Professor A. S. Abraham, M.D., F.R.C.P.
Director of Internal Medicine B, Shaare Zedek Medical Center, Jerusalem

Excerpted from the author's handbook, Halachot for the Physician on the Sabbath and Festivals.

Differences between the Sabbath and Festivals
1. There are no major differences between the rules governing the physician's actions on the Sabbath or on the Festivals. Nor is there a basic difference between the first and second days of the Festivals (in the Diaspora), except for the fact that that which is forbidden to be done for a patient on the first day of the Festival, is permitted on the second day provided the act only involves a Rabbinical prohibition. However, there is no such difference between the first and second days of Rosh Hashana. 1 Therefore, whenever I have used the word "Sabbath," my intention is, unless otherwise stated, to include the Festivals.

2.  It is one's duty to set aside the laws of the Sabbath, including those involving acts that are ordinarily forbidden by the Torah, in case of danger2 or possible danger to human life. 3 In doing this one should be as alert and act as speedily as possible. 4 One who delays setting aside the Sabbath laws in order first to consult competent halachic authority is considered as having "shed blood," because such delay may indeed result in a deterioration of the patient's condition. 5 However, when there is no risk of danger to life in taking time to consult a competent halachic authority, it should be done. 6

3.  Thus wrote Maimonides: When the laws of the Sabbath are set aside for a seriously ill person, this should not be given over to non-Jews, minors, servants or women, lest they should come to regard Sabbath observance as a trivial matter, but this is to be preferably done by adult Jews and Sages. Furthermore, it is forbidden to delay setting aside the Sabbath regulations for the sake of a person who is seriously ill, for Scripture says (Leviticus 18:5): "Which if a man do he shall live by them," that is to say, he should not die as a result of observing them. Hence, we learn that the ordinances of the Torah are meant to bring to the world not vengeance, but mercy, loving-kindness and peace. It is heresy on the part of those who claim that such behavior is a violation of the Sabbath and therefore pro- hibited. Of them Scripture says (Ezekiel 20:25): "Wherefore I also gave them statutes that were not good, and ordinances whereby they should not live." 7

4.   One must do everything necessary to cure, or to pre- vent deterioration of the condition of a seriously ill patient, and set aside any otherwise prohibited acts, even if it is uncertain whether such an act would actually re- move or minimize the danger. 8

5.   The Sabbath rules are set aside for a seriously ill patient even if only to prolong life for a short while9 and even if the patient is near death. 10

6.   Although throughout this book I have written that whenever one has to set aside Torah prohibitions for a seriously ill patient, one should try and do so through a non-Jew or in a manner different from that used on a weekday, this ruling is only according to the Rama11 and the Mishnah Berurah. 12 However, according to the Rambam, 13 the Shulchan Aruch14 and the Taz, 15 one should personally do whatever is necessary for the benefit of a seriously ill patient and in the normal manner as on a weekday.

This latter ruling, however, applies only to acts directly affecting the patient's needs. Acts which are not part of the actual and immediate treatment of the seriously ill (or possibly seriously ill) patient - such as writing in the patient's chart, recording his temperature, pulse, etc., or turning off the light so that he may sleep - may, even according to this opinion, only be done by a non-Jew, or, if by a Jew, in an indirect manner. 16

What is Permitted
7.  The seriously ill patient or one who is probably so, for whom time is of the essence, and who requires immediate assistance, must be treated without hesitation exactly as on a weekday - and without qualms. With reference to such a case the Shulchan Aruch states: He who acts im- mediately is praiseworthy whereas he who takes time in order to obtain a halachic decision is as if he "sheds blood." 17 How- ever in the case of a seri- ously ill patient for whom immediate treatment is not vital, one should consult rabbinic authority as to what and how things should be done. Should such opinion not be available (for any reason) treatment of all kinds should be given without delay or hesitation. 18

8.   The patient with a serious psychiatric illness that may lead to danger to him or to others, is considered to be in the category of a seriously ill patient and Sabbath laws are set aside as necessary.

9.   The endangered limb. Whenever a limb is endan- gered such that there is a possibility that this may threaten the patient's life, everything necessary for his treatment is carried out. 19

10.   A patient whose eye [or his sight20 ] is endangered is considered a seriously ill patient. 21

11.   The non-seriously ill patient. One may instruct a non-Jew to care for such a patient - as necessary - even if the care involves setting aside a Torah prohi- bition. 22 However, a Jew may only perform an act which is Rabbinically prohibited and, where possible, in an in- direct manner. 23

Child. One may do whatever is necessary for the well-being of a child (up to the age of 9 or 10, depending on his development), in the same manner as one does for a non-seriously ill patient - provided there is real need and there is no way of treating him without setting aside Rabbinical prohibitions. 24

12.   The patient with a minor illness or aches and pains. Such a patient may not be treated on the Sabbath by a Jew, even if this involves setting aside a Rabbinic pro- hibition only, nor may he take any medication. He may, however, be treated by a non-Jew if this involves a Rabbinic prohibition only. 25

Regarding a child with a minor illness, see par. 11.

