Caring for the Sick on Shabbos - Rabbi Yosef Yitzchok Feiglestock shlita

00:02 Speaker 1 You’re listening to “Lema’an Yishme’u,” a podcast of Machon Halacha Chabad.

00:09 Speaker 2 Today we’ll talk about a dangerously ill person for whom Shabbos may be violated. We’ll focus mainly on what defines a dangerously ill person. This is very, very important. The Alter Rebbe writes in section 328, paragraph 2: If someone has a life-threatening illness, it is a mitzvah to violate Shabbos on their behalf, and the quicker one acts, the more praiseworthy it is. Someone who asks a rabbi whether it is permissible to violate Shabbos is considered to be shedding blood, because the patient might die while waiting for the rabbi’s answer. And the one who is asked—the rabbi who receives the question—is blameworthy. Why? Because he should have taught publicly that it is permitted. In other words, this is something a rabbi must teach the community before anyone asks. He cannot wait for a question to arise, because when it does, asking could cost a life. People need to know the answer beforehand, so that if the situation arises, they know immediately what to do and do it. And this applies even when there is doubt about the danger to life. There can be all kinds of doubt. One question is whether the person is in danger at all. Perhaps if I sit and do nothing, they’ll live anyway. That is a case of possible danger to life. Or perhaps the person is dying, but it is uncertain whether the treatment—what I’m going to do—will save them. That, too, is a case of possible danger to life. So even when there are multiple uncertainties, the Alter Rebbe says, Shabbos is violated on their account, as it says, “which a person shall do and live by them.” What does “and live by them” teach us? That a person must be certain to remain alive while observing the mitzvos, rather than be brought into possible danger by doing so. This isn’t only about Shabbos. It applies to all the Torah’s mitzvos except for three:

02:38 Speaker 2 All the mitzvos are set aside to protect a Jew’s life. That is, if there is a possibility that a Jew’s life will be endangered, all the Torah’s mitzvos are set aside except for three: forbidden sexual relations, murder, and idol worship. Those are the only three mitzvos that apply even where a life is at stake. We won’t go into that today; we’ll give a separate class on each of those subjects. Today we’ll focus mainly on Shabbos. Previously, I gave a class about asking a non-Jew to do something when someone is ill but not in danger. In that case, all the person’s needs can be taken care of by asking a non-Jew. For a dangerously ill person, all their needs are taken care of by an adult Jew. The Shulchan Aruch then says that if there is a choice of who will violate Shabbos—a man or woman, a minor or an adult—it is preferable for an adult to do it. If there is a Torah scholar and an ordinary person, the scholar should do it. That way, people will know that when there is danger to life, violating Shabbos is not something to leave only to a non-Jew, a child, or a woman. No, it is a mitzvah for an adult to do it. People should know that this is what the Torah commands in the laws of Shabbos. There’s the story of the Alter Rebbe, who violated Yom Kippur for a woman who had given birth. It was a great mitzvah: the Alter Rebbe himself went, lit the stove, and cooked porridge for the woman as she lay in her home on Yom Kippur. Today I want to emphasize this question: What defines a dangerously ill person? Are we talking about someone who isn’t breathing and has no heartbeat, whom people want to resuscitate, calling Hatzalah and the most advanced ambulance to save their life? Is that the dangerously ill person the Torah is talking about? No. No. The Shulchan

