Volume 15 Number 93
                       Produced: Fri Oct 21  2:09:44 1994

Subjects Discussed In This Issue: 

Doctors Leniency in Halacha
         [David Phillips]


From: <davidp@...> (David Phillips)
Date: Wed, 12 Oct 94 19:55:25 EDT
Subject: Doctors Leniency in Halacha

I've taken quite a beating from a number of respondents to my posting re:
doctors leniency in halacha (especially Shabbos) and it is time for me to
respond.  Let me say at the outset that I have no problem admitting I'm
wrong when I'm wrong, as I was on one or two points here, but I think that
the gist of what I meant was missed by many respondents so I want to clear
up a few points.

First of all, I was wrong when I wrote:
>>With the number of doctors around today, especially in the large urban
>>centers, and with the opportunities available in professions and
>>businesses for Orthodox Jews, I wonder sometimes if there is really any
>>"moral heter" for any individual person to opt for medicine, since
>>saving any particular life will never depend on his/her being a doctor!

I was wrong in two ways:  One, it would be devastating for us (our society
or community of Orthodox Jews) if we did not participate as fully as
possible in society at large and its businesses and professions.  (Although
it should be noted that because of halacha we do not participate, generally
or fully, in certain jobs or professions, like police or urban (pet)
veterinarian, as they present clear and generally unavoidable halachik
problems of Shabbos rotations and neutering of animals, respectively.)

Secondly, I left out a few words - a "chesurei mechsara", if you will.  I
meant to write:
"I wonder sometimes if there is really any "moral heter" for any individual
SHABBOS IN NON-PIKUACH NEFESH CASES either in school, in training, in
internship, or in practice."

At the time of my original posting I had not read up on the responsa
written about this issue and only knew whatever I recalled from classes and
discussions long ago.  Subsequent to my original posting I read "Practical
Medical Halacha," 3rd Edition, by Fred Rosner and Harav Moshe Tendler,
which was quite informative and interesting.  (While they are clearly not
the only people writing on the subject, they are certainly among the most
famous and probably most widely accepted in the U.S.)  Their piskei halacha
are very much in line with what I wrote; for example, on page 17 they
pasken that a Kohen may not study dentistry if it will involve anatomical
dissection or training on a human skull [cadaver] with its dentition.

The other major charge against me was this issue of "dan l'kaf z'chut"
(DLZ, in the future)- of giving the doctors the benefit of the doubt that
they were doing  what they were doing under permissible circumstances or
had asked a  "sh'aila" and received a (different) p'sak (from the one I'm
familiar with).  While DLZ is a wonderful standard that we should all
strive for, it is not realistic human nature.  Most of us stand around and
mentally "tsk, tsk" the behavior, dress, manners, etc. of others.  I was
coming from there - the reality of MY personal reaction - and wanted help
in dealing with that.  (More on this point later.)  Furthermore, DLZ has to
be balanced (in its conflict) with "ho'chai'ach to'chi'ach" - the
commandment to chastise our fellow man/woman when we see them doing
something wrong.  Obviously, if DLZ always applied unlimitedly, we could
never fulfill the mitzvah of "ho'chai'ach to'chi'ach".  Clearly, it
requires at least simple "drisha va'kira" - asking and investigating - even
simply asking the doctor the basis of his/her "heter" in regard to
something that I suspect he or she is doing wrong.

The problem here is that as bothered as I am by these doctors' actions, I
don't feel that it is my place to ask them.  I don't really feel that he or
she will think it is any of my business to ask, or that once I hear that it
was not based on any p'sak, that I have the "authority" (even quoting
Rosner/Tendler) to tell him he's doing wrong.  Let me also add that each
one of the cases I cited (in my original post and later in this one) are
people I consider OTHERWISE "frum", shomrei mitzvos, AND altruistic,
dedicated doctors - AND my friends.  (I don't think I'm afraid to confront
them because it might jeopardize our friendship; on the contrary, I'd feel
even less comfortable and inappropriate approaching a non-friend.)

I feel that this should come from our rabbanim - even our shul rabbis.  For
some reason, the ones that I know do NOT confront these people, even with a
simple inquiry.  The reasons appear to be many.  (I've even asked one or
two rabbis and/or people close to them.)   It seems that many are afraid
that after telling them that they are doing wrong the doctors won't listen
anyway.  Then you have a real problem of compounding their "aveira".  Other
rabbis believe that no orthodox doctor would do some of the things I
described without asking the "sh'aila".  IMHO, this is naive and wrong.  I
think that as community rabbis they have the right and responsibility to
ask, and will likely find that some of the most egregious actions are taken
on the basis of "morah heter l'atzmo" - deciding it's okay on your own.

