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Medicine and Health-Related Activities on Shabbos

One of the most practical halachic issues on Shabbos is using medicine, and performing treatments or other health-related activities on Shabbos.

Although the details involved are numerous and we will not be able to encompass all of them in a single article, we will try this week to present the general principles that govern taking medicine and performing other health activities on Shabbos.

Why is it forbidden to take medicine on Shabbos? When is it permitted to take medicine? Is it permitted to exercise on Shabbos? Can one take vitamins and food supplements? What about taking contraceptive pills on Shabbos?

These questions, among others, are discussed below.

A Rabbinic Prohibition

Preparing medicine on Shabbos can involve a full Torah prohibition. This is the case, for instance, when a natural substance such as plants has to be ground in order to prepare the medicine (tochen), or if a substance needs to be heated and effectively cooked (bishul).

In modern times, however, consumers rarely prepare their own medicine. The maximum we do is to add water to a powder to form a liquid – which would certainly not constitute a full Torah prohibition. The question which we wish to discuss is, therefore, not the preparation of medicines, but rather their use on Shabbos.

Even when no forbidden labor is involved, it is forbidden to use medicines on Shabbos. The Sages prohibited the unrestricted use of medication, due to a concern that this might lead to the performance of one of the forbidden labors. The labor most relevant to this matter is grinding, since grinding some substance is a prerequisite for almost every medicinal preparation (see Mishnah Berurah 327:1).

Beyond the actual use of medicine, the Sages included in their prohibition all treatments or procedures that are related to the use thereof.

The Shulchan Aruch notes the prohibition against sweating for medicinal purposes (Orach Chaim 328:42). Although there is no prohibition against exercise per se, and it cannot lead to any grinding, it is forbidden to exercise on Shabbos since the same effect (of sweating) can be induced by medicinal treatment (Mishnah Berurah 328:130). The fact that the same healing effect can be achieved by medicine renders exercise part of the rabbinic prohibition.

Only treatments and procedures that are medicine-related (meaning that the effect can be induced by medical means) are prohibited. Those treatments or procedures whose effect is unrelated to medicine are permitted. For instance, Rav Shlomo Zalman Auerbach permitted putting on braces on Shabbos to straighten teeth (see Shemiras Shabbos Kehlichasa 34 note 111; Meoros Shabbos Vol 1, letter 12, sec. 3) since this effect is not achieved by medicine.

Exercise on Shabbos

It is worth elaborating on the question of exercise on Shabbos, a very pertinent matter for many people.

The Mishnah (Shabbos 157a) writes “ein mit’amlin” on Shabbos, which Rashi explains refers to rubbing one’s body with force. Rashi asserts that this is forbidden because it is an uvda dechol, a weekday activity that is inappropriate for Shabbos. Rabbeinu Channanel, however, explains that the Mishnah refers to the practice of folding and unfolding one’s limbs, explaining that this is included in the rabbinic decree forbidding medicine on Shabbos. In modern terminology, these activities would be described as massage and physical therapy.

This is the foundation for the ruling of the Shulchan Aruch (Orach Chaim 328:42), as noted above, whereby one should not press on his body with enough force that it will cause him to sweat. The Mishna Berura (301:7) forbids jogging on Shabbos for the same reason. He even cites a minority opinion that exercise walks on Shabbos are forbidden. (Speed walking for exercise is equivalent to jogging since it is clear that one is exercising.)

In fact, two reasons are mentioned by Poksim for why it is not permitted to exercise on Shabbos. One reason is because it is considered a refu’ah – an act of healing. A second reason, is that exercising contradicts the concept of rest on Shabbos. Most people who exercise for health purposes must strain themselves, and this of course is not restful (see Aruch Hashulchan 301:44).

The Shulchan Aruch (301:2) adds that youth who derive pleasure from running, are permitted to run on Shabbos. The Shemiras Shabbos Kehilchasa (citing Rav Shlomo Zalman Auerbach; 16:39, note 99) extends the idea to exercising for adults: If somebody takes pleasure from exercise, and it is not being done for health reasons alone, it is permitted to do so.

However, one must be careful judge what is considered enjoyable and what is actually strenuous yet beneficial. Children enjoy running around, and although they exercise while they do so, they do not find it a strain. This is true for many sports. But usually it is not the case for lifting weights, and even for jogging, which would then not be permitted.

Another reason why it might be permitted to exercise on Shabbos is that today exercise is performed not only by those who are sick but even (and in particular) by healthy people. As we will explain below, activities that are generally done by healthy people may not be included in the rabbinic prohibition. There is also a debate concerning a healthy person taking medicine for preventive reasons.

Yet, Poskim have generally not permitted any form of health-related exercise on Shabbos (see Melamed Leho’il 1:53; Tzitz Eliezer 6:4; see also Shemiras Shabbat Kehilchasa 34:22 who permits light exercise for purposes of alleviating pain). Even somebody who exercises for pleasure should not do so publicly, because of the subjective nature of this halachah.

The Prohibition Today

As we mentioned above, consumers rarely prepare medicine today, and it is usually prepared at a factory or at the pharmacy. This being the case, why should the prohibition against taking medicine remain in effect? Surely there is no concern that a person taking Advil will come to transgress the forbidden labor of grinding?

In spite of this, mainstream halachic authorities maintain that the prohibition against taking medicines remains in effect even today. One of the principle reasons for this is that once enacted, a rabbinic decree is not repealed even when the reason behind it no longer applies. This is the approach given by the Ketzos HaShulchan (134:8), though he notes that because the nature of grinding herbs is not known to us, there is room for leniency in certain circumstances (see also Chelkas Yaakov 4:41).

