Last week we opened a discussion concerning healing and halacha, discussing the basic questions of whether it is a mitzvah to heal, whether a physician is permitted to take payment for his healing, whether a person can refrain from receiving treatment and related issues. In this article we will continue our discussion of the subject, turning to the question of physicians and mitzvah performance.
Given that healing is a mitzvah, does it follow that physicians on duty are exempt from the performance of other mitzvos? Is the exemption contingent on being swamped by work, or does it apply even when a person has breaks in between patients? Are there differences between doctors in their regular work and in life-threatening situations? And does a doctor who misses davening have to make it up?
These questions, among others, are discussed below.
Osek BeMitzvah Patur Min HaMitzvah
The general halachic principle is that a person who is occupied with the performance of a mitzvah is exempt from performing other mitzvos.
This principle is taught by the Mishnah in Sukkos: “Messengers on a mitzvah-related mission are exempt from the mitzvah of Sukkah; the sick and those caring for them are exempt from Sukkah” (Sukkah 25a). We learn that a person involved in one mitzvah is exempt from others. Moreover, the Ritva explains that it is in fact forbidden for him to leave the mitzvah he is performing for another mitzvah. Since he is engaged in one mitzvah, he must complete that mitzvah rather than stop for a different mitzvah.
Rashi explains that travelers on a mitzvah mission are exempt from the mitzvah of Sukkah even while they are encamped. Meaning, even while they are not actively traveling, since their encampment is a part of a larger mitzvah journey it is sufficient to exempt them from the mitzvah of Sukkah.
Tosafos, however, finds difficulty with this position: “If they are able to fulfill both mitzvot why are they exempt? Is a man who has Tzitzis on his clothing and Tefillin on his head exempt thereby from other mitzvot?” The conclusion of Tosafos (which is possibly an understanding of Rashi) is that indeed, the exemption from mitzvos applies only to cases in which their occupation with the mitzvah of Sukkah at night prevents them from fulfilling the relevant mitzvah the next day.
The Ran disputes this ruling, explaining that even somebody who is not actively involved in a mitzvah remains exempt. He writes, “Someone involved in a mitzvah is exempt from another mitzvah, even though he could fulfill them both. […] The Torah exempted anybody involved in G-d’s labor from going to the trouble of fulfilling other mitzvos, even where it theoretically possible.”
The Ran concedes that if someone does not need to expend any special effort to fulfill both mitzvos, he should certainly do both—though this is only “proper practice” rather than a full obligation.
The halachic ruling concerning this dispute is given by the Rema (Orach Chaim 38:8). The Shulchan Aruch rules the basic halacha of exemption: “Scribes writing Tefillin and Mezuzos, their wholesale and retail salesmen, and anyone involved in the Heavenly work, are exempt from putting on tefillin all day except during the reading of the Shema and during prayer.” To this the Rema adds: “And if they must do their work (writing Tefillin and Mezuzos) during the time of reading the Shema and of prayer, they are exempt even from reading the Shema and prayer and Tefillin. For anyone involved in a mitzvah is exempt from another mitzvah, provided performance of the other mitzvah involves an exertion. If he can do both without any special exertion, he should do both.”
As the Biur Halacha explains (Orach Chaim 38, s.v. “Im Tzarich”), the Rema thus rules in accordance with the Ran, against Tosafot. There is no obligation to perform an extra action in order to fulfill a second mitzvah while engaged in one, and only where a single action can perform both mitzvos it is worthy to do both. The Biur Halacha gives an example of somebody who is digging a grave to bury a dead person, and who is resting in order to gather strength to continue digging. Since this resting is a part of the process of burying the dead, he is exempt from other mitzvos (such as giving charity to the poor) even while not digging.
Doctors’ Exemption from Mitzvos
One of the categories of people exempt from mitzvos, as mentioned by the above Shulchan Aruch, is merchants of Tefillin and the like. The Magen Avraham (38:8) distinguishes different types of intention: “It seems that he who sells them for profit is not considered to be called ‘involved in a mitzvah.’” Meaning, if a person is doing a mitzvah-related act, but doing it for personal gain, it is not considered a mitzvah that exempts from other mitzvos.
The Mishnah Berurah (in Biur Halacha) raises the question of the Gemara in Nedarim (33), where it seems that one who returns a lost object is called “involved in a mitzvah” even if he is paid for returning the item. Possible resolutions of the contradiction are that the case of returning lost property is different because he is only paid for time lost from work, and not for the mitzvah performance. Alternatively, the main intent of somebody returning lost property is to return the lost object; merchants primarily intend to profit.
Thus to the question of exemption from mitzvos for doctors: Nowadays, a doctor is paid for his work and not merely for his lost time. On the other hand, his conscious intention is primarily to heal—though he doubtless wishes to make a living too. Is he therefore exempt from mitzvos on account of his occupation with the mitzvah of healing?
