Medicines on Shabbos

Question #1: Vitamin E oil

“May I rub Vitamin E oil on Shabbos into my skin to alleviate some discomfort?”

Question #2: Mixed before Shabbos

“May I mix a medicine into food before Shabbos and then take it on Shabbos?”

Introduction

In parshas Chukas, the Torah teaches that when the Bnei Yisroel complained against Hashem and Moshe for taking them through the desert without adequate provisions and for providing them with mann, a plague of poisonous snakes was unleashed among them and killed many Jews. When the Jews did teshuvah and asked Moshe to daven on their behalf, Hashem commanded him to make a snake out of copper and place it on top of a pole. Subsequently, anyone bitten by a poisonous snake would look at the copper snake and live.

The Mishnah (Rosh Hashanah 29a) comments: Does the copper snake determine life and death? No, it does not. When people looked in its direction, they were reminded of Hashem, prayed to Him and survived the bite.

Later in history, an image of a snake wrapped around the upper end of a pole became the international symbol of an apothecary or other medical facility. Obviously, this is the perfect week to discuss the halachos of using medicines on Shabbos, particularly since the work of the pharmacist is the basis for this halachic discussion.

Don’t take your medicine!

The Mishnah and Gemara allude to a prohibition that Chazal instituted not to take medicines on Shabbos. For example, the Mishnah (Shabbos 111a) records the following:

Someone whose teeth are causing him pain may not sip vinegar as a remedy, but is permitted to dip his food into vinegar in his usual method of eating; there is no concern if this accomplishes his purpose of using the vinegar as an analgesic.

From this Mishnah, we see that Chazal prohibited doing anything that is clearly performed to alleviate pain or discomfort. This prohibition is called “refuah” by the poskim.

The Gemara concludes that it is prohibited to sip vinegar only if he spits it out, but it is permitted to sip vinegar and swallow it, since people sometimes do this to arouse a greater appetite.

From a different passage of Gemara (Beitzah 22a), we see that this prohibition also exists on Yom Tov. This article will attempt to clarify the rabbinic prohibition of refuah on Shabbos. Explaining this topic adequately requires two introductory lists:

Hierarchy of prohibitions

To begin with, we need to understand that there are different levels of prohibition that are set aside for the needs of a person who is ill. First, I will list these, and then afterward, we will see what rules apply to permit these activities – in other words, how ill must a person be to permit them.

A. De’oraisa – A Jew performing an action that is usually prohibited on Shabbos min haTorah.

B. DerabbananA Jew performing a rabbinic prohibition.

C. Derabbanan with a shinuyA Jew performing a rabbinic prohibition in an unusual way.

D. Amirah lenachriAsking a non-Jew to do something that a Jew is not permitted to do.

E. RefuahAn action that is prohibited solely because it serves a medical purpose.

Hierarchy of conditions

According to most poskim, levels of “illness” or “wellness” are classified under five categories (cf. Eglei Tal, Meleches Tochein 17, 18 and notes who disagrees). I am listing these beginning from the category that is most severe medically, where the halacha is most lenient:

  1. Choli she’yeish bo sakanah

Any medical condition or situation that might be a threat to life, even if remote, is called a choli she’yeish bo sakanah. In this situation, we perform whatever is necessary to make the patient safe and properly treated. In other words, none of the categories of activities above is prohibited, and it is meritorious and required to perform whatever is necessary as quickly as possible to save the patient (pikuach nefesh).

What type of condition qualifies as choli she’yeish bo sakanah?

In general, an internal injury is assumed to be pikuach nefesh until determined otherwise (Avodah Zarah 28a, see Tur, Orach Chayim 328). Excess or unusual internal pain is similarly assumed to be pikuach nefesh until determined otherwise. The extensive details germane to these situations will not be dealt with in this article.

2. Sakanas eiver

This is a situation in which there is no threat to a person’s life, but he runs the risk of losing the use of part of his body irreversibly, if it is left untreated. Contemporary authorities rule that this category includes a patient in which the result may be a limp or permanent weakness in a limb (Chut Hashani, Volume 4, 89:27), and even if this result is only a possibility (Minchas Shelomoh, Volume 2:34:36).

The Shulchan Aruch quotes several opinions regarding what the halacha is germane to this situation. He concludes that although violating Torah law is permitted only when there is risk, albeit remote, to someone’s life, violating any rabbinic prohibitions is permitted in a situation of sakanas eiver (Orach Chayim 328:17). This includes asking a non-Jew to do anything for his needs (Ran, Shabbos 39b s.v. Umeiha). It goes without saying that the prohibition not to take medicines does not apply to this category. In other words, to treat this patient, all categories of prohibitions listed above, except for level A, are permitted.

To the best of my knowledge, the approach preferred by the Shulchan Aruch is accepted by all the subsequent authorities (Rema, Magen Avraham, Taz, Gra, Nishmas Adam 69:1, et al.).

