In cases where there is a real danger to human life on Shabbat, the decision whether to desecrate Shabbat should be made by professionals or others present, and it is forbidden for them to go and ask a Rabbi * Shabbat should also be desecrated to save the life of a non-Jew * If the patients’ illness is complex, one may drive to a more distant hospital that has greater expertise
Saving a life overrides Shabbat, as the Torah states: “Keep My decrees and laws, which a person shall do and live by; I am the Lord” (Vayikra 18:5). The Sages expound: “‘live by’ – and not die by” (Yoma 85b); the mitzvot of the Torah were given so that people may live by them, not die to fulfill them. In a case of uncertainty, we still desecrate Shabbat. For example, if a building collapses, and we do not know whether anyone was inside, and even if someone was inside, we do not know whether he is still alive, we clear away the rubble on Shabbat despite the uncertainty (SA 329:2-5). The act of clearing rubble (“mefakĥin et ha-gal”) lends its name to the general category of piku’aĥ nefesh, which overrides Shabbat.
Even if a rescue attempt fails, God rewards all who made an effort. Similarly, if several people drove to different places to obtain a certain medicine that someone needed, they all receive divine reward, even though some of them traveled for naught (Menaĥot 64a; SA 328:15).
Any illness that doctors normally consider dangerous or that regular people would make haste to save a patient suffering from it, is deemed dangerous halakhically, even if only a small minority of people die because of it, and therefore justifies desecrating Shabbat. One way to assess an illness is to speculate what would be done if on a weekday, in the middle of an important event such as an important meeting or the wedding of a close relative, a certain pain or illness had flared up. If the medical instruction was to stop everything and take the person to a hospital immediately, it should be done on Shabbat. However, if the medical instruction was that it was possible to wait until the end of the event, then this is a sign that it was not a life-threatening situation, and Shabbat should not be desecrated.
Our Sages defined certain conditions as dangerous. These include internal injuries (severe pains or wounds or internal bleeding); injuries on the back of the hand and foot (that is, infections and dangerous cuts); very high fevers; scorpion or snakebites; and eye afflictions (SA 328:3-9). The Sages determined all of these cases based on experience, and today’s doctors agree in principle, though they use different terminology to describe the conditions. The general principle is that if those present think that the ill or injured party might be in mortal danger, they immediately do whatever is necessary to help him. If they need to call a doctor, they should do so; if they need to drive him to the hospital, they should do so.
When people nearby do not know whether the patient might be in danger, they should ask a doctor, nurse, or medic in the vicinity, or they should call a doctor (Peninei Halakha: Shabbat 27:2).
Do Not Ask a Rabbi
If, in an effort to be pious, one asks a rabbi whether to desecrate Shabbat in order to help someone in mortal danger, he is a killer, for while he is asking, the patient’s situation is liable to deteriorate, and the Torah commands us: “Do not stand idly by the blood of your neighbor” (Vayikra 19:16). Furthermore, the rabbi whose students ask such questions is reprehensible, as he should have taught them that saving a life overrides Shabbat (y. Yoma 8:5; MB 328:6).
Indeed, from time to time I mention in classes not to come to me with urgent questions, because since a rabbi is not a doctor, paramedic, or a commander, he cannot answer urgent questions (the most urgent questions are about abortions, and in such cases, there is usually an interval of a couple of days to clarify the issue).
For Whom is Shabbat Desecrated?
Indeed, our Sages offered a rationale for desecrating Shabbat to save someone’s life: “Desecrate one Shabbat so that he will observe many Shabbatot” (Yoma 85b). However, in practice, even when it is clear that the person being saved will not observe Shabbat, one is commanded to desecrate Shabbat to save him because the Torah strives to increase life. Therefore, we desecrate Shabbat to save a mentally impaired person (shoteh), who is exempt from observing the mitzvot. Similarly, we desecrate Shabbat for someone who is unconscious and about to die, in order to prolong his life for a short while (BHL 329:4, s.v. “ela”).
We desecrate Shabbat in order to save an unborn fetus, even if forty days have not yet passed since conception. Similarly, we desecrate Shabbat to save a premature baby. And although in the past it was forbidden to desecrate Shabbat to save a baby born in the eighth month whose nails and hair had not yet grown in as it was certain that it would not survive, nowadays, with the improvement of medicine and the invention of the incubator, whenever doctors assess that a premature baby has a chance of long-term survival, we desecrate Shabbat to save him. (See SA 330:7-8; SSK 36:12 and n. 26.)
Saving a Non-Jew
Technically, a Jew may not desecrate Shabbat to save a non-Jew, since one may only desecrate Shabbat for the sake of someone who is himself commanded to keep Shabbat. However, in practice, this rule only applies when another non-Jew is present to save his fellow non-Jew. If no other non-Jew is present, one must treat the non-Jew, even if this requires desecrating Shabbat. Since we want non-Jews to save Jews, we must save them as well. Thus, saving a non-Jew’s life is included in the category of piku’aĥ nefesh. This is the case for all non-Jews, but for a righteous non-Jew, who is in the sense of a ger toshav (a “resident alien,” a non-Jew who has accepted the seven Noaĥide laws before a beit din), some poskim say that even without this rationale, we must desecrate Shabbat (Ramban, Maharitz Hiyut, Rabbi Rabinowitz).