Rav Eliezer Waldenberg (Tzitz Eliezer Vol. 8, no. 15, sec. 15) adds that the reason for this decree continues to be relevant since even today many people grind medicines when preparing home remedies.

Rav Waldenberg writes that there is greater room for leniency concerning ailments for which there is no possibility of a home-made cure (so that there is no possible concern for violation of Shabbos). This is based on opinions that the Sages didn’t make a general decree against use of medicine, but rather prohibited their use wherever there is an actual concern (see Rambam, Shabbos 21:31).

When Medicines are Permitted

The rabbinical prohibition against using medicines will not apply, of course, where there is a danger to life or to limb. But beyond this, the Mishnah Berurah (328:1) rules that if a person is suffering from a sickness to the degree that without medical treatment he would be bedridden, or if the discomfort is so intense as to affect his entire body (so that the person would not be able to function properly), it is permitted to take medicine on Shabbos (for in circumstances of illness, the rabbinic prohibition is waived). The decree to refrain from taking medicine on Shabbos applies only to someone suffering from discomfort.

Rav Shlomo Zalman Auerbach (cited in Nishmas Avraham 1:164; see also Shemiras Shabbat Kehilchasa 34:16) moreover ruled that one who is suffering from a mild headache can take aspirin if this will avoid his developing a severe headache – one is not required to wait until the headache develops to take the medicine, and it is permitted to take it preemptively.

Although the categories of requiring bed rest or feeling “weak all over” are subjective, and depend on each individual and his condition, Poskim generally agree that when a person has fever it is permitted to take medication. There is no requirement to be overly stringent when judging the degree of illness (see Mishnah Berurah 328:85 and 130; Tzitz Eliezer 14:50-7 and 17:13).

In addition, even healthy infants and babies below the age of three are classified by halchahah as being equivalent to an adult who is ill but not dangerously. This means that the prohibition against taking medication is suspended with respect to babies in general, and they are permitted to take all forms of medicine. The question of the age at which the prohibition begins is disputed by different authorities, and some are lenient for children below the age of six or even nine (see Tzitz Eliezer 8:15-12; Minchas Yitzchak 1:78).

Vitamins on Shabbos

The prohibition against medicines applies only to medicines – substances that are only used for healing. Certainly, then, it is permitted for somebody who suffers from a cold to drink a hot tea, even if this might help his condition. Since tea is a common drink for healthy people, it is permitted to drink it even if the intention is to use it as a medicine.

By the same token, it is permitted to take medications that have no healing effect, but serve to regulate certain functions of the body.  Common examples are pills taken by women to increase fertility, or contraceptive bills. Because these pills do not heal or cure any ailment, and only serve to regulate hormones,many authorities maintain that the prohibition does not apply (see Iggros Moshe, Even HaEzer 4:67 and Cheklas Yaakov 23. Shemiras Shabbos Kehilchasa 34 note 82 notes that this ruling is not universal).

Taking sleeping pills on Shabbos brings us to a dispute between Rav Shlomo Zalman Auerbach, who claimed that sleeping pills are not medicine and are therefore permitted for use on Shabbos (Shulchan Shlomo 328), and others who are stringent (see Tzitz Eliezer 9:17:2:40). Shemiras Shabbos Kehilchasa (33:16), based on Rav Shlomo Zalman, writes that one can certainly be lenient in this matter where significant discomfort is involved.

Concerning vitamins we find three major opinions among Poskim. Some are generally lenient, considering vitamins to be maachal bri’im – generally used by healthy individuals (see Tzitz Eliezer 14:50). A similar argument is cited by Rav Yitzchak Yaakov Weiss Shut Minchas Yitzchak (3:34) concerning the use of pain killers in circumstances of discomfort alone – though Rav Weiss defers this opinion.

However, other authorities, such as Shemiras Shabbos Kehilchasa (34:20 and note 85, citing Rav Shlomo Zalman Auerbach) are stringent, considering vitamins to be parallel to medicine (see also Minchas Shlomo 2:37).

Rav Moshe Feinstein (Iggros Moshe, Orach Chaim 3:54) adopts a nuanced approach, ruling that if a weak person wishes to take vitamins to strengthen himself then it is forbidden, but that a healthy person may take them to prevent illness.

These opinions derive from a dispute between the Beis Yosef and the Magen Avraham. According to the Beis Yosef (328) the prohibition against medicine does not apply to a healthy person – a ruling he bases on the Tur. The Magen Avraham (328:43), however, explains that the leniency of the Tur applies only where the person is taking medicine to satisfy his hunger or thirst, but it is forbidden if there are also health considerations.

The Mishnah Berurah (328:120) and the Aruch HaShulchan (328:48) rule like the Magen Avraham. According to Rav Moshe, it is permitted to take vitamins as a preventative measure alone, since this is not being done to improve one’s health.

Taking Medicine Over a Period of Time

A person taking a course of antibiotics is often not bedridden, yet needs to complete the course of antibiotics. Is it permitted to take antibiotics on Shabbos?

Shemiras Shabbos Kehilchasa (34 note 76) cites Rav Shlomo Kluger and the Chazon Ish, who permit taking medicine on Shabbos if it is part of a routine that was established before Shabbos.

Other authorities are less ready for leniency in this matter (see Iggros Moshe, Orach Chaim 3:53; Tzitz Eliezer 8:15:15:15) – but the mentioned opinion has become generally accepted today.

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