Healing on Shabbos

What motivated Chazal to prohibit taking medicine on Shabbos? Is there an actual prohibition to treat a sick person on Shabbos, and if so -- which types of treatments are forbidden? What is the halachic stance on taking vitamins? Is there a difference between immune-boosting supplements and dietary supplements? What if someone wishes to use a folk remedy that doesn’t cure anything? Can a sick person who continues walking around take medication? Can a raw egg be drunk to improve vocal quality? Is it permissible to prepare a medicinal solution before Shabbos for use on Shabbos? This week’s article delves into these questions, exploring the boundaries and allowances for treating illness on Shabbos.

Healing on Shabbos

In last week’s article, we discussed the Dead Sea, identified with the remains of ancient, devastated Sodom. Alongside this, we explored several related halachos, including the prohibition on rinsing one's eyes with Dead Sea water and bathing in the Dead Sea or mineral-rich springs on Shabbos, given Chazal's Shabbos-restrictions on performing medicinal treatments. This week, we’ll examine this topic further, clarifying which therapeutic remedies are prohibited, and identifying circumstances in which they are permitted.

Reasons for the Prohibition

There are two main reasons for the prohibition of engaging in medical treatment on Shabbos:

1. Preparation of Medicinal Ingredients: In ancient times, preparing medicines often required grinding herbs right before use to ensure maximum potency (the mortar and pestle still represent the pharmacist). However, because Grinding (Tochen) is one of the prohibited forms of labor on Shabbos, Chazal extended a general prohibition to all forms of medical treatment. This enactment was intended to prevent accidental transgressions, as individuals might mistakenly grind herbs or prepare potions in ways that violate the halachos of Shabbos.
2. Applying Ointment on Shabbos: Spreading ointment on wounds or dressings falls under the prohibition of Memareach (smoothing or spreading). To avoid accidental violations of this prohibition, Chazal extended restrictions to any treatment that might involve or lead to smoothing ointment onto the skin. Although not every medical activity is forbidden due to Memareach, any treatment with a risk of spreading ointment, even inadvertently, is generally prohibited. This helps prevent even unintentional acts that could resemble or lead to a full Memareach violation.

The prohibition of Memareach deserves its own discussion to fully understand its complexities. In this week’s article will focus on the broader prohibition of performing medical treatments on Shabbos, including those that don’t involve ointment application.

Why is Healing Strictly Prohibited, Even When Risks Are Absent?

When a person is in pain, his distress may easily cloud his judgment and cause him to act impulsively, perhaps even overlooking Shabbos prohibitions. Chazal were concerned that, in the heat of the moment, someone seeking treatment might forget about Shabbos and inadvertently violate its laws, such as by grinding herbs—a classic example of Tochen. As a safety measure Chazal enacted a blanket prohibition on all medical activities, even those unrelated to grinding (such as the one mentioned in last week’s article: bathing in or rinsing with Dead Sea water).

The prohibition includes two aspects: (1) avoiding situations where the person receiving treatment might inadvertently violate Shabbos ; and (2) preventing observers from learning to engage in such activities themselves.

Contemporary Perspective

Today, most medicinal substances are available in pre-processed or packaged forms, and the mortar and pestle have been (on the most part) relegated to attics and museums. Nevertheless, contemporary halachic authorities maintain that this rule, established by Chazal and codified in the Mishnah, remains in effect even if the original reason is no longer relevant. Moreover, modern treatments often involve electronic devices which could lead to other Shabbos violations.

This prohibition also conveys an important lesson on recognizing human flaws: one must always have firm boundaries in place to protect himself from his own impulsive actions in moments of distraction or distress.

Permitted Shabbos Medical Treatment

The laws of Shabbos include several leniencies for the above-mentioned rabbinic prohibitions. While the general prohibition against medical treatment on Shabbos helps prevent accidental transgressions, these leniencies are carefully designed to balance respect for Shabbos with the need to relieve pain and preserve one’s well-being.

Here are some key leniencies that apply to treating the sick on Shabbos:

- Life-threatening situations: All Shabbos prohibitions are overlooked in any situation with potential risk of life, even where the threat is remote.

- Severe pain or risk of limb loss: Shabbos restrictions are significantly relaxed for one who is bedridden or at risk of losing a limb, even when there is no life-threatening danger.

- Treatment with a “shinui” (an unusual manner or modification) to serve as a reminder that medical actions are normally restricted on Shabbos.

- Actions that don’t appear medical: Activities that are considered pleasurable or done by healthy people for non-medical reasons are permitted on Shabbos for medical reasons, since they don’t necessarily appear like medical treatment.

- Indirect treatment: Indirect treatments, such as placing wine near a wound and letting it drip down naturally (an ancient wound-treating method, likely due to wine's alcohol content), are permitted, as they avoid direct medical application.

Medical Conditions Treatable on Shabbos

Halacha classifies and differentiates between the following five levels of illness:

1. Pikuach Nefesh: When faced with a life-threatening situation or even a remote life-threatening risk, all necessary actions must be taken to save the person, even if they involve violating Torah prohibitions (with the exception of the three cardinal sins).
2. Bedridden Illness With No Risk of Life: Certain rabbinic prohibitions are waived for a person confined to bed by illness, even if there is no danger to his life. This leniency allows for instructing a non-Jew to perform certain tasks and other medical treatments. However, any action that violates a Torah prohibition remains strictly forbidden (Mishnah Baruah 328:1, 328:121). For a comprehensive review of rabbinic allowances in this case, see Shulchan Aruch and its commentaries (OC 328:17).
3. Risk of Limb Loss Without Systemic Illness: If an otherwise healthy person faces the risk of losing a limb or body part unless a certain action is taken, all necessary treatments are permitted, provided they do not involve violating a Torah prohibition (Shulchan Aruch, OC 328:17).
4. Localized Pain (Mi’chush): For a generally healthy individual experiencing localized pain—known in halachic terms as mi’chush—the Shabbos prohibition against engaging in medical treatments applies in full force. This is the classic example for the prohibition which is the topic of this article.
5. Preventative Treatments for a Healthy Individual: Halachic authorities are divided about whether healthy individuals can use preventative treatments on Shabbos to feel better or avoid future illness, or not. Further details of these opinions will be discussed below.

