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words of the Divine presence, referring to Am Yisrael as a beloved 1. My words apply only in the case where the healthcare clinic #
only son. Despite the fact that He has another seventy nations in the does not clearly forbid referring the patient to the emergency
world, Hashem refers to Am Yisrael, who are wandering, as his “only room, but when doing so is not the normally accepted way.
son.” However, since there is a presumption that Jewish physicians, The physician’s referral could be labeled “underhanded” but
as Hashem’s emissaries, will do what is necessary regardless, it is not not an act of deception. Moreover, the healthcare clinic may be
necessary to deceive them. On the other hand, one should not blame spared the high expense of the echocardiogram test, and that
the woman for what she said. of a trans-esophageal echocardiogram, so it turns out that the
However, my father-in-law, Rav Y. S. Elyashiv zt”l said that if the physician is benefitting the clinic as well.
mother sensed that her child was not receiving proper treatment, she 2. If the healthcare clinic is supported by the Ministry of Health,
had the right to speak as she did. However, if they were treating him then the financial resources come from every citizen.
well, but she wanted even better treatment, she was prohibited from
deceiving them. 3. In basic halacha, the physician is permitted to make the referral.
There are some places in the world where physicians neglect elder- If, however, he knows that the patient is wealthy, then it is not
ly patients past the age of seventy or eighty, and there, it is a mitzvah correct to rely on this permissive ruling. If the physician does
to change the truth in order to save their lives. not know if the patient can afford to pay, then he is permitted to
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1 SuMMaRy and Conclusion 4. Changing information is falsehood and stealing. However,
doing something underhanded in a case where the healthcare
One should not alter the truth in order to receive better treatment, clinic may profit is perhaps permissible.
unless the doctors are not treating the patient as they should.

I shared the question with my father-in-law, Rav Y. S. Elyashiv zt”l,
and he did not agree to permit the physician to deceive the health-
care clinic and refer the patient to the emergency room, as long as
the administration of the clinic does not specifically permit it. This
would apply all the more so to Dr. Wald’s question, in which case it is
certainly prohibited.
We can add to the words of my father-in-law another source which
proves how careful one must be not to refrain from deception.
It says in Tractate Baba Metzia (59b): Produce may not be mixed
with other produce. (i.e. the owner of a field cannot claim to be selling
wheat from one field when in fact it is mixed with wheat from another
field.) There is no need to add, that it is forbidden to mix old produce
with new produce. (i.e. if a field owner wants to sell old wheat he
should not mix in new wheat, because dried wheat makes more flour

164 1 Medical-HalacHic Responsa of Rav ZilbeRstein Deceiving a Healthcare Clinic 2 161