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4. Which treatments may be done?

A. Must use a known treatment or one prescribed by a medical expert:[1]

Even if there is a definite danger one may only transgress Shabbos for medical treatment that is known to all or is done by a professional [doctor]. When it is a known form of healing then even if one does not know if he will be cured through it or not, one transgresses Shabbos out of doubt [that perhaps it will heal]. [See Q&A regarding a Kemiah and Homeopathic treatments]

Summary of which treatments may be used? One may only do a treatment that is either being administered by an expert, or is known to be able to cure the person.[2]  Q&A May one do forms of treatment that work in accordance to Segula and are not recognized by science?[3] Some Poskim[4]  rule that any treatment that is based on Segula [supernatural healing] and not due to scientific understanding, is forbidden to performed on Shabbos if they involve Shabbos desecration. This applies even to those treatments mentioned in Chazal that work based on Segula.[5] Other Poskim[6] however rule that even treatments that work based on Segula may be used on Shabbos so long as they have been proven to work or have been written by Chazal. Practically, one may be lenient so long as it has been verified to have healing abilities, even if it works as a way of Segula.[7] If this is not the case then it may only be given if the patient is asking for it and doing so will calm him down.   May one write a Kemiah [Kabalistic charm] for the patient?[8] Patient is asking for it: If the patient is asking for this and it will calm him down and help him live then this may be done. Patient is not asking for it: If the patient is not asking for the Kemia and one simply desires to use it to try to heal the patient then it follows the same dispute as mentioned above: Some Poskim[9] rule that it is forbidden to be written in all cases. Other Poskim[10] rule that it may be written if it has been proven to work three times and the person writing it has written at least three working charms. Practically, one may be lenient in this matter.[11] May one do homeopathic treatments and other forms of natual treatment which are not recognized by conventional medicine?[12] If the treatment has become accepted by medical experts and has been experienced with for a while and is verified to have healing abilities then it is allowed to be done without limitation, even if it works as a way of Segula.[13] If this is not the case then it may only be given if the patient is asking for it and doing so will calm him down.

B. Must a treatment that does not involve Shabbos desecration be given over one that does?[14]

If there is no danger involved for the patient in doing the permitted method: In a scenario that one can begin [preparing] the treatment immediately [in a form] that does not contain desecrating Shabbos but [because of this it] will be delayed a slight amount of time [until it is ready to be applied to the patient], then one may not desecrate Shabbos just in order to prepare the treatment in the shortest amount of time possible without any delay, if the situation is that there is no danger at all involved in this short delay [in the application of the treatment].

The reason for this restriction is: because [the prohibitions of] Shabbos are [simply] overruled in a life-threatening situation and are not completely revoked [from being in affect], [thus] in any scenario that something can be done to save a person without desecrating Shabbos, Shabbos is not overruled for him.

An example of the above Halacha:[15] If [the patient] was evaluated to require two figs and they only found two figs which were attached [to the tree] each one to a separate stem or on their own, as well as [they found] three figs which were all three attached to the same stem, then one is to cut the stem which has the three on it [rather then cut two individual figs] as although that by doing so one is increasing in the amount of figs [that are being detached] nevertheless he is lessening the amount of detaching [that he must do] which is the main aspect of the prohibition [in detaching fruits].

However if [the patient] was evaluated to require two figs and there were two on one stem and three on another single stem then one may only cut the stem that has two on it because it is forbidden to increase onto the amount [needed for] the forbidden action to be done, even though that [that in this case cutting the stem with three] is not increasing the amount of effort needed for the action being that [all three figs will be cut] simultaneously.

If the matter is urgent: [16] Nevertheless if the matter is urgent then we are not particular about this so one not come to push it off and delay it.