05:30 Speaker 2 Aruch talks about an internal wound and all sorts of other things. I won’t use the Shulchan Aruch’s terminology, because you wouldn’t understand it. I’ll speak in our own terms. I would put it this way: Any sick person for whom, during the week, you would stop everything you were doing and take them to the emergency room—even if you wouldn’t call an ambulance, but would drive them in your own car or call a taxi to take them—is a dangerously ill person. That’s the definition. So on Shabbos, too, call a taxi, drive your car, or call an ambulance and take them to the emergency room. Don’t wait until after Shabbos. If you don’t know whether to take the person in, and on a weekday you would call an urgent-care clinic or your health clinic to ask a doctor, “What should I do with this person? These are their symptoms,” then call on Shabbos too. And if the doctor tells you to bring them in—even if the doctor is a non-Jew, or not religious, or whatever—don’t ask, “Is it important enough to bring them in on Shabbos?” That question is out of place. This is what is meant by “the one who asks is shedding blood, and the one who is asked…” The doctor said, “Bring them here. I want to see them.” So bring them on Shabbos, on Yom Kippur, even on Yom Kippur that falls on Shabbos. Whether the driver is Jewish or not doesn’t matter. Bring them. You don’t play games with danger. I’ll tell you something that happened to me. I was here in Israel one Shabbos, and my granddaughter wasn’t feeling well. She was a little girl, a year old. I decided to take her to the emergency room. I didn’t want to call an ambulance; I wouldn’t have considered it. It would take too long for the ambulance to arrive. I was in a remote village. So I called a taxi. The driver answered, “I don’t go into that community

08:17 Speaker 2 on Shabbos. It’s a Haredi community. If I go in on Shabbos, they’ll throw stones at me.” I called another taxi on Shabbos to take my granddaughter and me to the hospital. We would pay him. “I don’t go into a Haredi community on Shabbos.” So I took my own car and drove to the hospital. I brought my granddaughter to the hospital on Shabbos. I could see that trying to arrange it by phone was taking too long. My granddaughter, her mother, and I went to the emergency room. We were there from Shabbos afternoon until the middle of the night—after Shabbos, until around two in the morning. After many tests, the doctor discharged us and sent us home without giving her any medication. He just did a lot of tests and gave her no medication. In other words, if I had stayed home and they hadn’t done any of those tests, the outcome would have been the same. The doctor hadn’t done anything. So why had I violated Shabbos? That’s what I thought. I’d gone to the emergency room and spent about fourteen hours there. They sent her home without giving her any medicine or treatment, only lots of tests. Why had I come? The test results were whatever they were. I didn’t receive them, but the doctors decided to do nothing and send her home. If I’d sat at home, the outcome would have been the same. That’s how I felt. So when the doctor discharged us, I asked him: “Listen, doctor, you didn’t give her any medicine or treatment, only tests. I violated Shabbos. I could have stayed home. I don’t mind that I violated Shabbos, because I did what the Torah says to do: when there may be danger to life, you travel on Shabbos. I didn’t commit a transgression by violating Shabbos; I did a mitzvah. I went to save a Jew’s life. But what I actually did was of no use.” So he said, “You’re right that

10:57 Speaker 2 What you’re saying is true, but if you remember, at seven another baby arrived with his parents. They had waited until after Shabbos. Their tests showed a different problem, and I have just finished signing that baby’s death certificate because they waited until after Shabbos. If they had brought him to me on Shabbos morning, when the first symptoms of the illness appeared, there was a very good chance I could have saved his life with medication. But they waited until after Shabbos, so there was nothing left for me to do but sign the death certificate. That’s why I think you did the right thing by coming. I couldn’t make a diagnosis. How should I put it? I can’t determine what illness this baby has, so I can’t give her treatment. We truly need to pray to Hakadosh Boruch Hu. We doctors are limited; we don’t know everything, though we can try our best. As for your granddaughter, there’s nothing I can do. Whether you had come or not, the outcome would be the same, but the outcome isn’t always this good. So I think you did the right thing by being careful and coming to the emergency room to save your granddaughter’s life. And now, here’s what I recommend you do to save her life: pray for her, because I can’t do anything.” Boruch Hashem, we prayed for her, and the next morning she woke up healthy and everything was fine. But I learned from this not to take lightly what the Shulchan Aruch tells us: we desecrate Shabbos for a person whose life is in danger. What defines a person whose life is in danger? What is the definition today? I would say that today, anyone whose doctor gives them a prescription to buy

