I have a close relative who is very seriously ill. The doctors say that there is a new but very expensive drug that almost certainly will save his life. The problem is that my relative can’t afford the drug-at least not now. I can afford it but it will be a very great expense. Must I buy the drug for him? When he recovers Be’ezras Hashem, will he have to pay me back-to the best of his ability or can he tell me then that it was my mitzvah and he isn’t obligated to reimburse me?
The first issue that requires clarification is what is your responsibility, in general, when you are needed in order to save someone else’s life. The Gemara in Sanhedrin (73A) writes, “What is the source that one who sees someone drowning etc. must save him? The pasuk, lo sa’amod al dam rei’echo.” The Gemara says that the only reason we require this pasuk is in order to teach us that one must even hire someone in order to save someone else’s life. Thus, it is clear that one must spend money in order to save another person’s life, and one who does not do so violates a Torah prohibition.
The next issue is whether the one whose life was saved must reimburse the one who spent money on his behalf, or do we say that the one who saved him incurred a mitzvah expense for which one does not receive reimbursement, like any other mitzvah expense.
The Rishonim address this issue.
The Rosh (Sanhedrin 8, 2) proves, “One does not need to bear the expense involved in saving someone else’s life if the one whose life is being saved can afford the expense. Therefore, the one whose life was saved must reimburse his savior for his expenses.” Similarly, the Ramah (an early Rishon) deduces from the Gemara that one is only required to expend his personal efforts in order to save someone else’s life, but one does not have to give up his money for it, so that the one whose life was saved must reimburse his savior. This is also the ruling of the Mahari Ben Lev (3, 11).
While there are Rishonim (e.g. Ritva Kiddushin 8B) who do not obligate the one who was saved to reimburse the one who saved him, nevertheless, the Tur (Choshen Mishpot 426) follows the Rosh’s ruling and writes: “If the one who was saved has the funds, he must reimburse the one who saved his life.” The Ramo (Yoreh Deah 252, 12) rules this way in the case of one who was taken captive. The Shach (Choshen Mishpot 426, 1) writes that this applies to every case when one spent money to save someone else’s life. Therefore, if the one being saved has the funds, he must reimburse you.
In case your relative does not have the funds at the present time, there is another dispute if he will be obligated to pay you in the future, if and when he has the funds. The issue is that generally when one borrows money or in some other way incurs a monetary obligation, the obligation remains in place until it is paid. The fact that one does not have funds at a particular time does not remove an obligation and even declaring legal bankruptcy does not remove one’s debts.
However, in the case of saving one’s life, the Rosh and Tur, as we mentioned earlier, write that the obligation of the one who is being saved to pay, applies only if he has the funds. If he does not have the funds, the one being saved never became obligated to pay for his being saved. While there are opinions that the one being saved will have to pay even if he has the funds only later, the Ramo (ibid) follows the opinions of the Rosh and Tur and the Mahari Weill (siman 149) that the liability of the one who was saved is limited to the money he has at the time he was saved. The Machane Efraim (Avodim 3) and Rav Wosner (5, 137) rule this way as well. He will certainly have to pay as much as he has now, in any case.
Having established that you have to: 1] Spend money in order to purchase of the drug, and 2] that your sick relative’s liability to reimburse you is capped at the amount of money he has now, we must address the issue if your other relatives must participate in the cost of purchasing the drug or can they argue that you are the only one who can afford the drug and, therefore, the obligation is yours alone.
In the case of saving someone from captivity, the Shulchan Aruch (252, 12) rules that it is a joint responsibility of all the relatives with the responsibility resting more on those who are closer relatives. Therefore, you are not the only one who is responsible and you can ask the other relatives to share in the cost if they can.
Finally, there is an issue how much one must spend in order to save another person’s life. The general rule (Orach Chaim 656) is that in the case of a positive command one’s responsibility is capped at one fifth of what he owns but for a negative command one must spend all that he owns (Yoreh Deah 157, 1), if necessary, in order to avoid violating the negative command. As we mentioned at the outset, one who stands idly by when he can save someone violates a negative command. Therefore, it might seem that you need to spend all the money you have in order to prevent your relative’s death.
However, there are Poskim (see Chasam Sofer, notes to Orach Chaim 656) who maintain that the critical feature is not whether the command is positive or negative but rather the manner in which a person violates the command. One must forfeit all his money rather than act in a way that violates the law. However, one only needs to spend up to a fifth of his money to do something to actively fulfill the law. According to this view, since the way in which one violates the negative injunction against standing idly by is by inaction, perhaps one does not need to spend all his money to avoid violating the negative injunction.
However, it is possible that since we are dealing with someone’s life, there is no limit on the amount which you need to spend in order to save a life. This approach is supported by the language used by Rashi to explain the above-cited Gemara: “Do anything you can to prevent your fellow man’s death.” This is the ruling of the Marcheshes (1, 43).
The Tzitz Eliezer (19, 2) disagreed and ruled that one may rely on the opinions that one is not required to spend all his money in order to save another person’s life. However, one who does so will certainly not violate any prohibition.
The question the Tzitz Eliezer was asked, concerned a religious doctor who worked in a hospital (in the U.S.) where the medical team had decided that since the patient was old they should let him die. The religious doctor was in a position where he could save the patient’s life, but he feared that if he would save the patient’s life, he would be fired. He ruled that the religious doctor does not have to endanger his livelihood in order to prevent the patient’s death.
These questions are very weighty and a leading poseik should be consulted.