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vein. The pediatrician decided to wash the catheter that was in the had entered his domain and caught his mistake. Here, a serious moral 5
umbilical vein with saline solution, but instead of saline solution he ethical problem arose for me. Is it part of my job as director of an
mistakenly injected potassium chloride. As a result, the baby’s heart independent medical laboratory to approach the treating physician
destabilized and he died. An investigation revealed that the physician with the results of the blood tests, even though Dr. Reuven asked me
erred because of his haste in removing the drug for injection from the not to tell him? There is a possibility of real pikuach nefesh for many
medicine cabinet. He did not pay attention to the letter K as a sign for future patients of Dr. Shimon.
potassium, which was written on the box. The physician was severely Is Dr. Reuven, who is under the authority of the treating physician,
punished by the court.) Dr. Shimon, and dependent on him for his livelihood, required to
The physician wants to know if he should confess to his supervi- speak out about Dr. Shimon’s mistake, due to the possible danger to
sors. life of future patients?

1 AnsweR
1 AnsweR
At first glance, it would seem that the physician should confess his
error in order to find atonement. His actions are considered “close to In order to answer these questions, we have to clarify three topics:
intentional,” because he knew that a patient’s life was in his hands and 1. To what degree is Dr. Shimon responsible for what occurred
by switching the faucets it is as if he killed with his own hands. here? Was he completely criminal in his actions, close to crimi-
I sent this question to my revered father-in-law, Rav Yosef Shalom nial, or can we consider his act unintentional?
Elyashiv zt”l, who said that the physician should remain silent, for 2. Do we obligate a physician who was criminially negligent to pay
several reasons:
for the damages he caused?
1. There is reason to suspect that the father of the child (or an- 3. Is it proper in this case to revoke the physician’s license, or can
other relative) may kill him. The father wanted to hurt himself we make do with a warning that if this type of mistake occurs
out of grief and sorrow, and he may take out his anger on the again, he will be fined?
physician. The Torah is concerned about such a possibility, as it
says (Bamidbar 35:25): “And the congregation shall save the [un- Regarding the level of the criminality of the physician, and whether
intentional] murderer from the avenger of blood.” The Rambam or not he is obligated to pay for the damages:
(Hilchos Rotzeach 5:8) writes that the unintentional murderer is We learned in the Tosefta (Gittin 3:13): “An expert physician who
given two Torah scholars [who watch over him] lest the avenger healed with a license from a beis din and caused damage, if it was
of blood kill him on his way to a city of refuge. Thus there is unintentional, he is exempt, ’for the good of the world.’ (Although
legitimate room for concern that the father will kill him. a person is forever held accountable, nevertheless our Sages exempt
him so that physicians will be available to heal the sick (Minchas
2. According to Torah law, one cannot punish this physician with Bikkurim).) If it was done on purpose, he is obligated to pay. If one
prison because Rashi implies (in Pesachim 91a, s.v. beis haasurim) dismembers a fetus in its mother’s womb with the permission of a
that one may be imprisoned for three things: beis din (because the fetus is endangering the mother’s life) and he

a. If a man is obligated to divorce his wife but refuses to do unintentionally did damage, he is exempt “because of the good of

134 1 Medical-HalacHic Responsa of Rav ZilbeRstein Dangerous medication causes death 2 143