For further details see Nishmat Avraham. 26

13.    Remember always, every act (as per the rules enumerated above) on behalf of the patient is not a "desecration" but, on the contrary, is a sanctification of the Sabbath. 27

Washing of the Hands
14.  A physician who needs to wash his hands before or after examining a patient on the Sabbath, should pref- erably use a liquid soap. If this is not available, he may wash his hands with ordinary soap, preferably under a running faucet. 28

Hot water from a boiler which automatically refills with cold water may not be used if the patient is in the cate- gory of the non-seriously ill, 29 unless the tap was opened (and closed) by a non-Jew. It is preferable not to even use hot water from a solar heater. 30 If the patient is seriously ill, the physician may open the hot water faucet (if possible, in an unusual manner) in order to wash his hands before examination or treatment of the patient; however, a non-Jew should be asked to close the faucet. 31 If, however, it is even remotely possible that more hot water will be needed during the Sabbath for such a patient, the faucet may be closed by the physician. 32

After the examination or treatment, even of a se- riously ill patient, a non-Jew should be asked to open (and later close) the faucet in order to enable the physician to wash his hands. 33

On Festival days hot water from any source may be used as usual. 34

Putting Up a Partition
15.  It is permitted to open a folding partition on the Sabbath to place round a patient's bed so that he may rest, or in order to examine or treat him in privacy. Sim- ilarly it is permitted to draw curtains that are fixed to the wall around the patient's bed. 35

Examining the Patient
16.  Physical examination of a patient is permitted on the Sabbath as on a weekday - to include pulse, tempe- rature, and blood pressure. 36 The type of contact thermo- meter which is blank before use and on which figures can be seen only after it has been in contact with the skin, may not be used on the Sabbath un- less the patient is seriously ill and it is not possible otherwise to take his temperature. 37

17.   A non-Jew must be asked to record the important details of the history and physical. If a non-Jew is not available and the patient is seriously ill, and there is therefore a possibility that the patient - because of the absence of notes in his chart - might not receive ap- propriate treatment on the Sabbath, the physician should record the important information concerning the patient in the chart, writing with his left hand (if he is right- handed). However, if time is short, as there are other patients who might be seriously ill who need to be examined and treated, he may write even with his right hand. It is preferable to record the physical findings as line diagrams with brief notes rather than write out full notes. 38 If the patient is not seriously ill a non-Jew may be asked to record the findings, but the physician himself may not do so even with his left hand. 39

18.   If the head-piece of the stethoscope becomes de- tached from the rubber tubes, it may not be reattached; another stethoscope should be used. 40

Ancillary Investigations
19.  All ancillary investigations that may help in the di- agnosis or treatment of a se- riously ill or possibly seriously ill patient should be performed on the Sabbath, even if they involve setting aside Torah pro- hibitions. This includes drawing blood from a patient, perform- ing X-rays and cardiograms, etc. On the other hand one is not permitted to perform "routine" tests (for example an ECG or chest film) unless there is the slightest suspicion of relevant pathology. When drawing blood, one may only draw the amount necessary for diagnosis and treatment.

20.  One may use electrical instruments in order to ex- amine a seriously ill or possibly seriously ill patient. Thus the examination of the throat, ear drums and fundus are all permitted. The instrument should be switched on by a non-Jew, or by the physician in an unusual manner (using the dorsum of the finger or hand) unless time is of the essence (see paragraph 6). A non-Jew should be asked to switch off the instruments at the end of the examination or the physician should switch them off (in an unusual fashion using the dorsum of the finger or hand), if it is likely that they will be needed again that Sabbath 41 . This includes battery operated instruments. 42

21.   During endoscopic or bronchoscopic examination it is permitted to photograph the findings, using camera, tape or video, if necessary for future follow-up comparisons, even if these will not be used that Sabbath. This is not how- ever permitted for teaching purposes. The films may not be developed on the Sabbath43 unless they are needed for im- mediate patient care on the Sabbath itself. Biopsies may be taken as usual and put into the appropriate media. 44

22.   One may wash instruments such as endoscopes and bronchoscopes after use in order to prevent clotting of re- maining blood within the instrument. Where possible, how- ever, a non-Jew should be asked to do so.

23.   It is permissible to perform an ECG on a patient who may be seriously ill, preferably using a computerized model. Where possible, this must be done by a non-Jew or the machine activated in an unusual manner (using the dorsum of a finger or hand). Jelly for good electrical contact may be used as required. 45

It is similarly permissible to perform cardiac angio- graphy on such a patient where the indication is urgent and the procedure cannot be safely postponed until after the Sabbath.

24.   All urgent X-rays, C.T.s, M.R.I.s or radionuclide scans may be performed as necessary for a seriously ill or possibly seriously ill patient. They may be carried out to substantiate or negate a diagnosis or for treatment, for example to perform a controlled drainage procedure. If possible the light in the viewing box should be turned on by a non-Jew or in an indirect manner (dorsum of hand or finger). The screen should not be extinguished after use.

