Refuah On The SabbathRabbi Alfred 5. Coh'en

In the Gemara, we find a prohibition instituted by our Sagesconcerning healing, "refuah", on Shabbat: 1

,13K pt:lY"VJ ""JIlJ:l C~I':)J. 1nU( D"'OYtl c, n"K'oU C1X

.D'JD13D np'nlU C,1UtI inu K'"y

If a person has an attack of congestion, he may bemake to stand in water to cool off [but he may nottake medication]. Ulla said, "It is a gezera (preventivemeasure) on account of crushing herbs,"

Commenting on this, Rashi explains1

'nK MK1D1 CllU n'110 'K' p:n "u mmn, '''1':);)

.1"'U 'lin Kn""K1 K"D'K Xlm 0'31':)130 np'nlU '1Utn?

Since the concern for physical soundness is very great, aperson trying to assure that he would get better from his illnessmight "grind herbs," which is biblically forbidden as tochen,grinding, one of the 39 activities proscribed on Shabbat.

1. Shllbbllt 5Jb2. See also R..shi ,0, no,]; :np n]v; )101' 1(0, 1"1'" .ro I"),',

,'.l:Jp n]RT ""I(C ;I:nKi"I n'ln 'DtI 1:11:), :,]o,:n n'" :"ttI ruRT nUltTln

Rabbi, Young Israel of Canarsie; Rebbe, Yeshiva UniversityHigh School, Boys

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• THE JOURNAL OF HALACHA

In codifying the law, Rambam follows the talmudic teachingand rules;3

pMtv' Kl3lU il1U n::1tu:l. n'K!nnil' /'('1:" "OK 1:J'!IC,.r )Y.Il'Jtm

Therefore, it is forbidden for a healthy person to behealed on the Shabbat; [it is] a rabbinic stringency,lest he grind herbs.

OUf purpose in this paper is to study the issur of refuah andexplore its specific parameters and applications today; this is notan easy task in light of the complex nature of medical treatmentsand the art of healing in the modern world. A number of areas willbe discussed:

(1) To whom did the rabbis intend this prohibition to apply?(2) What action did ChaUll have in mind when they said

n:nU:l M1X!l1nilr, "CK "it is forbidden to be healed on Shabbatl"(3) Does the issur still apply today, since virtually no patient

grinds or mixes herbs on the spot to minister to his ills?(4) How does the issur operate in specific situations?

To Whom It AppliesIn order to have a better understanding of the halacha, it is

essential for us to understand what persons the Sages werespeaking about when they taught that one should not do anythingto promote healing on Shabbat nor take medication. Jewish lawrecognizes several distinct categories of persons requiringassistance, and not all of them are included in the proscription:

(A) m:lO 1.::1. lU'lU i171n4 - A person whose life is in danger. Forsuch a person, we are bidden to transgress all Shabbat laws, and

3. Hi/chot Shllbbllt 21,204. When the halacha teaches that one may violate the Shabbat in order to save a

life. does that mean that one may do any action which will help save his life, OT

does it mean that anything which will be helpful to a deathly sick person mayalso be done - for example, may one heat water to bathe this very sick person,even though the bath will certainly not save his life?

See U"1O :n ~7n '1V'7/C r:r .7 ,"n nJn 1"l'",.

MEDICATION ON SHABBAT

virtually all Torah laws, in order to save his life. Obviously, hemay take medication or do anything else needed to heal or savehim.

(B) 117m' - A person is considered "sick" when he feels sobad that he has to get into bed or when his entire body is in pain.A person this ill is not among those who may not be healed on theSabbath. The Ramo'" specifically notes, "tU DlV737 ?!:ll) Of< pl, "Ifhe is bed-ridden, then it [healing or medicine) is permitted."

The opinion of most rabbinic decisors is that children up tothe age of nine7 are considered as "sick", and there is no reasonnot to give them medication. It has also been reported (but notrecorded in print) that Rav Moshe Feinstein considers a personwho cannot function properly on Shabbat due to his physicalcondition - even if it is not sufficiently severe to force him intobed - to be equivalent to a :1:llVl'J? ?DU, bedridden individual. Aperson who cannot daven due to his condition, or someonehampered by a condition such as arthritis or Parkinson's Disease,for example, would be included, according to this report, amongthose who may take medication. We will consider later the statusof a person who is sick but, thanks to the medicine he takes, isable to walk around like a healthy person.

(C) A person in extreme pain is not prevented from seekingtreatment. Although it is difficult to find quantitative evaluationsof how much pain is extreme pain, we do find that rabbinic theoryconsiders the individual's own perceptions of his well-being as amost relevant factor for the application of the halacha. In thewords of Rav Brown,! P:l, ,'U f<? ?1'" ,1I.Y 1? 'P'lV?:l "The rabbisdid not restrict a person who has great pain [from taking steps totreal the pain]."

S. In ;'Y"1 '1' .:"l:l';Ii'l:l O'l'1m C"VIlI Rav Brown rules that pregnant, nursing, ormenUruanl women are classified as ··sick" and permitted 10 take medication. See'''7 n"::J1lI n",,.; for Ihe rules governing a nursing women's expressing milk wilha pump on Shabbal.

6. 1"'7 :n":llU7. Dill ;"1'::J mvm8. ~:u"or 'P 1071'1::1 C'l'1Yt:I C"V1l1

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8 THE JOURNAL OF HALACHA

His conclusion is based upon a distinction made by theTalmud itself:~

nnYY1J1 .,. ,nm ":1 ,p" 11ll,!l CK... illU"!lIU 1,'!l'Y,'10K C,:lK ""!l ,c,:J:I .,n,~ ":1 P'01i1? lnH<

If a fingernail became separated... if most of it is off,it is permitted [to tear the rest off] with his hand ...and if they cause him pain, he can remove them byhand. To use an instrument is forbidden, but nosacrifice would be required [in the days when theTemple stood.]

