Pikuach Nefesh: Saving a Life on Shabbat
Last week's issue discussed the source for performing melacha in a life threatening situation (pikuach nefesh) as well as the nature of the mandate to perform melacha. One of the issues discussed was whether Shabbat is suspended in the face of pikuach nefesh (hutrah) or whether pikuach nefesh overrides Shabbat (dechuyah). This article will explore other questions that may be contingent on the question of hutrah vs. dechuyah.
Minimizing the Melacha
The Gemara, Shabbat 128b, quotes a Beraita that if one must violate Shabbat to treat a yoledet (a pregnant woman who is in an advanced stage of labor), one should try to perform the melacha in an abnormal manner (shinui) in order to minimize the melacha involved. If it can't be done in an abnormal manner, one may perform the melacha in its normal manner.
Ramban, Torat Ha'Adam, Sha'ar HaSakanah, deduces from this Beraita that when violating Shabbat for pikuach nefesh purposes, one should try to do whatever possible to minimize the melacha involved (if it will not cause any delay in treatment of the patient). Maggid Mishneh, Hilchot Shabbat 2:11 contends that Rambam disagrees with the opinion of Ramban on this matter. Rambam, Hilchot Shabbat 2:11, records the requirement to minimize the melacha regarding a yoledet. However, regarding a life threatening situation, Rambam, Hilchot Shabbat 2:1, omits any requirement to minimize the melacha involved. R. Yitzchak Z. Soloveitchik, Chiddushei Maran Riz HaLevi, Yoma pg. 52, explains that a yoledet is not in a life threatening situation. The reason why one is permitted to violate Shabbat to treat her is because failure to treat her may lead to a life threatening situation. Therefore, the treatments must be done in a way that minimizes the melacha. However, there is no requirement to minimize the melacha involved in treating someone who is already in a life threatening situation.
Shulchan Aruch, Orach Chaim 328:4, implies that regarding a life threatening situation, there is no requirement to minimize the melacha involved. Nevertheless, Rama, Orach Chaim 328:12, rules that one should try to minimize the melacha involved in whatever way possible.
Some Acharonim (R. Shlomo Kluger, HaElef L'cha Shlomo, Orach Chaim 297 and R. Malkiel Tannenbaum, Divrei Malkiel 4:15) explain that the dispute between Shulchan Aruch and Rama is contingent on whether pikuach nefesh on Shabbat is hutrah or dechuyah. R. Tannenbaum adds that the Gemara, Yoma 6b, states that the term dechuyah connotes that if there is a possibility of minimizing the prohibition, one must do so. [This statement is not said regarding life saving missions but rather regarding the principle of tumah dechuya b'tzibbur, the concept that ritual impurity is overridden for the communal sacrificial order.]
Use of a Non-Jew to Save a Life
Another issue that may relate to the question of hutrah or dechuyah is the use of a non-Jew or a minor for life saving missions. If one assumes that pikuach nefesh on Shabbat is dechuyah, it should follow that if there is a need to perform melacha for pikuach nefesh purposes and there is a non-Jew or minor available, one should employ the non-Jew or the minor in order to minimize the melacha involved. Yet, a Beraita quoted in the Gemara, Yoma 84b, states that one should not seek out a non-Jew or a minor for life saving missions on Shabbat. Tosafot, ad loc., s.v. Ela, explain that one should not seek out a non-Jew or a minor out of concern that they may not act as quickly to perform the life saving mission. However, Ran, Yoma 4b, s.v. V'Ain, explains that the reason why one should not seek out a minor or a non-Jew is because there is a concern for a future calamity. One of the bystanders may deduce that in a life threatening situation, one must attempt to find a minor or a non-Jew to perform melacha. In the future, he may be in a position to respond to a life threatening situation and his initial reaction will be to seek out a non-Jew or a minor. If neither of them is available, the delay may endanger the life of the patient.
Presumably, the practical difference between the opinion of Tosafot and the opinion of Ran should be limited. Regardless of the reason, the Beraita states unequivocally that one should not seek out a non-Jew or a minor for a life saving mission. In fact, Or Zarua, Shabbat no. 38, sides with the opinion of Tosafot that the reason why one does not seek out a non-Jew or a minor is out of concern that they may not respond as quickly. Yet, he concludes that even in a situation where it is known that there will be no delay, one may still not use a non-Jew or a minor. However, Rama, Orach Chaim 328:12, rules that if there is a non-Jew available and there will be absolutely no delay if he performs the life saving mission, it is preferable to use the non-Jew in order to avoid melacha performed by a Jew.
Rama's ruling does not go uncontested. Taz, Orach Chaim 328:5, claims that even if one accepts the possibility of seeking out a non-Jew according to Tosafot, one must still be concerned about a future calamity. Basing himself on the opinion of Ran, Taz notes that every life-threatening situation serves as an informal training session in handling emergencies for all who are present. Therefore, one should shun the practice of seeking out non-Jews or minors. Furthermore, one should assign performance of melacha in life threatening situations to the rabbis and leaders of the community in order to teach the importance of pikuach nefesh on Shabbat.
R. Tannenbaum, op. cit., explains that if one assumes that pikuach nefesh on Shabbat is hutrah, there is no need to seek out a non-Jew or minor to perform the melacha. Only if one assumes that pikuach nefesh is dechuyah is it possible to require one to seek out a non-Jew or a minor in order to minimize the melacha involved.
However, R. Moshe Feinstein, Igrot Moshe, Choshen Mishpat 2:79, claims that the question of whether to seek out a non-Jew or a minor is not dependent on the question of hutrah or dechuyah. If there is a life threatening situation where one option involves no melacha but does involve delay and the other involves melacha but no delay, one would certainly choose the latter, even if pikuach nefesh on Shabbat is dechuyah. If neither option involves any delay but one involves melacha and the other does not, one should choose the option that involves no melacha, even if pikuach nefesh on Shabbat is hutrah. R. Feinstein suggests that the question of hutrah or dechuyah is limited to a situation where there are multiple parties (or one party with multiple options) obligated to perform a commandment and one of those parties can perform the commandment in a manner that would involve no prohibition. This does not apply to a situation where one must choose between an adult Jew and a non-Jew or minor. Neither the non-Jew nor the minor has an obligation to perform the life saving mission. Therefore, the adult Jew is assigned the primary responsibility of carrying out the life saving mission. There is no need to seek out a non-Jew even if pikuach nefesh on Shabbat is dechuyah. Rama's ruling that one should seek out a non-Jew or a minor if there will be no delay is only an added stringency and is not required from the letter of the law. For this reason Taz shuns this practice out of concern that it will lead to a future calamity. If there was a true requirement to seek out a non-Jew, the concern for a future calamity would not be sufficient to permit violation of melacha by an adult Jew when there is a non-Jew or minor available.
R. Feinstein implies that the question of whether one must perform the melacha in an abnormal manner is not contingent on the question of hutrah or dechuyah. One must explain that even if pikuach nefesh on Shabbat is hutrah, there is still a requirement to minimize the melacha involved if it will cause no delay. [Nevertheless, one is still compelled to understand the opinion of Maggid Mishneh - that there is no requirement to perform the melacha in an abnormal manner - as based on a more expansive approach to hutrah.]