Pikuach Nefesh: Are We Always Allowed to Save a Life? (Part 2)

Understanding the Gemara in Yoma

 Now that we have developed a strong foundation, we can revisit the Gemara in Yoma (85a) and understand it on a much deeper level. The Gemara asks, "What is the Torah source that one can override Shabbos in order to save a life?" The Gemara goes on to give two different main sources:

 1) Chaleil Alav Shabbos Achas Kidei Lishmor Shabbasos Harbei: we can push aside one Shabbos in order to keep many more Shabbasos in the future.

 2) V’Chai Bahem: we should live by the mitzvos, and not die by them.

In conclusion, the Gemara seems to prefer the source of V’Chai Bahem, because this would allow us to violate Shabbos even if there was only a safek (doubt).

Let us begin our analysis by returning to a few of our introductory questions:

1. Why Did the Gemara Specifically Ask About Shabbos?

Is the Gemara only asking about whether we can violate Shabbos in order to save a life, or this a universal question about all cases of pikuach nefesh? In other words: 

1) When the Gemara framed its question as asking about Shabbos, was this the Gemara's way of asking a universal question about whether we can violate any aveirah in order to save a life? Because, if that is the case, the discussion of this Gemara can be applied to all other aveiros as well, and not just the question of overriding Shabbos.

2) Alternatively, did the Gemara already know that we can violate any aveirah in order to save a life – because of the source of V’Chai Bahem. However, since we also know that there are three aveiros that we cannot violate in order to save a life (murder, idolatry, and adultery), the Gemara was therefore posing the following question:

We know that violating Shabbos is a much more severe aveirah than most aveiros, but it is also not one of the “Big 3” cardinal aveiros. As such, the Gemara is asking: are we also allowed to violate Shabbos in order to save a life– just as we are with all other aveiros? Or, perhaps Shabbos might be so severe that it actually has the same din as the “Big 3” cardinal aveiros, in which case we would not be allowed to push aside Shabbos in order to save a life?

And if we are allowed to push aside Shabbos to save a life, we would need a source for this heter, which explains why the Gemara is looking for such a source.[1]

If this is the case, then this Gemara becomes a very important source specifically for the halachos of pikuach nefesh on Shabbos. The Gemara first suggests that the only reason we can violate Shabbos is because of "Chaleil Alav Shabbos Achas Kidei Lishmor Shabbasos Harbei "

However, this would potentially limit the halachos of Pikuach Nefesh on Shabbos for several reasons:

1) Higher Standards: While V’Chai Bahem seems to be a complete heter – with no added requirements, Chaleil Alav Shabbos Achas seems to imply that there is a certain expected outcome that is required in order to justify pushing Shabbos outside – namely, the person being saved would need to be able to keep future Shabbasos.

2) Safek: The Gemara implies that for the source of Chaleil Alav Shabbos Achas, you can only violate Shabbos if there is no safek, whereas V’Chai Bahem would apply even in a case of safek. However, we still need to determine what the Gemara means by this.

2. What Does the Gemara Mean by "Safek"?

The Gemara states that if we only had the source of Chaleil Alav Shabbos Achas, we would only be allowed to push Shabbos aside to save a life if we were certain (vadai), but not if there was a safek (doubt). However, since we have the source of V’Chai Bahem, we can even push Shabbos aside to save a life when there is a safek.

What did the Gemara mean by the term "safek"? What are we in doubt about?

There are a few possible options:

1) Whether it is a Sakana in the First Place

The doubt could be whether this is even a case of pikuach nefesh. Sometimes, we are not even sure if a person's life is in danger. In such a case, it might not be muttar to violate Shabbos, since we do not even know if this is a real case of sakana (danger). In such a case, the Gemara is debating whether or not we are allowed to violate Shabbos.