Furthermore, this conclusion is accepted also by ShulehanAruch.1o

In Tzitz Eliezer,1I Rav Waldenberg, citing Mar Uketziyah,permits the preparation of medication for someone who is in greatpain, provided it is done with some sort of modification (shinui),The Mishnah Brurah l1 similarly requires a shinui. Pain isconsidered by many poskim as an extenuating factor to limit thescope of the issur of medicine on Shabbat; in this regard, RavBrown u relies on Minchat Elazar to permit taking aspirin for avery bad headache, However, Rav Weiss14 dissents, arguing thatsince aspirin also has curative powers and is an anti-inflammatorydrug, it should be prohibited, even if the person is taking it onlyfor its ability to mask painful sensations, Even so, Rav Weissconcludes ?j'il? ilK"] C,"1 'YY ,c, IU" CK, "If he has extreme pain, itis possible to be lenient:'l~

9. 5nabbal 94b10, 1<7 n":lIuII..CV

12. , nll< ,CV

13. CV .<u7i"1:::1 C'l'l:rTl C',YV

14. :::I :m-l j'1m j'rn" nnlC

15. What a person may do if he suffers great pain form a toothache is discussed in;1'I'i' f1' 'n r';.n "Y'71'1 r:t ;1 n":::Iv lI"'V .1'!U" f1,nl'l c,tmy <U'mJ O')'lYl:l O"lIlU.In '''D n":::Ii1" n"l/( thell:' is discussion of what a ~TSon should do if he breaks abone on Shabbat.

MEDICATION ON SHABBAT

Who then is included in the rabbinic prohibition againsthealing on Shabbat? It is those in the last category which halachadistinguishes:

(D) wm')'J - A person who "feels ill," who perceives a vaguesense of malaise. The Shu/chan Aruch l6 describes him as

K,.,:l:J 17m' i'tnnn K'ill Kn7Y:l 1V1n'D '7 IV'IV 'n Ki''''

Only one who has an unspecific ill feeling but he getshold of himself and walks around like a healthyperson...

Thus we see that the prohibition is directed at the person whois basically healthy but suffers some minor discomfort - aheadache, a backache, perhaps some hay fever or minor arthriticstiffness. Similarly, people who are healthy but want to dosomething to enhance their physical well-being or to build up theirresistance to disease fall within the rubric of the gezera. Thespecifics will be discussed hereinafter.

What Did Chazal ProhibitA careful study of halachic sources leads to the conclusion

that the issur of taking steps to heal a person was not intended asan all-inclusive ruling. An action which has therapeutic value, butis either not recognizable as such or may also be done by non-sickpersons, would be permitted. For example, drinking tea or whiskeymay be soothing to a person with a cold or fever, and he may evenwant to drink the tea only for that reason - but since other peopledo drink tea not for medicinal purposes he is permitted to do so onShabbat,l7

In the past, some conditions were not treated with herbs,potions, or medicines; therefore, these alternate forms of healingwere not subsumed in the gezera "shemo yischot sammemanim."One instance might be a stomach ache - it was treated byapplication of heat. Consequently, today it would not be forbidden

16. " M"::IW l<"ll::1 ;1<"'::1 j"'O n"'::IlU on,,::1 i'llWl::I ;'O".,n 1"" 1"::1'" ::1"1 "I<' _,ur, '0111

11. n"::Iw "'Y ,M':>1£1

9

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to use a hot waler bottle for a person with stomach cramps.l&But Ihis should nol be understood to indicate that JUSI because

an action of refuah carries wilh it no similarity or danger of"grinding herbs," it follows that it is permitted on Shabbat, Aperson may indeed drink tea on Shabbat to soothe his throat andapply a hot water bottle to a painful limb, but he cannot rub oilinio a sore muscle. 19 Whal is the difference? Were someone toobserve his activities, it would be readily apparent that rubbing oilinto the sore muscle is done for therapy, while no one watchinghim drink lea would be able 10 deduce that he is doing it fortherapeutic purposes. Thus we find that the gezera of healingextends nol only to the patient himself but also involves anotherperson who, observing him, might conclude that it its permissibleto do things in order to feel better. Since this is precisely the fearinvolved in the promulgation of the issur in the first place - thefear that in pursuit of healing a person might transgress theSabbath - any act which is perceived by the onlooker as being forhealing, is forbidden (but only to the exlent that this gezeraapplies, as we have noted),ZO

18. ':l"i' mn:l ;'lllUl'l ,unJ :n":l'Zl tI"n m,,..19. 1:J ::l"YtIl 1"Y In':11020. On the olher hand. ~s noled above Ramo permits a person who is bedridden to

lak" medicine. Why? Mish'1Rh Brlm~h, in his gloss there expresses the opinionthat Ramo's words imply only that the bedridden patient may eat those foodswhich only sick people eal - the rationale being that ahhough the onlooker willobserve him eating such therapeulically-intended foods, he will not therebydraw the general conclusion that it is permitted to be healed on Shabbat; rather,the observer will reason that it is only benuse the person is so sick thaI he ispermiUed 10 ingest medicinal foods.

The author of Shmi,at Shabba/ Kehilchatah, 20;2, wants to extend thelenient ruling of Ramo to the taking of pills, or to gargling, provided that nobiblical issur is involved in the preparalion of the ffi('dicine. He opines that sinceRamo agreed that the person's having to be in bed lifts some of the rabbinIcrestrictions from him, then taking pills which w~re prepared before Shabbatought also to be included within those restrictions eased.

The 5111flchlln Arwch also appears to limit the parameters of the rabbinicregulation against healing. After disnJssing 'various opinions on the matter, herules (328;17);

MEDICATION ON SHABBAT

Does The Gezera Still Apply?

In deciding to prohibit refuah on Shabbat, the Sages clearlyindicated the rationale for their ruling - "lest he pulverize herbs,"which is a biblically-forbidden act on Shabbat. We might very wellquestion if, in the light of changed circumstances, the issur stillapplies to the realities of modern society. Since virtually allmedicines are prepared beforehand and no one grinds his ownherbs to make pills for himself, we might logically conclude thatthe entire issue has become moot.

There is precedent for this line of thinking: the Gemaralt

states that certain forms of dancing and clapping should not bedone on Shabbat, since they are customarily accompanied by amusical instrument. They were afraid "shemo lIetaken klei shir"u"lest ht' fix the musical instrument," an act which is not allowed

·UI< nno 1J rIO '1111"1 ?::l '7ln 1<,1"1 01<. '11'1/1 '''y i"'1 O1J1/11"1 7J O1vlh '011:1It is permitted to do any 5hvut (minor rabbinic retriction) but onlywith some change [in the manner of doing it] if the person is sick inhis entire body and there is no danger to a limb.

