The seriously ill patient

121. A seriously ill patient may even take medication that is not essential for saving life, for example pain-killers for a concomitant toothache, provided that Torah laws are not set aside, such as asking a doctor to write a prescription for the medication (in the case of the concomitant toothache which is not endangering life he is considered a non-seriously ill patient and the appropriate rules apply)[180].

122. A seriously ill patient who requires to inhale humidified air on the Sabbath may activate such a machine as necessary, with either cold or hot water (where possible using hot water previously boiled before the commencement of the Sabbath)[181].

123. A person who suffers from angina pectoris on effort, and therefore finds it difficult to have relations with his wife after she has been to the mikveh on Friday night, may take appropriate preventive medication beforehand[182].

124. A diabetic who is receiving a continuous subcutaneous drip or multiple daily injections of insulin, and has to measure his blood sugar level repeatedly during the day in order to adjust the dose of insulin suitably, may use a glucometer, turning it on in an unusual manner (using the back of the hand or the back of a finger)[183].

The non-seriously ill patient

125. A non-seriously ill patient may also take medication on the Sabbath. The medication itself is muktzeh and may not be moved on the Sabbath or Festival unless for the patient. If however he was already ill prior to the commencement of the Sabbath, the medication is not muktzeh[184]. The covering of the medication may be torn, where possible avoiding tearing through any print that is on it[185]. A tablet may be crushed if necessary[186]; it may also be broken in half along the groove[187].

126. In contra-distinction to that written in paragraph 121 above regarding a seriously ill patient, the non-seriously ill patient, although permitted to take medication, may only do so for his illness and not for any other minor concomitant illness. Thus, for example, a patient with influenza may not take something to relieve a minor itch[188].

127. A non-seriously ill patient may receive subcutaneous or intra-muscular injections[189]. The paper covering the syringe, medication etc. may be torn even along the perforations. One should not tear through print[190], but tearing between two letters of the same word is permissible[191]. One may not scrub the place of injection with cotton-wool soaked in an antiseptic fluid but should instead use a synthetic swab or else pour some of the antiseptic liquid on to the place of injection and then wipe off with dry cotton-wool[192]. It is preferable to use syringes that are packed already attached to the appropriate needle, but where there is no alternative, the needle may be attached to the syringe prior to use[193].

128. A woman receiving daily medication to enable her to conceive, or alternatively for contraception (having received permission to do so from a competent Halachic authority), may continue to do so on the Sabbath[194].

129. A woman receiving daily injections of progesterone should receive the Saturday dose after the termination of the Sabbath. If the days immediately preceding or following the Sabbath are a Festival, she should ask her doctor to prescribe a long-acting (depot) injection over that period.

130. A patient who has warning of an impending attack of severe pain unless warded off by premedication, for example a sufferer from migraine, make take appropriate medication to ward off such an attack[195].

131. A patient suffering from hemorrhoids, may take medication to prevent constipation[196]. He may use suppositories on the Sabbath to treat pain[197]. If there is bleeding during defecation, he should preferably clean himself with water. If this is not possible, he may use toilet paper[198].

132. One may use eye drops or ointment for even a mild eye infection[199].

The patient with minor illness (see paragraph 14) or mere discomfort (see paragraph 15).

133. A minor pain may not be treated on the Sabbath; if however it is severe enough to affect the whole body or make the patient take to bed, medication may be taken[200].

134. Medication may not be taken for a minor cough or cold. If however severe enough to affect the whole body or make the patient take to bed, medication may be taken[201].

135. Constipation, unless severe enough to affect the well-being of the person such that his whole body is affected[202], may not be treated with medication[203], suppositories[204] or enemas[205].

[180] Shemirat Shabbat Kehilchata 32:56.

[181] Shemirat Shabbat Kehilchata 37:15.

[182] Resp. Minchat Yitzchak 1:108. See Shemirat Shabbat Kehilchata 34:81.

[183] Oral communication from R. Sh.Z. Auerbach.

[184] Because he has the medication in mind.

[185] Shemirat Shabbat Kehilchata 33:4.

[186] Because there is no prohibition to grind material which has already been ground; Rema Orach Chayyim 321:12 and Peri Megadim (MZ) 321:10; Shemirat Shabbat Kehilchata, ibid.

[187] Shemirat Shabbat Kehilchata 33:4 in the name of R. Sh.Z. Auerbach. Even if he is careful about the measure, the prohibition of cutting (mechattech) applies only if one wants to use the cut part. But if one wants to swallow it, it is considered food. Further, the suppository which he wants to insert into his body has, in this case, the status of food. Further, his principle concern is with the amount of medicine, not its size. Thus he might not care if it brakes into two or three pieces. Further, he is not initially concerned about the width and length of the pieces because he does not care whether the cut is made in the width, length, or diagonal; Shemirat Shabbat Kehilchata 33, note 30. Further, the purpose of the groove is only to simplify braking the pill; oral communication from R. Sh.Z. Auerbach.

[188] Shemirat Shabbat Kehilchata 33:5.

[189] Shemirat Shabbat Kehilchata 33:7.

[190] Shemirat Shabbat Kehilchata 33:4 and 9:4.

[191] Shemirat Shabbat Kehilchata 9, note 48.

[192] Shemirat Shabbat Kehilchata 9:10.

[193] See R. Sh.Z. Auerbach in Shemirat Shabbat Kehilchata Pt. 3, ch. 35, note 65. See further Shemirat Shabbat Kehilchata 33, note 43 and Nishmat Avraham Pt. 1, Orach Chayyim 313:1 and pages 355-364. See Resp. Or le-Tsiyyon Pt. 2, 36:19 who is strict.

[194] Shemirat Shabbat Kehilchata. 34:19.

[195] See Shemirat Shabbat Kehilchata 34:16.

[196] Resp. Tsits Eliezer 11:37, quoted in Nishmat Avraham Pt. 1, Orach Chayyim 328:22 (page 181).

[197] Resp. Tsits Eliezer 8:15, ch. 10:5.

[198] Written communicatin from R. Y.Y. Neuwirth.

[199] Shemirat Shabbat Kehilchata 34:8 and note 40.

[200] Shemirat Shabbat Kehilchata 34:3.

[201] Shemirat Shabbat Kehilchata 34:10.

[202] See Shemirat Shabbat Kehilchata 34:11 and 33:12.

[203] Mishnah Berurah 328:118 and 328:140.

[204] Orach Chayyim 328:49.

[205] Mishnah Berurah 328; 150.