Pikuach Nefesh on Shabbos
One of the basic foundations of halacha is that saving a life supercedes every mitzvah in the Torah, with the exception of forbidden relationships, murder and idol worship. In discussing this issue vis-à-vis Shabbos prohibitions, the Gemara (Yuma 85b) mentions several possible sources for this halacha. One of the pesukim quoted in the Gemara, “And the Bnei Yisroel shall observe the Shabbos” (Shemos 31:16), appears in this week’s parsha. The Gemara derives from this, “desecrate one Shabbos for this person, in order that he can observe many Shabbosos.” Rashi (Yuma 85b) explains the connection between the words of pasuk and the Gemara’s statement. The Torah is instructing us that we must be careful in our adherence to the laws of Shabbos to allow for future Shabbos observance. In other words, do not be over zealous in keeping hilchos Shabbos if that will be the cause for one not to observe future Shabbosos.
Let us now review some of the basic halachos concerning pikuach nefesh on Shabbos.
EXPLAINING THE TERM – WHAT IS PIKUACH NEFESH
Before proceeding, it is advisable to define the term “pikuach nefesh.” This is because its colloquial use differs from how the expression appears in halachic literature. When a serious medical issue is at hand, or if a child runs in front of a bus, most people will say, “Its pikuach nefesh!” What they really mean to say is, “That’s sakanas nefashos” – a danger to life.
In actuality, the word “pikuach” comes from the “pokei’ach” as we find in the bracha “pokei’ach ivrim” – to “open” the eyes of the blind. Thus, pikuach nefesh is to open one’s eyes, or to supervise or oversee matters of the soul, i.e., guard one’s life.
PIKUACH NEFESH IS A MITZVAH
As we pointed out in the introduction to this article, pikuach nefesh supercedes almost every prohibition in the Torah. One should not think, however, that pikuach nefesh is merely a waiver and one is only allowed to do so, but rather it is an obligation and a mitzvah to involve oneself with pikuach nefesh. As the Ohr HaChayim points out, overriding the Shabbos for the sake of pikuach nefesh is not chillul Shabbos, but rather shemiras Shabbos (Ohr HaChayim, Shemos 31:13).
This is based on a different pasuk, also cited by the above-mentioned Gemara: “You shall observe My decrees and My judgments, which man shall carry out and live by them (vachai bahem)” (Vayikra 18:5). Chazal derive from this “vachai bahem – velo sheyamus bahem” – that the mitzvos are a vehicle through which to live and not to die. We are thus commanded to see to it that we stay alive.
It should be noted that in actuality, the Gemara concludes that the preferred drasha and source for the halacha of pikuach nefesh superceding Shabbos is that of “vachai bahem – velo sheyamus bahem.” However, the Rishonim still use the earlier drasha of “desecrate one Shabbos for this person, in order that he can observe many Shabbosos” for other situations related to pikuach nefesh. Unfortunately, these situations are beyond the scope of this article. (See Minchas Asher [Rav Asher Weiss, shlit”a], Shemos, pp. 402-403.)
SPEED IS OF THE ESSENCE
When it comes to saving a life, one must act with the greatest alacrity and should not hesitate. The Gemara (Yerushalmi Yuma 8:5) puts it very pithily: “The one who acts with alacrity is to be praised; the one who is asked (concerning whether to desecrate Shabbos) is disgraceful; and the one who asks is a murderer.”
While the first of these three statements is understood, the other two require explanation. Why is it that the halachic authority being asked a shylah of pikuach nefesh is considered to be disgraceful? This is because every rav has the responsibility to teach that pikuach nefesh supercedes Shabbos. If someone still finds it necessary to ask a shylah, this is an indication that the rav has been lax in his duties.
It must be noted that the Gemara’s condemnation is referring specifically to where time is of the essence. If this is not the case, then one is encouraged to ask a halachic authority (Aruch HaShulchan Orach Chaim 328:1-2).
The third statement of the Yerushalmi, that the one who takes the time to ask the question in a life-threatening situation is a murderer, is because under such circumstances, speed is of the essence, and one does not ask questions. If the patient dies due to his deliberations, the petitioner is held responsible. However, as we mentioned in the previous paragraph, if the danger to life is not imminent, one should indeed ask a rav as to the correct procedure (ibid.).
WHO DOES THE MITZVAH?
The Rishonim maintain that when chillul Shabbos is necessary for the sake of pikuach nefesh, it is preferable to be done by Jews rather than non-Jews. (Please note that we are speaking specifically about an emergency situation. Non-emergency pikuach nefesh has slightly different rules.) Additionally, it should be done by adults and not by children. The reason for this is because we are concerned that if we permit pikuach nefesh matters to be done by non-Jews or children, people will think that pikuach nefesh does not supercede Shabbos and only those not commanded to keep mitzvos may do so. This could cause the loss of life in a situation where no child or non-Jew is available. By specifically insisting that adult Jews override Shabbos, we indicate that it is indeed a mitzvah (Shu”t Tashbetz, vol. I #54).
