Thankfully, the coronavrius has not overwhelmed hospitals in America or Israel like it has in Italy. But halachic experts discuss all sort of situations – both practical and theoretical – and so The Jewish Press recently asked Rav Yigal Shafran, head of the Jerusalem Chief Rabbinate’s Department of Medical Ethics and Halacha, who receives medical care first when a hospital’s resources are limited.
Rabbi Shafran is also the founder and director of the Merhavim Teacher’s College in Jerusalem and lectures widely on medicine and halacha throughout Israel.
The Jewish Press: According to halacha, if there are a limited number of respirators, who is treated first?
Rabbi Shafran: Each case must be decided by the halachic authorities on the scene, but as a general matter, precedence in the present crisis should be given to medical staff.
They are the most endangered and most involved in aiding the public. When the life of a doctor or nurse is threatened, the lives of all the public who could benefit from his or her wellbeing is threatened as well. By saving an ailing doctor, thousands of others can be saved as well.
The only exception is if the respirator is the personal property of the ailing person. In that case, he has precedence.
What if the doctor in question only has a minimal chance of surviving?
Then some other medical practitioner should get the respirator. It must be emphasized that we are speaking of a case where the respirator is not being used. If a patient is connected to it, it cannot be disconnected and given to someone else – even if we know the patient is going to die shortly and even if the machine could save the life of someone else who will otherwise die.
What if there is one available respirator and the choice is between a doctor and the head of the government?
The doctor has precedence. A king does not have precedence over a doctor who can save the lives of many others. We look at the doctor as if he has a line of people waiting for his immediate assistance. In this matter, he is more important to the overall public.
What if there is no immediate question of life and death? Suppose, for example, 1,000 people are waiting to be tested for the coronavirus and there are only 500 test kits available?
A committee of halachic experts and experts from the national health department should determine these matters. But they would have reason to decide that preference should be given to people who have the greatest chance to be saved. So a healthy young person would have preference over an 80-year-old with an existing chronic disease.
We act similarly if a platoon of soldiers is wounded in battle with some soldiers severely wounded, others moderately wounded, and others lightly wounded. The available medical resources should be concentrated on the moderately wounded.
The lightly wounded will hopefully survive until more help or equipment arrives. Meanwhile, none, or only a few, of the most severely wounded will be saved if they are treated first while many others who could be saved [among the moderately wounded] will be lost.
What about the miracle cure and vaccine we are all waiting for? When they are discovered, it will take time before they are available to everyone. Who should get it first?
There are differing opinions. One is whoever is first in line. Another is the order established by our Sages in tractate Horayot: kohanim, leviim, talmidei chachamim – but this opinion is not followed in our time. Another opinion is via a lottery.
My opinion is that the distribution must be according to a person’s value to the public. So when the first shipment of vaccinations arrive, precedence should go to the medical force, the heads of the government, army, the departments of health and economy, electric workers, bakery workers, water-system employees, etc.
Included in the list must also be people who are important in maintaining the public’s spiritual and emotional strength in dealing with the crisis, to avoid the weakening factors of depression and despair, such as rabbis. There is also room for people who keep others happy, such as popular singers and comedians.
When Israel, America, or any other country, produces the first cure, who gets the first batch?
The citizens of the country where the medicine is produced.
In a world-threatening epidemic, if the government of America faces the choice of directing its financial resources into saving a crashing national and global economy or saving as many lives as it can, where should the money be spent?
Saving the economy – even at the immediate expense of great loss of life – because this will allow for saving more lives in the long run. The economy of a country like America, which influences the overall stable economy of the world, must be safeguarded to prevent global economic collapse and further disaster – even if many may perish in the process.
Needless to say, the topic is fraught with significance, and impossible to explain in an interview. That is why halachic experts must sit with any panel formed to decide such a world-impacting question.