Pikuach Nefesh: Are We Always Allowed to Save a Life? (Part 6)

We will now finish our analysis of a very important question: is it possible for there to be a case where we would not be able to use the source of V’Chai Bahem? Because, if such a case where to exist, then the only Torah source we would be able to utilize to justify the violation of an aveirah for the sake of pikuach nefesh would be Chaleil Alav Shabbos Achas.

We will therefore now continue to analyze several such cases where V’Chai Bahem would likely not apply, and as such, Chaleil Alav Shabbos Achas would therefore be our sole halachic source for allowing us to engage in pikuach nefesh.

1) Checking Someone into a Non-Kosher Hospital 

The poskim discuss another fascinating question: is it muttar to check someone into a hospital or a facility where they will be served non-kosher food to eat? Ideally, when someone needs to visit a hospital or facility, the patient themselves should try to have kosher food available or their family members should try to arrange for kosher food to be delivered to the patient. However, what if there is a case where the only way to get care would be to stay at a hospital or facility that only provides non-kosher food? Would staying at such a place – and eating non-kosher food – be muttar?

The particular case that several poskim discuss is whether a boy with a mental disability (who is unable to perform mitzvos) can be checked into a hospital that will care for him, but serve him non-kosher food.[1] In terms of applying the principle of V’chai Bahem – it would seem difficult to apply this principle, as the child’s life is not at risk. However, in terms of applying the principle of Chaleil Alav Shabbos Achas – if the hospital will be able help him get healthy enough that he would gain the ability to perform mitzvos, then we can use the svara of Chaleil Alav Shabbos Achas – let him eat the non-kosher food so that he can gain the ability to perform many more mitzvos in the future. However, if the hospital is only providing care and comfort, and does not have the ability to help the patient recover, then it would be harder to justify the eating of non-kosher food. That is, unless, we this is still considered this to be a form of pikuach nefesh – as this would enable us to use V’Chai Bahem. 

The Shu"t Beis Yitzchak[2] rules that it would be muttar to place a shoteh in such a hospital, as long as the hope is that he will get better. In other words, as long as the goal of the hospital is for the child to get better, we can use the svara of Chaleil Alav Shabbos Achas Kidei Lishmor Shabbasos Harbei, allowing us to violate a few issurim now (of eating non-kosher food) so that he can fulfill many more mitzvos in the future.

The Chasam Sofer,[3] however, takes an extremely machmir stance on this case. He rules that even if the child would be able to get better and perform mitzvos in the future, he still should not be sent to a hospital where they will serve him non-kosher food; the Chasam Sofer based this chumrah on the severe spiritual damage that non-kosher food has on the neshama. In the case of ma’achalos asuros[4], the non-kosher food is mitamtem ha'lev – it blemishes the inner heart of a person on a spiritual level. Thus, the Chasam Sofer maintained that it would be better for this child to remain a shoteh and retain his pure soul than to become a non-shoteh through eating non-kosher food. Nevertheless, most poskim do not rule like this chumrah of the Chasam Sofer though, as they think it is justified to eat non-kosher food for the sake of refuah and the fulfillment of future mitzvos.

If, however the shoteh would not be able to get better, then it would be more difficult to find a heter for this child to eat non-kosher food, as the svara of Chaleil Alav Shabbos Achas would likely not apply. Nevertheless, some poskim[5] disagree and maintain that even if the child cannot get better, we can still send him to this hospital as long as there is no other place he can go for care.[6]

What Should Our Attitude Towards Pikuach Nefesh on Shabbos Be?

Now that we have analyzed these two important sources for Pikuach Nefesh,[7] let us briefly concretize what we have developed by establishing some important principles regarding the attitude we should have when engaging in pikuach nefesh on Shabbos.

There is a general principle (quoted in the Shulchan Aruch) that when it comes to a question in Halacha, one should always seek to first ask and clarify the halacha before engaging in the action. However, when it comes to Pikuach Nefesh, the Gemara[8] states that one who acts expeditiously in matters of pikuach nefesh is praiseworthy. The lashon of the Gemara is as follows:

תלמוד בבלי מסכת יומא דף פד עמוד ב

תנו רבנן: מפקחין פקוח נפש בשבת והזריז הרי זה משובח, ואין צריך ליטול רשות מבית דין.

One should engage in saving a life on Shabbos, and one who is vigilant to do so is praiseworthy. And one need not take permission from a court.

