Vaccination
Vaccination iStock

I hate the use of the word "jab", instead of "vaccine", when referring to the Corona vaccine. The word "jab" sounds so negative, as if damage is being done to the one "jabbed". With so many people unwilling to get this life-saving vaccine, to refer to it as a jab is a major error in public relations. Yet many news outlets, to save space, refer to the Corona vaccine as "The Jab"- instead of shortening the word to "vax".

In this case, however, thanks to the Rabbinic luminary known as the Chazon Ish, the term jab is highly appropriate.

My thesis is that it is permissible (מותר) for the Israeli government to use coercion to give the Corona vaccine to those who've refused vaccination. I am not a Posek, a decider of Jewish law (Halakhah)- but I herein present what seems to me to be clear evidence that coercion to vaccinate is permissible in Judaism:

I'm presenting here only chapter headings, not detailed expositions of the Halakhah; this will be a sort of "Halakhah For Dummies" (I intend no disrespect to the reader; yet if Hungry Minds, Inc. can publish volumes for novices with titles like "Gardening for Dummies", or "Photography for Dummies", then I guess a treatise about the approach to anti-vaxxers can appropriately be so labeled).

The approach of Halakhah to medicine is based on several verses in the Torah.

Classically, this starts with Exodus 21;19 : "v'rapo yerapeh"- one who inflicts damage is responsible for the injured party's medical care. On this verse, the Talmud says:"From here we see that permission(רשות, reshut) is given to a physician to treat the sick" (Tractate Baba Kamma, 85a).

The issue gets a bit complicated due to other verses which indicate that healing the sick is not a matter of permission, but that Jews have an actual obligation to treat the sick: "Vahasheivota lo" (Devarim, 22;2)- You shall return a lost object to your friend. The Talmud broadens this, to include returning a person's lost health to one who is sick. However, this is a command; and leads to the question:

Does the doctor merely have permission to heal the sick, or is he under an OBLIGATION to treat?

The answer is that "reshut" does not really mean permission, and is not to be understood in the sense of a discretionary act, as in a "driver's permit". Reshut is to be understood in Halakha the way the Rambam uses the word in his Hilchot Teshuvah, in the openings of Chapters Five and Seven (see Rav Matis Weinberg's Treatise on Hilchot Teshuvah):

Man has been given a space in which to operate. In that space, his decisions to act carry weight, in that the Almighty will not interfere with those acts. Reshut thus is used in terms like " reshut hayachid"- a private domain- in which a man can act and his action will make changes in that domain. Similarly in medicine: it's not like a Christian Scientist may think, that a doctor gives penicillin, but the medicine really is a bluff, a smokescreen doing nothing, since it's the Lord who healed the patient of his pneumonia- No! The physician has his reshut, his domain, in which his decisions and acts have efficacy.

Thus, there really is an obligation for one Jew to heal another.

Other verses, as understood in Halakhah, directly contradict Western philosophy and "morals" in that human beings are not viewed as the "proprietary owners of their physical bodies"(Radvaz) .This explains why the Talmud says "that a person is not allowed to injure himself"(Tractate Baba Kamma, 91b). Therefore, in Halakhah, if a Jew is trying to throw himself off of a roof to commit suicide, every Jew has the obligation to stop him, even by physically restraining the would-be suicide.

Not so, of course, in Israeli law, where the individual is supreme lord over his/her body, and restraining a would-be suicide constitutes assault (instead, call the police, and if in the meantime he jumps- well, too bad). In Halakhah, ונשמרתם מאוד לנפשותיכם (Devarim 4; verses 15 and 9)- V'nishmartem, take care of yourselves – are understood as a command to safeguard oneself from physical danger(source: the Levush).

This leads to the following Halakhah in the Code of Jewish Law, the Shulchan Aruch: " We violate the Sabbath (and do forbidden work) to save someone from any illness that a doctor says is a threat to the patient's life" (Orach Chaim, 328, paragraph 10). On this, the commentator Magen Avraham says that if the patient refuses to take the treatment, we force him.

Rabbi Yitzchak Zilberstein (Shiurei Torah L'Rofim, volume 3, pages 215 and 243) expands on this, based on Rabbi Yaakov Emden's Mor Uktziah:

The most clear-cut case of the coercion is if the patient says that he refuses the Sabbath-violating treatment BECAUSE it's a violation of the Sabbath prohibition of work. Since that puts him in direct opposition to V'nishmartem and Vahasheivota lo, the patient has a status of a Rebel (moreid) against the Torah- and we can force him. Even when a patient refuses a clearly efficacious treatment of a life-threatening condition, one may use force to treat in most cases (exceptions exist, such as a terminal patient with intractable pain, not responding to the strongest analgesics).

