Parashas Beshalach includes the promise, given by Hashem to the Children of Israel, that they will not suffer the ailments of Egypt: “If you will give earnest heed to the voice of Hashem, your God, and do what is right in His eyes, and listen to His commandments, and keep all His statutes, I will put none of the diseases on you which I have put on Egypt; for I, Hashem, am your healer” (Shemos 15:26).
Though Hashem is our healer, the agent of healing is often the doctor, or the medicine he prescribes. In the present article we combine the idea of healing, as mentioned in the passage above, with the concept of the Shabbos, which appears later in Parashas Beshalach concerning the double portion of manna that fell on Friday.
One of the most common and most practical questions of Shabbos observance is the use of medicine and other healing techniques on Shabbos. When is it permitted to administer medical assistance to somebody who requires it, and when it is forbidden? What is the halacha concerning medicines, lotions, stitches, and other medical procedures? Which preparations should be made before Shabbos?
These questions, among others, are discussed below.
Treatment of Patients at Risk
The first halacha one needs to know concerning healing on Shabbos relates to somebody who might be endangered by his illness. Of this the Rambam writes (Hilchos Shabbos 2:3):
“It is forbidden to delay violating the Shabbos for a person who is dangerously ill, as it says: ‘Man shall fulfill them, and live,’ and not fulfill them and die. We learn from here that the laws of the Torah do not mean to achieve vengeance in the world, but rather they bring compassion, kindness, and peace to the world. And those heretics who claim that this is a violation of Shabbat and it is prohibited, of them the verse states: ‘and I have given them evil decrees, and laws by which they cannot live.’”
This halacha refers to somebody who is dangerously ill or wounded, and applies to cases in which there is even a slight element of danger to life (or of deterioration to this condition), and not only to cases of imminent danger.
The source for this ruling is the Gemara in Yoma (85a), which notes a number of sources for the unanimously agreed halacha permitting violation of the Shabbos to save a life. Another source mentioned in the Gemara is logical proof: One should violate the Shabbos to save a life, since the Jew whose life is saved will be able to go on to observe the Shabbos on many weeks. Although the Gemara ultimately prefers the source noted by the Rambam, which is derived from a biblical verse, authorities also make use of the logical proof for a number of halachic dilemmas.
As is clear from the words of the Rambam, it is not only permitted to violate the Shabbos to save a life, but absolutely obligatory to do so, and wherever the possibility of saving a life rises, one must behave on Shabbos just as one would on an ordinary weekday (Rambam 2:2).
As the Gemara and the Rambam also rule, one should not seek to carry out the required actions by means of children or non-Jews, but rather by adult Jews. These halachos are also noted by the Shulchan Aruch (Orach Chaim 328). The Mishnah Berurah (6) adds that if the sick person objects to the violation of Shabbos on his behalf, he should be informed that this is nothing but “foolish piety.”
Huttra or Dechuya: Minimizing the Violation
There is an important dispute in characterizing the nature of Shabbos violation for purposes of saving a life. According to one opinion, the Shabbos is entirely permitted in the face of danger to life (huttra); according to another, Shabbos is set aside for the purpose of saving a life (dechuya), but not entirely permitted.
The practical difference between these opinions arises where it is possible to diminish the gravity of Shabbos violation without causing any delay or lowering in any way the quality of the treatment. According to the first approach (huttra), even under such circumstances there is no need to lessen Shabbos violation, since Shabbos is entirely permitted in the face of danger to life (see Mishnah Berurah 328:39; Shut Tashbatz 3:37; Shut Avnei Nezer 2:455).
However, the Rema (328:12) and the Mishnah Berurah (328:35) rule in accordance with the second approach, so that if the level of Shabbos desecration can be lessened, without any effect on the treatment—such as performing an auxiliary action with a shinuy (in an unusual way)—one must do so.
Another important point to note is that while it is permitted to violate the Shabbos to save a life, wherever possible one must do whatever can be done before Shabbos, so as to minimize Shabbos violation. In this light we find that when a bris milah takes place on Shabbos, all possible preparations must be made in advance (Orach Chaim 331:6).
Where there is a high likelihood of needing to administer life-saving treatment on Shabbos, one must thus take care of whatever can be done in advance of Shabbos (Mishnah Berurah 330:1). However, where doing so involves a major inconvenience, there is no obligation to do so (Shemiras Shabbos Kehilchasa 32:34, and note 104).