13:40 Speaker 2 antibiotics at the pharmacy is a person whose life is in danger. Today life expectancy reaches, let’s say, seventy or eighty, and ninety-nine percent of babies born today live to fifty or sixty, or even thirty years of age. We have almost no child deaths. A hundred years ago, fifty percent of children born did not live past ten. Twenty-five percent died in their first two years, and the other twenty-five percent died in the years that followed, by age ten or eleven. These were childhood illnesses. Take whooping cough, for which they give antibiotics today, or strep, for which they now give antibiotics for seven days. Strep used to cause heart disease. There was no heart surgery. A child with strep could be gone within a year; with whooping cough, within a month. And there were all kinds of illnesses for which we now have vaccines. There was whooping cough, for example, and for strep there are antibiotics. All kinds of medicines have been discovered in our generations for illnesses that killed children a hundred years ago. Vaccines and antibiotics have turned our state of health around by a full 180 degrees. That doesn’t mean a person with strep is not in danger. If we don’t treat him, he may develop heart disease. Then, if we don’t treat him, perhaps surgery will save him. Surgery doesn’t always save a person. But if we give him antibiotics in the first two weeks—in the first week after he gets strep, as soon as he starts running a fever, right?—the chance he’ll recover is 99.9 percent. He recovers without a trace of it remaining, and his heart will never become diseased. In other words, without treatment, he is a patient whose life is in danger. There is a treatment. He doesn’t need to go to the hospital; we don’t need to bring him anywhere. We just notice that the child has a bit of a fever. We look at his throat, and it’s a little red.

16:57 Speaker 2 We take a swab, a throat swab, and send it to the lab. If it comes back positive, meaning he has the illness, we give him antibiotics, and that’s the end of it. But this is a patient whose life is in danger. If we don’t take him to the doctor, do the throat swab and give him antibiotics, he won’t— The question is whether this is a possible danger to life or a certain danger to life. He won’t die tomorrow; he may die in a year or two from all the complications it can cause. That is called a patient whose life is in danger. Yes. In other words, if a child or an adult has a fever and we don’t know why, and on a weekday we would stop what we’re doing and take them to a doctor or to an urgent-care clinic, that is a patient whose life is in danger. We must desecrate Shabbos for them and not take a risk. Is it possible that nothing will happen if we wait until after Shabbos? It’s possible. But it’s also possible that they have a condition for which, if we wait until after Shabbos, the antibiotics will no longer work. You don’t know what the illness is; the doctor hasn’t seen them yet. It’s possible that every hour counts. In most cases, waiting a few hours won’t make a difference, but we desecrate Shabbos even for a remote possibility. We don’t take any chances. If there is even a remote concern that it could become complicated, or that after Shabbos we won’t find a good doctor, or the urgent-care clinic will be closed, or the illness will worsen, or antibiotics will no longer work—those are risks we may not take. Obviously, bleeding that won’t stop, that I can’t manage to stop, is an immediate danger to life. Depending on how severe the bleeding is, within two minutes or five minutes a person could be ready for the cemetery. But that’s not what we’re talking about. We’re talking about a patient

19:39 Speaker 2 whose life is in danger even if we treat him a little later. As in the example in the Shulchan Aruch: a doctor comes and says the patient needs medicine or treatment for eight days, otherwise his life is in danger. We don’t wait until after Shabbos and say we’ll desecrate only one Shabbos for him. We begin treatment immediately, on Shabbos, and desecrate two Shabboses for him rather than risk a possible danger to his life. That is the case in the Shulchan Aruch, right? So we don’t put it off. The life of a Jew is precious in the eyes of Hakadosh Boruch Hu, and the mitzvah of “You shall live by them” is so important that it overrides all the mitzvos of the Torah. If Hakadosh Boruch Hu places such importance on a Jew’s life, we may not take it lightly. We must take it seriously, desecrate Shabbos and set aside all the mitzvos stated in the Torah to save a Jew’s life—even when the danger is only a possibility, or a remote possibility. There is a dispute in the Shulchan Aruch about a patient whose life is in danger who has seen a doctor and been given the treatment needed to save his life. Boruch Hashem, he is taking the medicine and receiving the treatment, and everything should turn out well. Now the patient doesn’t feel so good, and he needs certain things that, even if they aren’t done, his life won’t be in danger—but they would make him more comfortable. Let’s give an example. A patient whose life is in danger is in intensive care. What do you call that in Hebrew? Intensive care, the intensive care unit. Everyone in intensive care is considered a patient whose life is in danger. I’m saying that it’s not only those in intensive care, or those in a hospital ward who meet the definition of a patient whose life is in danger. Children taking antibiotics who are outside playing with their friends, their brothers and sisters, also meet that definition, even though

