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As per the injunction of "לא תעמוד על דם רעך" - "Stand not [idly] over the blood of thine fellow"(Leviticus 19:16), is a Torah-observant doctor obligated to vaccinate an unvaccinated patient for a potentially deadly disease, even if that patient and/or that patient's parent/legal guardian is unwilling? Would the patient have the status of a rodef (pursuer) whom one is obligated to prevent from committing a murder, by inflicting an injury upon the pursuer?

See also:

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    I suspect that while anti-vaxxers are wildly incorrect and sinning by not vaccinating, it's probably too indirect to be technically considered a Rodef. Otherwise, just about anything could be stretched into Pikuach Nefesh (i.e. "I have to work on Shabbos, otherwise I might lose my job and not be able to pay my bills and become homeless and starve to death"). May 13 '19 at 22:10
  • @Salmononius2 Over 500 American Rabbis came out shortly before Pesach signing a letter declaring vaccinating a chiyuv d’Oraisa. I don’t recall if they went so far as to declare them Rodfim, but certainly sinning.
    – DonielF
    May 13 '19 at 22:37
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    Would the patient have the status of a rodef (pursuer) whom one is obligated to prevent from committing a murder, by inflicting an injury upon the pursuer? You ask for an ill person who is carrier of the virus? The Shut clearly does not address a problem of Rodef. But an ill contagious person can be considered as Rodef. e.g one is AIDS carrier an has intercourse with can be viewed as attempting to kill it and may be Rodef.
    – kouty
    May 14 '19 at 1:20
  • @kouty [HIV carriers] May 14 '19 at 8:29
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    @AlBerko one obvious difference between this and exercising is that if you don't exercise you're only killing yourself, while if you don't vaccinate you're potentially infecting thousands of other people.
    – Heshy
    May 14 '19 at 13:16
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+50

I obviously can't give an opinion on how the following would apply to any specific case, but there are sources which talk about the need to provide medicine to patients, even against their own wishes. Magen Avraham and Kaf Hachaim both cite the Radbaz when saying that one can force a patient to take medicine even if the patient doesn't want to. These opinions are independent of the patient being a rodef - they are all based simply on the patient's own well being. The Rambam likewise says that one is not allowed to risk one's own life unnecessarily.

  • Magen Avraham 328:6

    אם לא רצה החולה לקבל התרופה כופין אותו, חולה אומר צריך אני לתרופה פלונית ורופא אומר א"צ שומעין לחולה ואם הרופא אומר שאותו תרופה יזיקהו שומעין לרופא [רדב"ז ח"א ס"ו כ"ה]:

    If the patient does not want the medicine, we force the patient to take it. If the patient says he requires a certain medicine, and the doctor says the patient does not need it, we listen to the patient. If the doctor says that that medicine will harm [the patient], we listen to the doctor.

  • Kaf HaChaim 328:45

    שם. כל חולי שהרופאים אומרים וכו' ואם לא רצה החולה לאכול או לעשות תרופה משום מדת חסידות כופין אותו לעשות. הרדב"ז ח"א סי' ס"ו, כנה"ג בהגה"ט. מ"א סק"ו. ר"ז או' י"א. ח"א כלל ס"ח או' ח'.

    If the patient does not want to eat or receive medicine because of a matter of piety, [the patient] is forced to do so.

Regarding parents, the same basic principle applies. The Radbaz has a relevant teshuva. A baby was 2 years old and was still very weak. The baby would be potential danger if it was weaned. It would not nurse from anyone other than it's mother, so a wet nurse wasn't a viable option. The Radbaz suggests a number of options, but ultimately concludes that even if the woman wants to stop nursing, she can be forced to continue nursing because it is important to the babies health. (Teshuvot HaRadbaz 1:349 - I believe this is the one the acharonim above are referring to and either their citation system is something unfamiliar to me or the numbers of the Teshuvot are printed differently in their edition compared to the probably more modern edition digitized by Sefaria).

Although the above answers your question without needing to resort to calling someone a rodef, it is an interesting question. I haven't seen anyone who explicitly says this, however, Rav Aviner comes fairly close. He does say that there is an obligation to vaccinate and dismisses the notion that one has the freedom to chose not to vaccinate. He also says that a non-vaccinator can be considered a rodef.

ש: האם חייבים להתחסן?

ת: כן. ונשמרתם מאוד לנפשותיכם. "הרבה דברים אסרו חכמים מפני שיש בהם סכנת נפשות. וכל העובר עליהן ואומר: הריני מסכן בעצמי ומה לאחרים עלי בכך או איני מקפיד בכך, מכין אותו מכת מרדות" (רמב"ם, הלכות רוצח ושמירת נפש יא ה).

ש: במדינות מודרניות יש חירות הפרט לעשות כרצונו אם לחסן.

ת: א. החירות האמיתית היא לשמור תורה ומצוות. ב. אין לו חרות לסכן ילדיו שיחלו בגלל שלא חיסן אותם. ג. הוא גם מסכן אחרים שעלולים להידבק ממנו, ויש בזה משום דין רודף.