Danger to life permits medical procedures that involve both biblical and rabbinic violations of Shabbos. However the sages prohibited even the use of medicine on Shabbos for a person who suffers from a minor ailment. This was done out of concern that a person would come to grind the medicine on Shabbos, grinding (tochen) being a Torah violation of Shabbos.
While it is uncommon for people to grind their own medicines today and virtually all medications we use are ready-made, the great majority of authorities state that the prohibition remains in place. However, in some instances authorities are lenient, and they sometimes mention the changes in preparations of medicines as a factor in deciding that the treatment was not part of the original decree.
For instance, Rav Shlomo Kluger (Sefer Hachaim 328:6) writes that medicines one began taking before Shabbat are excluded from the decree, since even in times of Chazal these were prepared in advance, so that there is no concern for grinding. He also makes a distinction between medicines that are ground, where the decree was made and still stands, to medicines that are boiled, where the decree was never made.
According to some authorities it is permitted to continue taking medicine on Shabbos if the medication (even for a minor malady) is effective only when taken every day (Shemiras Shabbos Kehilchasa 34, note 76, citing Rav Shlomo Kluger and the Chazon Ish). According to other authorities, this is only permitted where refraining from taking the medicine will cause a person to fall ill (see Shemiras Shabbos, citing Rav Shlomo Zalman Auerbach; Iggros Moshe, Orach Chaim 3:54).
Note that the decree only applies to medicines meant for sick people. Products intended for the healthy are not included. Thus, healthy foods, deodorant, vitamins (according to some authorities), nutritional supplements and even preventative medicine (meant for the healthy), are not included in the decree (see Iggros Moshe, Orach Chaim 3:54, anaf 4).
Sick But Not Endangered
The rabbinic decree against taking medicine only applies to people suffering from a minor ailment or malady. To a person who is classified even as a choleh she-ein bo sakana, a sick but not endangered person, the decree does not apply, and it is permitted for him to take medicine on Shabbos. As the Mishnah Berurah (328:1) explains, in these cases the decree was never made.
The rule for this type of illness is somebody who is so sick that he needs to lie down, and cannot function regularly and move around freely. Another good indication of illness is high fever. A third is great pain, that also restricts regular function. In all of these cases, it is permitted to take medicine to alleviate the condition. Sometimes, the threat of losing a limb is not considered to be in this category, but falls under the category of a life-threatening condition, since the loss of a limb may deteriorate into life-threatening conditions.
If a person in the state of a sick but not endangered person requires medical care that violates Torah laws, it is only permitted to perform these by means of a non-Jew (Shulchan Aruch 328:17). Concerning care that only involves rabbinic prohibitions, the Shulchan Aruch rules that it is permitted to perform actions that are required for treatment that cannot wait until after Shabbos, but these must be performed with a shinuy (in an unusual way) unless there is danger of the loss of a limb. It is likewise permitted to move or utilize an item that is muktzeh when this is necessary for the treatment (see Shemiras Shabbos 33:6; concerning a Torah prohibition with a shinuy, see Shemiras Shabbos 33:2, note 17).
Stitches on Shabbos
It is permitted to administer stitches on Shabbos?
Shemiras Shabbos Kehilchasa (34:4) writes that one should not administer stitches on Shabbos.
However, lenient rulings were given by Tzitz Eliezer (20:18) and Rav Yechezkel Abramsky (cited in Nishmas Avraham 340:7).
Nishmas Avraham quotes a lengthy and ongoing dialogue with Rav Shlomo Zalman Auerbach on this topic, of which the final conclusion is that the actual stitches do involve a Torah prohibition, and are therefore prohibited in a non-life threatening situation.
On the other hand, it is permitted to use other adhesive techniques which don’t actually join two parts of the skin together, but only prevent them from coming apart. Shut Shevet Halevi (9:74) also mentions that in adhesive techniques each part of the skin acts of its own accord to join together with the other part, so that the prohibition of tofer is not transgressed (though Rav Wosner leaves the question undecided).
Rav Elyashiv zt”l, however, is quoted as being stringent concerning all forms of stitches and adhesives, as being potential Torah transgressions, and prohibited in non-life-threatening situations. Concerning a knot, Rav Elyashiv is quoted as ruling that the knot can involve a Torah desecration of Shabbos if the stitches are later cut out, and only if the knot is later untied do the stitches involve a rabbinic prohibition alone.
Thus, the best course of action for non-life-threatening situations is to find a non-Jewish doctor, who can administer stitches—to prevent suffering, and to aid the full (and aesthetic) healing of the wound.