Treating Non-Life Threatening Illnesses on Shabbat

The previous three issues discussed treatment of life-threatening situations on Shabbat.  While treatment of life-threatening illnesses warrants violation of all prohibitions on Shabbat, non-life threatening situations do not warrant violation of Shabbat.  Nevertheless, there are certain leniencies regarding a choleh (an ill person) in a non-life threatening situation.  This issue will discuss what leniencies apply to a choleh and what types of illnesses define one as a choleh. 

The Leniencies for the Choleh

The Gemara, Shabbat 129a, states that one may ask a non-Jew to perform any melacha in order to treat a choleh.  There are four interpretations in the Rishonim regarding the nature of this leniency.  First, Rashba, Teshuvot HaRashba 3:275, states that this leniency is indicative of a broader leniency to permit violation of any rabbinic law for the purpose of treating a choleh.  Requesting a non-Jew to perform melacha constitutes a rabbinic prohibition which is lifted in order to treat a choleh.  Similarly, a Jew may perform a task that would ordinarily constitute a rabbinic prohibition.  Second, Ran, Shabbat 39b, s.v. MeHa, limits the leniency of the Gemara to that which is stated.  The only prohibition that one may violate to treat a choleh is the prohibition of asking a non-Jew to perform melacha.  A Jewish person may not violate any rabbinic prohibition (aside from the prohibition of asking a non-Jew to perform melacha) in order to treat a choleh.  Third, Ramban, Torat Ha'Adam, Sha'ar HaMeichush, states that one may ask a non-Jew to perform a melacha in order to treat a choleh.  Alternatively, a Jew may perform a task that would constitute a rabbinic violation on condition that he performs that task in an abnormal manner (shinui).  Fourth, Rambam, Hilchot Shabbat 2:10, implies that the leniency to ask a non-Jew to perform melacha is indicative of a leniency to violate lower-level rabbinic prohibitions in order to treat a choleh.  Asking a non-Jew to perform melacha is one example of a lower-level rabbinic prohibition.

Shulchan Aruch, Orach Chaim 328:17, quotes all four aforementioned opinions.  He rules in accordance with the opinion of Ramban that one may ask a non-Jew to perform melacha or one may personally perform a task that constitutes a rabbinic violation on condition that it is performed in an abnormal manner.  Rama, ad loc., does not interject on this matter, implying that he concurs with Shulchan Aruch that the normative opinion is that of Ramban.  Taz, Orach Chaim 328:25, questions Rama's opinion based on another ruling.  There is a rabbinic prohibition to take medicine on Shabbat out of concern that it may lead to the grinding of herbs (See, Gemara, Shabbat 53b.)  However, Rama, Orach Chaim 328:37, rules that a choleh is permitted to take medicine on Shabbat.  Taz asks: if in fact Rama rules in accordance with the opinion of Ramban, why does he allow one to violate a rabbinic prohibition without requiring that it be done in an abnormal manner?

Mishna Berurah 328:121, suggests that one can answer this question based on the comments of Radvaz, Teshuvot Radvaz 3:640.  Radvaz notes that even Ramban agrees that one may violate lower-level rabbinic prohibitions in order to treat a choleh.  The requirement to perform tasks that violate rabbinic prohibitions in an abnormal manner only applies to higher-level rabbinic prohibitions.  Radvaz states that the prohibition to use medicine on Shabbat is certainly a lower-level rabbinic prohibition and a choleh may use medicine on Shabbat in a normal manner.

Mishna Berurah 328:102, alludes to another answer to this question.  Chayei Adam 69:12, posits that Ramban's requirement to perform the rabbinically prohibited task in an abnormal manner only applies if it is possible to perform the task in an abnormal manner.  If this is not possible, one may perform the task in the normal manner.  [See addendum for a possible proof to Chayei Adam's position.]  One can then suggest that Rama's leniency to allow a choleh to take medicine without requiring that it be performed in an abnormal manner is due to the inability to take medicine in an unusual manner.  Since medicine is not something that can ordinarily be taken in an abnormal manner, and its use only constitutes a rabbinic prohibition, it is permitted to take the medicine in a normal manner.

