Since Parshat Terumah describes the construction of the Mishkan which serves as a source for the categories of forbidden labor on Shabbat, we will begin this week a series of essays on how Hilchot Shabbat apply when there is a danger to life (Pikuach Nefesh).
Any discussion of Pikuach Nefesh must begin with the following statement that appears in the Shulchan Aruch (Orach Chaim 823:2), "it is a Mitzvah to violate Shabbat for one who is dangerously ill. Furthermore, one who acts quickly (הזהיר) in such circumstances is worthy of praise, and one who poses a question [to a rabbi to see if it is permissible to violate Shabbat to preserve life] sheds blood." The Mishna Berura (823:6) notes that the Jerusalem Talmud condemns Torah scholars who are posed with the question of whether danger to life warrants the desecration of Shabbat. The Mishna Berura explains that a Torah scholar must publicize the fact that one must desecrate Shabbat in case of Pikuach Nefesh, so that in case of emergency on Shabbat, people should not hesitate to do whatever is necessary to preserve life. The Mishna Berura also cites the Radvaz's ruling that if one refuses to desecrate Shabbat to save his own life, the individual may be coerced to desecrate Shabbat to preserve his life. The Radvaz also writes that one should try to convince the person in such a case to desecrate Shabbat to preserve life - probably because coercion may traumatize the patient and may make matters worse (see, for example, Igrot Moshe Choshen Mishpat II:37:5 and Rabbi Yigal Shafran's excellent essay on coercing patients to receive medical treatment, Techumin 41:333-153).
Moreover, the Rambam (Hilchot Shabbat 2:3) describes those who believe that it is forbidden to violate Shabbat in order to save a life as אפיקורסים (heretics). The Rambam emphatically describes those who expound such views as degrading the Torah by erroneously implying that "the Torah laws are not good and laws which one cannot live by." The Rambam writes that "the Torah laws are not mean-spirited rules, rather they are merciful, kind, and promote peace in the world."
An example of how important it is to preserve life even if it involves violating Shabbat is illustrated by a story I once heard from Rav Soloveitchik. Once, as a young boy, Rav Soloveitchik was ill on Shabbat and his illustrious father and grandfather were present at the sick bed. His Grandfather, Rav Chaim Soloveitchik, inquired of the doctor who came to see the young patient if turning on a light would be helpful. The doctor replied "that's not a bad idea." Rav Chaim immediately instructed his son, Rav Moshe, to turn on the light to aid the doctor in his work. When Rav Moshe hesitated (the doctor did not say that the light was unquestionably necessary), Rav Chaim called his son a heretic. When Rav Chaim was asked how he could be so lenient regarding Shabbat, he replied that he was not lenient regarding Shabbat, he was strict regarding Pikuach Nefesh.
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The Talmud (Yoma 28a) presents the celebrated rule אין לך דבר העומד בפני פקוח נפש חוץ מעבודה זרה גלוי עריות ושפיכות דמים, that Pikuach Nefesh overrides every Torah law, except for the prohibition of idolatry, sexual immortality, and murder. Moreover, the Talmud (Yoma 58a-58b) presents numerous reasons why Pikuach Nefesh overrides Shabbat. Interestingly, these reasons were articulated during an informal symposium held when Rav Akiva, Rav Yishmael, Rav Elazar ben Azaria, and other greats were taking a walk together. Here are some of the arguments they put forth: Rav Elazar ben Azaria reasons that of Brit Mila overrides Shabbat and involves the needs of only one body part, how much more so (קל וחומר) do the needs of the entire body (to maintain life) override Shabbat. Rav Shimon ben Menashe presents the famous rule - "'and the Jewish people shall keep Shabbat' - one should violate one Shabbat to preserve many future Shabbatot." Rashi explains that one should take care on Shabbat to facilitate observance of future Shabbatot. Shmuel adds that had he been present during that "symposium," he would have added that the Torah states וחי בהם, that one should live by the Torah laws - ולא שימות בהם, implying that the Torah laws should not cause death.
One could reasonably ask why it was necessary to present so many text proofs that Pikuach Nefesh overrides Shabbat. Rav Eliezer Waldenberg (Tzitz Eliezer 8:51:1) suggests that since the Talmud (see, for example, Chullin 5a) equates desecration of Shabbat with idolatry, one might think that Pikuach Nefesh does not override Shabbat just as one may not worship idols to save his life. Hence, the Talmud needed to emphasize that one may violate Shabbat in order to preserve life.
