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I was posed a hypothetical question about medical ethics today. I am not looking for a psak as much as for sources on the discussion about halachic responsibility.

Case 1:

You are personally told by person A, that person A has received a medical diagnosis that if left untreated, is most likely fatal. Person A also informs you that he has no intention of pursuing treatment. With treatment, the condition would be treatable. You try to convince said person to rethink and make a different decision but to no avail. What is your halachic obligation? Would you be obligated to intervene further? An intervention? Or is Person A completely responsible for his own choices?

Case 2: Same facts except person A is the legal caregiver/decision maker for person B and has received the diagnosis for person B but has chosen not to direct medical staff to pursue treatment for person B. [Would it matter if person B had a living will that said either to or not to pursue treatment?]

This isn't about a person's obligation to help himself, but about another person's potential obligation to step in and intervene.

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    Do the treatments greatly affect quality of life? – Double AA Feb 25 '16 at 15:28
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    from an Halachic point of view, two commandments are involved Hashavath Aveda and Lo taamod Al Dam Reecha. But the law in the Arkaoth don't permit generally intervention against the against the will of the patient. So much so that even in psychiatry there are matters or the law does not deny facculte patient's judgment that threatens, as in anorexia nervosa (in some countries) or suicidal intentions. Similarly, the guardianship of a patient refusing surgery by an irrational fear is most often refused by the court. – kouty Feb 25 '16 at 15:48
  • If the person has a living will, how is the caregiver able to make decisions contrary to what it says? – Daniel Feb 25 '16 at 15:56
  • @DoubleAA would it make a difference halachically if the treatments were more or less uncomfortable? Are there limits to what a person can be forced to go through to live? – rosends Feb 25 '16 at 17:50
  • @Daniel if a person is carrying out the wishes of a living will to withhold treatment and allow death eventually. Is that any different from contravening a living will which says to allow death, halachically? And what if the living will requests treatments and the caregiver decides not to abide by it -- do I, halachically, have a position to intervene? – rosends Feb 25 '16 at 17:52
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First, I'll copy the Hebrew text of the Gemara with Rashi's comments and Tosfot about this problem. But I will mark it in English. Thus, readers who do not understand the Hebrew or Aramaic able to just read the annotations. Annotations can be read linearly. Translations are borrowing from Soncino. I skip the first sentence of the Gemara in order not to confuse the explanation.

Sanhedrin 73A

גמרא סנהדרין דף ע"ג עמוד א

ת''ר מניין לרודף אחר חבירו להרגו שניתן להצילו בנפשו ת''ל {ויקרא יט-טז} לא תעמוד על דם רעך (רש"י: לא תעמוד. לא תעמוד עצמך על דמו אלא הצילהו [2] ) והא להכי הוא דאתא האי מיבעי ליה לכדתניא מניין לרואה את חבירו שהוא טובע בנהר או חיה גוררתו או לסטין באין עליו שהוא חייב להצילו ת''ל לא תעמוד על דם רעך[1]...וכו'...גופא מניין לרואה את חברו שהוא טובע בנהר או חיה גוררתו או לסטין באין עליו שהוא חייב להצילו ת''ל לא תעמוד על דם רעך והא מהכא נפקא!? מהתם נפקא: אבדת גופו (רש"י אבדת גופו. כגון נטבע בנהר מניין שאתה מצווה על השבתו) מניין ת''ל והשבותו לו [3](רש"י ת''ל והשבותו לו. קרא יתירא הוא למדרש השב את גופו לעצמו) אי מהתם הוה אמינא ה''מ בנפשיה (רש"י הני מילי בנפשו. אם זה הרואהו יכול להצילהו יצילהו) אבל מיטרח ומיגר אגורי אימא לא קמ''ל [4](רש"י קמ''ל. לא תעמוד על דם רעך לא תעמוד על עצמך משמע אלא חזור על כל צדדין שלא יאבד דם רעך)


Rambam adds some precisions.

Sefer Nezikin, Hilchoth Rotseach, Chapter I, Halacha 14

יד כָּל הַיָּכוֹל לְהַצִּיל וְלֹא הִצִּיל עוֹבֵר עַל (ויקרא יט-טז) 'לֹא תַעֲמֹד עַל דַּם רֵעֶךָ'. וְכֵן הָרוֹאֶה אֶת חֲבֵרוֹ טוֹבֵעַ בַּיָּם. אוֹ לִסְטִים בָּאִים עָלָיו. אוֹ חַיָּה רָעָה בָּאָה עָלָיו. וְיָכוֹל לְהַצִּילוֹ הוּא בְּעַצְמוֹ. אוֹ שֶׁיִּשְׂכֹּר אֲחֵרִים לְהַצִּילוֹ וְלֹא הִצִּיל. אוֹ שֶׁשָּׁמַע עוֹבְדֵי כּוֹכָבִים אוֹ מוֹסְרִים מְחַשְּׁבִים עָלָיו רָעָה אוֹ טוֹמְנִין לוֹ פַּח וְלֹא גִּלָּה אֹזֶן חֲבֵרוֹ וְהוֹדִיעוֹ. אוֹ שֶׁיָּדַע בְּעַכּוּ''ם אוֹ בְּאוֹנֵס שֶׁהוּא בָּא עַל חֲבֵרוֹ וְיָכוֹל לְפַיְּסוֹ בִּגְלַל חֲבֵרוֹ לְהָסִיר מַה שֶּׁבְּלִבּוֹ וְלֹא פִּיְּסוֹ[5]. וְכָל כַּיּוֹצֵא בִּדְבָרִים אֵלּוּ. הָעוֹשֶׂה אוֹתָם עוֹבֵר עַל לֹא תַעֲמֹד עַל דַּם רֵעֶךָ:

If this is the person herself, who wants him to happen to him, it is forbidden to even remain indifferent. We must deploy everything to dissuade. This seems obvious but I hope to find a reference.


[1] Whence do we know that if a man sees his fellow drowning, mauled by beasts, or attacked by robbers, he is bound to save him? From the verse, Thou shalt not stand by the blood of thy neighbor!
[2] Rashi: Thou shalt not stand still in front of his blood, but will help him.
[3] [To revert to] the above text: 'Whence do we know that if a man sees his neighbour drowning, mauled by beasts, or attacked by robbers, he is bound to save him? From the verse, Thou shalt not stand by the blood of thy neighbour.' But is it derived from this verse? Is it not rather from elsewhere? Viz. , Whence do we know [that one must save his neighbour from] the loss of himself? From the verse, And thou shalt restore him to himself!
[4] From that verse I might think that it is only a personal obligation, but that he is not bound to take the trouble of hiring men [if he cannot deliver him himself]: therefore, this verse teaches that he must.
[5] If he hears the idolaters or informers who are about to hurt him or setting a trap against him, and he did not warn his friend; or intends that idolatrous or vandal goes against his friend and may deter but does not do so, it violates... "Thou shalt not stand by the blood of thy neighbour".

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