In other words, if the medicine is taken in an unusual manner (with achange, a shi..ui) so that the person taking it rl'lllizes - ''I'm only allowed totake it th'is unusual way, to remind me that taking it in the ordinary manner isforbidden" - then the geura does not apply. There are many other instancl'$ ofShabbat law where precautionary rabbinic prohibitions are waived if tht')' aredone with some modification, which is considered sufficient reminder.

What kind of shinui would be sufficient to suspend the geura of t,t,kingmedicine? There are rabbinic opinions that administering the medication by •non-Jew is of itself enough to remind the hwish patient that taking medicine isforbidden and is only permitted to him in this case with a ,hinui. Others arguethat if the pills are made up before the Shabb.t, that too is a ,hinui (sinceclearly the Gemara was talking about situations in which the sick person wouldgrind the herbs he nveded, on the spot, then having them prepared beforeShabbat would be a change). However, that argument is rebutted by th~ whopoint Otlt thaI nowadays all medication is prepared beforeh.nd. As far as theperson taking a pill on Shabbat is concerned, he is not doing anything in anyway different when he takes his pill, from the way he would do it on Friday orSunday. So where is the shinui, the modification? How will it be impressedupon his aWarenes5 that actually medicine is prohibited unlt'Ss taken with amodification. when in his case absolutely no modification at all is taking pl.ce7

21. 7 .,:rJ22. CIl1 ,''"'lrI

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12 THE JOURNAL OF HAlACHA

on the Sabbath. However, in commenting on this passage, theTosafot nole thai the issur of dancing and clapping no longerapplies since we no longer fix our own instruments. 1J

In view of the rabbinic willingness to acknowledge that agezera need not continue when the circumstances which promptedits enactment no longer obtain, the Kerzot HaShulchan questionswhether we may similarly assume that the rule regarding healingon Shabbat had been voided.1t Ketzot HaShuIchal1 concludes thaisince there are still places in the world where people do personallymake their own medicine for immediate consumption, the gezeradoes remain operative. Nevertheless, he considers the prevalence ofprepared medications as constituting a mitigating factor whichshould be taken into consideration when other circumstanceswarrant it; it may affect the final ruling. 1S

Despite the cogent rationale for a lenient reading of the law,the accepted halacha is that the rabbinic regulation restrictingmedicine and healing is still in effect today.

Yom TovThere are numerous instances where the laws of Yom Toy

vary from Shabbat law, and we have to determine whether thegezera of healing was intended also for Yom Tov.

As we have seen, the impetus for the rabbinic regulationcontra healing derives from the biblical issur of grinding onShabbat. However, on Yom Toy the issur of grinding is suspended,to allow for the preparation of food. Logically, therefore, the issurof taking medication should also be suspended on Yom Tov.Indeed, this is the position taken by Ritva16•

However, it is not so simple. "Tachen", grinding, issuspended on Yom Toy in order to enable food to be prepared. Wemight therefore think that tochen is permitted on Yom Toy for

23. Thi~ is not II lone opinion; See-I< :n"?IU C"1:11< pc ,C"?IU 1<"01

24. :I' '11 1nr"llI01 n1)'p

2S. ;1:1\:1 'C 'n p?n 1'V'71< y'Y :1:1<:1 O1n:l"01:1 n:lIU nl'1'J1U ;12 '11 .1< p7n I<'lll< 011<1.'::1 nll< 1":1 '1 p7n :lpll' np7n ;1")'1 '11 ,111nl< Clllllp ,O1::1?O1:1 O'l'U'C 0'1)1111

26..::1:1 01)"':1

MEDICATION ON SHABBAT

other purposes as well. But the derivative permission to grind non­foods is not automatic. It only proceeds in a situation which is"equal for all" (shaveh lechol nefesh). Not all poskim are preparedto accept the contention that the permissibility of grinding non·foods follows logically from the permissibility of grinding foods;thus, they do not consider the gezera of refuah suspended on YomTov.

Mishnah Brurah rules,'lox T1VJX' :110 O"J ilXHn "Healing isforbidden on the first day of Yom Tov."J7 He bases his conclusionon a text in Shu/chan Aruchl& which discusses the differences inhalacha between the first day of Yom Tov and the second.Shulchan Aruch permits application of medicine to a painful eyeon the second day, but not on the first. Obviously, MishnahBrurah reasons, the variation arises from the prohibition to takemedicine on Yom Tov, and it is only on the second day, which insome regard has a lesser status, that we can be lenient about takingmedicine.

Why the prohibition does apply on Yom Tov is not clear andis the subject of considerable rabbinic debate. Shmirat ShabbatKehilchatah Z9 disputes Ritva, suggesting that taking medicine is notsomething which is the same for all (shaveh lechal nefesh):KJ andfor this reason is not permitted on Yom Tov. His premise isarguable, for logically one would assume that all people takemedicine to make them better; all people want to get better andstay healthy - this is shaveh lechol nefesh.

Rav Waldenberg, also disputing Ritva,3! arrives at thefollowing guidelines concerning medicine on Yom Tov:

1. On Chol Hamoed, all medication and healing is permitted.2. Many illustrious rabbinic authorities forbid healing on Yom

Tov.3. If there is a significant gain on Yom Tov in the patient's

27. "nlle I<'pn 11':lI'i"I -'1'IU :1<"1:1 -, p7n ::IpV' np7n::l D1 1"1' :::1,,""" .::I.D ::I") M:l:ll'n28. '::1 l":lI'n n"ll<29. lD,ru ,::I P,g30. 1..,'nl:1 i"I"-' nUltlln 7Y :\,17 l1::1111 YlU1M" 'lD 1"Y31. ro"l\,1 'n p',n 'TY'71< r:ll'

THE JOURNAL OF HALACHA

well-being due to taking medicine, many rabbis permit it.4. If he cannot enjoy Yom Tov unless he takes the medicine,

he is permitted to do so.5. If he started taking the medicine before Yom Tov and he

needs to take it for a few days, one can be lenient. In general, ifone is lenient on this point, there are many poskim on whom torely.JZ

Mental Anguish

Although the science of psychology is relatively new inWestern society, Jewish law has always been cognizant of theenormous impact which the emotions have upon the quality of life;the patient's state of mind is always considered a major factor inarriving at a halachic conclusion.