Should Efforts be made to Minimize Transgressing a Prohibition to Save Life?
Ostensibly, we have conflicting sources. On the one hand, we have learned that when a dangerously ill patient needs to be fed figs, Torah prohibitions should be minimized in picking them (Menachot 64a; SA, OC 328: 16). On the other hand, we learned that even when it is possible to ask a non-Jew to perform the rescue operation, a Jew should do it (Yoma 84b), because there is concern the non-Jew might hesitate and not act aggressively enough to help the sick person (Tosafot), and even if it is clear he will act aggressively enough, we are concerned that if faced with a similar situation sometime in the future, others might delay helping in order to look for a non-Jew, and in the meantime, the sick person might die (Ran).
Some say that there is a disagreement here between those who believe that Shabbat is superseded (deĥuya) by danger to life (Rashba and Ran) and in their opinion only melakhot necessary to rescue should be done and nothing more, and if possible, should be done using a shinui (in an irregular manner) in order to minimize Torah prohibitions, and others who believe danger to life effectively suspends Shabbat and causes all melakha to become completely permitted (hutra) (Maharam of Rothenburg), and consequently in their opinion, it is permissible to do everything customarily done on a weekday, without a shinui.
The Practical Halakha
However, it seems actually, there is no disagreement. The basic principle is that rescue efforts must be undertaken in the best and fastest way possible. If trying to do melakhot with a shinui is likely to delay treatment, it is preferable to do them in the normal fashion, without any shinui. This is because according to halakha, the rescuer may do melakhot in the normal way, since saving a life overrides Shabbat. Nevertheless, when it is clear that a shinui will not hamper the rescue in any way, it is preferable le-khatĥila (ideally) to make use of a shinui. Therefore, it is advisable for doctors, nurses, and emergency medical workers to learn how to minimize Shabbat desecration while saving a person’s life.
There is a similar dilemma regarding treatments normally administered to a gravely ill patient during the week, some of which are not necessary to prevent his death. Since the caregivers do not know which treatments are truly necessary and which are not, they must treat the patient just as they would treat him during the week. However, one who understands medicine and knows for certain that a specific melakha is not necessary to save the patient, or that the treatment can be postponed until after Shabbat, he should avoid doing the melakha on Shabbat (SA 328:4). Palliative treatments are administered on Shabbat even when it is clear that they do not treat the disease, because when the patient’s pain is reduced, he will have more strength to overcome his illness (Peninei Halakha: Shabbat 27: 4-5).
Traveling to the Nearest Hospital
Q: What is the rule when there are two hospitals, one farther than the other, and the patient or a woman in labor wants to travel to the more distant hospital on Shabbat, because they have heard that it is better, or, for the woman about to give birth, to make it more convenient for relatives to visit her after the birth?
A: One must go to the nearest hospital, because only for the purpose of saving a life is it permissible to desecrate Shabbat, and any travelling beyond that is a desecration of the Shabbat. And although there are differences between hospitals, regarding routine treatments such as injuries, normal illnesses and births, there is no significant difference between them regarding the risk of death, and therefore one should travel to the nearest hospital (Peninei Halakha: Shabbat 27: 7).
In Complicated Cases, Travel to a Distant Hospital is Permissible
However, when a case is more complicated and there is a medical reason to prefer a more distant hospital, for example, if the more distant hospital specializes in the treatment of the patient’s illness, one may drive further to get there.
So too, if a woman’s pregnancy is considered high-risk, and the distant hospital has a protocol in place for her needs, one may drive her there on Shabbat. Everything should be done in accordance with accepted medical recommendations. The more complicated and difficult the case, the farther one may travel to ensure the best care. Thus, if there is only a slight medical advantage, one may travel only slightly farther to gain that advantage. After all, during the week, sick people and women in labor are not advised to travel long distances to the best hospitals for every minor medical issue. So too on Shabbat, they may not travel farther to reach the best hospitals, since accepted medical recommendations do not demand it (Peninei Halakha: Shabbat 27:7).
Is it Permissible to Extend the Trip Slightly to Please the Patient?
When medically there is no reason to prefer the distant hospital, however this is the patient’s wish, it seems that as long as it is a minor addition of travel, it is permissible to extend the trip a little to please the patient (Peninei Halakha: Shabbat 27:7).
Returning from the Hospital
If the patient is released after determining he is not in danger, he and his chaperones may not desecrate Shabbat to return home. Only if necessary – for example, if the patient needs to rest – may he be transported home by a non-Jewish driver. However, the chaperone may not ride along, unless the patient needs help en route (Peninei Halakha: Shabbat 27: 9).
This article appears in the ‘Besheva’ newspaper and was translated from Hebrew.