Pain control on Shabbos
RabbiM
Yaakov Weiner, who runs a center for studying medicine and halacha in
Jerusalem. The subject is whether the permission to do medical
procedures on Shabbos for a seriously ill person applies also to
processes which are not therapeutic but needed for pain control.
Dear friend,
We at the Shirley & Morris Sutton Israel Forum are pleased to send you
this bulletin concerning issues relating to medicine and Halacha. Our
hope is that with Hashem’s help these bulletins will become a regular
JCR feature of keeping in touch with the greater Forum community.
During the last several months JCR organized lectures: in New York in
central synagogues in the Ocean Parkway community and at local
schools; in Panama City, senior physicians of Punta Pacifica Hospital
participated in lectures delivered by Rabbi Weiner, in the University
of Illinois Champaign-Urbana, a Shabbat program was organized for
staff and students. Three programs are planned for the near future:
the Third Biennial medical retreat in Detroit, the 13th annual weekly
program in Jerusalem and the Macabbi Sick Fund Shabbat program for
senior physicians.
Two halachic questions (sheilot) were recently addressed to JCR*. The
first dealt with a case concerning a terminally ill patient whose
only effective method of delivering pain relief was by smoking the
medication, similar to smoking a cigarette. The IV drip was not
sufficiently ameliorative. The query that arose concerned the
permissibility of smoking for pain management during the Shabbat.
The second halachic issue concerned the well known electrical pump
system for patient self administration and management of severe post
surgical pain. The query dealt with the permissibility of a patient
pressing a button to electrically activate the system on Shabbat.
These two scenarios both touch directly on issue of pain management on
Shabbat.
In Chazal sources are found that indicate that calming a patient in a
life threatening situation (chole sheyesh bo sakana) compromises the
Shabbat and allows for its desecration.
* The purpose of this bulletin is to raise interest and impart
information. Regarding practical halachic issues, one should not rely
on the bulletin; rather one should consult with competent halachic
authorities.
Gemara Shabbat (128b) states that “one may light a candle on
Shabbat for a woman who has just given birth. Even if the woman is
blind, it is permissible if only to calm her (she worries that if it
is dark, her friends may not discern her needs).” The Rambam (Laws of
Idolatry, 11:11) rules: ”One may utter magical incantations on Shabbat
for another who was bitten by a snake or scorpion in order to calm him
and to strengthen his resolve (to give him hope). Even if this offers
no practical benefit, nevertheless, since he is in a life threatening
situation, they (the Sages) allowed this in order to prevent his
becoming overwrought with extreme anxiety.” Rav Moshe Feinstein (in
Igrot Moshe, Vol.2, 73:9) discusses a case (not having to do with
Shabbat) in which a gentleman was dying of testicular cancer that had
widely metastasized and who was suffering great pain. He concluded
that “it is permitted to remove the testicles of a patient in a life
threatening situation in order to eliminate the severe pain.” He
continues and says that “it is logical that (removing pain) will
extend life for a short period of time even though this (fact) is not
recognized by physicians. Clearly for two patients with the same
illness, one suffers from extreme pain and the other does not, it is
natural that the one without pain will survive a bit longer.
Furthermore, severe pain shortens life and therefore it is permissible
to remove the testicles even though this will castrate the patient, a
Torah level prohibition (Leviticus, 22:24). For a dangerously ill
patient, the castration is performed even if it is only to remove the
pain.”
Hence concerning smoking the pain reliever, it would be allowed on
Shabbat in that it would serve to alleviate the severe pain of the
terminally ill patient.
Regarding the second case of the self administered pain management, if
the patient is just after major surgery, he would be considered a
dangerously ill person and would be able to depress the button to
activate the electric pump to deliver a dose of pain reliever. However
for a patient after a minor procedure or one about to be released from
hospital who is not in a dangerous situation but still suffers from
extreme pain, he would yet be defined as a sick person because of the
pain and would thus be permitted to activate the pump on Shabbat, in a
non-ordinary fashion on Shabbat, for example by pressing the button
with a spoon. (See Ramah, 328:12 who rules that even for a dangerously
ill person, it is preferable to perform the activation in a non-
ordinary way if this causes no delay.) To be
continued