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an abscess, immobilizing a broken bone, or even removing a limb. All # only a possibility. One must clarify this further and define
of the above can be done by force in order to save the patient’s life. the limits.
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 In the past, travel by ship was assumed to be very dangerous. Accord-
is needed to save him from death… Every person is commanded to do ing to Rav Yehudah in the Yerushalmi (Mo’ed Katan, 3:1), it is forbid-
so by the Torah’s words, ’Do not stand idly by the blood of your fellow den to sail on the ocean because of the danger. The Rambam (Hilchos
man.’ It does not depend on the wishes of the patient.” Nachalos 3:1) states that if a person who owns a boat on the ocean
An additional source for this can be found in the Tosefta (Shekalim, dies, his eldest son does not receive a double portion of the boat, since
1:2) where it states: “For example, if a man has a wound in his leg and it is not certain that the boat will make it safely back to port, and
the physician bound him and cut into the flesh in order to heal him…” thus it does not qualify as “all his father’s actual assets.” Nonetheless,
Moreover it states in Responsa Tzitz Eliezer (Part 15 #40), that halachah asserts that one is allowed to place oneself in this chance of
“the physician is obligated to heal and the patient is obligated to seek danger by going out to sea. So, too, one can refuse to sin even in the
healing. This applies not only in cases of danger to life but in case of face of person who threatens him with death, although there seems
any serious illness that cannot heal by itself without the assistance of to be real concern for danger. The words of the Divrei Malkiel do not,
a physician. In these situations one should convince the patient to ac- however, define the degree of danger in which one is permitted to
cept the necessary treatment, and one should even treat him by force. place oneself.
Especially if there is the danger of blindness, if the patient refuses to We discuss at length (in Chapter 113) the issue of participating in
accept treatment, one forces him to do so.” It seems that the same law medical experiments or detonating explosives. There we bring, a) The
would apply to a contagious disease. view of the Imrei Eish (Yoreh Deah #52), that one can place oneself in
In such cases, if there is less chance of danger in one medical facil- a 16% chance of danger during a voluntary war, and this is a very big
ity than in another, one is obligated to inform the patient, so that he chiddush. b) The view of the Noda Biyehudah (second edition, Yoreh
could choose the safer alternative. Similarly, if it is not clear that this Deah #10) who permits hunting in a forest where there are wild ani-
treatment is the correct one, such as if some physicians say he should mals, for the purpose of making a livelihood. His view is that one may
be treated differently, one is obligated to inform the patient, if he is endanger oneself in order to make a living or for some other benefit if
normally intelligent, so that he can choose the treatment he wants. If the danger is equal to that of encountering packs of wild animals. The
he is not considered a bar daas, one should tell the information to his practical definition of this type of danger remains unclear, however.
legal guardian. (See Responsa Iggros Moshe, Choshen Mishpat, Part 2
#74, which discusses who in the family is considered to be the legal In any event, we learn that although we are concerned about a min-
guardian.) ute chance of danger when it comes to pikuach nefesh, if the particular
For cosmetic treatment or surgery, or any other treatment that is danger is a rare occurrence, there are times when a person is allowed
not dangerous to the patient and is not due to a serious illness, one to put himself in danger. Therefore, in our case, if the possibility of
should not force the patient to accept the medical treatment. Even if danger from the treatment is very small, the physician is exempt from
a young man’s appearance is repulsive and makes it difficult for him payment for damages if he did not inform the patient of the chances.
to find a match, one cannot force him to undergo cosmetic surgery to The Iggros Moshe (Choshen Mishpat, Part 1 #104) discusses wheth-
enhance his appearance. Although one forces people to do mitzvos, er or not it is permissible to earn a living by being a professional

104 1 Medical-HalacHic Responsa of Rav ZilbeRstein Failing to inform a patient of possible risks 2 109