A TALMID CHOCHAM
According to some Rishonim, it is preferable that a talmid chocham performs what is necessary for pikuach nefesh on Shabbos. There are two reasons for this: 1) A talmid chocham has the halachic knowledge of what is permitted and what is forbidden, and 2) we are concerned that if we allow a unlearned person to do so, he will come to be lax in his general shemiras Shabbos.
However, this is assuming that the talmid chocham is readily available and knows what to do. If this is not true, than we do not give preference to the talmid chocham, rather anyone can do it (Rambam, Mishnayos Shabbos 18:3; Mishnah Berurah 328:34 and 618:24).
THE PATIENT HIMSELF
The mitzvah of superceding Shabbos for the sake of pikuach nefesh applies to other people even when the patient can perform the chillul Shabbos himself. The Chasam Sofer compares this situation to the mitzvah of milah. If it were not for the fact that the Torah commands that milah overrides Shabbos, it would be forbidden because it entails making a wound. However, there is no difference who performs the milah, be it the father or anyone else, as everyone has a responsibility to see to it that the child is circumcised. The same applies to pikuach nefesh – everyone has the mitzvah, both the patient and those around him (Shu”t Chasam Sofer, Orach Chaim #82; see also Sefer Eshkol, Hilchos Milah #36).
MEN VERSUS WOMEN
The halacha is that, all things being equal, preferably a man, as opposed to a woman, should perform the necessary melachos for the sake of pikuach nefesh. The reason for this as explained by the Rishonim is that we are concerned that if pikuach nefesh were relegated to women, they would think that in actuality it is forbidden to desecrate Shabbos for pikuach nefesh and the only reason why they are asked to do it is that they are women. This might cause them to either be lax in the performance of pikuach nefesh specifically, or in the rest of Hilchos Shabbos in general (Shulchan Aruch 328:12 and Mishnah Berurah #33; Shulchan Aruch HaRav 328:13).
Of course, if a woman comes to assist in the pikuach nefesh, she should not be prevented from participating (Shulchan Aruch HaRav ibid.). Additionally, if the woman is a greater expert than the men who are present, she should be the one to perform the pikuach nefesh. This is derived from the halacha that although a talmid chocham should be given precedence in performing pikuach nefesh, nevertheless someone of less stature who is more proficient has priority (see Mateh Efrayim 618:18; Sefer “VaChai Bahem” 4:3).
Although, as we said, generally, men have preference in performing pikuach nefesh, it is understood that if only women are present, they should perform whatever is necessary to save the person’s life (Mishnah Berurah 328:34).
Additionally, women who are professional medical personal, such as doctors, nurses and midwives, are given preference due to their expertise. We are therefore unconcerned that they will come to be lax in the performance of their duties (Ran, Yuma 4b [dapei HaRif], s.v., ein; Mishnah Berurah 618:1; Ketzos HaShulchan 135, Badei HaShulchan #9).
IT IS NOT THE MITZVAH, BUT LIFE
Although the pesukim and the drashos of Chazal that we have quoted seem to indicate that the point of saving a life is to allow the person to continue his mitzvah observance, the truth of the matter is that this is not so. Even though adhering to the mitzvos is of utmost importance, the intent of the pesukim and the words of Chazal is that human life is even more important. Even if we know for a fact that the victim will not be physically able to perform any mitzvos with the extra time allotted to him, there is still a mitzvah to prolong his life (Biur Halacha 329:4). Here are three examples of this halacha:
1) There is a mitzvah to be mechallel Shabbos to save the life of a person who is not mitzvah-observant. Even though he will not perform mitzvos after being saved, we are obligated to save him (Shu”t Maharam Shik, Orach Chaim 140-143; Ohr Samayach, Shabbos 2:18; Chazon Ish, Yoreh Deah 2:18).
2) There is an obligation to transgress the laws of Shabbos for the sake of pikuach nefesh even if the victim’s life will only be prolonged by a few minutes. This is true even if he will not have the opportunity to perform a mitzvah in that short amount of time (Shulchan Aruch 329:4; Biur Halacha ad loc.).
3) Even where the victim is a child and not obligated in mitzvos, there is still a mitzvah to save his life. The same applies to individuals who are deranged or mentally incompetent and therefore exempt from mitzvos (ibid.).