3. Choleh kol gufo she’ein bo sakanah

This refers to a condition in which someone is ill in a way that affects his entire body, such as he is ill enough to go to bed (Shulchan Aruch, Orach Chayim 328:17). It also includes situations in which the discomfort is intense enough that he feels that his entire body is affected (Rema ad locum), he is running a fever that is higher than his usual body temperature (Shemiras Shabbos Kehilchasah 33:1) or if, without medical intervention, he will end up with a condition similar to one of those mentioned above (Shemiras Shabbos Kehilchasah 33:1). In addition, a child, an elderly person or someone whose general condition is weak may be in this category.

In this situation of choleh kol gufo, we find differing opinions among the rishonim regarding how lenient the halacha is. All authorities agree that a choleh kol gufo may ask a non-Jew to do something for him (level D), and it is prohibited for a Jew to perform on Shabbos or Yom Tov a melacha min haTorah for this patient (level A).

The Rosh was uncertain whether you can perform an issur derabbanan other than asking a non-Jew, and Rashi may have been stringent regarding this issue (levels B and C, see Eglai Tal, Meleches Tochein #36 and #38). On the other hand, the Rambam rules that any issur derabbanan is permitted. The Ramban splits the difference, permitting a Jew to do a melacha only with a shinuy, in other words, permitting level C and forbidding level B.

The Shulchan Aruch concludes, according to the Ramban, that an activity that is ordinarily prohibited because of a rabbinic injunction may be performed by a Jew in an indirect way (i.e., with a shinuy). Furthermore, a non-Jew can be asked to do anything for his needs (Ramban and Rashba, Shabbos 129a). In addition, the prohibition of performing a refuah activity does not exist for this person when no other melacha activity is involved. In other words, to treat this patient, all categories listed above, except for levels A and B, are permitted.

4. Meichush

The word meichush means an ache, and carries with it the inference that it is a relatively minor discomfort. The term also includes someone who is mildly ill, but does not pass the threshold of the previous category of choleh kol gufo. One of the terms used to describe this category is that the person is walking around like a healthy person – he does not appear to be ill, but he is suffering from some minor ailment. If it is clearly noticeable that he is in pain or that he is experiencing discomfort, he is not in the category of meichush, but in the previous category of choleh kol gufo.

A meichush does not permit performing any melacha activity, even one that is prohibited only because of a rabbinic decree. Furthermore, he may not attempt to alleviate the discomfort by use of any treatment being performed for that purpose. This is referred to as the prohibition against refuah, established by Chazal. In other words, to treat this patient, all categories listed above are prohibited.

5. Bari

This refers to someone who is perfectly healthy, but would like to do something that is usually considered a medicinal-type act to maintain or bolster his health. All authorities agree that a person may not perform a melacha activity for this purpose, whether the activity is forbidden min haTorah or miderabbanan. There is a dispute between the Shulchan Aruch and the Magen Avraham whether the special prohibition of refuah, i.e., preparing or taking medicinal aids or doing healing acts, applies to someone who is not sick. The Shulchan Aruch (Orach Chayim 328:37) rules that it does not; the prohibition to perform refuah applies only to someone who qualifies as being a bit ill. The Magen Avraham concludes that the prohibition of refuah applies, also, to someone who is completely well, but wants to do something that would usually be considered a medicinal type of activity.

In other words, a person who is healthy may certainly not do anything in categories A-D to enhance or bolster his health. Whether the prohibition of refuah, category E, applies is a dispute between the Shulchan Aruch, who is lenient, and the Magen Avraham, who rules strictly. As there does not appear to be a consensus among halachic authorities which approach to follow, I recommend that our readers consult with their rav or posek for halachic guidance.

Why are medicines prohibited on Shabbos?

The rest of this article will focus on explaining what I called above “Category E”: the rabbinic prohibition to do anything on Shabbos that is usually performed for medical reasons.

First we want to understand: Why did Chazal establish this prohibition?

The Gemara (Shabbos 53b) implies that the reason for the prohibition of refuah on Shabbos is because preparing medicines often involves crushing raw herbs, thus violating the melacha of grinding. This reason is mentioned by the primary early rishonim in several places (Rashi, Brachos 36b, Shabbos 108b, Beitzah 11b, Avodah Zarah 28a; Tosafos, Shabbos 64b, 93a, Eiruvin 102b; Rambam, Hilchos Shabbos 21:2; Rashba, Shabbos 129a; Rosh, Avodah Zarah 2:10). Other authorities provide an additional reason for the prohibition: at times, the application of a medicinal preparation involves a different melacha activity, that of memarei’ach, smearing and smoothing the salve onto the skin (Chayei Adam 69:1).