 

Summary of must a treatment that does not involve Shabbos desecration be given over one that does: If one can do a treatment without transgression that will take a little more time than doing a treatment with transgression, then if there is no danger in this short delay, one must do the former.[17] Certainly then if one can do a permitted or forbidden treatment and neither take more time than the other, one must do the permitted treatment. Nevertheless, if the matter is urgent then we are not particular about this so one not come to push it off and delay it.[18]   Q&A What’s Halachically better, to drive to the hospital oneself or to call an ambulance?[19] Emergency: In all cases of emergency that medical assistance is immediately required even prior to reaching the hospital then obviously an ambulance is to be taken. Non-Emergency: If the matter is not this urgent then it is better for a religious Jew to drive the patient to the hospital rather than call an ambulance.[20] [However see footnote with regards if one knows that the driver is a gentile[21]]. However, if no religious Jew is available to drive then it is better to call an ambulance then have a non-religious Jew do the driving.[22] If a light needs to be turned on and one has different options of which light to use is there preference of one type of light over another?[23] Yes. It is better to turn on a fluorescent light then to turn on a regular light bulb. As well it is better to turn on a smaller light bulb then a larger light bulb. Q&A with regards to getting help from neighbor in order to prevent desecration of Shabbos Should one ask a neighbor to drive the patient to the hospital rather than call an ambulance?[24] One is not obligated to ask his neighbor to drive the patient to the hospital if his neighbor is currently sleeping or if by doing so his neighbor will end up being stuck away from his family for Shabbos. Must one drive his sick neighbor to the hospital in order to prevent an ambulance from being called?[25] One is not obligated to drive the patient to the hospital if by doing so he will end up being stuck away from his family for Shabbos. Nevertheless, as a meticulous act of kindness and sanctification of G-d’s name it is best for one to help diminish as much desecration as possible.   Must one provide his Shabbos food for his sick neighbor in order to prevent them from needing to cook food on Shabbos?[26] One is not obligated to provide his neighbor with hot food or his candles and the like in order to prevent the neighbor from needing to desecrate Shabbos. Nevertheless, as a meticulous act of kindness and sanctification of G-d’s name it is best for one to help diminish as much desecration as possible.

 

C. Must one do the Biblical prohibitions involved in the treatment with an irregularity?[27]

Note: The dispute brought below is brought by Admur in conjunction with the two opinions mentioned in Halacha 2. The 1st opinion here is in accordance to the First opinion there and the second opinion here is the same opinion as the second opinion there!

First Opinion-No need for irregularity:[28] [One need not do the forbidden actions using an irregularity[29].]

The reason for this allowance is: because since the only option in saving him is through doing an action which is forbidden on Shabbos, therefore Shabbos is overruled on his behalf for [all] Jews which are obligated to save him and there is thus no transgression of Shabbos here at all.

Other Opinions[30]– Do the labor with an irregularity: [However] there are opinions which say that since [in life threatening cases the] Shabbos [prohibitions] are [merely] being overruled and the [holiness of Shabbos has not been] revoked at all, [therefore] whatever [treatment] is possible to be done without Biblically transgressing [Shabbos] is required to be done through not transgressing a Biblically forbidden action and therefore if one is able to do [a transgression] without suspension and delay through an irregular form [of action used for that transgression], then one is to do it with an irregularity, as when done so there is no Biblical transgression.

The Final Ruling: The main Halachic opinion is like the first opinion[31], although the custom in these countries is like the latter opinion. Nevertheless, it is best not to follow this custom[32] because there is worry that perhaps since people will now see that the treatments are only done through a gentile, they will come to think that it is always forbidden to do so through a Jew, and occasionally there will not be a gentile available and the ill person will be endangered as a result of their delay in waiting for the arrival of a gentile. [However, regarding the dispute in doing the actions with an irregularity the Alter Rebbe here does not give a final ruling, and one thus is to be stringent when there is no delay involved in doing so.[33]]

Those who follow the custom must announce to all: At the very least one who wants [to follow the custom, when one does the action with an irregularity, he is to announce that in truth it is permitted to do even without an irregularity[34].]