EVEN A DOUBTFUL SITUATION
Not only does pikuach nefesh supercede Shabbos prohibitions, but even a safek pikuach nefesh does as well. If fact, this holds true even in a situation where several doubts come together. For example, if a building collapses and we are unsure whether anyone was in there at the time and even assuming that someone is there, we are also unsure whether there are any survivors. Nevertheless, in such a case the halacha is that we employ any method to save those individuals (Shulchan Aruch 329:3; Mishnah Berurah 328:17).
Additionally, even if a person has a life-threatening illness and we are unsure whether a particular medication or procedure will be effective in this case, we still must desecrate the Shabbos in order to attempt to save a life (Shulchan Aruch 328:2). This is because the mitzvah of pikuach nefesh is not necessarily to heal the patient. Rather the mitzvah is to attempt to save a life (see Shu”t Sheivet HaLevi, vol. I, #60.5).
Rav Shlomo Zalman Auerbach zt”l discusses the situation where a particular illness is theoretically life-threatening, but the chances of it being so are relatively slim. Does this also warrant chillul Shabbos?
He maintains that if most people would act immediately due to the urgency of the matter, then this is a case of safek pikuach nefesh and chillul Shabbos is required. However, if most people are unconcern about such an illness, chillul Shabbos is not allowed as there is no sakanah. The example that he gives is the smallpox vaccination. Although technically speaking, once the doctor says that the child needs the vaccination, one should administer it as soon as possible, nevertheless, since most people did not do so, as the need is not urgent, one is not allowed to transgress the Shabbos for it (Shu”t Minchas Shlomo, vol. II, #29.4 [in later editions: vol. II-III, #37.2]).
However, in a location where there is an outbreak of smallpox, most people would seek to be vaccinated immediately, even though the chances of becoming infected are slim. Nevertheless, in that situation, chillul Shabbos is permitted in order to prevent a potential life-threatening disease (Mishnah Berurah 330:5; Halachos of Refuah on Shabbos [Rabbi Yisroel Pinchos Bodner and Rabbi Daniel B. Roth, MD], pg. 75).
SITUATION MIGHT DETERIORATE
Rav Moshe Feinstein zt”l writes (Shu”t Igros Moshe, Orach Chaim vol. III #69) that the requirement to desecrate Shabbos for pikuach nefesh is not limited to where there is an immediate danger on Shabbos. Even if there is no immediate danger to life, however if by not treating the condition immediately a situation will be created where it might not be treatable after Shabbos, one is also permitted to override Shabbos.
Additionally, even if the current illness is in and of itself not life threatening, but it can lead to a different illness that is, chillul Shabbos is permitted to treat the first illness (ibid.).
For example, an abscess – a swollen, pus-filled pocket – in the gum is not life threatening. However, if the infection spreads to the face or throat, there is a danger of the infection spreading to the brain or to the esophagus, which can be fatal. Therefore, the abscess is viewed as life threatening even before it spreads (Halachos of Refuah on Shabbos, pg. 77).
FOUND TO BE UNNECESSARY
It is possible that after someone desecrates Shabbos for the sake of either pikuach nefesh or safek pikuach nefesh, he discovers that his action was unnecessary. This could be for any number of reasons, for example: the victim’s health improved, or he died or someone else had already seen to the victim’s needs. Nevertheless, it is considered as if he performed a mitzvah and he will be rewarded for it (Shulchan Aruch 328:15 and Mishnah Berurah #42).
TWO METHODS TO DO IT
It must be pointed out that the entire premise to allow chillul Shabbos for the sake of an emergency situation of pikuach nefesh is only where it is either faster or better to do it through chillul Shabbos. However, when one can do what is necessary for the situation with the same speed and effectiveness without chillul Shabbos, or by only transgressing a Rabbinic prohibition as opposed to something forbidden by the Torah, then one must attempt to minimize the issur as much as possible (Biur Halacha 278, s.v., mutar). For example:
1) A dangerously ill person is trying to fall asleep and the light in the room disturbs him. If there is no other choice, one may turn off the light. However, it is possible to make the room dark in some other fashion, e.g., either by putting a blanket over the lamp (assuming there is no danger of fire), or by moving the lamp to a closet or another room (assuming the cord is long enough) one must take this approach (ibid.). (Moving the lamp only involves handling muktzah, and is more lenient than turning it off.)
2) If there is a choice of two doctors to call, and one will have to transgress Shabbos in order to come (he lives far away) and the other will not (he lives nearby), the closer doctor should be called. This is assuming that both doctors are equally competent and it makes no difference to the patient. If however the doctor who lives further away is either a bigger expert, he is more familiar with the patient, or the patient is more comfortable with him, that doctor should be alerted (Shu”t Igros Moshe, Orach Chaim vol. I, #131; Shemiras Shabbos Kehilchasa 32:38).