2) Whether it is Necessary to Violate Shabbos in Order to Save Them

The doubt could be whether this person would be able to survive without your help. Sometimes, we are certain that it is a case of sakana, but we are not sure if we need to violate Shabbos in order to save them. It is possible that even if we do not intervene (and violate Shabbos), the person may still survive. Alternatively, it might also be possible that we can save this person without violating Shabbos. In such a case, the Gemara is debating whether or not we are still allowed to violate Shabbos.[2]

3) Whether We Have the Ability to Save this Person’s Life

The doubt could be whether we will be able to successfully save the person's life.  Sometimes, we are certain that it is a case of sakana, but we are not sure that we will be able to save the person’s life, even if we push Shabbos aside. In such a case, the Gemara is debating whether we are allowed to violate Shabbos, even though there is no certainty that the person's life can be saved.

4) Whether this Person Will Keep More Shabbasos

If the entire din of Chaleil Alav Shabbos Achas is so that this person will keep more Shabbasos in the future, the doubt could be whether or not this person will keep more Shabbasos. In other words:

1. Maybe he will die before we can save him.
2. Maybe he will survive, but die something during the week, before the next Shabbos.
3. Maybe he will survive, but will still choose not keep any future Shabbasos (since he is not a religious Jew.)

3. What is the Maskana of the Gemara?

It seems pretty clear that the maskana (conclusion) of the Gemara is that V’Chai Bahem is not only a better source for Pikuach Nefesh than Chaleil Alav Shabbas Achas, but it is also the source that we accept l'halacha. As we will soon see, it appears that many of the Rishonim and Achronim ruled this way as well.

The Gemara in Sanhedrin[3] states that one can violate all the mitzvos in the Torah in order to save a life, except for the “Big 3” cardinal aveiros (murder, idolatry, and adultery). The lashon of the Gemara is as follows:

תלמוד בבלי מסכת סנהדרין דף עד עמוד א

כל עבירות שבתורה אם אומרין לאדם עבור ואל תהרג - יעבור ואל יהרג, חוץ מעבודה זרה וגילוי עריות ושפיכות דמים.

With regard to all other transgressions in the Torah, if a person is told: Transgress this prohibition and you will not be killed, he may transgress that prohibition and not be killed, because the preserving of his own life overrides all of the Torah’s prohibitions. This is the halacha concerning all prohibitions except for those of idol worship, forbidden sexual relations, and bloodshed. Concerning those prohibitions, one must allow himself to be killed rather than transgress them.

When commenting on this Gemara, Rashi states that the source for this principle – that we are allowed to violate all aveiros in order to save our life – is V’Chai Bahem.[4] 

He does not differentiate between Shabbos and other mitzvos. (He does not state that Chaleil Alav Shabbos Achas applies to Shabbos and V’Chai Bahem only applies to all the other non “Big 3” mitzvos.) Thus, Rashi clearly seems to hold that V’Chai Bahem applies to Shabbos as well. As such, according to Rashi’s opinion, V’Chai Bahem is the Torah source that teaches us Pikuach Nedesh is docheh Shabbos. Of course, Rashi is not alone; Tosafos[5] and the Rosh[6] also imply that V’Chai Bahem is the primary Torah source for the principle that pikuach nefesh allows us to push aside all aveiros other than the “Big 3” cardinal aveiros.

However, this is not as simple as it seems; the Gemara in Shabbos[7] states that the reason we can push aside Shabbos in order to save a one-day old baby is because of the svara of Chaleil Alav Shabbos Achas.[8] Significantly, the Rambam and the Shulchan Aruch both quote this Gemara l'Halacha.

In other words, even though the Gemara in Yoma 85b seems to indicate that, in the maskana, we hold of V’Chai Bahem (and reject the source of Chaleil Alav Shabbos Achas), there are several Gemaras and Rishonim which seem to breathe life into Chaleil Alav Shabbos Achas, suggesting that we accept this source l’halacha. We are therefore left with a question: which one is it? At the end of the day, do we accept the principle of Chaleil Alav Shabbos Achas or not?

