Mind Matters: Is Mental Illness Pikuach Nefesh?

Adapted from the writings of Dayan Yitzhak Grossman

May 21, 2026

In our previous article, we cited several sources that permitted abortion to women whose pregnancies resulted from rape during the attacks of Simchas Torah 5784, on various grounds. One provocative basis for leniency is advanced by R’ Zvi Ryzman: Allowing such a pregnancy to continue may endanger the mother’s mental health and ultimately even cause her to commit suicide.

As Rav Ryzman notes, some poskim consider at least certain types of mental illness to constitute sakanas nefashos (lethal danger). As the Pri Ha’aretz (R’ Yisrael Meir Mizrachi, 18^th-cent. Yerushalmi posek) explains: “Because he lacks understanding (da’as), he may endanger himself by throwing himself into an endless body of water (mayim she’ein lahem sof) or kill himself.”[1] His brother the Admas Kodesh (R’ Nissim Chaim Moshe Mizrachi) espouses the same view and elaborates upon the concern:

Even if he is not in danger of dying of natural causes (al yedei Shamayim), he is nevertheless in danger, because he has the power to kill himself, and people are therefore careful not to leave with him any destructive implements, even a small needle, and they also place his hands and feet in iron chains so that he will not choke himself with his hands or throw himself from heights. It was not long ago that such a thing happened to a postpartum woman whose her relatives did not watch over her as necessary, and she…cast herself into a pit…and she lived. But it happened to another woman and she died in the pit, and this was caused by derangement and confusion of the mind, Rachmana litzlan.[2]

Rav Ryzman further notes that some recent authorities have invoked a concern for maternal suicide as a justification for abortion. R’ Moshe Sternbuch discusses girls that became pregnant out of wedlock and threatened to kill themselves if they could not abort. He rules that at least in principle, the imperative of forestalling maternal suicide does justify abortion—as does any other danger to the mother’s life—so if it can be established that her mental health is seriously endangered, abortion would be permitted. But he is generally inclined to dismiss threats to commit suicide as unserious and is unwilling to automatically accept the assessments of mental health professionals, which he considers to often be mere speculation. He concludes that “it is impossible to establish a general principle; in each case the decision must be given over to a rav muvhak.”[3]

R’ Yitzchok Zilberstein, too, takes for granted that abortion is permitted when necessary to prevent maternal suicide, with the crucial proviso that the mother is mentally ill:

Indeed, if this girl would be in the category of shoteh (mentally unfit) and lacking da’as, it would certainly be permitted to perform the abortion to save her life, for just as a non-Jew threatening to kill her would be considered pikuach nefesh, so is the suicide threat of the shoteh herself—for they are both oness (circumstances beyond one’s control).

He proceeds to qualify, however, that a threat of suicide by someone who is otherwise lucid and rational is not sufficient grounds to classify her as a shoteh, and he argues that if she is not a shoteh, abortion would be prohibited, as discussed below.[4]

The Sheivet Halevi (R’ Shmuel Wosner) discusses the case of a pregnant woman whose fetus was diagnosed via ultrasound as suffering from multiple fatal heart defects, and the physician opined that the woman’s knowledge of its fate posed a threat to her mental health. Rav Wosner seems to implicitly concede that in principle, this danger to her mental health would justify abortion. (He does not even mention a concern for suicide, and he seems to take for granted that mental illness is inherently life threatening, as per the Mizrachi brothers.) But like Rav Sternbuch, he argues that in his experience, physicians sometimes “greatly exaggerate” the possibility of danger,

and a fortiori in the case before us, where the physician says only that the primary danger is the mental health of the mother who knows that in her womb is a baby with a defect that cannot live. And if we would chas veshalom permit abortion for this reason—lest it cause shock to the mother and a concern for her nerves—we would be extending a hand to sinners to be lenient in the murder of fetuses, because there is absolutely no basis (raglayim ladavar) to consider the situation now a safek pikuach nefesh. And it is a mitzvah to calm her spirit and her depression. Indeed, even in circumstances as grave as this one and more so, there is room for consideration, but in our case all the above seems obvious…[5]

Beyond the context of abortion, we find several cases in which poskim were unwilling to allow the violation of isurim to prevent suicide. R’ Dovid Zvi Hoffmann was asked in his Melamed Leho’il:

A young man was told by his father to write in business school on the holy Shabbos, and he is unwilling to do so. His mother told him that if he does not listen to his father and there is a quarrel in the home, she will commit suicide, R”l. Should he listen to his father because of his mother’s pikuach nefesh?

He replied:

It is not pikuach nefesh for which Shabbos is desecrated if his mother wishes to deliberately (bezadon) commit suicide in order to turn her son against the Torah, for if that were so, all inciters (to sin) would exaggerate and say that they will throw themselves into the sea if their incitement is not heeded…And even if he will write with his left hand, which is certainly a deRabanan, we can nevertheless not permit it…[6]

R’ Shlomo Zafrani rules similarly regarding a businessman who experienced financial collapse and owed enormous sums to creditors. He told his sister, a senior official at a bank, that his life was not worth living and he would kill himself unless she embezzled from the bank to cover his debts. His sister could not bear his distress and believed he would kill himself, so she stole the money. Rav Zafrani rules: “This action is considered absolute theft despite having been performed for the benefit of the brother who was threatening suicide, and there is no dispensation whatsoever to commit a sin on behalf of a sinner threatening suicide.”[7]

Indeed, Rav Zilberstein himself, in discussing the woman who threatened to commit suicide if her fetus was not aborted, rules that we may not violate a prohibition to prevent the suicide of a non-shoteh. He invokes this doctrine elsewhere to forbid acceding to the demands of young men that a physician mutilate them in a “sex change” operation (which would violate the prohibition against sirus (sterilization) and facilitate their future violation of other serious prohibitions), despite their threats to commit suicide if the surgery was not performed.[8] Rav Zilberstein cites the Melamed Leho’il and other precedents to prove that we may not violate an issur to save someone from willfully killing himself. He explains that the standard rule that danger to life overrides almost all prohibitions in the Torah does not apply here for a couple of reasons, including the principle that the imperative to help someone in need applies only if he cannot help himself; if he can but refuses to do so, there is no obligation to help him, even if this will result in his death.

It should be noted that these psakim of Rav Hoffmann, Rav Zafrani, and Rav Zilberstein are not based on doubts about the seriousness of the suicide threats; they simply assert that an individual’s sinful choice to commit suicide does not justify violating a prohibition.

Rav Sternbuch, in explaining (see above) why in his view abortion is permitted to prevent maternal suicide, writes:

And that which I wrote that a woman threatening suicide is pursuing herself (and the fetus isn’t considered a rodeif (pursuer) who may be killed to save his target), that is for a normal woman. But since this one is mentally ill (cholas nefesh), she is considered anusah, so it would appear that would once again be a basis to classify the fetus as pursuing her…

It is thus possible that he would agree with Rav Zilberstein that even an entirely credible threat of suicide does not permit violating an issur unless the one threatening is a shoteh and an oness.

[1]Shu”t Pri Ha’aretz cheilek 3 Y.D. siman 2 s.v. Umitoch divrei mohara”m halalu.

[2]Shu”t Admas Kodesh cheilek 1 Y.D. siman 6 s.v. Teshuvah. These two teshuvos are cited briefly in Birkei Yosef Y.D. siman 155 os 2 and Shu”t Levushei Mordechai kama C.M. siman 39 s.v. Vehinei benidon zeh.