The coronavirus pandemic has given rise to some of the most complex and significant medical-ethics dilemmas in recent history, namely the question of triaging ICU care and, by extension, deciding who shall live and who shall die. As society begins to contemplate how to readjust to the new normal and eventually lifts isolation measures, new and similarly challenging ethical questions will arise.
One such question that has not yet received much discussion, but which I believe requires our community’s attention, revolves around the rush to develop a vaccine. While it could take well over a year before a vaccine is available, the associated ethical issues will likely arrive much sooner.
One reason developing a vaccine takes so long is that researchers have to randomize test subjects into two groups. Group A gets the vaccine; group B gets a placebo. Researchers wait to see if more people from group B get sick than those in group A. If that happens, it is a sign that the vaccine is effective. However, it can take months before researchers get their answer because, in its simplest form, this kind of study depends on waiting for people to be naturally exposed to the virus—which takes even longer with social distancing measures in place.
To speed up things, an alternative is something called a “challenge study.” In a challenge study, just like the traditional study above, some people are given an experimental vaccine and some are not—but unlike with the traditional approach, everyone in a challenge study is deliberately exposed to the contagion. Researchers then compare the two groups: the vaccine versus the control. Running a study in this manner could save months, and thousands if not millions of lives. However, deliberately exposing people to the coronavirus involves risk: some may get very sick, and some may die.
How do Jewish law and values guide us in this? When it comes to taking risks in general, Judaism obligates us to attempt to help those in need, such as for instance jumping into a river to save a drowning person. But the degree of risk one is required (or permitted) to take to save life is a matter of debate.
The general consensus is that although one is not obligated to put his or her life at risk to save another person, it is praiseworthy to do so—unless there is a significant risk, in which case doing so may be forbidden. The rabbis encourage us to make a cost-benefit analysis of the level of risk versus the potential good. For example, kidney donation, which carries some risk, is encouraged but not required, whereas bone-marrow donation, which carries negligible risk, may be viewed as obligatory when performed to save a life.
For that reason, I believe once plasma donations from those who have recovered from the coronavirus are shown to be safe and effective in treating current coronavirus patients, it can be seen as an expectation of Jewish law that those who have recovered must make such blood donations if they are able to.
In Jewish law, hatzalat harabim, or “saving the many,” is given more weight than saving the individual when it comes to risk. For example, in the Purim story recounted in the book of Esther, Queen Esther was permitted to risk her life by approaching Ahasuerus since it was to save the entire community.
Similarly, the Talmud relates that in the city of Lod, the Roman emperor’s daughter was murdered and the Jewish community was blamed. The emperor threatened the Jews with mass execution unless they could produce the murderer. To save the Jewish people, two innocent brothers, Lilianus and Pappus, stepped forward and falsely confessed to the crime. Only they were executed by the Romans, sparing the rest of the Jewish community. Many rabbinic authorities have permitted voluntary self-sacrifice to rescue the broader community, based on Esther and the Talmudic praise for these righteous brothers.
On the other hand, other rabbinic authorities argued that although saving the community is a very high value and some level of risk is acceptable to this end, these stories do not prove that one who is not currently in any danger may opt to risk his or her life for the sake of the community, since the brothers in Lod, and Esther, would have died along with their community anyway.
This brings us back to the “challenge study.”
I believe that the lesson here is that it certainly would be permitted for a Jew to serve as a participant in a challenge study associated with rapidly developing a vaccine for coronavirus, and indeed, would be a very pious act. This even according to the stricter opinion, since the level of risk for those in such a study is relatively low—only young, healthy people would be accepted, and would receive careful medical oversight—and because everyone in the world is at risk for contracting the coronavirus; the participants were already at some risk just by living in society.
Participating in the study simply transfers the risk to a controlled setting, while at the same time potentially significantly benefiting all of society, and thus is a mitzvah.
The Jewish community should endorse such protocols, and if a Jew has the opportunity to enter such a study, he or she should enthusiastically do so.
Rabbi Jason Weiner is senior rabbi and director of spiritual care at Cedars-Sinai Medical Center.
This article was first published in the Jewish Journal.