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We can add to the words of the Chelkas Yaakov, that if a physician 11 hand, if at the moment there is no danger present, but one fears future
has made the physician’s oath to safeguard patient confidentiality, he
is prohibited from revealing the medical knowledge that he has. Even
though the Rama (Yoreh Deah 239:7) rules that if one swears not to
reveal to his fellow something that may save him from a loss, this is
an oath to nullify a mitzvah, and is not valid - nonetheless, it is best to
find a way to release the person from his oath. This law only applies
to someone who swore not to reveal the secret to the one specific
person whom it can save from a loss. If he swore not to reveal the
secret to anybody, the oath is valid, since an oath is valid if it includes
things that are permitted, together with things that are prohibited, as
explained in Shulchan Aruch (Yoreh Deah #236:8) and in the Mishnah
Berurah (#485:1). Therefore, the physician has to annul his oath of
confidentiality before revealing the medical information that he has.
Dr. Avraham Pinchas shlita pointed out, regarding the Chelkas
Yaakov, that if physicians would breach their patient’s confidential-
ity, people would be afraid to tell their doctors the details of their
symptoms and thus they would not receive the appropriate care. They
might even receive treatment that is harmful to them as a result, lead-
ing to a possibility of pikuach nefesh. Therefore, physicians should not
reveal their patients’ secrets.
Even if this is correct, in any event it only relates to the situation
addressed by the Chelkas Yaakov, where if the physicians reveal the
groom’s illness, they may cause pikuach nefesh, but if they remain
silent, the bride’s life is not in danger, although she may become a
widow. On the other hand, if a driver suffers from epilepsy, then if
the physician is silent it will cause danger. The driver is liable to kill
himself and others, and therefore it would seem that the physician is
required to reveal the danger to the authorities.
However the Binyan Tziyon (#137) suggests that the known prin-
ciple that “we do not go according to the majority when it comes to
pikuach nefesh” only applies if the danger to life is in front of us. For
example, if someone is trapped under the rubble of a collapsed build-
ing, then even if the chances that he is still alive are very small, one is
nevertheless obligated to desecrate Shabbos to save him. On the other
330 1 Medical-HalacHic Responsa of Rav ZilbeRstein
# 20818
danger, then one does go according to the majority. One can therefore
go down to the sea or out to the desert without fearing the possibility
of danger. This is not a violation of “And you shall watch over your
lives very well,” because at present there is no danger before him, and
therefore he can go according to the majority (i.e., most often no harm
occurs to one who goes to the beach or the desert). This idea explains
the mishnah in Berachos (33a): “Even if a snake is wound around his
ankle, he should not interrupt his prayer.” Both the Rambam as well as
Rabbi Ovadiah Bertinoro explain that since in most cases the snake
does not bite, one should not stop one’s prayers. This is difficult to
understand, since we do not go according to the majority in pikuach
nefesh. In light of the above, however, we can explain that since the
danger is not presently before us, we do go according to the majority.
(See another example brought down there.)
According to this, if the seizures occur only once in a long while,
such as once a year, one does not need to worry that he will have a
seizure while driving, because most of the day he is not driving. Even
if he has a seizure while driving, it is not certain that it will cause
an accident. If so, the physician can then withhold the information
from the authorities so as not to impinge on his patient’s livelihood.
This is the truth. Were it not so, a patient with epilepsy would not be
allowed to swim in the ocean or to walk on the sidewalk, lest he fall
and endanger himself.
Nonetheless, if the driver himself would seek out our advice, we
would advise him not to drive, since he has the responsibility to avoid
being trapped into the severe violation of “Do not kill.” Regarding the
physician, however, for whom it is a mitzvah of “Do not stand idly by
the blood of your fellowman,” this is not a situation that will clearly
cause damage like an open pit in a public thoroughfare, the danger of
which everyone is obligated to remove.
I heard from the gaon Rav Shlomo Berman, zt”l, Rosh Yeshivas
Ponovez, that Dr. Heinman - an expert on lung diseases - told him
that the Brisker Rav, Rav Yitzchak Ze’ev zt”l, once sent him a mes-
sage, informing him that “I ruled that a man with tuberculosis eat
Driver has epilepsy 2 331