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an abscess, immobilizing a broken bone, or even removing a limb. All
of the above can be done by force in order to save the patient’s life.
One pays no attention if the patient prefers not to suffer and chooses
death over life, but one even amputates an entire limb if that is what
is needed to save him from death… Every person is commanded to do
so by the Torah’s words, ’Do not stand idly by the blood of your fellow
man.’ It does not depend on the wishes of the patient.”
An additional source for this can be found in the Tosefta (Shekalim,
1:2) where it states: “For example, if a man has a wound in his leg and
the physician bound him and cut into the flesh in order to heal him…”
Moreover it states in Responsa Tzitz Eliezer (Part 15 #40), that
“the physician is obligated to heal and the patient is obligated to seek
healing. This applies not only in cases of danger to life but in case of
any serious illness that cannot heal by itself without the assistance of
a physician. In these situations one should convince the patient to ac-
cept the necessary treatment, and one should even treat him by force.
Especially if there is the danger of blindness, if the patient refuses to
accept treatment, one forces him to do so.” It seems that the same law
would apply to a contagious disease.
In such cases, if there is less chance of danger in one medical facil-
ity than in another, one is obligated to inform the patient, so that he
could choose the safer alternative. Similarly, if it is not clear that this
treatment is the correct one, such as if some physicians say he should
be treated differently, one is obligated to inform the patient, if he is
normally intelligent, so that he can choose the treatment he wants. If
he is not considered a bar daas, one should tell the information to his
legal guardian. (See Responsa Iggros Moshe, Choshen Mishpat, Part 2
#74, which discusses who in the family is considered to be the legal
guardian.)
For cosmetic treatment or surgery, or any other treatment that is
not dangerous to the patient and is not due to a serious illness, one
should not force the patient to accept the medical treatment. Even if
a young man’s appearance is repulsive and makes it difficult for him
to find a match, one cannot force him to undergo cosmetic surgery to
enhance his appearance. Although one forces people to do mitzvos,
104 1 Medical-HalacHic Responsa of Rav ZilbeRstein
# only a possibility. One must clarify this further and define
the limits.
In the past, travel by ship was assumed to be very dangerous. Accord-
ing to Rav Yehudah in the Yerushalmi (Mo’ed Katan, 3:1), it is forbid-
den to sail on the ocean because of the danger. The Rambam (Hilchos
Nachalos 3:1) states that if a person who owns a boat on the ocean
dies, his eldest son does not receive a double portion of the boat, since
it is not certain that the boat will make it safely back to port, and
thus it does not qualify as “all his father’s actual assets.” Nonetheless,
halachah asserts that one is allowed to place oneself in this chance of
danger by going out to sea. So, too, one can refuse to sin even in the
face of person who threatens him with death, although there seems
to be real concern for danger. The words of the Divrei Malkiel do not,
however, define the degree of danger in which one is permitted to
place oneself.
We discuss at length (in Chapter 113) the issue of participating in
medical experiments or detonating explosives. There we bring, a) The
view of the Imrei Eish (Yoreh Deah #52), that one can place oneself in
a 16% chance of danger during a voluntary war, and this is a very big
chiddush. b) The view of the Noda Biyehudah (second edition, Yoreh
Deah #10) who permits hunting in a forest where there are wild ani-
mals, for the purpose of making a livelihood. His view is that one may
endanger oneself in order to make a living or for some other benefit if
the danger is equal to that of encountering packs of wild animals. The
practical definition of this type of danger remains unclear, however.
In any event, we learn that although we are concerned about a min-
ute chance of danger when it comes to pikuach nefesh, if the particular
danger is a rare occurrence, there are times when a person is allowed
to put himself in danger. Therefore, in our case, if the possibility of
danger from the treatment is very small, the physician is exempt from
payment for damages if he did not inform the patient of the chances.
The Iggros Moshe (Choshen Mishpat, Part 1 #104) discusses wheth-
er or not it is permissible to earn a living by being a professional
Failing to inform a patient of possible risks 2 109