Already in the Talmud33 we find that when a woman is inlabor on Shabbat, one may kindle a light for her, to make her feelbetter. This ruling is to be followed even if the woman is blind!Although she can derive no physical benefit from the illumination,the Talmud teaches us that "Kny, ::nn' CHtm" since it will "settleher mind" and put her at ease, it should be done.

There is a lively discussion in rabbinic literature over thecenturies as to the broader implications of the talmudic teaching.Just how far are we permitted to stretch the halacha in order to puta sick person's mind "at ease?" What is the value - therapeutically- of the patient's being at ease; alternatively, what is the effect ofa sick person's being anxious about his condition or about thelikelihood of his getting better?

RadvazJ4 would permit violation of the Sabbath in order tomake medication for a sick person - even if the doctor says thepatient does not need' it, but the patient insists he does. J3 His

32. However. an article in Assia I. p. 3S, ciles many Ri,honim who forbid takingmedicine on Yom Tov. The author opines that had Rav Waldenbers been awareof all these early opinions forbidding the practice. he might not have relied onthe lenient opinions of the later Rabbis.

33. Snllbbllt 128b34. '0-' y7n35. "n":)'V ,K!!1' ""1 ":)7" 111<':). A somewhat different twisiio Ihe problem occurs

MEDICATION ON SHABBAT

OpInion is not necessarily the accepted one. Rav WaldenbergU

distinguishes between mental anguish related directly to thephysical condition of the person as opposed to some anxiety whichhe experiences, but which has no direct bearing upon his malady ­for example, he is in great distress because he was supposed todeliver a package but now that he is confined to his bed, he isunable to do it. In a case where the patient is upset aboutsomething connected to his condition, Rav Waldenberg permitsdesecration of the Sabbath (even biblically-enjoined laws) if that isneeded to put his mind at ease. However, in the situation where thepatient's distress is not directly related to his malady, RavWaldenberg permits transgression of rabbinic ordinances only.J1

15

when the patient is convinced that he needs a certain medication, but in truththe medicine has no value; many desperate people are convinced that laetrilewill cure them of cancer, although no one has ever demonstrated that laetrilecan do this. But in the patients's mind, it is very important. What is the halachain such a ca$('7 This situation is discusRd in:C1Kl!liD YUI:I" ;UlilU:l U";' fnlj, Km" n"j1lf n"lK ilJ1'l'jn ,,1:1 ;;''')? , ... K"I:I'

n"j n ,,"n 'TlI""K r:lr ;KD1' 'n jrI!l nl'llOD;' vn"!l D":lD' ;lD - ,Ion T"j" ;"n'K1l.n-,,,In other responsa we find the question of writing to a Rebbe on the

Shabbat to ask him for a blessing - if the patient feels that it can save him. canone do this? See:nmm :11 nlK rolO mn:J "lton ;I"D ''0 D"n:l n,n:l, - ,,\01'''1' mb'D' " n"l'D'

'0 1"nK O'UJ1" ,nj";n 1:1')'lm O"JI1l7 n nll( ro ;0"" 10 pi!! n:l'D nl:l";' '111:1''1:1.;'-::lY

Other rabbinic authorities were asked about carrying a "K~m~~h" (chann)which was wrillen by a person not versed in the Kibbalilh - but the sickperson believes thilt the K~meyah preserves his health. ;'''j K"'D' ;)" n"'D' n"lK.

36. u-m ;'''j 'n ~n 11,\0'''1( r y37. Note the comments of Mishnah Brll1llh 1:1:1"10 whether this rule would be in

effect even if the patient does not express his wish, but we know or nsume hisf~]jng.

A question was asked of Riv Breisch about the permissibility of a personwho ;s sick, although nol dangerously so, listening 10 the radio Oil Shilbbilt[having a non-Jew or an electronic timer turn it on and off]. Reluctantly, RavBreisch allowed it. although he did comment that m,'on i'1l1OD 11 l'K, it is not apious thing to do. Returning to the same issue later, Rav Breisch, whileadmitting that his ruling meets the technical demands of hilacha, express" hisregrel that he ever permitted it See n":lr '1 jt1n 011 j"O .K"O .M jt1n jPY' njt1nand also the Encyclopedia Talmudil I))' q, 1'" jt1n.

THE JOURNAL OF HALACHA

In his responsa, Rav Moshe Feinstein writes that a man mayride in a car with his wife who is in labor since she may be afraidto go alone to the hospital. 3& He even permits a person to takemedicine on Shabbat, which he would otherwise not be permittedto take, if the person's menial anguish at not being able to take itmight result in a nervous breakdown, But at the end of theresponsum, Rav Feinstein notes laconically, 'lYIJ 1'1'< ,C,fO D'Vnf<

"there are no such people."J&·What all this amounts to is a deep awareness of the power

which mind has over matter. At the same time that halacha issensitive to the subtle effects which a person's psychological statecan have upon his physical well-being, all precepts cannot beswept aside just because the person is going to get upset aboutobserving the Shabbat regulations. Some rabbis give considerableweight to the patient's psychological needs, while others limil thelatitude of that consideration.

The preceding discussion has a direct bearing on the questionof visiting a sick person in the hospital. If a person is confined tothe hospital on Shabbal, far from family or friends, what !hay onedo to prevent his being deeply unhappy and lonely on Shabbat7Rav Brown)? writes that it is permitted to transgress rabbinicprecepts - but not biblical ones - if it is important for the patientnot 10 be alone. For example, it would be permissible. to have aGentile drive the visitor to the hospital. Rav Brown also cites theopinion of Prj Megadim who is prepared to allow even biblicallaws to be set aside. tO The Chazon Ish considered it important for asick person to have visitors so that the hospital staff wouldrecognize that he has many friends who are concerned with hiswelfare, and therefore would nol neglect him,41

36. , J'? .K n"'K ,i"Iltm ""lK. Sei' alS<) K"O? \U'I( 111" ""lK.38a. )") '0 n"'K ,1 ?';.n.39, , y"O J"Y p,nK O'lmy ro';.i"IJ C'l',:m C"YIO.40. For a full discussion, see ,1'-1(' ,I" ?"lD ,i"IM::I"'i"I::I M::I1O M''l:)10

.,.'0 'K ?'m ::IyY' "y,n 01 .1"0 mlli"l r'y'.41. ::I""::In n"'K

MEDICATION ON SHABBAT

Medication Over An Extended Time

Everyone, comments Rabbi Shlomo Kluger,42 writes thatmedication being taken before Shabbat can be continued onShabbat. What is the source for this leniency? He proceeds toanalyze the conclusion to determine if it is halachically accurate.