For my purposes, that is, for what I wanted to generate as a discussion, I
would like you to assume that what these people are doing is "probably
wrong" according to halacha, and that they likely did not get a heter for
it from a reliable posek.  I fully realize that others may have a different
agenda than I do; I respect your agenda, as well.  But these are valid
assumptions that I believe, given what I wrote above, may be held for the
purposes of this discussion.  NOTE, THAT I DID NOT CONDEMN, NOR IS IT MY
my examples "anonymously" for the purpose of talking about this "problem"
to the extent that it is a common problem in my community and elsewhere.

One more point in this "mea culpa" section:  I did not mean to imply that
all or even a majority of the doctors (even) in my community are involved
in actions I consider likely violations of Shabbos.  They are a small
minority of the doctors I know.  Nevertheless, they are a visible and
audible - therefore, noticeable - minority.  And their actions still bother

I also want to tell you that notes like Steve Roth's about his personal
sacrifices (and those of his friends) for Shomer Shabbos internships and
practices, etc. were very uplifting.  They raised my spirits because I
truly believed (wrongly) that we are on the brink of developing an attitude
that for doctors, "anything goes."  (The old line about asking a doctor
guest for Shabbos to turn on a light or oven or air conditioner that went
awry with, "You can do it, after all, you're a doctor!", while still said
in jest, is getting closer to be saying without the humorous inflection.  A
doctor friend of mine who personally told me about his displeasure with
some of what I wrote, told me at the same time of his shock to having
guests for lunch on Shmini Atzeret who seriously wanted to know how come
they didn't see him being m'chalel Shabbos, for, after all, he's a doctor -
as if it is almost required that an orthodox doctor NOT keep Shabbos!)  It
is good to hear that there are many doctors who are steadfast about their
commitments to Shabbos at the same time I feel that others are sliding

I now want to address specific points raised by respondents:
I wrote:
>> 1.  A doctor has an opportunity to join a less lucrative practice with
>> less required Saturday coverages or a more lucrative practice with more
>> Saturday coverages and he opts for the more lucrative.

Jeremy Nussbaum responded:
>Perhaps we can judge this doctor l'kaf z'chut and consider that there
>may be other factors in his decision.

First of all, there always are multiple factors; things are never so simple
as a perfectly controlled "laboratory test".  Nevertheless, I wouldn't have
raised this example if it weren't the top two issues for this person.

I wrote:
>> 2. A Kohen opts to go to Dental School even though he must work on a
>> cadaver in his second year.  (I know about the heter of wearing many
>> gloves.  So what.)

Jeremy Nussbaum wrote:
>What will Kohanim and commoners like me gain if Kohanim are restricted
>these days from certain professions as well as from divorced women?

I'm not even sure what he meant by his answer, but others have dealt with
this already, as did I with the quote from Rosner/Tendler.  Such is the
halacha, pure and simple.

In response to my item 1., Steve Roth wrote:
>As for physicians in practice, finding positions is becoming extremely
>difficult. I think David should be careful to be dan l'kaf z'chut- give
>the benefit of the doubt. Perhaps there were no other positions
>available, or perhaps the spouse did not want to leave the large urban
>area (usually NY!), or numerous other reasons.

With all due respect to Steve and his own sacrifices, I know of plenty of
people who have relocated to, Heaven Forbid!, outside of NY for a first
job, for a better job, for any number of reasons.  If they can do it
voluntarily for more money, shouldn't people be required (i.e., "forced")
to do it for Shmirat Shabbat?

My friend, Steven Scharf, wrote:
>Finally, I agree that it is human nature to "stretch" halacha for
>convenience.  However, why pick on medicine?  One can apply this to any
>field of endeavor (parnerships in business which stay open on Shabbat,
>arrangements to sell a food business on Pesach rather than close, etc.).
>Surely this is a matter for each individual to wrestle with, probably
>with the help of competent rabbinical authorities.  However, to make a
>blanket denouncement of orthodox MD's for what may or may not be the
>aveira of a few is surely overstating the case.

The reason that the doctors' issue is different than the examples he cites
should be rather obvious:  The doctors act "b'farhesia" - out in the
public, with, literally, 500 witnesses to their actions each and every
week.  If someone has a partnership that is open on Shabbos, at least it is
not literally in front of my very eyes that he is doing it.

In my third example in my original posting I wrote:
>>3.  A frum pediatrician davens in the early (hashkomo) minyan on Shabbos
>>EACH WEEK, so he can go into the office where he has Hours every Saturday
>>although he never takes an appointment for those hours; he's there to see
>>walk-in "emergencies" only.

Shimon Schwartz (and, similarly, Zvi Weiss) wrote:
> The man is sacrificing Shabbat with his family and friends
> in order to be available for emergency pediatric work every weekend.
> And you're complaining about him?!?

