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more time to his treatment and indirectly causes harm to In a similar vein Rashi explains that (23:2) Sara’s death is jux-
the other patients. The other patients are also likely to
suffer directly from the presence of an incontinent patient
and the unpleasant effects of sharing a room with someone
who is unable to care for his excretory functions. It may
even come to point that his roommates will have to leave.
Certainly, they will not be able to host visitors in the room.
Moreover, a nursing patient is likely to require treatments
at night, disturbing the sleep of his roommates.
Leaving the nursing care patient where he is also causes
a monetary outlay because the cost of his treatments is
higher than that of the other elderly patients. The mone-
tary harm to the institution will ultimately result in other
patients not receiving what they need.
There are a number of solutions to the issue cited by
Dr. Brayer, above:
A) The medical staff and family should prepare the patient
emotionally for his transfer to another institution.
B) The patient should be around familiar people, such
as friends and family, during his first days in the new
institution. In this way, he will not feel helpless and
abandoned.
C) Possibly leaving him in a private room with a private
caretaker in the geriatric ward, at the expense of the
family.
These solutions have to be appropriate for the patient,
and in line with the opportunities available to the institu-
tion and the patient’s family. In any case, the patient should
be involved. The dilemma should be presented to him and
his opinion should be sought. There is great therapeutic
benefit to his involvement in the process.
In summary: The problem is multi-faceted and, in my
opinion, there is no single solution. Each case has to be
weighed separately. The physician has to choose the option
that is least damaging, according to the resources available
144 1 Medical-HalacHic Responsa of Rav ZilbeRstein
taposed with the binding of Yitzchak because the news of the
binding was so shocking to her that it caused her soul to depart.
Another example is when Yaakov was told that (Bereishis 45:26)
“Yosef is still alive and he is ruler over all the land of Egypt,”
the verse continues, “and Yaakov’s heart fainted, because he did
not believe them.” The Ramban explains that his heart stopped
beating and he was like a dead man, something that is known to
occur when one is suddenly overjoyed.
Likewise, Hashem called out to Adam and said “Where are
you?” (Bereishis 3:9), and Rashi writes: He knew where he was
but [He asked in order] to start a conversation with him, so he
should not be confused if he is punished suddenly.
2. The Me’iri writes (Pesachim, ibid) that one should try to refrain
from being put in the position of relaying sad news, for this is
not a good omen for a person.
3. The Ben Yehoyada writes (Pesachim, ibid, s.v. sham mai): If one
opens one’s mouth with a good thing it will help transform bad
news to good, because a covenant was made with the lips both
for good or the opposite. The bad can really become good. If the
earth produces a little bit, Hashem can send His blessing, and
the little will suffice for many, who will eat and there will be left
over. As an example of this he cites the story of a rich man who
wanted his two sons to do business and become rich. Therefore,
he promised that at the end of every week, if they inform him
that they made a profit, he would give them a gift. One week,
they both lost money. One son came and told his father “I lost
money” so his father gave him nothing. The other son thought:
Why should I tell him I lost money and open the mouth of
Satan? Instead, he told his father, “I made a profit last week. ”As
a result, his father, who heard the words “I made a profit,” did
not pay attention to the conclusion of his words, “last week,” and
he gave him a gift. In other words, he only gained from the fact
that he opened his mouth to make a positive statement. From
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