One of the more difficult bioethical dilemmas is whether we may compel a patient to receive medical treatment.
At its core lies the tension between benefiting the patient and respecting their autonomy. While doctors once paternalistically imposed decisions, today they are more cautious – because outcomes are uncertain and because Western values emphasize personal liberty over one’s body. Exceptions remain, such as suicide prevention, where a patient may be restrained because he is deemed irrational or mentally ill – i.e., not fully autonomous.
In such cases, temporary coercion may save a life and restore one’s autonomy.
Nonetheless, the prevailing moral assumption is that individuals have the right and capacity to decide for themselves.
Jewish ethics, however, are framed around obligations, not rights. These include the obligation to protect one’s own health (“Guard your souls carefully” – Deuteronomy 4:15), as well as the obligation to save others (“Do not stand idly over the blood of your neighbor” – Leviticus 19:16). Some sources compare the obligation to save someone to restoring his most valuable lost property – his body.
While one may willfully choose to discard one’s own property, the same is not true for our bodies. For this reason, Jewish law prohibits self-inflicted harm and mandates others to prevent such destructive acts. We are guardians over our bodies, not their owners.
What does Jewish law and ethics say about forgoing medical treatment?
Occasionally, some Jews have mistakenly believed that they may piously choose to forgo necessary healthcare treatments in order to avoid violating Shabbat restrictions or eating non-kosher food. Figures like Rabbi David ibn Zimra and Rabbi Avraham Gombiner asserted that such a person is a “pious fool” (hassid shoteh) who must be compelled to receive such treatments.
Indeed, the Talmud asserts that just as we compel a person to pay his share of the communal sacrifices for his spiritual benefit, so too we may amputate his leg for his physical benefit. Our respect for human dignity – based on the divine image found in all human beings – creates an obligation for the patient and his caregivers to receive necessary healthcare.
THE DECISORS debate how far we go in compelling patients to receive treatment. Rabbi Eliezer Waldenberg, for example, ruled that we may compel students to receive eye examinations and treatments in order to protect their eyesight. Others asserted that we only compel people to receive life-saving treatments or to address immediate health concerns.
Rabbi Moshe Feinstein, for example, ruled that we may force a patient to receive a well-trodden and life-saving medical treatment if his refusal stems from melancholy or despair after undergoing much treatment. Special consideration is also given to compelling people to receive treatments that will protect public health, as in cases of infectious diseases.
As Rabbi Yaakov Emden noted in the 18th century, compelling patients is appropriate when the therapy is proven and likely to succeed. It is far less justified when the patient lacks confidence in the treatment, doctors themselves are uncertain, or the procedure entails significant suffering. In such a circumstance, he asserted, a person may abstain from treatment.
Following this argument, Rabbi Feinstein contended that a patient may forgo interventions that won’t heal him and will only extend a painful dying process. When possible, we try to lift the spirits and strengthen the willpower of suffering patients, yet we must remain humble and cautious before imposing treatments that may prolong suffering rather than relieve it, recognizing that we do not fully grasp the depth of another person’s pain.
An often-cited case involved a 50-year-old diabetic patient, already blind and a single amputee, who faced necrosis in his remaining leg and was expected to die within days without a second amputation. Doctors agreed that surgery might prolong his life but wouldn’t cure his condition. The patient refused it due to the pain and the prospect of living as a blind double-amputee.
Rabbi Shlomo Zalman Auerbach asserted that we should not compel such a patient to undergo this surgery. Similar rulings regarding suffering patients who are terminally ill have been issued by Rabbi Asher Weiss, Rabbi Eliyahu Bakshi-Doron, Rabbi Zalman Nehemiah Goldberg, Rabbi Hershel Schachter, and others.
Rabbi Moshe Sternbuch has similarly ruled that if a patient cannot speak for himself, we should presume he would decline such painful and non-curative treatment.
It is therefore essential for patients to clearly articulate their healthcare values in advance, enabling loved ones or halachic proxies to advocate on their behalf. Ematai’s conversation guide (ematai.org/netivot) offers a helpful tool for initiating these vital discussions.
Rabbi Auerbach, however, argued that we would compel a patient to receive “natural needs,” which include oxygen, food, and nutrition. Rabbi Feinstein, in contrast, felt that we cannot force-feed a patient. In many cases, moreover, compelling such an intervention can cause harm from a resistant patient. In general, it is frequently difficult to compel cognizant patients to receive medical treatments, especially when it entails tubes or other invasive technologies.
Ultimately, these complex cases demand a sensitive balance between two cherished values: the sanctity of life, and the imperative to alleviate human suffering. While Jewish law affirms a deep obligation to preserve life, it also recognizes that life must be dignified and that excessive interventions which merely prolong pain may not be obligatory.
In respecting a competent patient’s wishes, rabbis have upheld that choice in such cases reflects not a disregard for life but a sober recognition that the obligation to prolong life has limits. In those moments, we allow a patient to forgo interventions and leave his fate in the hands of God. ■
The writer is executive director of Ematai (ematai.org) and author of Ethics of Our Fighters: A Jewish View on War & Morality.