Q: Is one obligated to vaccinate?

A: Yes. 'For your own sake be careful' (Devarim 4:15). Many things were forbidden by the sages since they caused mortal danger. Anyone who violates this and says 'I am putting myself in danger, what do other care?' or 'I will be careful' We give him [rabbinic] lashes (Rambam).

Q: In modern countries, we have some freedom to do as we wish with vaccinations.

A: 1) Real freedom is to guard the Torah and mitzvot. 2) One has no freedom to endanger one's children that they should become ill because he did not vaccinate them. 3) he is also endangering others that may be infected by him, and there is in this the law of rodef (the pursuer).

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  • +1 I tweaked the translations a bit. E.g. the rabbinic nature of makat mardus just means the lashes are not biblically mandated, not that the prohibition itself isn't biblical. Also, it does sound, at least based on the cited language, that Rav Aviner does indeed maintain an antivaxxer is a form of rodef.
    – Loewian
    Jan 11 at 5:53
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Let's suppose, theoretically, that forcibly vaccinating a patient who doesn't want it is akin to pulling someone out of the way of a speeding car when they intended to get hit; and let's suppose that both are akin to saving someone who was endangered by accident and had no intention of self-harm. (All of those are big ifs.)

Even then, there's plenty of halachic discussion on the cost incurred to get up and save a life. (The Talmud says to save someone's property I'm not expected to incur loss -- if I watch his lost ox, I can and should use the ox while I feed it. Whereas to save someone's life or limb, I should rent equipment if needed. It doesn't say "spend", it says "rent." The commentaries there assume the language -- normally the alternative to begufo is bemamono, but here it's leradia -- implies you may seek to be repaid afterwards.)

I'd imagine a doctor could lose his/her license, or even be criminally charged, by forcing any kind of medicine on a patient. At that point we do have a similar question addressed in the halachic literature -- suppose a doctor discovers a patient has AIDS, knows about it, and tells his doctor explicitly: my fiancee doesn't know about this, she's naive, I intend to keep hiding this from her, and not use protection; I don't care if she gets it from me. If there was no cost to the doctor, don't stand by would obligate him or her to speak up. (Practically, appropriate mechanisms allow for just that -- the doctor could take it to the hospital's ethics panel.) But if the only way to do so would mean the doctor could be fired or worse ... there's a lot of discussion on that one; it's likely considered a cost too high.

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  • The question's "Would the patient have the status of a rodef" means it's primarily thinking of others' welfare, not the patient's; the answer primarily addresses the patient's.
    – msh210
    Jan 6 at 11:15
  • @msh210 even so -- I'm only expected to go so far to fulfill lo saamod; the infected fellow breathing on others should be akin to the HIV-positive guy about to get married and not use protection (with his wife totally unaware of the danger). While you want to protect her, you're not obligated to take measures that will end with you in jail.
    – Shalom
    Jan 6 at 11:38
  • where are these?
    – Mordechai
    Jan 6 at 13:05
  • I'm not sure I understand what you're saying - the biblical prohibition of "lo saamod al dam reyecha" is negated by one's need to keep his/her job?! Do you have a source for that?
    – Loewian
    Jan 6 at 17:02
  • @Loewian any asei requires you to only spend a fifth of your assets. The Gemara doesn't say you have to lose money to save a life, only to lose liquidity.
    – Shalom
    Jan 6 at 22:52
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The first question is if giving vaccines to someone who is currently healthy has the halachic status of Pikuach Nefesh and Lo Saamid Al Dam Rayach . While it is possible someone will die and cause others to die as a result of their failure to vaccinate that possibly also exists with driving a car. A serious epidemic would be a situation of pikuach nefesh where one can be required to administer vaccines. One can even give them on Shabbos if there will be no other opportunity to do so but not all vaccines are given for such heavy risks. When a risk enters the category of potential pikuach nefesh is a complicated question of it's own.

When it comes to forcing vaccines on people when there is no epidemic serious enough to to make this vaccine clearly be considered pikuach nefesh there are differences in opinion. The Nishmas Avrohom (Choshen Mishpat 426b and 427a) says that parents (and by extension doctors) cannot be forced to vaccinate their healthy children, even if the parent is refusing because of an "irrational fear". While others are of the opinions that parents must vaccinate that would be relevant to parents. What obligation is there on a doctor to give a vaccine against someone's will anymore than giving any other treatment for a nonpaying patient?(It's safe to assume someone being vaccinated against his will isn't going to pay for it) Shulchan Aruch (Y.D. 336:3)discusses doctors (over)charging and the obligation to pay afterwards. The Rema says that even though a doctor has a mitzvah to treat this patient, it is not a mitzvah incumbent specifically on him. Theoretically anyone can become a doctor and heal people. Therefore no doctor has a personal obligation to treat people over anyone else. (note: Rashi gives the refusal to heal the poor for free as one the reason the Mishna says "Tov S'b'Rofim L'Gehenim)

If a doctor can refuse treatment over money he presumably can do so because the patient is also unwilling to accept it.

Ask your Rav if you are a doctor. None of the above is meant halacha l'maashe.

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