As expected, there are several possible ways to understand the maskana of the Gemara in Yoma 85b:

1) We Rejected Chaleil Alav Shabbos Achas, and We Only Need Vi'Chai Bahem

The first option is what we might have expected. Since V’Chai Bahem seems like a better source, as it even works when there is a safek, we reject Chaleil Alav Shabbos Achas and only hold of V’Chai Bahem. This appears to be the shitah of the Rosh.[9] 

2) Both Sources Remain, and We Accept Both of Them

Another possibility is that Chaleil AlavShabbos Achas was not rejected, but that V’Chai Bahem was simply added an alternative and independent source. In other words, Chaleil Alav Shabbos Achas is one heter, but it has its limitations and only works if there is a vadai. Thus, we also have another source, V’Chai Bahem, which does not have these limitations, and works even in a case of safek.[10]

3) V’Chai Bahem Transforms Chaleil Alav Shabbas Achas

Another possibility is that V’Chai Bahem is not an independent source, but rather a source that fundamentally affected the nature of Chaleil Alav Shabbos Achas. In other words, the Gemara originally assumed that the source for Pikuach Nefesh on Shabbos was the svara of Chaleil Alav Shabbos Achas. The only problem was that this svara only works if there is a vadai, but not if there is a safek. Thus, the Gemara offered an additional source of V’Chai Bahem. But V’Chai Bahem did not replace Chaleil Alav Shabbos Achas; it expands upon Chaleil Alav Shabbos Achas, allowing it to work even if there is a safek.

Now, in terms of the actual mechanism, there are two ways this could be working:

1. Transformation: V’Chai Bahem could be used to transform Chaleil Alav Shabbos Achas into a svara that can now even be used in a case of safek. [Thus, now that V’Chai Bahem is added to the equation, Chaleil Alav Shabbos Achas was elevated to a new level, now with the ability to even apply in a case of safek.]

2. Revelation: Alternatively, V’Chai Bahem could be used to reveal that Chaleil Alav Shabbos Achas was always able to work in a case of safek. In other words, once we understand the value of life and the inner svara of V’Chai Bahem, the svara of Chaleil Alav Shabbos Achas is now shown to have retroactively always been able to work, even in a case of safek.

There would potentially be an important nafkah minah (practical application) between these two options:

What if we have a case where we can't use the source of V’Chai Bahem, but we can use Chaleil Alav Shabbos Achas. Would Chaleil Alav Shabbos Achas still work by a safek?[11]

1. If V’Chai Bahem was used to transform Chaleil Alav Shabbos Achas into a source that can be used by a safek, then since V’Chai Bahem is not currently applicable in this case, perhaps it is also unable to transform Chaleil Alav Shabbos Achas in this case, and thus, Chaleil Alav Shabbos Achas would not work by a safek. Of course, we could still counter this by suggesting that V’Chai Bahem transformed the concept of Chaleil Alav Shabbos Achas forever, and it is not a transformation that needs to occur “in real time,” on a case-by-case basis. Because, if that is the case, then even without V’Chai Bahem, Chaleil Alav Shabbos Achas would work in the case of a safek.[12]

2. If V’Chai Bahem revealed that Chaleil Alav Shabbos Achas is always able to work in a case of safek, then even in a case where V’Chai Bahem is not applicable, Chaleil Alav Shabbos Achas should still be able to work by a safek; this is because the ability (koach) for Chaleil Alav Shabbos Achas to work by a safek was revealed to be inherent, and not continuously stemming from V’Chai Bahem.[13]

How Do the Rishonim and Achronim Rule on This?

1) Shulchan Aruch Ha'Rav: 

In a case where V’Chai Bahem does not apply, the Shulchan Aruch Ha'Rav[14] still applies the concept of Chaleil Alav Shabbos Achas even in a case of a safek.

2) Tosafos

Tosafos[15], however, seems to imply that in a case where V’Chai Bahem does not apply, Chaleil Alav Shabbos Achas would only apply if it was a vadai, not if it is a safek.

In our next article, we will continue to analyze this fascinating halachic topic.

[1] The Tzitz Eliezer rules that while one is allowed to violate all issurei d'oraisa for sakanas ever (an endangered limb), one cannot violate Shabbos for sakanas ever. Thus, we see that according to some poskim, there are three categories of issurim: The Big 3, Shabbos, and all other issurim.