It is important to note that both of these answers can co-exist.  Mishna Berurah codifies both of these answers as normative.  Therefore, lower-level rabbinic prohibitions are lifted for the treatment of a choleh.  Furthermore, even higher-level rabbinic prohibitions are permitted to be performed in the normal manner if they cannot be performed in an abnormal manner.  R. Shlomo Z. Auerbach (cited in Shemirat Shabbat KeHilchata ch. 33, note 17*), adds that there are many Acharonim who consider performance of melacha in an abnormal manner to be a lower-level rabbinic violation. He therefore rules that if there is no non-Jew available it is permitted to perform a melacha de'oraita in an abnormal manner for a choleh.

Who is Defined as a Choleh?

Ran, op. cit., states that the leniencies that are applied to a choleh are limited to one who is bed-bound.  One who has an ailment but is "walking around like a healthy individual" is not considered a choleh and no leniencies are applied to such an individual.  Maggid Mishneh, Hilchot Shabbat 2:10, adds that even one who is not bed-bound, but his ailment pervades throughout his body is considered a choleh, and may be treated with all of the aforementioned leniencies.  Maggid Mishneh's opinion is codified by Rama, Orach Chaim 328:17.  R. Shlomo Zalman Auerbach, Shulchan Shlomo 328:23, adds that if the illness is such that lying in bed does not alleviate the symptoms, but the symptoms are severe enough that if lying in bed would help, the ill person would certainly lie in bed, he is considered a choleh.

Even if one is not currently a choleh, there are grounds for leniency to treat someone as a choleh in order to prevent the onset of a bed-bound illness.  Rambam, Hilchot Shabbat 22:7 (based on the Gemara, Shabbat 140a), states that one may take medicine on Shabbat in order to prevent illness.  While Rambam does not state explicitly whether this leniency applies only to preventing life threatening illnesses or whether it extends to preventing non-life threatening illnesses, Chiddushei HaRan, Shabbat 140a, s.v. Ee Lo, quotes an opinion that states explicitly that this leniency applies to non-life threatening situations.  Based on the comments of Rambam and Chiddushei HaRan, R. Yehoshua Y. Neuwirth, Shemirat Shabbat KeHilchata 33:1, rules that it is permitted to use medicine in a situation where it is likely that one will become sick if the medicine is not taken in a timely manner.  An example given by R. Neuwirth, Shemirat Shabbat KeHilchata 34:16, is one who has a mild headache but is concerned that it will develop into a migraine.  He may take medicine immediately upon the onset of any symptoms of migraine in order to prevent the migraine from developing. 

The Leniencies for a Mitzta'er

A mitzta'er is someone who is suffering from an ailment that causes him a certain degree of discomfort, but his condition is not that severe so as to classify him as a choleh.  Rambam, Hilchot Shabbat 6:9, writes that one is permitted to ask a non-Jew to perform a rabbinic violation (i.e. what would constitute a rabbinic violation for a Jew to perform) in order to treat a "partial illness."  Rambam, ibid, 6:10, includes in this leniency one who is mitzta'er.  Rambam's position is codified by Shulchan Aruch, Orach Chaim 307:5.

Magen Avraham 307:7, contends that the leniency for a mitzta'er is not limited to asking a non-Jew to perform a rabbinic violation.  A Jew may perform a rabbinic violation in an unusual manner in order to treat a mitzta'er.  [See addendum for a discussion of how Magen Avraham distinguishes between choleh and mitzta'er.]  R. Avraham Borenstein, Avnei Nezer, Orach Chaim no. 118, disagrees with Magen Avraham, and maintains that there is no leniency for a Jew to violate a rabbinic prohibition in an abnormal manner for a mitzta'er.