In the Cemara43 there is a discussion among the rabbis abouttaking chilthit, a certain substance which was dissolved in waterand then drunk to relieve asthma. Rav Hiyya reports:

i1l'3n:::l n'JT.I1 11'Y:::l in,VI ...,~x, X)1M ::Ii" M'M"XIU 'I<MI<

,,::1 'MVI'X 1<" I<::I'M 11"M itll<' 'I<~' ,,,lJl< "VI' 11<J:l:::l

'niU 1<, '1< I<n:::lVl "YJ:l, I<lUJJn 'MVI'X' 111:l I<:ln ,::11<

.pMtI'~ M::IVI::I

I went and asked R. Huna [about doing this] and heanswered me... He may dissolve it [the medication] incold water and place it in the sun. Is this onlyaccording to him who permits dissolving? No, evenaccording to him who forbids iti that is only if onehad not drunk at all. But here, since he had drunk iton Thursday and FridaYr if he would not drink it onShabbat, he would be endangered.

Shulchan Aruch, basing his psak on this talmudic text, rules: 44

Ool mmu, 1"Y1 'lUlU c", 'VI'l:Jn CP 1ll:JJ:l nMVI 01<'

ill 0'1')' i1.l1:::lVl mmlU' mxun 1" x,n 1:::l1U ,ml:J M:::lIU::I

.1lJ:ltJ nnlU' 1<, 01< m::lO 1<1i1V1 'nm ...ill 'MI<

If he drank [a medicinal potion] on Thursday andFriday, and he needs to drink also on Shabbat, he isallowed, for this is the way he is healed, to drink itfor seven days in a row. [Therefore he may do it]because it is a danger if he does nol drink it [onShabbat].

42. TOO" n"J\O tin";, i~t1

43•.D"j7 nJ\I.I

44. n'" ""'J\I.I

"

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Since both in the Talmud and in the Shulchan Aruch theelement of danger is given as the rationale for permittingmedication on Shabbat, one might assume that if there is no danger10 the patient in not taking it, then even if he began the course ofmedicine a few days before, he is not permitted to continue duringShabbat. Hence it is somewhat surprising to read the law inMishnah Torah as follows;45

,nm 171m ilM11V Klil ',m n:UOil a"pn n'n"n ilntU,n::lIu:J ,mnlU?

A person who drank chilthit before Shabbat cancontinue 10 drink it on Shabbat.

Significantly, Rambam has included no mention whatsoever of"danger." The commentary Magid Mishnah 46 suggests thatRambam was using a variant lext of the Talmud - instead of thephrase "he would be endangered" (pno'I'J), his manuscript read"he would get sick" (ilC,n'). Whatever the reasoning, it is a factthat Rambam holds that if a person would get sick again if he wereto interrupt his medication, he may indeed continue. The Ran47

seems to share this view.4& However, it is only applicable if theperson will become truly sick and nol only be in pain.

Discussing this topic, Rav Waldenber~' concludes that ifstopping the medication over Shabbat would cause the patientconsiderable pain, it is possible to rely on the authorities cited byRav Kluger and continue taking it.

Rav Waldenberg adds that in general today one can be lenientabout taking medicine on Shabbat since it is not our custom togrind herbs ourselves. Rav NeuwirthSO is also lenient if the courseof medication has already been started, but the author of Eglei

45. ;n:J(;) ";)1/1 "1;)':>:"146. CI/1'CJC'':>'01JIIm "T'll'J

47. J(,DU .01/1

46. I:n ";)1/1 01;)':>:1.0::lD, 0111/101

49. n"Dr 'n r':>n i1yryl< r y

50. 1'::1, 'Ii O1n;)"",,;) ";)1/1 ""DItl

MEDICATION ON SHABBAT

Ta/51 prefers a strict interpretation of the talmudic text and onlyallows one to continue if it will endanger him to stop thetreatment.

In an uncharacteristically terse responsum, Rav MosheFeinstein52 finds no herer whatsoever to continue taking medicineon Shabbat, unless the patient will suffer such emotional distressthat he might have a nervous breakdown. But Rabbi Greinemanu

cites the Chazon Ish, permitting taking medicine on Shabbat if it ispart of a course of treatment which requires the person to take themedicine for a number of days consecutively.

Chronic ConditionsA somewhat different situation is presented by the patient

suffering form a chronic disease. Diabetes, for example, is acondition which is considered life-threatening; thus the diabeticwithout question may take whatever medication is required tomaintain the disease under control. However, some procedureswhich are utilized to monitor the pa.tient's vital signs and areessential to the long-term management of the conditions might besubject to halachic restriction. An instance of this is testing forsugar in the urine, which the diabetic does by inserting a sensitizedstick or paper into a urine sample and determining, by means ofcolor changes which ensue, whether his condition is stable or not.A potential halachic problem is involved in causing the stick tochange color, but Rav Brown54 rules that it is permitted.

As for taking insulin by injection, Rabbi Neuwirth55 permitsit, provided that the supervising doctor asserts that it is essentialfor the patient. However, if the doctor says that alternately thediabetes could be controlled by strict supervision of the diet, RabbiNeuwirth would not permit the pati~nt to opt for insulin-injectiontherapy; however, on Yom Tov he would allow it, for on Yom Tov

51. 1:) lnlU n:)/(l;ID'~ 'l;IHI52. II j"'n n"l/( .nlUll n1'1/(

'53. T'wn rpo ,,:.nr.J l;Iy '1U1' "Y\II'54. K':KY :'l:)l;I;':l O'l'l:tll C"Y'D55. 1"1'" l"U\U nn:)"';1:) n:l\ll' n,·r.J\II'

19

zo THE JOURNAL OF HALACHA

it is not proper to curtail one's enjoyment of food.

