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surgeon, helping them out with the expense is not considered charity hospital, in which case, if the physician assigned that bed to the chayei
unless using the private surgeon is pikuach nefesh. In other words, if sha’ah patient, the patient acquires it even though the decision was
chances of the surgery being successful are significantly higher if it is not correct. However, in a public hospital, if the physician decides
performed by the expert surgeon, then it is considered pikuach nefesh. to allocate the private bed to the chayei sha’ah patient and there was
On the other hand, if the physicians believe that the medical staff another patient with a longer life expectancy who could have been
paid by the healthcare clinic can perform the surgery just as well, then saved, then the doctor’s decision has no validity. One should remove
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helping the family pay for the expense is not viewed as charity, but as the first patient from the room and bring in the patient with the lon-
an act of chessed which helps the family be calmer. ger life expectancy. (If the first chayei sha’ah patient is attached to an
In the words of the Tiferes Yisrael, cited above, there is no qual- artificial respirator, one should not remove it from him, because that
ification for how much “wiser” the “wise woman” must be than the would be considered murder.)
regular midwife in order to justify calling for her on Shabbos. Thus we The Iggros Moshe also teaches us that if moving out the first patient
learn that even if the midwife could deliver the baby, it is still permis- will cause him to understand that his situation is hopeless, it is pro-
sible to desecrate Shabbos and call an expert. It seems that there is a hibited to remove him because of the possibility that he will lose his
contradiction here. If one can desecrate Shabbos to call a more expert mind and this will hasten his death.
midwife, why don’t we consider the expense of paying a more expert There is room to question this. If a person is in danger, he is per-
surgeon as an act of pikuach nefesh as well? mitted to violate biblical prohibitions in order to save his life, even

Perhaps one can answer that in regard to the desecration of Shab- only for chayei sha’ah. If so, why can’t the patient with a short life
bos even a slightly higher chance of saving life sets aside Shabbos. As expectancy claim: although the bed is not reserved for me, I wish to
explained in the Sha’ar Hatziyun (#328:11), desecrating Shabbos for a violate the prohibition of stealing and to grab that bed in order to save
great need, even according to the poskim who are stringent, would my own life?
be permissible. Similarly, we learn in Tractate Yoma (83) that “One The answer is that one is permitted to violate prohibitions only
may heat up water both to drink and in order to heal.” [i.e. For an to save the life of a Jew. But, in our case, since the halacha is that
internal wound, one can do whatever is usually done on a weekday, the bed should be given to the patient with chayei olam, there is no
even though withholding it would not endanger the patient, since the permissibility to steal, as doing so will not cause us to gain a life. On
illness is in itself dangerous. A number of poskim disagree, but only the contrary, while attempting to save someone with a short life-ex-
in a case where the medication is slightly needed. If there is “great pectancy, we lose a life which could have been saved for chayei olam.
need” to treat the illness, it is permitted according to all poskim, even Moreover, the Chazon Ish (Choshen Mishpat, Likutim #20 to Baba
if withholding it would not be a danger. For example, it is permissible Metzia 62a) refers to a dilemma involving two travelers on the road.
to heat up water for him on Shabbos to drink or to heal him.] One of them has a bottle of water in hand. If they both drink, they
But, in regard to spending money and the obligation to give chari- will both die. But if only one drinks, he can reach civilization and
ty, this type of situation would not be considered pikuach nefesh to the be saved. Rabi Akiva taught that the verse “And your brother shall
point that one who refrains from contributing violates the precept of live with you” implies that “your life takes precedence to that of your
“Do not stand idly by the blood of your fellowman.” If a patient has friend.” The Chazon Ish asks: Is the second traveler permitted to steal
a physician who can heal him, but he wants a more expert physician, the water from its owner, since pikuach nefesh sets aside all biblical
there is no obligation to give him money, and he who refrains from and Rabbinic laws, including the prohibition of stealing?

178 1 Medical-HalacHic Responsa of Rav ZilbeRstein Transfer of a Patient 2 147