22:27 Speaker 2 He is eating like a healthy person and playing with all the children like a healthy person, but if he does not take the antibiotics, his life is in danger. So someone in intensive care is certainly in danger; he is a patient whose life is at risk. Now he wakes up and says, “Press the button to raise the head of my bed a little.” The beds there are electric. Is this a need of a patient that does not itself involve danger? If I do not move the bed—raise his head a little, or raise his leg a little, as he feels he needs—nothing will change medically. Lowering his head or his leg as he wants will not put him in danger, but it will make him more comfortable. So may Shabbos be violated for all the needs of a patient whose life is at risk, or only for what is needed to save his life? There are two opinions on this. The Gemara itself rules that if it can be done by a non-Jew without delay and without creating danger, we should try to have a non-Jew do it. Otherwise, a Jew should do it. Yes? There is room to be lenient and have a Jew do it, because all the needs of such a patient are included—even those that are not part of the treatment to save his life. If he is uncomfortable, there may be a chance that this will make his condition worse each day, even if the doctor says it will not. He is uncomfortable. He would be more comfortable if his head were higher or lower, or if he could drink a cup of hot tea when there is no hot water unless we heat it on Shabbos, cook it on Shabbos. So Shabbos may be violated for the needs of a patient whose life is at risk. Regarding the bed, I would certainly rule that way, because moving the bed with the button is certainly

24:59 Speaker 2 only a rabbinic prohibition. There is no travel involved, and there is no non-Jew there; looking for one would cause some delay. So for a rabbinic prohibition, certainly. And I tell all patients, even those in a regular ward, not only in intensive care: if they are alone and want a little water, want to eat, or want to get up to use the bathroom, they should call for help for whatever they need. The patient may think of himself as someone whose life is not at risk. If I tell him that, halachically, he is considered a patient whose life is at risk, he will say, “My life is in danger,” become depressed, and think, “I have no future. I am in a dangerous condition. I am going to die”—and that could itself lead to his death. So I tell these people, “You are almost healthy, but pressing this button to call the nurse, or getting up—whatever you need—is nothing to worry about. It is a rabbinic prohibition, or even less. It is nothing. Call for whatever you need.” Because if a patient feels a little dizzy but does not ring to tell the nurse because it is Shabbos, what then? That feeling of dizziness may mean she has about five seconds before she faints. If she does not ring then, she will not be able to ring afterward: the dizziness will take hold and she will lose consciousness. Two minutes later, we might already have to recite Tziduk Hadin and Kaddish and bring the person to a Jewish burial. This can happen for a number of reasons. One major cause is internal bleeding. The feeling a patient has when internal bleeding may kill him within two or five minutes is dizziness. When he feels dizzy or his vision goes black, he has already lost a great deal of blood. If a nurse arrives within two minutes and gives the patient a blood transfusion, there may still be a chance to save him. After that, there may be nothing to do. So forbidding him to call—which is certainly only a rabbinic prohibition—and saying that it is prohibited is