The Yerushalmi in Yoma[9] even states that in a case of Pikuach Nefesh, the one who is asked the halachic question is worthy of denigration, while one who asks the question is a murder. At first glance, this appears quite strange. It is understandable that the person who asked the question did something wrong, since his question could have caused the death of the person in danger, as the question prolonged the saving of the person in need. But why should the rabbi who was asked the halachic question be at fault? To explain this, the Rishonim and Achronim offer several answers:

He Did Not Try to Save the Person's Life Himself

The Tashbeitz[10] and the Tzitz Eliezer[11] suggest that the Gemara is not referring to the person's personal Rav. Rather, the Gemara is referring to anyone who is asked about the case. When the rabbi is approached and hears the question, he has two options: He can either answer the question and tell the questioner to immediately begin his life-saving act, or he can take the initiative and actively participate in the life-saving act himself. The Gemara is warning us that we should never remain as a passive bystander when a life needs saving, but that we should become an active participant and move as quickly as possible to join in performing the life-saving act and help in any way that we can.

He Did Not Successfully Convey the Torah’s Approach to Pikuach Nefesh

The Terumas Ha'Deshen[12], however, offers another profound interpretation. He suggests that this particular rabbi is worthy of denigration because it is his responsibility to explain the importance of pikuach nefesh to his congregation, and how when it comes to pikuach nefesh on Shabbos, the Torah requires us to act first and ask the question later. Thus, if someone comes to their Rav on Shabbos and asks him whether they can save someone’s life, it is a sign that this Rav did not do his job in conveying this essential message.

Conclusion

From the above discussion, we clearly see the infinite value Hashem places on life. Does Hashem want us to perform mitzvos and live in alignment with the truth? Of course; that is the very reason Hashem created us. Does Hashem also want us to avoid aveiros? Of course. But does Hashem value mitzvos more than He values our lives? No.

This is what the Gemara in Yoma 85b means when it quotes the passuk of "V’Chai Bahem." The Torah states that we should live by the mitzvos, not die by them.

Humans are fallible. We make mistakes. When we violate an aveirah, we can do teshuvah. And if we have a choice between saving our life and violating an aveirah, Hashem is telling us that He values our life more than he values the mitzvah. Not only is our life more important than the aveirah, but in such a case, the only will of Hashem is for us to save our life so that we can continue to exist in this world and live a life of Torah and mitzvos.

[1] Halachically, such a child is referred to as a shoteh.

[2] Shut Beis Yitzchak- Even Ha'ezer- 1:39

[3] שו"ת חת"ס או"ח ס' פג 

[4] Where the cheftza itself is assur.

[5] Such as Rav Shlomo Zalman Aurbauch

[6] This concludes this section, where we discussed many of the nafkah minos between V’Chai Bahem and Chaleil Alav Shabbos Achas. There are, however, many other potential nafkah minos, including the following question: Should we be allowed to push aside Shabbos in order to save someone’s eyesight? The Chochmas Shlomo (חכמת שלמה, אורח חיים שכח:מו) shares a tremendous chiddush: he suggests that because Chazal considered a blind person to have the status of a meis (deceased person) in some ways, saving one’s eyesight would therefore be considered pikuach nefesh. Thus, even though a blind person is technically already alive, the Chochmas Shlomo suggests that the principle of Chaleil Alav Shabbos Achas Kidei Lishmor Shabbasos Harbei would allow us to violate Shabbos in order to save a blind person’s eyesight on Shabbos (or to prevent them from losing their eyesight).

Most poskim do not agree with this chiddush of the Chochmas Shlomo.

The lashon of the Chochmas Shlomo is as follows:

חכמת שלמה או"ח שכח:מו

מיהו כד דייקינן נראה לחלק בין עין אחת ושתי עינים כיון דלטעם אחד לכך פקוח נפש דוחה שבת מכח דמוטב לחלל שבת אחת כדי שישמור שבתות הרב' וא"כ הרי לדעת ר"י סומא פטור מכל המצות ולדעת רי"ו הובא בב"י הלכות פסח סי' תע"ג קיי"לן כר"י וניהו דרוב הפוסקים חולקים עליו מכל מקום אין הולכין בפ"נ אחר הרוב וא"כ יש לחוש לדעת רבינו ירוחם דסומא פטור וכו' וא"כ יש לו' בסכנת שאר אבר דאין בו ביטול תורה ומצות וכן בגמרא בעין שמרדה דמיירי בעין אחת אף אם לא יהיה לו עין יהיה חייב במצות לכך נידון רק כסכנת אבר וצריך לטעם משום דהוי סכנת כל הגוף.  אבל בשתי עיניו דיהיה סומא לגמרי ויפטור מכל המצוה יש לו' דודאי מוטב לחלל שבת אחת כו' לשמור שבתות הרבה.

[7] V’Chai Bahem and Chaleil Alav Shabbos Achas.

[8] Yoma 84b.

[9]

ירושלמי יומא ח:ה

תני הזריז משובח והנשאל מגונה והשואל הרי זה שופך דמים

[10] שו"ת תשב"ץ א:נד  

[11] שו"ת ציץ אליעזר ח:טו:ב

[12] תרומת הדשן א:נח ד"ה תשובה