Consider the following case:

A baby is born with severe congenital defects. The doctors say that if nothing is done to address them, the baby will die within days. They also say that there's a series of operations that, if done, have a 5% chance of granting the baby up to two months of life in intensive care. The operations and the intensive care require highly specialized personnel and equipment, with an estimated total cost of $500,000.

  1. Assume that there's no such thing as medical insurance or state-funded care. If the parents choose to have the operation done, the hospital will bill them for the full cost. Are the parents required to choose to have the operation done?

  2. Assume that the parents have medical insurance that will cover the cost of the operation. Are the parents required to choose to have the operation done?

  3. Is a medical insurance company (assuming it intends to follow Halacha) required to have a policy that would pay for the operation in this case?

  4. Assuming that such a choice exists, are would-be parents required to carry insurance whose policy would pay for the operation in this case?

I'm primarily interested to know if there's any difference between the answers to 1 and 2. In other words, is our implementation of the Halachic requirement to preserve human life affected by the existence of health insurance?

If there's no difference given the case as presented, but there would be a difference if the parameters of the case are changed (e.g. $10B instead of $500K or years of life instead of months), feel free to change the parameters.

Of course, people who have to consider these questions practically should consult their Rabbi.

2 Answers 2


One question is if there's an element of choice in end-of-life decisions. While many disagree, Rabbi Herschel Schachter famously quotes Rambam as saying that there are some situations where halacha has no say, it's all up to the patient (e.g. painful, aggressive treatment vs palliative care in an older patient with cancer. A twenty-year-old has no right to say "I'd rather die than live the rest of my life with a prosthetic limb.") I think, within reason, some calculus of cost might be allowed to weigh into the decision too, then. I don't know how this applies to parental decisions regarding a child, though.

As I see it, we have a concept that saving a life overrides almost any Torah commandment; however, that doesn't necessarily mean one must spend any sum of money on it. The obligation to save a life is "do not stand idly by your brother's blood"; the Talmud asks wouldn't this have been obvious already from the obligation to return your neighbor's lost cow (and thus certainly his life?). Answer: to save his cow, you need only exert some time and effort. But to save his life, you must ... RENT people/equipment. (Not just "b'gufo", but even "l'radya".) While it's debated, I believe we conclude that the halacha is that the Talmud didn't say you must SPEND money (and write it off -- in which case we would have said "b'gufo and b'mamono"); only loan it temporarily, and try to recoup it later. So I think the general rule applies, that one is exempt from a "yes-do" mitzva if it would cost them ~25% of their assets.

As for what a halachic insurance company would do here ... I don't know.

But reading the particulars of your case more carefully: if we're talking about a case where no matter what we do the baby doesn't have more than a few months, then it's a question of taking heroic (arguably "violent") measures just to delay death, rather than extend life. Halacha is if someone is on their deathbed but can't go because there's too much noise outside, we tell the noise outside to quiet down -- no sense causing additional agony. Nutrition, hydration, pain relief -- those we always provide. But beyond that, no heroics. As Dr. Fred Rosner said, in such a case, the doctor no longer has his Divine license to heal.

  • If I read you correctly, you're answering No and Yes to my first two questions, since in 1, they'd have to spend more than they have, and in 2, they don't have to spend any of their own money?
    – Isaac Moses
    Sep 27, 2010 at 19:39
  • I read your case more carefully -- if the baby has no chance of making it more than a few months, I don't think anyone is obligated. If there's a tiny chance of long-term success, but that needs to be weighed against the possibility of great pain, it might just be the parent's choice (assuming we can apply what I heard from RHS). Only in a case where "any reasonable person" would think the surgery is worth the risk (leaving costs aside) would the answer be 1 no 2 yes.
    – Shalom
    Sep 27, 2010 at 23:01
  • So, even in a case of "any reasonable person," e.g. 75% chance of going on to a normal childhood, the parents are not obligated to take on major debt to save their child?
    – Isaac Moses
    Sep 28, 2010 at 0:28
  • I don't think you'd be obligated to take on major debt to save a stranger's life; is there a specific different requirement for one's children? There's an obligation to feed and generally care for them, but beyond that, I really don't know. (I don't think a commandment needed to be given, it's just human nature -- like the Chasam Sofer said regarding women and the mitzva of having children.) Hm. This is a question for someone more knowledgeable. I know R' Moshe discusses how far one must (or should) pay for a sick spouse's treatment.
    – Shalom
    Sep 28, 2010 at 0:42

In this type of situation I do not see why it should make any difference if there is insurance or not. I think parents would have to try to do everything in their power to save the child. Maybe 2 months will stretch into many many years, as has happened in many instances.

  • 1
    What if the predicted likelihood of success is 1/200 instead of 1/20? Is there a level of such likelihood at which the obligation lifts? If so, is that level affected by the presence insurance?
    – Isaac Moses
    Sep 27, 2010 at 20:07
  • We tend to talk (and thus hear) about the 1/1000 miracle stories where there was a recovery. We don't hear about the 999/1000 stories where there was nothing but heartbreak.
    – Shalom
    Sep 27, 2010 at 23:02

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