INTRODUCTION
1. 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 danger[2] or even 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, that should be done[6].
2. 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 prohibited. 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].
3. One must do everything necessary to cure, or to prevent 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 remove or minimize the danger[8].
4. The Sabbath rules are set aside for a seriously ill patient even if only to prolong life for a short while[9] and even if the patient is near death[10].
5. 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 Rama[11] and the Mishnah Berurah[12]. However according to the Rambam[13] the Shulchan Aruch[14] 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 recording the patient's 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 by a Jew in an indirect manner[16].
6. There is no difference whether Sabbath laws are set aside to save life by the patient himself or by another Jew[17], neither is there any difference between saving the life of an adult or child[18].
Definition of types of patients and what may be done for them on the Sabbath or Festivals.
7. The seriously (or dangerously) ill patient (even if only possibly so)[19]:
(1) One who feels that he is so even if his doctor disagrees (provided that the difference of opinion does not relate to the diagnosis or the treatment of a recognized illness).
(2) The doctor believes that the illness is dangerous or possibly so, even if it is at the stage when the illness is not yet serious, but may become so if not treated on the Sabbath.
(3) An ambulant patient, who nevertheless may become seriously ill if not treated on the Sabbath; for example, a diabetic patient who has run out of insulin.
(4) One whose state or illness our Sages have defined as being dangerous, even if this is contrary to current medical opinion, for example, a woman during the first seven days following childbirth or abortion (after at least 40 days of pregnancy).
General rules regarding treatment for such a patient.
8. One must realize that whenever there is the slightest doubt that a patient is or may become seriously ill without appropriate treatment, he is categorized as being seriously ill, and Sabbath laws, even if involving Torah prohibitions, are set aside, if necessary for his care.
9. A patient who is or may become seriously ill, must be treated immediately if time is of the essence, without hesitation, and as on a weekday. It is of such a situation that Halachah says: He who is speedy is praiseworthy while he who takes time to ask (whether a particular act or procedure is permissible on the Sabbath for the patient), is as if he has shed blood[20]. If, however, there is time then a Rav should be consulted as to how and when Sabbath laws may be set aside. If such an authority is unavailable for consultation on the Sabbath, then everything that the patient (or his attendant) feels to be essential for his medical well-being must be carried out even if this involves the setting aside of Torah precepts. This is true even if there is a doubt as to whether the procedure is Halachically permitted on the Sabbath, or whether it could wait until after the Sabbath[21].
10. Danger to a limb. Since in almost all cases danger to a limb, if untreated, may lead to a threat to life, such a patient must receive all necessary treatment by a Jew, even if this involves setting aside Torah laws[22]. See also paragraph 24.
11. Where there is a danger of loss of an eye[23], Sabbath laws are set aside, even those involving Torah prohibitions, since such a patient has been defined by our Sages as being in the category of the seriously ill[24].
12. The non-seriously ill patient[25] is one who:
(1) Has to take to bed or feels generally ill for example, someone with influenza.
(2) Has a high temperature which would prevent most people from going out, even if the patient does not take to bed.
(3) Has severe pain (not internal) that makes him feel weak even if he does not take to bed.
(4) Although ambulant, will be forced to take to bed if not given preventive treatment, for instance, one who suffers from attacks of migraine or asthma.
(5) Has been so defined by our Sages, for example, a woman from the eight to the thirtieth day after childbirth or abortion (following at least 40 days of pregnancy), or a young child requiring treatment (see paragraph 13).
(6) A person with an eye infection, however mild.
General rules regarding treatment for such a patient.
13. Where necessary, one may request a non-Jew to do whatever is necessary for the well-being of such a patient even if this involves setting aside Torah laws[26]. A Jew may set aside only Rabbinically prohibited laws for such a patient and where possible these should be done in an unusual fashion[27]. However, if this is not possible they may be performed in the usual way[28].
Children. Our Sages permitted the setting aside of Sabbath laws for the well-being of a child until the age of 9 or 10 years (depending on his maturity) as one would do for a non-seriously ill patient, provided this was necessary for his health and could not be done without setting aside Sabbath laws[29].
14. The patient with a minor illness, or with aches and pains[30]. Someone with heavy nasal catarrh or an irritating cough or headache, but not severe enough to make him take to bed. Sabbath laws, even Rabbinical precepts, may not be set aside for such a patient, nor may the patient take medication. A non-Jew may be asked to do for the patient whatever is necessary for his well-being,
provided this involves the setting aside of Rabbinical laws only.
15. The patient with mere discomfort[31]. Such a person, for example, with a mild catarrh, cough or skin ailment may not be given any form of treatment on the Sabbath, nor may a non-Jew be asked to do anything for him which involves the setting aside of Sabbath laws, even those of Rabbinical origin only.
16. It is however important, whenever one has to set aside Sabbath laws for a patient (as outlined in the above paragraphs), to remember that: Setting aside the Sabbath laws when necessary for a patient is not a desecration of the Sabbath; on the contrary, it is a sanctification of the Sabbath[32].
[2] Orach Chayyim 328:2.
[3] ibid. 328:5 and Misnah Berurah 328:17.
[4] Orach Chayyim 328:2.
[5] Mishnah Berurah 328:6.
[6] See Aruch ha-Shulchan 328:2.
[7] Hilchot Shabbat 2:3.
[8] Aruch ha-Shulchan 32:18.
[9] Sect. 239:4; Shemirat Shabbat Kehilchata 32:2.
[10] Be’ur Halachah 329 s.v. elle. Shemirat Shabbat Kehilchata 32:2, note 12.
[11] Sect. 328:12.
[12] Mishnah Berurah 328:14 and 328:35.
[13] Hilchot Shabbat 2:3. See par. 2 above.
[14] Sect 328:12.
[15] Quoted in Mishnah Berurah 328:37.
[16] Resp. Or le-Tsiyyon Pt. 2, 36:2. Oral communication from R. Sh.Z. Auerbach. See Mishnah Berurah 378:1. Nishmat Avraham Pt. 5, Orach Chayyim 328:2.
[17] Shemirat Shabbat Kehilchata 32:4.
[18] Shemirat Shabbat Kehilchata 32:3.
[19] See the details in Shemirat Shabbat Kehilchata 32:6 and 32:9 and Nishmat Avraham Pt. 4, Orach Chayyim Introduction to Sect. 328 (page 38).
[20] Orach Chayyim 328:2 and 328:13.
[21] Oral communication from R. Y.Y. Neuwirth.
[22] See Nishmat Avraham Pt. 1, Orach Chayyim 328:46 (page 195).
[23] From the medical point of view, certain cases of acute danger to vision constitute a danger to the whole body.
[24] Orach Chayyim 328:9 and Mishnah Berurah 328:22.
[25] See the details in Shemirat Shabbat Kehilchata 36:15 and Nishmat Avraham Pt. 4, Orach Chayyim Introduction to Sect. 328 (page 35).
[26] Mishnah Berurah 328:47.
[27] Orach Chayyim ibid. and Mishnah Berurah 328:57.
[28] Mishnah Berurah 328:102.
[29] Shemirat Shabbat Kehilchata 37:2.
[30] See the details in Nishmat Avraham Pt. 4, Orach Chayyim Introduction to Sect. 328 (pages 34-35).
[31] See the details in Nishmat Avraham Pt. 4, Orach Chayyim Introduction to Sect. 328 (page 34).
[32] Or ha-Chayyim Exodus 31:14.