Interestingly, the Shulchan Aruch (603:41) rules that one must violate Shabbat if this is necessary to save someone from being converted to another religion. Some have attempted to apply this ruling to the question of inviting non-observant Jews to one's home, even if they will drive on Shabbat as a result. This is a complex issue and one should consult with his halachic advisor regarding how to deal with this issue. A summary of the literature on this topic can be found in the fourth volume of Rabbi J. David Bleich's Contemporary Halachic Problems pgs. 29-401.
The Observant or Non-observant Physician?
Some have argued that it is preferable to call an observant doctor to a medical emergency on Shabbat instead of a non-observant doctor. They argue that since the non-observant doctor drives a car on Shabbat in any event, his driving to an emergency would constitute a violation of Shabbat (based on an interpretation of the Beit Halevi to Shemot 2:52). Hence, some say that summoning a non-observant doctor to an emergency situation on Shabbat would be a violation of לפני עור - causing another to sin. However, Rav Zalman Nechemia Goldberg cites a Talmudic passage which appears to conclusively disprove this argument.
The Gemara (Menachot 46a) records a dispute whether one is considered to have violated Shabbat in the following situation. Someone on Shabbat heard that a child was drowning and this person spread his fishing net with the sole intention of catching fish (a prohibited activity on Shabbat known as צד). He raised the net and thereby both saved the child and caught fish. Rabba believes that he has not violated Shabbat since זיל בתר מעשיו - we ignore his intentions and consider only his action (that he saved a life) to be significant. Rava believes, however, that he has violated Shabbat because we believe that his intentions are crucial in determining the character of his actions - זיל בתר מחשבתו. The halacha follows the opinion of Rabbah (Rambam Hilchot Shabbat 2:61). Rav Zalman Nechemia points out that we see from this Gemara that even if one would have engaged in violation of Shabbat had it not been that someone's life was in grave danger, he does not sin if he is engaged in a lifesaving activity. Accordingly, it appears that there is no compelling reason to prefer summoning an observant doctor rather than a non-observant doctor (see, however, Shemirat Shabbat Kehilchata 23:54 and note 521; Rav Feinstein Igrot Moshe O.C. IV:97, appears to agree with Rav Zalman Nechemia's approach).
When is There Danger to Life?
The question is often asked regarding precisely when is a situation defined as a case of Pikuach Nefesh that warrants violation of Shabbat. Rav Moshe Feinstein (Igrot Moshe Orach Chaim 921) was asked at what temperature is one considered to be a חולה שיש בו סכנה, a sick person whose life is in danger. Rav Moshe responded that to is difficult to give such measurements. Instead, he says that "anytime someone feels he has excessive fever (Rav Moshe permits the use of a thermometer to measure fever on Shabbat, see Igrot Moshe Orach Chaim 821) he may violate Shabbat." One is forbidden to violate Shabbat only if it is clear that the fever is not a dangerous one.
Rav Moshe, nevertheless, does offer specific guidelines as to how to determine when a situation warrants violating Shabbat. He writes that 102◦F constitutes excessive fever which demands that one violate Shabbat to help the patient. He continues that one may violate Shabbat if he has only 101◦F but feels there is danger. He adds that if an infant is quite distressed and appears to be ill and has even just a slight fever above 100◦F, then Shabbat should be violated. He concludes that although one is forbidden to violate Shabbat for a common cold, one may violate Shabbat even if there is just a slight fever, if the fever is a result of a respiratory infection or infection of another internal organ.
Although Rav Moshe's approach has been the subject of much criticism (see Tzitz Eliezer 8:51:7 and Shemirat Shabbat Kehilchata 23:11 and note 30), nevertheless it appears that it may be followed. It seems prudent to follow Rav Chaim's approach and be strict regarding Pikuach Nefesh. It is especially advisable to seek a physician's advice by telephone in case of doubt since the use of a telephone most often does not involve a violation of a biblical prohibition according to most authorities (see Minchat Shlomo no.11)
Next week we will, God willing, discuss how to act in situations when Pikuach Nefesh demands violation of Shabbat rules.