Summary-Must one do the Biblical prohibitions involved in the treatment with an irregularity?[35] If doing so will delay the treatment, then one is to do so regularly. If not, then it is disputed whether it must be done with an irregularity [and one should be stringent regarding a Biblical prohibition[36]]. Q&A In cases that an action may only be done with an irregularity, what is defined to be an irregularity? One is to ask a Rav what is considered an irregularity for each particular forbidden action that he must do.[37] Is doing an action with two people if it is normally done alone considered an irregularity?[38] Some Poskim[39] rule it is considered an irregularity and therefore all forbidden acts that need to be done should, if possible, be done jointly with two people. Such as they lift the telephone off the hook together. Others[40] however argue that this does not constitute an irregularity as one is in any case still Biblically liable by a prohibition done jointly, as well as the exemption does not apply to simple acts such as lifting the telephone[41]. How may one dial the telephone with an irregularity?[42] Some Poskim[43]  say one is to have two people lift it together. Others say[44] that it should be lifted using one’s elbows and the like.

D. May non-urgent actions be done?[45]

The allowance to do everything that is normally done on a weekday: [One may make for him] foods and remedies which are good for a sick person, even if there is no danger at all involved in refraining from doing [these actions], as nevertheless there is danger involved in his illness.

Other Opinions regarding doing actions which are not a necessity: [However] there are opinions which say that even in a scenario that one needs to desecrate Shabbos a Jew is only allowed to do those forbidden actions which there is possibility that a lack of doing them can put him in danger. However, any action that if refrained from doing will not cause danger, then even though the patient requires it and it is accustomed to do so for him during the week one may only do so on Shabbos through gentiles as is the law by the needs of any sick person which is not in danger.

The Final Ruling: (One is to follow the latter opinion in these provinces which are likewise accustomed to be strict even regarding an action in which there is danger if refrained from doing, to not do so through a Jew so long as it could be done through a gentile without any wait and delay at all as will be explained [in 328/13], thus by an action in which refraining from doing involves no danger at all one is to do it through a gentile even if there is suspicion that he may take his time doing it. However, if there is no gentile available at all then one may rely on the first opinion, although nevertheless every meticulous person should worry for himself regarding [transgressing] a Biblical prohibition).

 

E. An example of the above dispute in D-Lighting a bonfire for a lethally ill person over warming him with clothes:[46]

One who let blood: One who has had his blood let and became cold is considered to be in [lethal] danger and one is to make for him a bonfire on Shabbos even in the season of Tammuz [the hottest summer month].

Other ill people: However, for other sick people even though they are lethally sick, nevertheless [since] the coldness is not a danger for them as it is possible to warm them up with clothing, therefore one may only make a bonfire for them through a gentile, unless there are no [available] clothes to warm them up with.

Other Opinions: [However] according to those opinions which say any deathly ill person may have done for him through a Jew anything that is normally done during the week [for ill people], even if refraining from doing a particular matter will not cause him danger, (then nevertheless) [here too] one is also allowed to make a bonfire for the patient through a Jew as is done during the week.

The Final Ruling: (It was already explained [above Halacha D] how one should follow in these countries).