Two problems here:  One is, I never realized how careful we have to be
(even on m-j) with our every word.  My item 3. should have read:  "... so
he can DRIVE into the office..."  The actual fact pattern changes
everything here.  (I am taking the blame for unintentionally misleading
you.)  I would probably tend to agree with Shimon and Zvi if, in fact, the
doctor davened hashkomo, went home, sat in his office in his house with a
chumash or g'mara until lunch time, and in case, chas v'shalom, a child was
sick, the mother or father could bring the child in to see the doctor. 
That would be lovely.  But his office is three miles away, the doctor
drives to the office, the office is too far for a parent to walk to with a
sick child and it is outside of the eruv so that even if the parent wanted
to avoid driving by strolling the child, he couldn't without Chillul
Shabbos.  So the avoidance of real problems and issues isn't there.

Secondly, and I think this is very important, despite the fact that the
Torah and our sages put such a great value on saving a single life, one has
to be careful about how one interprets the heter of pikuach nefesh.  Assume
for a moment that this doctor does drive to his office and NO emergencies
arise that Shabbos.  The fact that in other weeks he was involved in
pikuach nefesh cases, according to my understanding of halacha, does not
justify his Chillul Shabbos on that particular Shabbos.  In other words,
each act of Chillul Shabbos needs a particular pikuach nefesh (or "safek
pikuach nefesh") cause to justify it.

Many others wrote similarly how fortunate we are that some of us are
willing to sacrifice Shabbos (with their families) for our medical benefit.

While that is a lovely thought, I am concerned for him and his family and
their spirit of Shabbos.  I know some of those families intimately, and I
think that it is possible that the doctor/father's absence from so many
Shabbos lunches may leave his children with a very different attitude
toward Shabbos later on in life.  Once again, if such a child becomes non-
observant we will never have a controlled laboratory test to attribute it
to this, and certainly I know Shomer Shabbos people whose children became
non-Shomer Shabbos - and vice versa! - nevertheless, wouldn't it be a
terrible shame if not only the doctor lost out, but many future generations
lost out as a result?  Can't we all see that this detrimental result is
even likely, despite all heterim and the wonders of saving lives?  (Please
do not write back about how dare I try to predict the future, do I know
what Hashem has in store for us, etc.  We all do what we do because we
anticipate a likely result of our actions.  In this case I am talking about
the likely impressions on children.)  Again, I'm not weighing or comparing
the doctor's children's Shmirat Shabbos against saving a life, I'm talking
about the downside of so much Shabbos coverage for some doctors.

I wrote:
>> ... I nevertheless find Orthodox doctors with *options* not taking them,
>> not making sacrifices.

To which Shimon Schwartz responded:
> One of the primary mitzvot on Shabbat is -oneg-; I am not aware of any
> mitzvah to "sacrifice" for Shabbat.

We sacrifice in every single mitzvah we do, whether we sacrifice money,
time, comfort, instincts, etc.  We sacrifice money when we pay extra for
kosher meat, when we buy a lulav and esrog, when we don't work overtime on
a Shabbos or Yom Tov.  We sacrifice time when we don't sleep late on Sunday
in order to make "sof zman kri'as sh'ma".   We sacrifice our comfort when
we sit in the cold in a succah or fast on a fast day.  We show discipline
and sacrifice giving in to our instincts when we don't go out with office
friends to traife restaurants or drinking with the boys on a Friday night. 
These are the kinds of sacrifices I'm talking about.  Without a doubt one
has to sacrifice to keep Shabbos, even doctors.

Set Ness wrote in support of my position, basically that doctors have an
obligation to be careful doing only those things that are permitted because
it is necessary for pikuach nefesh, and not those unnecessary.  He then
>You ARE allowed to work on shabbat, but
>only to do those things which are permissible from the laws of saving a
>not anything that comes up, such as what i mentioned above. Rav tendler's
>son worked on shabbat, but he hired a physicians aide to follow him around
>the hospital and do all the stuff that remains assur for a jew. This is
>not an option for most of us.

I'm not sure why the aide is "not an option" for most doctors.  If it's a
matter of being too costly, it becomes part of the cost "of doing
business", just like I had to lose pay for not working on Yom Tov once my
vacation days were used up.  If Rav Tendler's son is "hiring" an aide
because that is what halacha requires, then you really have no choice.  (I
know of an oncologist in Cleveland who has to make rounds in the hospital
of his in-patients - many of whom (if not all) are pikuach nefesh cases -
and gets there by having a pre-arranged car service pick him up at 7 am (by
the way, he dresses for rounds in Shabbos clothes), take him to the
hospital, and bring him back before 9 am, in time to walk with his children
to shul.  Outside of the problem I raise below in no. 5, I have the utmost
respect for his respect for halacha.  I don't know of anyone in New York
who does this.) 