Eye CareIn halachic conceptualization, "the eyes aTe connected to the

heart."S6 Since vision is such a critical factor in the quality of one'slife, Jewish law considers a threat to one's sight as virtuallyequivalent to a threat to his life, as is evidenced in the Talmud:51

Someone who has pain in his eyes or eye, or tearsgush from them... we transgress the Shabbat for him.

However, absent such severe symptoms, the customaryrestrictions regarding healing on Shabbat apply also to eye care.Therefore, the Gemara" does not permit rinsing out the eye withwine, since this act was clearly done for its (supposed) therapeuticvalue, nor does it sanction other external applications of medicineto the eye.

Nevertheless, the Shulchan Aruch59 rules that it the act couldbe interpreted as being done for hygiene, not for healing, it wouldbe permitted. Thus, if someone wants to wash out his eye, he maydo it; if he wants to use a special solution for it, however, themixture should be prepared before Shabbat.

The author of Shmirat Shabbat Kehilchatah60 does allow aperson in pain to administer drops to his eyes or to use an eye cupfor rinsing; in some cases he even permits a salve to be placed inthe eye, although great care must be taken not to smear the salve,only to let it exit from the tube directly on to the eye.

Related Areas

Investigating the gezera of refuah, one is led down manybypaths of halacha, regarding both Shabbat law and other areas ofJewish jurisprudence. As we have noted, any action which furthers

56. ,n::l ml m'::ll/57. ,ro .", m1::ll/58. :np n::l1l159. /('"::1 n"::lV60. ,:tcI

MEDICATION ON SHABBAT

the healing process is liable to be included under the rubric of"rejuah." Rabbis have considered many aspects of this issue intheir responsa and commentaries; the subjects cover a wide gamutof activities:

(1 ) TemperatureTaking a person's temperature is a question whose

ramifications have to be considered from two angles - (1)Measuring is forbidden on Shabbat; does this include measuringtemperature? (2) Does taking the temperature constitute "healing?"

The Shu/chaM Aruch61 rules that it is forbidden to take anaccurate quantitative measurement of a substance, whether onShabbat or Yom Tov. Thus, if one is cooking or baking on YomTov, which is permitted, one is nevertheless nol allowed 10 measurethe ingredients precisely. One should not spoon flour, for example,into a measuring cup to get an accurate amount. The reasons forthis issur have been given as c'm, 1<':1.131, that precise measuringmakes it like an act done on an ordinary day; alternatively, thereason is given .that '1:1DC, "m, i'IK'J . it resembles measuring asif to sell.61

It remains to determine whether measuring the temperature isconsidered "measuring" within the meaning of that termhalachically. While conceding that measuring items is forbidden,the Shu/chan Aruchu adds that "it is permitted to take ameasurement for a mitzva" - illYJ:) C,ll1 il"'O ,nY.lc' ,nm. In thecourse of his discussion on this, the author of Mishnah Brurahcomments,'"

np'nllJ n,'Ul K'i'1 il1YJ:) rpm nKl!J'l I<'il ilKm, il,',n,.ill:l. 1"llJ KC, D'JnnO

Measuring is [a step in] healing, and healing the body

61. "'pn n"\1(62. '-)"::111I n",1(63. n"IU n"'1<64. 1"t, nll< ,OIU

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22 THE JOURNAL OF HAlACHA

is a mitzva; the geura against pulverizing herbs doesnot apply here.

On the other hand, Rav Moshe Feinstein,65 in also permittingthe taking of temperature, states his opinion that it is not evenmedical treatment; rather it merely informs the person that he issick and that healing is required. In no way does this fall under thecategory of healing, which is the subject of the gezera underdiscussion. A similar attitude is mirrored in Tzitz Eliezer.66

Parenthetically, it is worth mentioning that in his next responsum,Rav Feinstein expresses his opinion that a temperature of about102° F warrants, even mandates, desecration of the Sabbath if thatbe necessary to cure the patient, for he considers such an elevationto be an indication of a life-threatening condition. Some rabbisrulf67 that if a person has above 38° C (about 100.4° F) he maytake aspirin to lower the fever, but others61 do not agree that anyspecific elevation is the criterion for deciding whether one maydesecrate Shabbal. The author of Shmirat Shabbat Kehilchatahwrites that doctors have informed him that at times only low-gradefever accompanies a life-threatening illness." The Chazon Ish'1Orules that even slight temperature should be considered gravedanger for a young child.n .

A modern wrinkle in this old question has been brought aboutwith the recent introduction of new devices for measuringtemperature. In the words of Tzifz E.lieur71, there is now available,. a thermometer which is made [ike a small strip of plastic film, andwhen it is affixed to the forehead, after a few moments, it registersthe condition of the patient, whether he has fever or not." These

65. n"~p .f( n"\f( :"1111"0 m'lf(66. '-I i'7n '1V'7f( r y

67. f("7 11'171111:"1 "~ n''''p 1m,1II11 myp68. 1:~ :"Il"I~e,..:"O l"I:lI17 ""1"111169, Dill

70. T01 n"1f(71. See alSQ the lenient opinion of '~:1 p'::>n :1i'Y" l"Ip7n

n. 7]1 1",rc C'i',;ml 0'1"J1II\U:11 D7'!l 7111 mop IrIC l"I~mn n'1Jr~ '111l1l :"1m Cln-"1t111""n)/!l1:'1 ." 7)/ om 17 WI CI( :"I71nl1 7\11 \:LYl:l 7)/ O']r11ntl m'l'll :"ItI~ '1:1~ 'II( nYJ:In

.""t1'C:"I 7]1 "1"rctl nl")'I'1(7 "1'ml'i

MEDICATION ON SHABBAT

"new-fangled" thermometers indicate the elevation by letters,numbers, or some other coloration of sensitized material in thedevice.

Rabbi Ovadiah Yosef1J mulls over the halachic questionsimplicit in the use of these gauges - when body heat causes leiters,figures, or dots to become visible on the adhesive strip on hisforehead, is this considered "writing on Shabbat?" He notes thatthe temperature read-out does not last - shortly after the"thermometer" is removed from the body, the figures fade. Canthe short~lived appearance of figures be considered "writing?" Ifthere is no act of writing which causes the figures to appear, is itstill forbidden on Shabbat?