Summary of D/E-May non-urgent actions be done? All actions that are normally done during the week for this type of patient, which are insignificant for his survival, and thus he will live even without these actions being done, one is to only do them through a gentile. If no gentile is available then he may do so himself, although a meticulous person should worry of a possible Biblical prohibition in doing so.[47] Thus if the patient can be warmed up with clothing, then it is forbidden [based on the custom in these countries] to light a fire for him through a Jew but rather only through a gentile.[48]   Q&A May one travel to a hospital of their choice or must they go the closest available hospital?[49] One may travel to whichever hospital he/she feels that they will receive the best medical treatment or care. However, one may not travel to a further hospital simply to save money. May the relatives of a deathly ill patient be alerted to come visit him?[50] They may be alerted through a gentile and may come to visit the patient through being driven by a gentile, although must make sure to not transgress any Shabbos transgressions in the process, such as carrying, lights of car etc.] If the medical doctor however says that their visit is a matter of life and death for the patient [meaning that if they do not visit him his illness may become more severe] then the relatives may do whatever is needed to get there even if it involves Biblical prohibitions. May a relative or friend accompany the patient to the hospital?[51] Any relative or friend who will help the patient keep calm may travel with them. This applies even if there are other people in the car, such as a medic or EMT, and even if the patient says that he/she does not need the escort of the relative or friend.[52] [However care must be taken to avoid Chilul Shabbos in the process, such as not to carry items with him/her if there is no Eiruv.] However, there are Poskim[53] which are less lenient and only allow an escort in a case that the patient is asking for one, or is evident that she needs it.                                                   May a Tzaddik or Torah Scholar be alerted to pray for the patient if doing so involves prohibitions?[54] Such as sending a gentile to give a written note to the Tzaddik and the like. If doing so will calm the patient down, then the prohibitions involved may be done through a gentile. If the patient however asks for this to be done and the medical doctor says that it is a matter of life and death for the patient [meaning that if they do not visit him his illness may become more severe] then they may do whatever is needed to reach the Tzaddik, even if it involves Biblical prohibitions.   May a doctor/EMT which drove a patient to the hospital return home on Shabbos?[55] See Halacha 6 Q&A there! May one who was released from a hospital on Shabbos return home on Shabbos?[56] It is forbidden for one to drive back home. Although if there is no comfortable area where one can wait until after Shabbos[57] there is room to allow him/her to have a gentile drive her home, so long as her house is within Techum Shabbos.[58]

F. May a kosher animal be slaughtered if there is non-kosher meat readily available?[59]

If there is a deathly ill person [above the age of Mitzvos[60]] which needs meat and there is no kosher meat available, then] one slaughters [a Kosher animal or bird] for him.

The reason that: we do not say that he should be fed non-kosher food which contains only a prohibition of a negative command [without the capital punishment] rather than transgress Shabbos which is a prohibition [which contains the penalty] of stoning, [is] because Shabbos has already been overruled with regards to lighting the fire and cooking [the meat].

Another reason: As well, in [eating] non-kosher meat one transgresses on every single kezayis [of meat eaten] and even if one were to [verify that the ill person only] eat less than a kezayis [within the time of Pras], [nevertheless] there is [still] a Biblical prohibition [being transgressed] with every single bite [of the meat]. On the other hand, by slaughtering, one is only transgressing a single prohibition although that it is [more] severe.

Another reason: Furthermore, perhaps the sick person will be disgusted in eating non-Kosher food and will refrain [from eating it] and will thus be endangered.[61]

If one needs to eat meat immediately: Nevertheless, if the sick person needs to eat right away and the non-kosher meat is readily available and the slaughtered meat will be delayed [in arriving to him], then he is to be fed the non-kosher meat.

If one needs boiled wine for a deathly ill person: However[62] if [the ill person] needs wine to be heated up for him, then a Jew should fill up [the pot with the wine so that the wine not become Yayin Nesech] and based on the custom explained above [in Halacha 13] the gentile should heat it up supervised [by the Jew] (see Yorah Deah chapter 153 and 155) that he [the gentile] not touch [the wine] prior to it reaching a boil[63], and even if he touches it there is no problem involved, as even so there will only be a Rabbinical prohibition [involved in drinking it]. This is opposed to if the Jew heats it up in which case, he will be doing a Biblical transgression [and thus according to the custom explained above it is better to have a gentile cook it and take the chance of him touching it. However, based on the above ruling that one should not follow this custom and rather do the transgression himself, the same applies in this case].

There is no need to worry that [if the gentile were to touch it] perhaps the sick person will be disgusted in drinking it being that its prohibition is not so severe.