Rabbi Dr. Avraham Sofer addresses this question in his Nishmas Avraham (Orach Chaim 38:6), and writes (citing Rabbi Yitzchak Zilberstein) that “although doctors and nurses are paid for their work, they are still considered as returning lost objects—for there is surely no greater return of a lost object than healing! Therefore, since he does not think about profit at all while working but is only involved in healing the patient, and his care, or that of a nurse, is the mitzvah itself, he has the status of one who is involved in a mitzvah.”
Rabbi Sofer adds (93:1), citing Rabbi Yehoshua Neuwirth, that even when a doctor is not in the active process of healing, but rather performing related duties, he remains exempt from mitzvos: “I have heard from my master R’ Yehoshua Neuwirth that a doctor is exempt from prayer not only when examining or treating a patient (even without danger to life), but even when he is writing in the patient’s record, and even when he is writing release documents. All this is considered involvement in the mitzvah.”
This halacha emerges from the above statement of the Mishnah Berurah concerning gravediggers. Just as a gravedigger is exempt from mitzvos even when he rests to gather strength, since this is also considered involvement in a mitzvah (he notes the rest allows him to regain the strength for continued digging), so is the case for a doctor who is occupied with the peripheral tasks of the medical profession.
However, if a doctor can perform another mitzvah without special exertion, such as reciting the first Pasuk of Keriyas Shema with kavono, then it is correct to do so. As the Rema rules (cited above), “If he is able to do both without any special exertion, he should do both.” Thus, when he is not actively healing, so that he can recite Keriyas Shema (or at least the first Pasuk thereof) without being distracted from his work, a doctor should do so.
The Mishnah Berurah makes this clear concerning people involved in communal work, writing, “If one can stop for Shema and return to complete the communal needs without strain, he should do so” (70:18).
Life Threatening Situations
Although any doctor in the process of healing (and related work) is considered “occupied with a mitzvah”—healing is a mitzvah in any situation—there is a distinction between a doctor occupied in routine care and one who is dealing with a life-threatening situation.
In the latter, Poskim are more adamant that he should not stop his work, even momentarily, for the purpose of a mitzvah. For example, the Mishnah Berurah (640:10) writes concerning Sukkah: “In caring for a dangerously ill patient, it appears that one should be lenient even when the patient does not need him at that moment because someone is alternating for him.” Cases of Pikuach Nefesh, or cases that can develop into life threatening situations, are different from routine medical care.
Note, however, that today doctors normally take breaks during their working day. In such breaks, of course there will be an obligation to daven.
Rabbi Yosef Shalom Elyashiv zt”l addresses the question of whether or not a doctor is permitted to turn away patients in order to take a midday nap which will allow him to function better during the rest of the day. He concludes that this is permitted, and that it does not transgress any prohibition. This strengthens the position that under ordinary circumstances, a doctor will be able to find the time to daven.
In a teshuva on the subject, Rabbi Asher Weiss shlita reaches a similar conclusion: a doctor who is not involved in issues of pikuach nefesh should plan his day to ensure that he is also able to fulfill mitzvos. By contrast, one who is involved in pikuach nefesh, such as somebody working in the emergency ward, is exempt from mitzvos, even if he is being paid for his work—though if he takes coffee breaks and the like, he should say at least the first Pasuk of Keriyas Shema if he can.
He adds that if a person is exempt from davening because of his medical obligations, he will not have to make up the lost prayer (tashlumin; this is based on the Mishnah Berurah in siman 93). Since he was not obligated to pray, there is no reason to make it up.
We have seen that healing is considered a mitzvah, and that therefore doctors who are occupied with healing are essentially exempt from mitzvos while at work. They need not daven, they need not say Keriyas Shema, they need not wear Tefillin, and so on.
However, it goes without saying that where this is possible, a doctor must plan his day so that he will be able to perform these and all other mitzvos. It is forbidden for a person to intentionally place himself in a situation that exempts him from mitzvos, and though this might happen relatively often to doctors (in particular when working on emergency shifts and so on), it should be avoided wherever possible.
For instance, if another doctor is available to take over for the duration of davening (for example), an arrangement should be made (see Mishnah Berurah 640:10).
In addition, we have seen that where a person is able to perform both mitzvos, he should strive to do so in spite of the basic exemption. When involved in non-life threatening work, it is therefore proper for a doctor to perform mitzvos that he is able to perform without being distracted from his work.
The yoke of mitzvos is another factor in the challenging life of a doctor or other medical practitioner. We owe doctors, nurses, and all those involved in the field of medical practice a debt of gratitude for their dedicated work. May Hashem place His blessing upon their hands, that they should bring healing and wellbeing to their patients and be faithful envoys in performing their work.