The title of this book sprang forth from a discussion I had been having in a radio interview. The subject was Jewish medical ethics, and, after exploring many of its issues, the interviewer was now ready to conclude the dialogue. He said, “Oh I see what you’re saying. You’re saying, ‘Where there’s life, there’s hope.’” “No, no,” I protested. “I’m not saying anything as unoriginal as that. I’m saying ‘Where there’s life, there’s life. It’s precious in and of itself.’” Life is not only precious because there’s hope that the disease is curable. Regardless of apparent medical “futility,” life is precious because every moment of life has infinite value and intrinsic sanctity, even with no outlook for later, and even in diminished quality.
Such an attitude is profoundly different from one which measures life in terms of its promise or its relative quality, certainly from measuring it in terms of its level of productivity. It’s an attitude based on religious principles, but supported strongly by purely secular ones. Life is a gift, as irreplaceable as it is singular and unique. Just as we cannot deprive another human of his or her inalienable life, neither can we do the same to our own life. We cannot surrender it, abuse it, or curtail it. To so regard life as sacred and precious is our best protection against allowing deterioration of the spirit, and our best antidote to the callousness of those who hold life cheap and expendable.
An important motif in the chapters of this book militates against the notion, for instance, that becoming a burden to others must be avoided. The sanctity and inalienability of life also mean that we need not apologize for being alive, that we need not see our own continued existence as a burden to family, to society, to caretakers. Even if we haven’t “paid our dues” by caring for others we have not forfeited the right to be a burden. Our own right to life is intrinsic to our humanness, is non-negotiable, and needs no further justification.
Some of the theology and the halakhic directives embodying this view are set forth in the following pages. The presentation here highlights the mechanism of a majestic and pervasive teaching, that of pikkuach nefesh. According to this principle, virtually all other mitzvot and prohibitions of the Torah are to be set aside if, by doing so, a person can be saved from a threat to life or health. This is an eloquent, and underappreciated, doctrine of the preciousness of life embedded in Jewish law and practice.
“The greatest mitzvah is the saving of life,” declared R. Shimon ben Tzadok. He lived in fifteenth-century Spain, but he was making explicit what was implicit in the legal rulings of the rabbis in all the centuries and places before and after him. The attitude expressed itself consistently in the prescriptive and descriptive assessments of the Torah’s mandate. The attitude elicited disdain—the anti-Semitic philosopher Schopenhauer was said to have based his hatred of the Jews on their indomitable pro-life outlook. And it inspired confidence—in Jewish physicians that they would struggle mightily to heal. R. David Bleich relays a conversation he had with the late R. Yosef Henkin, when the latter had become blind and frail, life having clearly become a burden to him. “How far is one obligated to go in order to prolong life?” the younger rabbi asked him in the form of a halakhic query. Without the slightest hesitation, he answered, “So long as it is possible for a Jew to live, he ought to want to live.”
I hesitate to make mention here of the boast of some sponsors of suicide bombing for political reasons, namely that “we love death and you [Israel and the West] love life, so we will vanquish you.” The boast is uttered by fringe extremists and is surely not representative, even if it does give us pause. Phrases such as “culture of life” vs. “culture of death” have been seen in many a context in recent days. Most ominous is a phrase like “life unworthy of life,” cited by Dr. Paul McHugh of Johns Hopkins University, as the title of a book coming from Germany in 1920. Dr. McHugh laments the culture of death in that awful title and the horrendous public proportions it reached, but his concern is for now—that something like it might weaken the otherwise high resolve of medical caretakers to save life for its own sake.
If saying “where there’s life there’s hope” sounds “unoriginal,” that does not at all detract from its essential truth. More to the point, where there’s hope there’s life. We ought not to shorten life because we see no hope, and the presence of hope actually adds life. It enhances life when it doesn’t lengthen it, by sparing us the depression of forlornness, and it lengthens it medically by the same means. Even when hope ultimately disappoints, it has nurtured and elevated our lives for the duration. Often enough, hope does more: It advances therapeutic progress by its benign effect. This fact, too, is reflected in the details of the halakhic and philosophic motifs of the presentation herein. The power and potential of the pikkuach nefesh provisions come from both the affirmation of life and the exaltation of hope.
Hope’s healing power in situations of ordinary stress, and in those of medical crisis, has been effectively set forth in recent books. The Power of Hope by Rabbi Maurice Lamm calls hope “the essential ingredient in life and love” and demonstrates its positive and beneficent effect. Dr. Jerome Groopman, in The Anatomy of Hope, celebrates the role of hope at life’s critical junctures. The book keeps clear of fostering false hope, but encourages realistic hope that carries us through to the good outcome.
That life itself has infinite value is true in the technical legal sense, as we hear in the text of the Minchat Chinnukh, the commentary to a fundamental exposition of biblical precepts. That source declares: ”Even if the Prophet Elijah himself were to tell us that a given individual has only a few minutes to live, the Torah does not differentiate between one who kills a child who otherwise might live for many years, and one who kills a 100-year-old person with only a limited life expectancy. Even if the victim were about to die anyway, the act is the same one of homicide because life has been destroyed, if only by a second.”
The thesis of this book is the positive side of that coin, that life itself has infinite value, unrelated to any consideration of circumstances or of outcome. This theological affirmation is expressed in the legal provisions of Jewish law and practice, in a manner both impressive and unequivocal. Its message is that life is a precious gift even without hope for future relief or future survival, and that the presence of hope is a healing companion.
I am proud of the salutation “l’chayyim,” expressing the Jewish affirmation of life and inspiration to live, and confidently urge it on those who must make difficult decisions. Some thinkers disdain the approach, at least in its extremes, as mere “vitalism,” a kind of mindless respect for any human life, even of little or no quality. The point of “l’chayyim” is a more profound sanctification of life. It issues from an abhorrence of causing a death, or of callous cheapening of life’s value and, before that, it issues from awesome reverence for the image of God within us. It issues from a loyalty to faith in the transcendence of life over all that life presents, good and bad.
We are bidden “uvacharta ba-chayyim, you shall choose life.” Our basic supplication at High Holy Day time is “zokhreinu l’chayyim, remember us unto life,” a prayer which we direct to the Author of life, Who is “chafetz ba-chayyim,” the God Who endorses life, in spite of enormous challenges to the very idea. And if one is tempted to claim that these sentiments refer on some level to eternal life, to life in the next world, it is good to consider the standard expression of gratitude for life here and now and all by itself. Our inspiring culture of life thanks God “she-hecheyanu v’kiyy’manu v’higgiyanu la-z’man ha-zeh, Who hast kept us in life, sustained us, and brought us to this time.” That’s enough to ask for.
Where there’s life there’s hope, and where there’s hope there’s life, and where there’s nothing but life there’s life, which is everything.