27:50 Speaker 2 something that creates danger. Therefore, my instruction to anyone in a hospital on Shabbos who has no one there to help is: call the nurse. Do not think twice. Call the nurse just as you would on a weekday, even if there is no Shabbos system and the whole thing—and the rabbis there say it is entirely forbidden. This is not a matter of ordinary Shabbos observance, or of being outside Israel. A person in what people today call a hospital is in a situation of pikuach nefesh according to Torah law. Do not tell the patient that, because it does not help. When patients are told, “This is a case of pikuach nefesh, and Shabbos may be violated for you,” they panic. A layperson’s understanding of pikuach nefesh and of a patient whose life is at risk is as far from the Torah’s definition of danger to life as east is from west. The Shulchan Aruch’s definition of pikuach nefesh and a layperson’s definition are two very different things. So the layperson does not understand: when you say “pikuach nefesh,” he becomes depressed and thinks they will soon be calling the Chevra Kadisha. From the Torah’s perspective, 99.9 percent of patients considered to be at risk recover and, boruch Hashem, go on to enjoy much joy and goodness—because Shabbos was violated and they were treated. Most patients survive. Another day, another week, or another hour, and he will be completely well, because we violated Shabbos and did what needed to be done. That is the definition of a patient whose life is at risk according to the Shulchan Aruch. There are some cases involving danger to a limb rather than danger to life. I will not go into that. There is the Shulchan Aruch, there is the Tzemach Tzedek, there is the... We do not

31:45 Speaker 2 take a lenient approach to the mitzvah of “You shall live by them.” We are stringent about it in every respect, because this mitzvah overrides the entire Torah, and the Torah obligates us to be stringent about “You shall live by them” even when there is doubt, or a more remote doubt. So we are always stringent. We do not take a lenient approach, and we do not take any risks. That is the Torah’s approach. We look for every possible stringency in this matter. Just as we drink only cholov Yisroel and accept only the best kashrus supervision, and perform every mitzvah in the most beautiful way, we should fulfill the mitzvah of “You shall live by them” in the most beautiful way. We should act quickly to ensure that no Jew is exposed to danger in any situation or place. That is the point. I tell rabbis that it is very, very important to speak about this publicly. This is the mitzvah about which the Alter Rebbe says a rabbi must teach publicly. Today, dangerous situations include illness, and a fire can also pose a danger. If a fire breaks out on Shabbos or Yom Tov, there are many circumstances in which lives may be at risk. There is a very great difference between danger to life and danger to property. So rabbis must teach the laws concerning a fire, because that is not the time to ask a rabbi what to do. When I was examined, one of Rabbi Hendel’s questions concerned the needs of the community. That is why one must know these laws by heart, on the spot. Boruch Hashem, I passed that examination and answered all the questions correctly, even though I had not prepared; I did not know that was what he would ask. Today I tell my students who are receiving semicha to prepare and know these questions, because without that they will not receive a certificate. And I say more: questions of pikuach nefesh and a fire on Shabbos are not only for rabbis. Everyone needs to know, and rabbis need to teach this publicly so everyone knows that “one who is asked is blameworthy”—the rabbi should have taught the laws beforehand and did not. So we

35:29 Speaker 2 must teach the Jewish community what to do in practice. These situations arise without warning, so people need to know these things in advance, be prepared for every situation, and fulfill the mitzvos that Hakadosh Boruch Hu commanded us. The mitzvah of “You shall live by them”—may Hakadosh Boruch Hu bless each and every person with health of mind and body, and may no one encounter danger. We should be careful and protect ourselves, fulfilling “You shall carefully guard your lives.” We should make sure there is nothing that poses a danger, as Hakadosh Boruch Hu commanded us: “You shall make a railing for your roof.” We should take care of anything in the home that could pose a danger, installing a railing or whatever else is needed to prevent it. Preventing illness and other dangers—Hakadosh Boruch Hu commanded us to protect every person by being careful. And if something has happened, we should learn from it what we could have done better so that it does not happen again. At the same time, every day we pray, “Heal us, Hashem, and we shall be healed.” Hakadosh Boruch Hu heals the sick, and every day, in the second of the morning blessings, we bless Him as the One “Who heals all flesh and acts wondrously.” Hakadosh Boruch Hu acts wondrously and sends healing even before we arrive: “Who heals all flesh and acts wondrously.”