. A few highlights make the Jewish perspective fairly clear:

1. Freedom is not the same as Redemption – We were redeemed from slavery in Egypt in order to create a just society, not for the sake of personal freedom. Holding personal freedom above communal welfare is wholly antithetical to Jewish wisdom.

2. Save a Life – Pikuach nefesh, the saving of a “soul” is more important than almost any other commandment, including keeping Shabbat. Not only is mask wearing a good thing to do, but it has been suggested that one say the mitzvah blessing before donning one in order to fulfill the mitzvah of saving a life: “asher kid’shanu bimitzvotav vitzivanu al pikuach nefesh.”

3. Build a Parapet – When you build a house with an accessible roof (very common in hot places and biblical times) you must build a railing to assure no one falls. Pesky regulation say some. Torah says it is the law!

4. We are Responsible for One Another – The Aramaic here is “aravim,” or all mixed together. Our personal and communal futures are interconnected. Some choices are good for us and others. Others bring good to an individual only by creating hardship for others. Judaism prefers the first choice.

5. Scarcity creates Ethical Dilemmas – Here the rabbis are not clear and medical ethics continues to struggle. In Talmud, it was one jug of water for two people. There was not agreement on whether it was better that one man should live or none should watch a friend die. This recent article addresses this type of question in today’s terms.

As a healthcare professional with a long standing interest in ethics and public health, I have long struggled with the clash between personal freedom and our communal structures. Much of the “regulation” in our society – for instance, requiring wearing seatbelts or helmets, or passenger side airbags – aims to keep everyone safe from injury. But these individual choices have impact on broader systems in our society – insurance, healthcare, and the emotional and moral toll of someone having caused a death that could have been avoided.

Individuals demanding freedom from masks, social distancing, and take-out are then at higher risk for illness individually and in the community. While they choose to take the risk to become ill, they then depend on systems that are communally funded (insurance) and morally obligated to treat all patients regardless of ability to pay (and already stretched too thin.) This recent article addresses the need to treat all patients the same, even if they are lock-down protestors. It also discusses the horror and fear present in the hallways of hospitals and hearts of healthcare workers.

Similar examples apply to the helmet-less rider and unbelted driver and the critical-care patient who rejects the requirement for medical insurance. We all pay the collective financial, emotional, and civic toll caused by preventable deaths, injury, and illness and our system. Is it ethical to ask those who opt out of these regulations to opt out of using our communal resources?? Jewish law says no. But it also says that opting out is not really an option.