Shabbos Emergencies

clip_image002The last sentence of the haftarah we read this Shabbos is the basis for our daily beracha Refa’einu. This provides us with the opportunity to review the laws that we need to know about Shabbos emergencies.

I once received the following communication:

“As an active member of Hatzalah, but not speaking on behalf of any specific Hatzalah organization, I suggest that you cover a topic that would benefit many frum communities, especially those where, Boruch Hashem, new branches of Hatzalah have recently been established. In many instances of our responding to Shabbos emergencies, we discover that the patient, family, and bystanders do not know the basic halachos of pikuach nefesh; thus, they do not understand why we do certain things, such as using our radios or driving to and from an emergency. Although occasionally different branches follow different protocols (such as whether we drive back from a call) depending on different piskei halacha that each branch received, the basic rules are the same, and the differences in psak halacha among the different branches rarely affect what the patient does.

“Another phenomenon that I see is simply baffling. People call Hatzalah on Shabbos, with no intention of allowing us to transport the patient to a hospital if we deem it necessary. They tell us, ‘We can’t go to the hospital; it’s Shabbos.’ Guess what? You called us and it’s Shabbos for us too. People need to be taught that if Chas V’Shalom they need to call Hatzalah on Shabbos (or any other day), they MUST listen to our advice.

“We are trained to recognize problems that are not obvious to the untrained individual. If we say the patient needs to be transported to the hospital on Shabbos, please don’t argue with us!

“My understanding of the halacha is that it is the responsibility of the Rabbonim of a community to educate people what to do on Shabbos if someone is endangered.

“Thanking you in advance,”

The Hatzalah volunteer who addressed this letter requested that we withhold his name, and we are honoring his request.

Although I have never been involved in Hatzalah’s holy work, I would like to introduce my comments with the following tragic story: Yuddie, a hard working, mid-fifties, proud Jew, was feeling unwell on a Shabbos afternoon. His concerned children called the local ambulance service, who felt he should go to the hospital immediately. Yuddie refused to go on Shabbos. To bring the story to its abrupt end, Yuddie died a few hours later from coronary arrest.

This is only part of the tragedy. Imagine what probably happened when Yuddie arrived for final judgment in the court of the Olam HaEmes. Certainly the Satan charged him with manslaughter for bringing about his own demise by violating the halachos of pikuach nefesh. Maybe the Beis Din shel Maalah had rachmonus to mitigate his crime and judge him as a shogeg, someone negligent in his violation because he was unaware of the halachos. Certainly, Yuddie will receive some punishment for his serious breach of halacha since he should have studied the halacha.

To make sure such tragedies don’t reoccur, we will review the basics of these halachos.

The Gemara (Yerushalmi, Yoma 8:5) teaches: “Someone who was asked a shaylah (whether to desecrate Shabbos in the case of a life-threatening emergency) is disgraced and the one who asks is guilty of bloodshed.” We understand the second part of this statement — that someone busying himself with asking whether he can save someone’s life is wasting precious minutes that literally may be the difference between life and death, but why is the rav who was asked the shaylah considered disgraced?

The answer is because he is responsible to teach these halachos publicly so that people should always know these laws thoroughly. If people are asking what to do it this indicates that the rav has not adequately taught them, which is negligence on his part (Korban HaEidah ad loc.).

Let us quote the words of Shulchan Aruch (Orach Chayim 328:2): “It is a mitzvah to desecrate Shabbos for a dangerous illness. He who does so swiftly is praised; the person who goes to ask what to do is a shedder of blood!” and again: “Whoever is swift in desecrating Shabbos in a matter that involves danger is praised!! (Shulchan Aruch Orach Chayim 328:13)

By the way, this rule obviously applies equally on weekdays! If someone is uncertain whether a particular situation is life threatening or not, he/she is required to immediately seek proper medical attention. Delaying might be shedding blood!

IS THIS AN EMERGENCY?

But what if I do not know whether this is a life threatening emergency? Am I required to be a doctor to know what is and what is not? After all, only a life-threatening emergency supersedes Shabbos!

No, there is no halacha requirement to be a physician. However, this is the rule that one should follow:

“One must desecrate Shabbos even if there is only a slight possibility that the situation is dangerous. One does not need a professional opinion or an expert physician. Whenever one is uncertain whether the situation is dangerous, he is required to desecrate Shabbos (Shu’t Tashbeitz 1:54).”

Thus, Yuddie’s children were absolutely correct in calling the emergency service and certainly could have driven him to the hospital themselves, even if it would have turned out to have been nothing but indigestion from too much cholent. Certainly, I have only praise for the Hatzalah volunteers who drive on Shabbos to attend emergencies.

The source for this halacha is the following statement: “An uncertainty whether the situation is life-threatening supersedes Shabbos. Not only if it is uncertain whether the situation is immediately dangerous, but even if there is no danger now and the situation may create a danger for the future (Gemara Yoma 84b).” The last clause teaches that we supersede Shabbos for someone when inferior care received now may affect his future health, such as a person suffering from an apnea condition which, left untreated, may eventually cause permanent heart damage. The same applies to kidney conditions or diabetes.

In short, the Torah demands that when you are uncertain whether a situation is dangerous or not, be mechaleil Shabbos first to get proper medical care, and ask questions later.

Years ago, I was visiting a physician friend of mine when a well respected member of the frum community, who lived quite a distance from the house, arrived on Shabbos afternoon to determine whether his child’s illness was life-threatening. They had just walked with the child forty minutes to have a frum physician evaluate whether the situation warranted chillul Shabbos! To this day I am astonished at how little this yeshiva-educated man knew about pikuach nefesh. When uncertain whether a situation is life threatening or not, assume that it is until someone knowledgeable informs you that it is not.

WHAT IS CONSIDERED MEDICALLY KNOWLEDGEABLE?

The halachic definition of a physician for these purposes certainly includes a trained Hatzalah emergency medical technician. I can prove this from an anecdote concerning Rav Yaakov Kaminetzky, zt”l. Rav Yaakov’s first rabbinic position was in a small Lithuanian village that had no physician. Thus, living there violated the psak of the Rambam (Hilchos Dayos 4:23) that a talmid chacham may live only in a town that has a physician. Rav Yaakov needed a solution to accept this position and move into the community. He resolved the problem by reading through medical books until he felt he met the halachic requirements of being a local doctor (Reb Yaakov, page 106). Thus we see that someone who knows enough to treat commonplace medical problems is halachically qualified as a physician.

One can conclude that a Hatzalah volunteer has sufficient training to be considered halachically a physician for the emergencies with which he deals. Therefore, a lay person who disobeys the instructions of a Hatzalah volunteer to desecrate Shabbos is a shofeich domim!

WHAT IF THE SITUATION IS NOT LIFE THREATENING?

If a medical authority, such as a Hatzalah volunteer, tells you that the situation is not life-threatening, a Jew may not perform any activity that involves violating a Torah prohibition, although depending on circumstances, rabbinic takanos may often be set aside.

It is beyond the scope of this article to detail what one may do under these circumstances, but I will supply two rules of thumb that one should usually follow under these circumstances:

1. If the person is ill (even not seriously) or uncomfortable, one may ask a gentile to do whatever is necessary (Shulchan Aruch Orach Chayim 307:5).

2. If the patient and his family do not include any talmidei chachamim, and the Hatzalah volunteer tells you that based on his experience of asking shaylos from Rabbonim, you should be able to do something yourself, you may rely on this information until one has the opportunity to ask a shaylah what to do.

May we always merit that to perform mitzvos in good health and in the way that Hashem wants us to.

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