As is his wont. Rav Yosef examines the topic exhaustively,citing many relevant opinions on the matter. His own lenient rulingis based on the response of Ramo/4 who permitted opening orclosing books which have writing stamped on the sides of thepages, since this is not the "normal" way of writing. By analogy,neither is the temperature strip's registering of figures or letters the"normal" act of writing. n As final support for his argument, hecites the biblical precedent of King David, who consulted the U,imVeTumim on Shabbat, even though its response was effected by"illumination" of the letters inscribed upon it.

(2) VitaminsVitamins are ingested by many people in the belief that they

promote good health. Are they medicine - or food? The answer tothis apparently trivial distinction will have a radical effect on thehalacha as it pertains to taking vitamins on the Sabbath.

In Tur'6 it is written:

73. 0";):' !1Y'1 ,n"'74. 'r' ;l"I(W'

75. In a wholly different context, Rav Feinstein discusses the prohibition of writingon the Shabbat as il might apply to the practice in some synagogues to positionnumbers on a display board indicating what page the Ch"um is up to..,.,"? I( n"ll( 1'l1lm m'll(

76. IT.! nIl( 17;n";11/1

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O?::ll'c7 ,n1Y.l C'K',J. ?~Kl'J CilVJ C'i'lVtJ1 C'?J.1K ?~

Kn?'l'J iln:J'l'J1 C'K"J. nyi'? C'VJp emu !)"Y'x ImnlV?'O'X',J. ilPlUlJ1 ?:JXI:) U'XlU ?:J, "lU i'lN!lX "J.,Y ilK'!)'?'KI:)?'yJ. VJm'l:) ,? VJ'VJ '1:) Xi"'1 ilXm,? ,mnlU? .,'OXlUm'l'J O'lU 1? 1'X OK ?JK X'''J.~ 1?1il' i'Tnnn K1il'

.,n1Y.l

Any food or drink which is food for healthy personsmay be eaten {on Shabbat] even if it is difficult {todigest] for some healthy persons and even if it isevident he is taking it for medical purposes, even soit is permitted. But whatever is not food or drink forhealthy persons it is forbidden to ingest it for healing- but all this refers only to a person who has a vaguemalaise but is yet able to overcome (it] and walksaround like a healthy person. However, a person whohas no pain is permitted [to ingest it].

The essence of this ruling is that if a substance is consideredfood by most people, then a person can eat it on Shabbat, even ifhe happens to be doing so for the healing qualities of this food.Conversely, a substance which is perceived to have healingqualities may not be taken by a person who is slightly sick on theShabbat - but if he is not sick at all, there is no restriction in thisregard. This sweeping heter is limited, according to MagenAvraham'n, to a healthy person who eats the medicinal substancenot for its healing properties but to satisfy his hunger. If he iseating it simply because he is hungry, then there is no re!ltriction;on the other hand, if he is eating it for its health-enhancingpowers, then he may not do so on Shabbat. According to Mager!Avraham, it was not the intention of Tur to abrogate the geura ofrefuah for a healthy person. However, the Bet Yostf" interpretsthe dictum to mean that a person who is not sick at all may ingestany food or substance he desires.

Obviously, the difference in interpretation will playa crucial

77. CIV

78. n":l\u n"lle

MEDICATION ON SHABBAT

role in determining.the halacha. If we accept the Tur at face valueas does Bef Yose!, then a healthy person may take vitamins onShabbat without qualms; however, if the opinion of MagenAvraham prevails, the following decision has to be made: Arevitamins substances which people take in order to be healed? Thena healthy person cannot take them on Shabbat, unless he is eatingthem to satisfy his hunger. But if vitamins are food, not medicine,then one may ingest them on Shabbat.

In Mishnah Br"rah19, the opinion of Magen Avraham isaccepted; according to this ruling, if a person wants to takevitamins for their therapeutic value, he may not do it on Shabbat;the author of Shmirat Shabbat Kehilchatah&O follows suit.

However, in a lengthy responsum,'1 Rav Moshe Feinsteintackles the iss"r from another vantage point altogether. He opinesthat it is possible to view the talmudic gezera against healing asreferring in the first place otlly to a person who is not feeling well- perhaps, due to his concern over his well-being, he might forgetthe issur of "grinding herbs." One not sick at all was neverpresumed to be liable to such inadvertent error - and the gezerawas never intended for him at all! This is quite a sweepingdispensation, radical in its implications; although Rav Feinsteincites Tosafot .md Rashi in support of his theory,12 he concludes hisresponsum with the following ruling: The strict opinion of MagetlAvraham is to be followed if the person feels weak and expects thevitamins to help him regain his strength; but if a person takesvitamins on the theory that they are helpful in building up thebody's ability to resist disease, there is no reason for him not totake them on Shabbat too. Although Rav Feinstein does not spell itout, he seems to be saying, in the latter instance, that if a persontakes vitamins for the same reason he eats many foods - because awell~balanced diet promotes well~being, then basically they are

'19. :l"?"n"::I1/)80. 1<':10

81. "I]:} n"ll<

82. S~ also ':1 '1'lID DIU ,I<Y ,":n 'p T1,nl< 0'0]11' ,i"Ol:ll'l:l D'l',yn O"lIlU

zs

Z6 THE JOURNAL OF HALACHA

considered food, and there is no reason to avoid them on theSabbath.

The distinction between "healing" and "promoting goodhealth" is onE' which continues to characterize the halachicdiscussions in regard to refuah. The former is eschewed, but thelatter is often permitted. Ketzot HaShulcltan&J finds nothing wrongwith using an inhaler (vaporizer) since it only provides relief butdoes nol actually promote healing. The same lenient Tuling appliesto using mouthwash, which removes or masks any mouth odorpresent, but does not cure the underlying condition which causesbad breath. But Shmirat Shabbar Kehilchatah," with a mOTE'

restrictive interpretation of the halacha, permits the inhaler only ifthe patient has such a terrible cold that he is bed~ridden or else ifhis entire body aches. Clearly, he considers an inhaler to beefficacious in easing the cough or congestion, even if onlytemporarily; on these grounds, it is assur as refuah.