 

Summary of Kosher verses non-Kosher food: If the patient does not need to eat urgently, then one is to provide him with Kosher food despite non-kosher food being readily available, even if proving the kosher food involves a Shabbos prohibition.[64]   Q&A May one salt the meat to remove its blood?[65] Some Poskim[66] permit this to be done. Others[67] only permit this to be done through a gentile as the prohibition of eating cooked blood is only Rabbinical. Is there a Halachic difference between slaughtering a cow and a chicken if both are available?[68] No, as the transgression of killing an animal is equal to both. Nevertheless, there are those[69] which are stringent.

___________________________________________________

[1] Admur 328:2

^[2] Admur 328:2

[3] Piskeiy Teshuvos 328:4 [old] 328:5 [new]

[4] Radbaz 1436; 1526 [2:153] based on Rambam Pirush Hamishnayos Yuma 8:4

[5] The reason: As the treatments that are based on Segula are mild and don’t work well. [Radbaz 1436] Alternatively, the Rambam holds that these treatments don’t really help and are not a Refua at all. [Radbaz 1526]

[6] Rashba 1:413; 167; 865; 4:245; Tzemach Tzedek 38; Many Poskim in Piskeiy Teshuvos ibid

[7] So rules Tzemach Tzedek ibid and majority of Achronim

[8] Piskeiy Teshuvos 328:4

[9] Radbaz 1436; 1526 based on Rambam Pirush Hamishnayos Yuma 8:4; Uvacharta Bachaim [Rav Shlomo Kluger 87]; Shevet Halevi 5:55; Tzitz Eliezer; See Nishmas Avraham 301 p. 285

[10] So rules Tzemach Tzedek 38

[11] So rules Tzemach Tzedek ibid and majority of Achronim

[12] Shevet Halevi 5:55; Piskeiy Teshuvos 328:4 [old] 328:5 [new]

[13] Vetzaruch Iyun why not just say like Admur that it may be done if “is either being administered by an expert, or is known to be able to cure the person.”

[14] Admur 328:13

[15] Admur 328:18

[16] Admur 328:18

^[17] Admur 38:13

[18] Admur 328:18

[19] Piskeiy Teshuvos 328:13

[20] As by doing so one diminishes in the transgression of making the phone call, as well as the ambulance drivers usually are not careful in matters of desecration of Shabbos which are not needed, such as driving back to the station, while a religious driver will be. [Now, although the Ketzos Hashulchan 140: footnote 3 rules the opposite that it is better to take an ambulance then to have one drive, this was only because back then the cars would drive back home, which was forbidden, while the ambulances would drive back to their station which was permitted due to that they need to be on call. However today even the Ketzos Hashulchan would agree that it is better for a religious Jew to drive as the religious driver will not drive back home. Thus, there is desecration of Shabbos being saved.]

[21] Tzaruch Iyun if according to Admur which rules that a Jew is to do the desecration over a gentile, if this applies even in this case [that a Jew should do the driving rather than call a gentile ambulance] being that here people will simply think that the gentile ambulance was contacted not because that a Jew cannot do the driving but rather because it is an emergency, and there is thus no longer a worry that people may come to think that the Jew cannot drive. Furthermore, it is evident to all that the Jew had to call the gentile ambulance and it is thus evident to all that a Jew may desecrate Shabbos to save a life. Thus, it seems clear that in a case that a gentile ambulance driver is available he should be contacted rather than have a religious Jew drive to the hospital, being that although one adds in the phone call he nevertheless diminishes the entire transgression of driving. To note that so rules Piskeiy Teshuvos 328:13

[22] As he will do extra Shabbos transgressions unnecessarily.

[23] Piskeiy Teshuvos 328:14

[24] Piskeiy Teshuvos 328:13; SSH”K 40:72

[25] Piskeiy Teshuvos 328:13; SSH”K 40:72

[26] Piskeiy Teshuvos 328:13; SSH”K 32:74

^[27] Admur 328:13

[28] The first opinion is the view of the Michaber [12] in the name of the Rambam.

