Parshas Yisro - Crucially not Crucial- Different Treatments on Shabbos
While the halachos of Shabbos are complicated enough in their own right, the addition of medical considerations compounds the Halachic challenges and confusion. In Hilchos Shabbos, there are three basic categories in halacha: choleh shyesh bo sakana (life-threatening illness), choleh sha’in bo sakana (non-life threatening illness), and meichush (someone who’s uncomfortable). It is generally assumed permissible to treat a choleh shyesh bo sakana on Shabbos even if doing so will necessitate chillul Shabbos either because of the logic better to desecrate one Shabbos to keep many more or because of the Halachic principle of pikuach nefesh doche kol hatora.
While both of these reasons would permit necessary treatment on Shabbos, there is some discussion in the Poskim about treatment that does not directly relate to the sakana threatening the patient.
The Magid Mishna (Shabbos 2:14) rules following the Raavad that when tending to a choleh shyesh bo sakana, one may desecrate Shabbos for all his needs, even if refraining from doing so will not cause a sakana. Given the reasons that differentiate a choleh shyesh bo sakana from the other two categories of patients, it is difficult to understand why the Magid Mishna permits treating non-life-threatening concerns.
The Avnei Nezer explains this ruling based on the fact that we are never 100% sure how certain things will benefit or compromise a patient’s well-being. Accordingly, in the case of a choleh shyesh bo sakana, where we are stringent in all ways to save them, it is permissible to administer aid that does not seem to us to be life-threatening. Similarly, the Brisker Rov explained that although withholding a treatment may not directly endanger the patient, the treatment can potentially reduce the overall recovery process and is thus allowed on Shabbos.
Regarding Halacha L’masseh, the Shulchan Aruch (328) rules like the Magid Mishna. However, the Biur Halacha cites many Rishonim who disagree with this ruling and forbid treatment in such a case. Accordingly, the Biur Halacha holds that such treatment may only be administered when doing so will violate an issur dirabonan, not a diorraysah. As always specific situations and concerns should be discussed with a Rav.
Adapted and translated from Rabbi Yossi Sprung on medicalhalacha.org