Yet there are limits on V'nishmartem- and they begin in cases when the treatment isn't efficacious in the overwhelming number of cases, and/or the treatment has known side-effects- then the patient cannot be forced, IF HE HAS RELIABLE OPINION ON WHICH HE RELIES.

Even more difficulty in coercion comes about when the illness is not life-threatening; vahasheivota and v'nishmartem have their limits, and again, a patient may not be forced.

The most troubling case of all: when the "patient" is not even sick.

This is what we are facing in this Covid-19 pandemic, and the question of whether people can, per Halakhah, be coerced to vaccinate (with restrictions on work, on leaving home, etc.- Israeli law prohibits physical coercion that the Halakhah allows Beit Din and its agents).

The facts are these: the Pfizer and Moderna vaccines have been 90% effective in preventing any Covid-19 disease in vaccinees (Thompson, New England Journal of Medicine, vol.385, p.320; Bernal, NEJM, vol. 385; 585; Bar-On, NEJM, Sep. 15,2021); these studies cover more than a million vaxxed people. Serious disease in those vaxxed was 5% of those unvaccinated. Serious side effects didn't occur in those vaxxed except for the rare case of myocarditis (heart inflammation) Even that was less than three cases per 100,000 persons vaxxed- as compared to those infected with Covid-19 disease, in whom the rate of myocarditis was much higher, 11 cases per 100,000.

More importantly, the vaccine stopped the 3rd Covid surge (Jan. 24 – March 15), in which 1,500 Israelis died, and the 4th surge (Aug.1-Oct. 15), which killed another 1,500. During both surges, hospitals were filled to over-capacity, and the Health system was severely strained. The 4th surge was unique, in that 90% of the hospitalized were unvaccinated patients; hospitals were filled, with no available ECMO machines for more patients, and no more ICU beds.

It is indisputable that people with Covid died on the regular hospital floors because of the lack of ICU beds and personnel. All hospital physicians and nurses were working like dogs, longer hours, in sweaty space-suits, to treat sick people- 90% of whom would not have been in hospitals if they'd had the vaccinations. There would have been no strain on the health delivery system if, instead of Israel having nearly 1,000 ventilated patients at the height of the 4th surge , the populace had been maximally vaxxed and there had been only 100 persons on ventilators.

That leads us to the "Jab". There has been a classic problem that university ethicists have entertained for several decades: a railroad train in barreling down the track out of control, and will run into and kill ten people. We can pull a lever changing the track, diverting the train to a different track, where it will kill only one person. Is one allowed to pull that lever, and kill that poor innocent guy who is in no danger, unless we divert the train into him?

The Chazon Ish (quoted by Rav Zilberstein, ibid., p60) preempted those professors by decades. He entertained the following question: an arrow has been shot, and it will kill several people- but I can divert the arrow from its path, saving those people, but it will kill one fellow who is out of the original path of the arrow. The Chazon Ish answered that the act of diverting the arrow is an act of saving, not related at all to the death of the one guy now to be "jabbed" by the diverted arrow. Rav Zilberstein finishes that there is definitely a basis to say that one may even actively kill that one victim in order to save the many, in order to limit the loss of life as much as possible.

Thus, if one may kill one to save the many, it seems to me incontrovertible that one may force a nonfatal "jab" on our unvaccinated populace to prevent another possible collapse of the Israeli health system, as occurred in the 3rd and especially 4th surges. Rav Zilberstein has other proofs, as well, that coercion of treatment in a public health issue is allowed[1]

In short, Israel is at a crossroads now: we may be on the verge of a 5th surge of Covid-19 disease- or this Omicron variant virus might be the end of the pandemic. This is the Holy Land, and the critical difference will not be medical, but rather our behavior to each other, and prayer to the Almighty for an end to the most menacing epidemic in the last 100 years. Responsible behavior to each other includes vaxxing of the unvaxxinated population, in my opinion by coercion, if necessary.

Footnote:

[1] Most prominently: ibid., pp 215 and 218; the Tosefta compares the coercion of individuals to pay the communal shekalim for the communal sacrifices, to the medical case of coercion- and not to the Jewish court's permit to coerce a husband to grant a divorce. I believe the comparison is to the medical case of coercion because it also includes public health cases of coercion, a communal issue; divorce, on the other hand, is a purely private issue.

Rabbi Dr. Aryeh Hirsch is a physician residing in Beit El who works at Hadassah Hospital. He recently completed Rabbinical ordination of the Chief Rabbinate of Israel through an adult study program at Yeshivat Merkaz Harav.