I do not want to go into great detail answering every point everyone raised
in opposition to my original post.  I do want to answer some broad points
raised, and raise some new ones.

Let me also raise three more cases for discussion.

4. An oral surgeon's beeper goes off in shul EVERY WEEK AT (ALMOST) THE
EXACT SAME TIME (i.e., 10:45 am).  It is his service calling in with the
status of his hospitalized patients (many of whom are probably at least
"safek pikuach nefesh" cases).  Why can't he just walk out on his own and
call them at that time without getting beeped and disturbing the davening? 
To my knowledge no one has ever asked him this question.

5. An obstetrician lives on Long Island but has his office (and hospitals
he's affiliated with) in Brooklyn some 20 miles away.  He is Shomer Shabbos
and so is his (only) partner.  This means that they are both on at least
two Shabbatot each month, besides splitting all the chagim.  According to
Rosner/Tendler (p. 145) if a doctor expects to be called in on Shabbos (on
pikuach nefesh cases) ONCE A MONTH OR MORE, he is required to live within
walking distance of the hospital.  (Note that many of these issues are
relatively new ones, i.e., less than 35 years old.  Until the 1960's, few
doctors, Jews or gentiles, lived more than a few miles or minutes from his
office or hospital.)  I believe that acceptance of their p'sak leaves
virtually no room for a DLZ in this case.

6. At the time of my original posting I was expecting it to happen; little
did I know it already had happened:  A doctor returned a beeper call on his 
cellular phone he brought to shul on Shabbos.  While he did not make the
call from inside the sanctuary, he made it outside the building where he
was seen by many people.  Until now, the practice had been to go into the
rabbi's study and return beeper calls in private (with the door closed). 
(I wonder how long it will take before the calls will be made from inside
the minyan during kedusha!)

To sum up:
1) I think there is a problem with some Orthodox doctors being lax about
Shmirat Shabbat in public.  I believe that many are "morah heter l'atzmam"
(deciding that these issues are permissible on their own).  I also feel
that things have gotten worse in recent years and continue to get worse.

2) I believe that as a matter of philosophy, many doctors and non-doctors
believe that "anything goes" when it comes to doctors and halacha, that no
efforts to minimize Chillul Shabbos are necessary.

3) I believe that repeated displays of cavalier attitudes towards Shabbos
in public, even by doctors, is detrimental to the "aveera d'Shabbos" (the
spirit of Shabbos) in shul, in the doctors' family, and the community at
large.  I believe it also makes it hard to legitimize such actions and
behavior to all our children, as a matter of chinuch.

4) I believe that as a society we (Jews, in general, Orthodox, in
particular) still put doctors up too high on a pedestal and believe the
stereotype of our parents' greatest pride being able to boast about "my
son/daughter, the doctor."

5) I believe that most of our LORs are too timid to take such issues on
directly, with the doctors individually or as a group.

(One LOR I spoke with (not my LOR) admitted that the doctors-Shabbos issue
is a real problem in his shul, that he's afraid to bring it up since he
thinks they won't listen to him, and he proposed that a potential solution
to the problem would be if rabbanim, bigger than he, got together and
publicized the p'sak that while doctors may do certain things for pikuach
nefesh on Shabbos, they may not charge a fee for the services they render. 
He feels that while they are very altruistic in their dedication to
medicine, even regarding their Shabbos calls, that if they couldn't charge
for it they would go in less or look for other ways to get coverage for
these situations.  In other words, removal of the fee would be a
disincentive to work on Shabbos.  Rosner/Tendler have a more complex answer
to the question of whether or not doctors can charge a fee for their work
on Shabbos; according to them, this proposed solution may not work in

I want to end on at least a constructive, if not positive, note:  Once
again, credit should be given to the majority of doctors who are meticulous
in their Shmirat Shabbat.  Besides having my spirits lifted by those who
wrote about the sacrifices they've made for Shmirat Shabbat, I was also
inspired by someone telling me that a Rav Scheinberg in Brooklyn (on Ocean
Parkway and Ave. M) has a weekly shi'ur for doctors on Halacha and
Medicine, which is attended by some 40-60 doctors.  Kol Ha'Kavod!  I also
strongly recommend that everyone read the Rosner/Tendler book, especially
pages 132-135 and 142-150.

Finally, I would like to hear from people about how their LORs and
communities have dealt with these issues (setting limits or rules of how
doctors should properly conduct their activities on Shabbos), etc.

--- David "Beryl" Phillips


End of Volume 15 Issue 93