Rav WaidenbergS5 makes the same distinction in discussingwhether one may take bicarbonate of soda on Shabbat. In the sam':!responsum he renders a lenient opinion with respeci 10 a woman'staking birth control pills on Shabbat.M Since the pills do not in anysense make her healthy - their only purpose being the avoidanceof pregnancy, which might make her sick - he allows them onShabbat (assuming that she is permitted to use them altogether).Following the same reasoning, Shmirat Shabbat K,!titt:hatahs7 isinclined also to be lenient.ss

(3) Sleeping PillsNext we have to consider the situation of a person who is not

sick, laking a pill which does not heal - a sleeping pill. Is thereany reason not 10 do it on Shabbat?

Many poskim have been quite lenient about this, for a variety

83. It':> In':>llU.. ..,~~ ,Yt' In':>llUi''I mYj784. !:It~ j7'!:185. 01 1U'1 i"I'"' ""·'0 n j7':>n ,IY'':>1t ry86. It'~l i"I'" ....oj7 9'

87. '''Y' '1' ~ j7':>n88. 1"::l - 1 pn ::lj7Y' nj7':>n 01 i"Ilt'

MEDICATION ON SHABBAT

of reasons. One avenue follows the theory that if a person's entirebody is in pain, he is allowed 10 take medicine on Shabbat89 and"when a person lacks sleeps, it is a distress for the entire body."90

Ketzot HaShuIehan 91 is also permissive, but bases his rulingon the absence of any healing performed by sleeping pills - theymerely induce sleep. but do not heal. This, he maintains, isanalagous to the case cited in Shulchatl Aruch. 91

lDW:::l ""1" ,." nUl:::l "0" U"M ,nXUJ'Vl ':::lnVlllU 'tl.n::lIU:::l C:::lltl? ,mtl

A person who got drunk, whose cure" is to anointthe palms of his hand and feet with oil, may anointthem on Shabbat.

However, the permission to take sleeping pills is extendedonly to those pills which only make a person sleep; but if the pillalso contains substances which heal, it may not be taken.93

Not all poskim agree that a sleeping pill may be taken.Che/kat Yaakov9<l is one.of those who opposes any leniency on Ihisissue. In a reverse situatJon, Rav Weiss refuses to grant permissionfor a man to take pills to keep him awake, even if his purpose is tobe able to stay up on Friday night and learn Torah.9'

(4) ExerciseAs we have seen, Ihe implications of the gezera of healing on

Shabbat extend 10 a surprisingly wide sphere of human activity. Inits broadest sense, the gezera has been understood to prohibitanything which is done 10 restore the body to health or for healthimprovement. But how far does this take us?

How should one define an activity which :s designed 10

89. '::1 11n:l"'''~ n:llt' n,'olt'90. ::1 ";'1'1:1 1<:1:191. 1<" fill< In"'!U11 ":1 mil92. 1<"0 n":I1t' D"n 1'1"1(. For the nme rnson. Shu/chan Aruch In"" .O\fl) permits a

cantor to ut a raw egg on Shabbat to enhance his voice.93. 1"13 .D!U In':nlt'11 nu'i'94. I<"D " y"n95. ";":l - 1 y',n yl"lY' nnltl

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28 THE JOURNAL OF HAlACHA

strengthen the body? Is that, too, part of "healing?" ManyAcharonim do indeed consider t}llil :m~, conditioning the body, 35

"healing" within the intent of halacha.The Mishnah in Shabbat% teaches:

p"lntJ xr" p'l:IlInlJ xc, ?JK l'vn:nzmm 1':10

[On the Shabbat] one may anoint and rub but oughtnot to exercise or knead [the muscles].

Rashi explains that a light body massage is acceptable, but oneshould not massage strongly or pummel the muscles to increasecirculation. In his Code,'" Rambam adds that one should not usehis body on the Shabbat in such a way as 10 raise a sweat, becausethis is healing:

.i1Xl!n K'i1'.U n::lU1J YlPlU '1:1 'tJYlI nK 1/,"" "OKlU

Following Rambam's format, Shu khan Aruch98 also forbidsany activity which raises a sweat. Mishnah Brurah99 explains that itis forbidden to exercise - since medication is given to raise a sweatin the patient, then exercise, which also raises a sweat, is forbiddenas a form of refuah. It is interesting to note, however, that if aperson exercises for pleasure only, without thought of the healthbenefits involved, there is no reason not to do it. Quite simply,Shulchatl Aruch rules lOO ,n1l'::l cnY'!JpJ O'UlInl::li1 O"lMJ, "Youthswho enjoy jumping - it is permitted." By extension, if it is notevident to the observer that an activity is done for health reasons,it may be undertaken, as Ramo101 comments, 7""7 p1

,nll::l "and it is also permitted to take a walk."However, Mishnah Brurah prohibits running on Shabbat,

since it is obviously a health-related activitylo2 although Shaar

96.•I"O?

97. ;nm i"IllIm

98. J"D n"JW. See also 1I1"lV "J .,", i"IJ7i"1 "I('J99. 7"? nll( .DIU

100. J"D I("W

101. DW

102. OW

MEDICATION ON SHABBAT

HaZiol1 10l cites the Opinions permitting running in order to buildup an appetite. In Shulchan Aruchl~ there is also some discussionabout playing ball on Shabbat. Writing in the last century, RabbiHoffman 105 vacillates between the lenient vieV>', which he is notprepared to accept, and the strict opinion, which he also does notwant to lay down as law. Finally, he rules that if one is asked, heshould not permit playing ball on Shabbat, but in a place wherethe custom is to be lenient, one need not announce that it isforbidden. But Shmirat Shabbat Kehilchatah,loo in a brief comment,forbids all exercise.

This survey of halachot regarding healing on Shabbat,although brief and certainly not intended as a comprehensivereview of the subject, has, it is hoped, provided an insight into thebreadth and complexity of a subject about which there is a greatdeal of discussion. What has been written here should not beregarded as a compendium of piskei halacha but as an introductionto a difficult subject for the person concerned. about meticulousShabbat observance.

103. \.l nIl< p":rn 'YI/.l

104. n"T,) '0 n",,", n"'1<

105. 1"] n"11< "'11';,', 'T,)?D106. :3',1<:3 i"!l