25.   One may carry out ultra-sound examinations or vas- cular studies (Duplex, etc.) on a patient who may be se- riously ill; the findings may be photographed if necessary for follow-up. Jelly for good electrical contact may be used as required (see ref. 45).

26.   When using a microscope to examine a urine, blood or sputum smear or any other fluid for a seriously or possibly seriously ill patient, it should be switched on in an indirect manner (using the dorsum of the hand or finger). The intensity of light should be regulated by changing the distance of the condenser from the slide and not by changing the intensity electrically. Preparation of the slide which involves drying it above a naked flame, fixation and staining of the specimen are all permissible for the diag- nosis and/or treatment of a seriously or possibly seriously ill patient, although, where possible, this should be done by a non-Jew.

27.   Investigations such as X-rays or ECGs may not be carried out on the Sabbath for routine or medico-legal reasons only, but should be delayed till after the Sabbath. However if there is any possibility whatsoever that their performance may help in the diagnosis or treatment of a seriously or possibly seriously ill patient, they must be carried out.

  1. Shemirat Shabbat Kehilchatah 31:27-28.
  2. Orach Hayim (O.H.) 328:2.
  3. O.H. 328:5 and Mishnah Berurah 328:17.
  4. O.H. 328:2.
  5. Mishnah Berurah 328:6.
  6. See Aruch ha-Shulchan 328:2.
  7. Hilchot Shabbat 2:3
  8. Shemirat Shabbat Kehilchatah 32:18.
  9. O.H. 329:4; Shemirat Shabbat Kehilchatah 32:2.
  10. Be'ur Halachah 329 s.v. elle; Shemirat Shabbat Kehilchatah 32:12.
  11. O.H. 328:12.
  12. Mishnah Berurah 328:14, 328:35.
  13. Hilchot Shabbat 2:3; see sect. 2 above.
  14. O.H. 328:12.
  15. Quoted in Mishnah Berurah 328:37.
  16. Rabbi B. Z. Abba Shaul, Responsa Or le-Tsiyyon 2:36 (2). Rabbi Shlomo Zalman Auerbach concurred in an oral communication. See Mishnah Berurah 278:1; Nishmat Avraham vol. 5, O.H. 328:2.
  17. O.H. 328:2 and 328:13.
  18. Oral communication from Rabbi Y. Y. Neuwirth.
  19. See Nishmat Avraham vol. 1, 328:46 (=p. 195).
  20. May lead to a serious illness. Rabbi Y. Y. Neuwirth concurred in an oral communication.
  21. O.H. 328:9 and Mishnah Berurah 328:22.
  22. Mishnah Berurah 328:47.
  23. O.H. 328:17 and Mishnah Berurah 328:57 (cf. 328:102).
  24. Shemirat Shabbat Kehilchatah 37:2.
  25. O.H. 307:5 and Mishnah Berurah 307:21.
  26. See vol. 4, O.H., introduction to 328.
  27. Or ha-Chayyim on Exodus 31:14.
  28. Shemirat Shabbat Kehilchatah 40:11.
  29. See Shemirat Shabbat Kehilchatah 1:39.
  30. Written communication from Rabbi Y. Y. Neuwirth.
  31. Written communication from Rabbi Y. Y. Neuwirth.
  32. Rabbi Shlomo Zalman Auerbach; Lev Avraham vol. 1, p. 15 (note on 6:22).
  33. Oral communication from Rabbi Y. Y. Neuwirth.
  34. Shemirat Shabbat Kehilchatah 2:7.
  35. Shemirat Shabbat Kehilchatah 40:42.
  36. Shemirat Shabbat Kehilchatah 40:2. See his discussion of the use of thermometers.
  37. Shemirat Shabbat Kehilchatah 40:2 (note 8* quoting Rabbi Shlomo Zalman Auerbach).
  38. Oral communication from Rabbi Y. Y. Neuwirth.
  39. O.H. 328:17 and Mishnah Berurah 328:47.
  40. See O.H. 313:6 and Be'ur Halachah 313 s.v. darkah; oral com- munication from Rabbi Y. Y. Neuwirth.
  41. Oral communication from Rabbi Shlomo Zalman Auerbach.
  42. If he does not switch it off and will therefore have to exchange the batteries, he will probably be in violation of the prohibition of build- ing; oral communication from Rabbi Shlomo Zalman Auerbach.
  43. Resp. Har Tzvi Y.D. 230; Resp. Shevet ha-Levi 1:121 (3); see Nishmat Avraham vol. 1, O.H. 340:6 (= p. 248).
  44. Nishmat Avraham vol. 2, Y.D. 349:2(6) (= p. 258) and vol. 4, O.H. 321:1 (= p. 32).
  45. Oral communication from Rabbi Y. Y. Neuwirth; cf. Shemirat Shabbat Kehilchatah 40:31.
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