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the future. b) the mitzvah of returning a lost object, i.e. preventing the
loss of health of this physcian’s patients.
We have already cited the words of Biyur Halachah (#608, s.v.
aval), that one is not obligated to rebuke those who reject the yoke of
Torah. In view of this, if the negligent physician is among those who
have completely rejected the yoke of Torah, there is no mitzvah to
rebuke him in order to stop him from sinning, but there still exists the
obligation to rebuke him in order to prevent him from harming his
patients, for this is considered the mitzvah of returning a lost object
(the patient’s lost health). One is exempt from this mitzvah as well,
if it will cause harm to the person rebuking (see above, Chapter 48).
Because of this, if the physician feels that he will lose his liveli-
hood if he speaks to his supervisors, then he is exempt from doing so.
However, if his only concern is that it will be uncomfortable or cause
tension between him and the doctor, and the patients will not suffer
as a result, then he should not refrain from speaking up.
If a negligent physician can easily come to causing the death of
patients, then one is obligated to do everything to stop him. A person
should not hesitate to report the physician’s poor performance to his
supervisors, even if that will cause his own dismissal from his job.
He who stays silent violates the precept of “Do not stand idly by the
blood of your fellowman.” Many of our Sages rule that a person has
to spend more than one quarter of his assets in order to save lives.
Therefore, if there is no other way to deter the negligent physician,
except to reveal his incompetence to his supervisors, one should do
so and not worry about the harm one may suffer as a result. Hashem
rewards those that revere Him, and will certainly not abandon those
who have faith in Him and fear no man in their fulfillment of the
mitzvah “And your brother shall live with you.”
If there is no danger to the patients’ lives, and rebuking the doctor
will lead to tension among the staff of physcians, with the patients in
the hospital suffering as a result, then one needs to weigh the possible
harm to the patients against the benefits of rebuking the doctor. If it
seems probable that the rebuke will do great harm, it is possible that
one must be silent and refrain from rebuking. As written in Responsa
240 1 Medical-HalacHic Responsa of Rav ZilbeRstein
1 AnsweRs
A hospital has no heiter to perform unnecessary tests or procedures
without the patient’s consent. Even though physicians learn and
experiment in order to benefit the public, nevertheless, they have no
permission to do so at the patient’s expense without his permission.
We find in maseches Niddah (47a) that when Shmuel Harofeh sought
to study the physical signs of adulthood in girls, he examined his
gentile maidservant for this purpose. He paid her four zuz for her
shame, in spite of the fact that she was his maidservant. Thus if a
doctor wants to experiment, he must obtain the patient’s permission,
which he can get in exchange for payment or some other favor, such
as medical services. This has already been done successfully in some
hospitals. One can also obtain consent from prisoners in exchange
for their early release or the like. Without the patient’s permission,
however, there is no permission for a doctor to use him for research.
Even worse is experimenting on the body of a dying patient. We
learn in maseches Shabbos (151b) that he who closes the eyes of a dying
patient as the soul is departing is guilty of murder. Rashi explains
that this small action shortens the patient’s life. This is analogous to a
flickering candle: if a man touches it with his finger it is immediately
extinguished. One is obligated to protest any form of experimenta-
tion on the body of a dying person. Obtaining the patient’s consent
in this case does not help. Even if the person who speaks up will be
harmed, he is still obligated to protest and fulfill “Do not stand idly
by the blood of your fellowman.”
The nurse in our case, however, is sure that her words of rebuke
will often go unheeded. Particularly in question two, she makes note
of the reasoning guiding the hospital administration in giving prefer-
ence to patients who have a chance of recovery. If this is really so, it
depends on her judgment. If she is certain that no one will listen to
her, and that she is liable to lose her job, she is not obligated to speak
up and lose her livelihood. While a person is obligated to speak up
about a wrongdoing he observes, if he knows that his protest will not
bear fruit, he is not obligated to endanger his livelihood. The Shulchan
Aruch (Yoreh Deah #334:48) rules that a person is obligated to pro-
Notifying Authorities about deficiencies 2 229