The discussion about this prohibition is scattered across many different places in the Gemara, and the conclusions are explained in Shulchan Aruch in Orach Chayim, Chapters 327 and 328.

At this point, we will return to the Mishnah I quoted above (Shabbos 111a): Someone whose teeth are causing him pain may not sip vinegar as a remedy, but he is permitted to dip his food into vinegar in his usual method of eating; there is no concern if this accomplishes his purpose of using the vinegar as an analgesic. Someone experiencing pain in the sides of his body may not smear wine or vinegar as a remedy, but he may apply oil as long as it is not rose oil.

Based on our previous discussion, we now know that this Mishnah is discussing someone who is uncomfortable because of a toothache or minor irritation on his side, but who does not qualify as a choleh kol gufo — in other words, what we called before someone suffering from a meichush (category 4). We also see another very important principle: An activity that would commonly be done for a non-medical reason may be done notwithstanding that the person intends to alleviate thereby pain or discomfort — a medical reason.

Rashi explains that people smear oil on their bodies for other than medical reasons, but not wine, vinegar or rose oil. Wine and vinegar were smeared only for medical reasons, and rose oil was not smeared for non-medical reasons, because it was too expensive to use for this purpose. Therefore, smearing wine, vinegar or rose oil is clearly for a medical reason, and is included under the rabbinic prohibition of refuah, but smearing other oils is not.

Incidentally, we see from this Mishnah that there is no prohibition of memarei’ach when rubbing oil into your skin on Shabbos. This is explained by halachic authorities to be permitted because oil is too thin to smooth out surfaces. Since this is not our topic for today’s article, we will not spend more time on it.

Individual circumstances

Whether something is done usually for medical purposes or not might be subjective. In certain societies, there are things that are considered a normal activity, whereas in others, the same activity would not be done except as a medical treatment. How do we determine what is a “normal activity?”

The answer to this question is found in the continuation of the Mishnah, which states: Princes may smear rose oil on their injuries, because they smear it on regular days, even without a medical purpose. Rabbi Shimon rules that all Jews are treated like princes, and that therefore they may all smear rose oil as a medical treatment.

Both the first tanna and Rabbi Shimon agree that an activity that is sometimes performed for non-medical reasons may be done to alleviate a discomfort. Therefore, princes, who might apply rose oil not as a medical treatment, may use it to alleviate discomfort, whereas, according the first tanna, common folk ,may not. Rabbi Shimon permits someone to do something that a different person would be doing for non-medical reasons, whereas the first tanna requires that he, himself, would do this activity on other occasions when not uncomfortable.

Notwithstanding Rabbi Shimon’s position, the majority of early authorities and the Shulchan Aruch (Orach Chayim) conclude according to the first tanna’s opinion: someone can do something to alleviate discomfort only if he, himself, might do the same for a non-medical purpose.

Vitamin E oil

Thus, we can now answer our opening question: “May I rub Vitamin E oil on Shabbos into my skin to alleviate some discomfort?”

The answer is that it will depend: If people do rub Vitamin E oil when there is no medical discomfort, this would be permitted. I believe that this is not standard practice, and therefore it would seem to me that this is prohibited on Shabbos, unless the person is a choleh kol gufo.

Local circumstances

We see from this part of the Mishnah that when an act is performed commonly for non-medical reasons, someone may do it on Shabbos to alleviate discomfort or for a different medical reason. The Gemara expands this by noting that Rav permitted people in his town to smear rose oil on Shabbos, because where he lived it was plentiful, inexpensive and was used commonly without medical need. We see that local circumstances can determine what is permitted typical use.

Does this concept apply only lekula or even lechumrah? Is an activity that is common for non-medical reasons, be performed in a geographic location where it is done only to alleviate discomfort? The answer is that this concept is true also lechumrah: the Rema (Orach Chayim 327:1) prohibits rubbing oil on the body on Shabbos if locally this is done only for medical reasons.

From this discussion, we see that a Shabbos prohibition existed even to use a medicinal process or aid whose preparation did not involve the melacha of grinding. We also see that an item that might be used by a healthy person is not included in the prohibition, and that determining whether a substance may be used or not can be dependent on local circumstances.

May I mix?

At this point, let us address the second of our opening questions: “May I mix a medicine into food before Shabbos and then take it on Shabbos?”

Based on an extensive analysis of one of the sugyos, Rav Moshe Feinstein permits mixing a medicine into food before Shabbos and eating the food on Shabbos, since people see him eating regular food. Rav Moshe demonstrates that the mixing of the food must be before Shabbos, not on Shabbos itself (Shu”t Igros Moshe, Orach Chayim 2:86).

Conclusion

The Gemara teaches that the rabbinic laws are dearer to Hashem than the Torah laws. In this context, we can explain the vast halachic literature devoted to understanding this particular prohibition, created by Chazal to protect the Jewish people from major sins.