A Bedridden Patient

The term “bedridden” includes anyone confined to his bed or unable to continue his regular activities due to weakness or pain, even if the pain isn’t widespread.

This term also applies to those who continue functioning despite feeling unwell. If they wish they could “just go to bed” but can't do so due to circumstances, they are also halachically considered "bedridden". In these cases, one may ask a gentile to perform a medical treatment and can himself do an action which was prohibited by the rabbis in an unusual manner (OC 328, 17).

A Healthy Person

Rabbi Moshe Feinstein, in Igros Moshe (OC 3:54), maintains that according to the Beis Yosef the prohibition does not include taking vitamins, even for naturally weak individuals, provided that they are not taken to cure an existing medical issue. However, he explains that the Magen Avrohom (328:43) disagrees and maintains that vitamins are prohibited even for a weak but healthy person. However, if a person is healthy and just takes vitamins in order to prevent possible illness, he maintains that everyone including the Magen Avrohom permits. Rabbi Feinstein advises to adopt this more stringent position. However, for followers of the Sephardic halachic method of ruling, following the lenient view may be permissible.

The Nehar Shalom (328:11) and Kaf Hachaim (OC 328:221), permit drinking a raw egg to enhance voice quality.

Permissible Medical Treatments

Food or drink consumed by healthy people which might be taken as medicine for the ill (like a cup of tea or orange juice for those suffering from the flu) is not prohibited.

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Practical Application

The Shulchan Aruch (OC 328:24) allows practicing preventive medicine on Shabbos. For example, while placing a medicinal leaf directly on an open wound to help it heal is forbidden, placing it on a healed wound is permitted.

Another example: disinfecting a minor wound with alcohol or iodine is prohibited, but applying it to prevent infection is permitted. Similarly, taking vitamins or supplements to recover from a mild illness is prohibited, but taking them to boost the immune system, is permitted.

Mistaken Remedy

The Gemara (Shabbos 109a) writes that there’s no prohibition to heal with coriander on Shabbos. Rashi and the Rambam understood the medical use the Gemara is referring to is eating it, while Tosefos understand it refers to using the leaves as eye compresses.

Why is coriander permitted? According to the Rambam, it is permissible because although it may have medicinal properties, it is also commonly consumed by healthy people. This leniency applies even if one dislikes coriander and consumes it solely for its therapeutic benefits.

In contrast, Rashi and Tosefos hold that using coriander is permitted because Chazal knew it has no real medicinal properties. Thus, using it as a remedy does not constitute a violation.

Rabbi Moshe Feinstein, in Igros Moshe (OC 3:54), elaborates on this issue. He explains that using a remedy based on a mistaken belief that one is ill, or to using a treatment unknown to have actual curative properties is permitted.

Vitamins and Dietary Supplements on Shabbos

Can a healthy person take vitamins or dietary supplements in capsule or bitter syrup form on Shabbos? Rabbi Moshe Feinstein (Igros Moshe, OC 3:54) provides practical guidance:

1. Healing Vitamins: vitamins or supplements taken in order to treat or cure an illness should not be taken on Shabbos.
2. Nutritional or dietary supplements aimed at strengthening weak people are the topic of a halachic dispute. Ashkenazim are advised to be stringent and avoid taking them on Shabbos, while Sephardim may rely on the Beis Yosef’s lenient opinion (although many Sephardic authorities also recommend refraining from it).
3. Vitamins taken to prevent potential future illnesses are generally permitted if they don’t affect one’s current health. This is allowed because they are not considered a “healing action” on Shabbos.
4. Dietary Supplements: According to all opinions, supplements that function like food and naturally strengthen the body are permitted, because they are categorized as food, rather than medicine.
5. Appetite Stimulants: Taking medication to stimulate one’s appetite is prohibited, as appetite loss is considered a health issue. However, if one’s condition is severe enough to cause weakness or pose danger, taking medication is permitted.

In his view, taking fasting aids is permissible—for instance, when Tisha B'Av begins on Motzaei Shabbos—because it does not qualify as a medical treatment or affect a healthy person’s state. Rather, it involves taking something to help the body manage the fast more effectively, such as to prevent dehydration or to supply a slow-release caffeine boost.

Mixing Medicine With Food before Shabbos

It is permissible for a healthy person to eat vitamin and mineral rich foods on Shabbos if they are consumed as part of one’s regular diet. According to Rabbi Shmuel Wosner (Shevet Halevi, Vol. 3, Siman 36), one can mix medication with food before Shabbos to be consumed on Shabbos. However, mixing it on Shabbos is questionable. The Minchas Yitzchok (Volume 6: 28) permits doing so for a person who is quite uncomfortable.

Rabbi Moshe Feinstein (Igros Moshe, OC 2:86) maintains that one may not mix medicines into food even before Shabbos, unless the medication is commonly combined with food right before it is taken, in which case using it is permitted if prepared before Shabbos.

Chut HaShani (Shabbos, Volume 4:89, footnote 31) maintains that if the medicine’s presence is noticeable in the mixture, it should not be used on Shabbos. However, if the medication is undetectable, and only the person taking it is aware of its presence, there is no prohibition involved.