שו"ת ציץ אליעזר יג:צ

[2] This seems to be Rashi's shitah. His lashon is as follows:

רש"י מסכת יומא דף פה עמוד ב

דשמואל לית ליה פירכא - אשר יעשה האדם המצות שיחיה בהם ודאי, ולא שיבא בעשייתה לידי ספק מיתה - אלמא: מחללין על הספק.

[3] Sanhedrin 74a.

[4] רש"י מסכת סנהדרין דף עד עמוד א

יעבור ואל יהרג - וחי בהם - ולא שימות בהם.

[5]

תוספות מסכת יומא דף פה עמוד א

ולפקח הגל אינו כן - אומר ר"י דהיינו טעמא דאין הולכין בפקוח נפש אחר הרוב משום דכתיב (ויקרא יח) וחי בהם ולא שימות בהם שלא יוכל לבוא בשום ענין לידי מיתת ישראל.

[6]

רא"ש מסכת יומא פרק ח סימן טז

ומנא ליה דפיקוח נפש דחי שבת [דף פה ע"ב] אמר רב יהודה אמר שמואל אמר קרא אשר יעשה אותם האדם וחי בהם ולא שימות בהן:

[7] Shabbos 151b.

[8] The passuk use to support this svara is "Vishamru Vinei Yisrael es Ha'Shabbos," and the Gemara mentions this source as the proof for this heter to push aside Shabbos.

[9]
רא"ש מסכת יומא פרק ח סימן טז

ומנא ליה דפיקוח נפש דחי שבת [דף פה ע"ב] אמר רב יהודה אמר שמואל אמר קרא

אשר יעשה אותם האדם וחי בהם ולא שימות בהן:

[10] It is also possible that V’Chai Bahem was not introduced as a new source to replace Chaleil Alav Shabbos Achas, but rather, it was added in order to enable the source of Chaleil Alav Shabbos Achas to work even in the case of a safek; as such, we would still always need to use the svara of Chaleil Alav Shabbos Achas as the foundation, but the addition of V’Chai Bahem now allows the source of Chaleil Alav Shabbos Achas to be more expansive in its application.

As we will soon see, this suggestion will create major nafka minos. For example, take the following case, where even if we violate Shabbos in order to save a particular person's life, we know that they will not live until the next Shabbos; If we can't use V’Chai Bahem as an independent source, then this would not fulfil the requirement of "Kidei Lishmor Shabbasos Harbei." (But if we can use V’Chai Bahem as an independent source, this would most likely apply – even in this case.)

A more developed version of this approach will now be introduced as “V’Chai Bahem Transforms Chaleil Alav Shabbos Achas.”

[11] We will soon explain in much more depth how there can be a case where V’Chai Bahem does not apply, but Chaleil Alav Shabbos Achas still does apply.

[12] It would be like a “lo plug.”

[13] One could, however, argue that this revelation does need to be continuously revealed through V’Chai Bahem; nevertheless, such an argument seems to be a bit of a stretch.

[14]

שלחן ערוך הרב קונטרוס אחרון שו:א

ומכל מקום הכא בהצלת עבירה (צ"ע) אם מחללין מספק, דהא אמרינן בגמרא פרק בתרא דיומא דדוקא מוחי בהם מוכח דמחללין מספיקא אבל משום שאמרה תורה חלל עליו כו' לא ידעינן בספיקא עיין שם. ומיהו בר"ן פרק יום הכיפורים מבואר בהדיא דמחללין אפילו בעובר מהאי טעמא. ואפשר דלבתר דגלי לן קרא דמחללין מספק גבי פיקוח נפש אם כן הוא הדין בשביל שישמור שבתות הרבה, שהוא חשוב גם כן כפיקוח נפש. ומיהו בר"ן דוחק לומר כן, שהרי מותר להרגו. וצ"ע.

[15]

תוספות מסכת בבא מציעא דף קיד עמוד ב

אמר ליה לאו כהן (אתה) - תימה לר"י היאך החיה בנה של האלמנה כיון שכהן היה דכתיב (מלכים א יז) ויתמודד על הילד וגו' ויש לומר שהיה ברור לו שיחייהו לכך היה מותר משום פיקוח נפש.