AS LITTLE AS POSSIBLE
Not only must one try and minimize the acts of chillul Shabbos whenever possible, one must also try to minimize how much chillul Shabbos is produced. For example:
1) If the pikuach nefesh necessitates turning on a light, and one light switch activates two bulbs while another only one, assuming that one light bulb is sufficient, that is the one that should be lit. Additionally, if possible, one should turn on the switch in an unusual way, e.g., with his elbow, as this downgrades the prohibition from a de’Oraisa to a de’Rabbanan (Shulchan Aruch 328:16 and Mishnah Berurah ad loc.; Shemiras Shabbos Kehilchasa 32:66).
2) If the patient requires cooked food, one is only allowed to cook the amount necessary. One might have thought that there is no difference between cooking a large pot of food or a small pot; in either case, he has committed one act of cooking on Shabbos. Nevertheless, since one is obligated to minimize the amount of melacha being performed, he must still limit himself to the amount needed (ibid. 32:75).
It is necessary to emphasize that the above is reserved for a situations where employing these limitations will not affect the speed and the quality of the pikuach nefesh. If however the acts of pikuach nefesh will be compromised as a result, one must do whatever is needed even if seemingly unnecessary chillul Shabbos will take place.
DEFINING A SAKANAH – DANGER
There are several scenarios in defining a particular illness as life threatening:
1) If a doctor maintains that this illness is either life threatening or even possibly so. Additionally, even if the danger is not imminent, but it will become so if not treated (Biur Halacha 328:4, s.v., kol; Aruch HaShulchan 328:40; Mishnah Berurah 328:17).
2) If the patient himself feels that the illness is life threatening, even if the doctor disagrees (Shulchan Aruch 328:5 and Mishnah Berurah #25). The reason why the patient’s opinion supersedes that of the doctor is based on a pasuk: “The heart knows the bitterness of his soul” (Mishlei 14:10). Based on this, the Gemara states that even if a doctor maintains that the patient does not need to eat on Yom Kippur, but the patient contends that he does, we allow him to eat (Yuma 83a).
3) If there are no doctors present to access whether chillul Shabbos is warranted, we can rely on the opinion of one who claims to recognize the illness that it is either life threatening or possibly so. This is provided that this individual is either Shabbos observant or we recognize that he is speaking with utmost sincerity (Rama 328:10 and Mishnah Berurah ad loc.; Shemiras Shabbos K’hilchasa 32:10).
PATIENT KNOWS HIMSELF
That which we said that we follow the patient’s wishes over the doctor does not apply in all situations. The poskim maintain that this is only true where we are unsure of the proper treatment. However, if the illness is well-known and the doctor says that it is unnecessary to desecrate Shabbos in order to treat it and the patient says that it is, we follow the doctor’s opinion. Since he is familiar with the illness and how it is to be treated, he has the final say (Biur Halacha 328:10, s.v., verofei).
On the other hand, if the patient maintains that he is familiar with the tendencies of his body and he knows that it will respond positively to the treatment that he is requesting, it is possible that we indeed listen to the patient over the doctor (ibid).
Additionally, another factor that must be taken into account in this situation is the mental well-being of the patient. If the patient will become depressed when he sees that we are not following his instructions, and this will effect is physical health, we treat him according to his instructions against the doctor’s opinion, even if it involves chillul Shabbos (ibid.).
There is another situation where we do not follow the patient’s instructions. Where the illness is not so well-known and its treatment is unclear, although normally we follow the patient’s request, if the doctor contends that this course of treatment will be detrimental, we do not listen to the patient (ibid).
DOCTOR VERSUS EXPERT
Earlier, we made a distinction between doctors and experts. Concerning a doctor, whether or not he is Shabbos observant does not make a difference, and even a non-Jewish doctor can make the decision to desecrate Shabbos. On the other hand, when it is only an expert making the decision, lechatchilah we prefer someone who keeps Shabbos. Why is this so?
The poskim maintain that all doctors have a reputation to maintain and they are concerned about government supervisory boards. They will be extremely careful in their decision-making in order not to weaken their reputation. Non-medical personal however, do not have to answer to a higher authority and if they are unconcerned about Shabbos observance they might wrongly decide to override Shabbos (Shiyurei Bracha 328:1).
It must be noted that there is an opinion that in most cases of doubt, even if a mechallel Shabbos says it is necessary to override the Shabbos, one is allowed to listen to him, as it is a case of safek pikuach nefesh. In such a situation, it is preferable to consult a rav (Sdei Chemed, Ma’areches Yom Kippur 3:5 in the name of the Chasam Sofer).
THE GREATNESS OF THE JEWISH SOUL
The Ohr Hachayim writes (Shemos 31:13) that the fact that pikuach nefesh supercedes the Shabbos indicates to us the kedusha of the Jewish neshama is greater than the kedusha of Shabbos. This is why saving a life takes precedence over Shabbos. Ashreinu ma tov chelkeinu!