The purpose of this article is to discuss patient autonomy and the right to refuse treatment through the eyes of Jewish law (halachah). Refusing resuscitative attempts, and withdrawing care when terminal illness is involved, is a more specific discussion that will be dealt with separately.

In secular bioethics, it is accepted that an individual possesses personal autonomy, which can be defined as “self-rule that is free from both controlling interference by others, and from limitations such as inadequate understanding that prevent meaningful choice.”1 This means patients retain complete control over their own bodies and can make decisions as they see fit—including refusing life-saving treatment—as long as they understand the ramifications. Understandably, determining whether a patient does indeed have the capacity to refuse treatment is a complex matter which has spurred much discussion in the medical literature.2

How does halachah view these matters?

Consider the following scenario: A 50-year-old man suffers from multiple complications of diabetes. He is already blind and has had one of his legs amputated. He is now hospitalized with an infection of the remaining leg, and the doctors unanimously agree that if he does not have the remaining leg amputated he will die. The patient adamantly refuses, preferring to die. Would halachah sanction his request? This dilemma was posed to Rabbi Shlomo Zalman Auerbach, one of the leading halachic authorities of the 20th century. Towards the end of this article, after elucidating several principles, we will circle back to his answer.


It is an established principle in Jewish thought that our bodies do not belong to us3 (see detailed discussion on this matter in our article about suicide). Not only is a physician obligated to heal,4 but the patient is obligated to seek healing,5 to the extent that refusing life-saving treatment has been morally equated with suicide.6

It follows that halachah does not actually acknowledge personal autonomy in the contemporary sense. But does this mean a patient may never refuse treatment? Are there times it could be allowed?

Refusing Treatment

One of the earliest examples of halachah addressing this issue is the question posed to the Radvaz7 in the 16th-century, involving a patient who—in a misguided act of piety— refused to desecrate Shabbat to procure life-saving treatment.8 In a strongly worded response, the Radvaz condemned the behavior as the opposite of piety, and ruled that the person must be forced to accept the treatment by any means available, even pouring it down his throat if so needed.9 It is likewise written in the Code of Jewish Law (Shulchan Aruch) that if doctors disagree as to whether Shabbat must be desecrated to save a patient’s life, we err on the side of desecrating the Shabbat.10 In the event that the patient refuses, halacha mandates that he be forced to accept the treatment against his will.11

One can argue that the patient’s refusal to accept treatment in these scenarios arises from a misguided sense of piety, and perhaps that is why halachah is so insistent that he accept treatment. But would we be equally insistent if the patient’s refusal arose from a more reasonable consideration?

Rabbi Yaakov Emden, a renowned 18th-century sage known as the Yaavetz, qualifies the Shulchan Aruch’s ruling, explaining that it only applies to situations where the treatment was unequivocally mandated and the patient was acting out of misguided piety. If the patient has real misgivings as to the efficacy of the treatment (even if unfounded), then he or she cannot be forced to accept the treatment.12

The Yaavetz concludes by reiterating, in very strong terms, that if there is indeed no doubt that the treatment works, “ ... we force him against his will, in order to save a life .... We even amputate a full limb if need be … against his will … the opinion of the patient is not considered relevant, as he is not permitted to take his own life … ”

As we shall see, this strongly worded opinion is mitigated to an extent by some of the more contemporary halachic experts.

Role of the Jewish Healer

We understand that the patient is halachically mandated to not refuse treatment. If, however, the patient does nevertheless refuse treatment, why do we not allow him to exercise his free will? The halachic wording we’ve encountered thus far implies that the healers are obligated to override his refusal and treat him against his will. What halachic principles are operative here?

Of course, the simplest answer is that there is the obligation of the healer to heal, and not to “stand idly by your brother’s blood.”13 An additional principle, which may be invoked here as well, is the concept of arvut (lit. “guarantorship”) which states that every Jew is responsible for his or her fellow Jew. If one has the ability to influence a friend’s actions and does not, then they bear some of the responsibility for that friend’s actions.14 Perhaps it can be said, then, that in addition to the fundamental obligation on the healer to heal, there is an obligation to intervene when a patient refuses to seek healing.

Another issue from the perspective of the healer is the legality of overriding a patient’s refusal of treatment in a scenario where the prevailing bioethical, and therefore legal, consensus is that the patient’s request ought to be honored. Should the healer risk their career, economic stability, and possibly their freedom? In our article addressing the limits of patient confidentiality, we address these concerns, and discuss the various opinions that suggest that halacha does not expect that degree of sacrifice; see here for further discussion.

Mitigating Factors in Refusal of Treatment

Rabbi Moshe Feinstein, one of the foremost halachic arbiters of the 20th century, takes a nuanced approach. If the patient refuses treatment because he does not trust his doctors and their recommendations, he cannot be forced to accept the treatment unless every attempt to find a doctor whom the patient trusts has failed, and every available doctor in the vicinity unanimously agrees that the treatment is indicated. If however, the patient’s refusal is borne from their not considering the long-term implications of their refusal, then indeed the patient can be forced to accept the treatment.15 (This appears to be analogous to the assessment of whether the patient has the capacity to refuse treatment.)

What about the presumed psychological toll upon patients forced to accept treatment they do not want? Indeed, Rabbi Feinstein writes that a patient should never be forced to accept treatment if we suspect that the psychological effect of such coercion would produce more harm than good.

Moreover, Rabbi Feinstein explains that even in scenarios where the patient can be forced, that simply means we apply significant pressure and attempt to strongarm the patient into accepting the treatment in whatever way we can. However, “to literally force someone against their will, to hold them down and force something down their throat - a competent adult cannot be treated in such a manner.”16

Quality of Life Considerations

Let’s return to the scenario mentioned at the beginning of this article where the patient is forced to choose between having his remaining leg amputated or almost certain death. There are several critical factors we have not yet discussed. The proposed surgery will not cure his underlying condition and will not improve the quality of his life as it was until now. On the contrary, it will condemn him to a life as a double amputee! And his underlying diabetes, with all the risks it poses, will remain a continuing source of morbidity. This is in addition to the fact that the amputation itself carries significant risks!

Rabbi Shlomo Zalman Auerbach rules that in light of these considerations the patient should not be forced to undergo the procedure against his will, and we should not attempt to persuade the patient to change his mind.17 He qualifies this by saying that more basic necessities such a food and oxygen must still be provided to the patient, even against his will. (The discussion of withdrawing basic life necessities from someone who is terminally ill is a related but distinct discussion which will be dealt with in a separate article.)


We’ve seen that the halachic value system does not acknowledge personal autonomy in the modern sense. In theory, therefore, a patient may not refuse treatment, and treatment may even be forced upon him against his will. At the same time, we’ve seen that there are certain scenarios where we need not force the patient to accept treatment, such as if the patient has legitimate misgivings about the efficacy of the therapy; if there is concern that forcing treatment will cause more harm than good; and if the patient is fearful of the risks of a procedure and the inevitable quality of life decline that will follow.

As always in situations involving bioethics and halachah, every situation is distinct, and for practical application a competent rabbi who is an expert in the related branches of halachah and medicine should be consulted. May we speedily merit a time where the Healer of all flesh, the Almighty G‑d, heals us from our captivity of exile.