[29] Although Admur does not mention this explicitly in the 1^st opinion, nevertheless, so is implied from Admur in a) the reasoning of the first opinion with regards to having a Jew do it over a gentile implies this to be the case as well regarding an irregularity. B) In the second opinion there Admur states that their ruling of having a gentile to so over a Jew is a result of them holding that an irregularity must be done, thus implying that the 1^st opinion does not hold that an irregularity must be done. C) So learns Ketzos Hashulchan mentioned below.

^[30] Rama, in the name of the Ramban and Or Zarua. The first opinion is the view of the Michaber [12] in the name of the Rambam.

^[31] So rules Tzemach Tzedek O”H 38; Minchas Yitzchak 10:31-16

^[32] So rules also Taz and Mishneh Berurah 37, albeit for the reason that the gentile will do so at a slower pace. However according to Admur, even when we know for certain that a gentile will not do so at a slower pace, nevertheless one is to do so himself.

^[33] Ketzos Hashulchan 135 footnote 10. See there for reasoning.

^[34] Ketzos Hashulchan 135 footnote 10.

^[35] Admur 328:13

^[36] Ketzos Hashulchan 135 footnote 10. See there for reasoning.

^[37] Ketzos Hashulchan chapter 134 Halacha 4

[38] Piskeiy Teshuvos 328:8

[39] SSH”K 32:28

[40] Minchas Yitzchak 10:31; Bear Yitzchak 14

[41] Being that the prohibition is not an elongated process, as would be the case by crushing herbs and the like, but is rather a single movement of lifting the telephone, and in such cases, we do not apply the exemption of two people doing it together. [Minchas Yitzchak ibid]

[42] Piskeiy Teshuvos 328:8

[43] SSH”K 32:28

[44] Piskeiy Teshuvos ibid

[45] Admur 328:4

[46] Admur 328:24

^[47] Admur 328:4

^[48] Admur 328:24

Vetzaruch Iyun if in this case that clothing are available, but no gentile is available, if he himself may light the fire and follow the Michaber? How would the Alter Rebbe rule in this case that in any event?

[49] Piskeiy Teshuvos 330:3

[50] Piskeiy Teshuvos 328:4

[51] Piskeiy Teshuvos 330:3

[52] So rules Chazon Ish and Az Nidbaru 1:29

[53] So is implied from Igros Moshe 1:132; Teshuvos Vehanhagos 2:177-Although there he says that by a woman giving birth for her 1^st few times one may be lenient even if she says that she does not need him.

[54] Piskeiy Teshuvos 328:4

[55] Piskeiy Teshuvos 329:5

[56] Piskeiy Teshuvos 330:1

[57] This includes if one will not be able to pray with a Minyan or eat the Shabbos meals. [Teshuvos Vehanhagos ibid]

[58] SSH”K 36:10; Teshuvos Vehanhagos 2:174-However there the allowance is only if the gentile is any ways traveling to their area, or one hints to a gentile ambulance driver to do so. However, to ask a regular gentile to drive them back he does not allow.

[59] Admur 328:16

^[60] See end of next note

^[61] Each one of these three reason is itself enough of a reason to slaughter the animal rather than feed non-kosher food to the patient. [Ketzos Hashulchan 135 footnote 6]. The Ketzos Hashulchan [135 footnote 6] adds another two reasons 1) The Mordechay says because eating non-kosher food is looked down upon [even in such a scenario]. 2) The Nitziv writes that non-kosher food creates evil tendencies in one’s nature. Regarding a child, the Ketzos Hashulchan [there footnote 8] based on Mishneh Berurah rules that one is to rather feed him non-kosher then to slaughter for him on Shabbos.

^[62] Meaning that in the following case it is better for the Jew to eat non-kosher rather than have a Jew transgress a Shabbos prohibition.

^[63] However once the wine has reached a boil it is no longer prohibited by the touch of a gentile.

^[64] Admur 328:16

[65] Piskeiy Teshuvos 328:12

[66] Daas Torah 14; Maharam Shik 138

[67] Beis Shearim 111

[68] Piskeiy Teshuvos 328:12

[69] Kaf Hachaim 328:87