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1 AnsweR Chinese women around an important event in their lives. This
If a doctor works in Hospital A himself, and sends patients for
treatment in a different place, then he is discrediting his job. Even
if it is for the benefit of the patients to receive outstanding care in
a different place, the physician receives his salary from Hospital A,
which provides adequate care, and he should therefore not violate
the instructions of his superiors. If it is a case of pikuach nefesh, such
as if he knows that in Hospital B the patient has a better chance of
survival, or a greater chance of living longer, then “there is no wisdom
nor discernment nor advice against the Lord” (Mishlei 21:30; Berachos
19b).
If the physician works for the Kupat Cholim, or in his own private
clinic, he is allowed to repay the kindness of Hospital A, where he
grew and developed. Therefore, if he has a choice of referring to two
equally good hospitals, he should send his patients to the hospital
where he studied.
A partial source for this can be found in the words of the Har Tzvi
(on the Tur, Choshen Mishpat #7). He deals with the case of a dayan
who was asked to magistrate between an institution and a private
individual, the institution being the place where the dayan himself
learned most of his Torah and became certified. The dayan wanted to
know whether he was permitted to judge this case. In response, the
author brought the words of the Shitah Mekubetzes on the Gemara,
(Baba Kamma 92b) which states that a person should not throw a
stone into a well that he drank from. This indicates that if a person
benefits from a certain source, he should not do anything that may
cause damage to it. This can apply to our case as well. The difference
between the two, however, is that while here there was a chance of
actually harming the institution, in our case, the physician would
simply be preventing the hospital where he studied from profiting.
Moreover, we would still need to determine whether the obligation
of showing gratitude applies when doing so would affect others, such
as the patients.
All this would apply when the treatment provided by the two
184 1 Medical-HalacHic Responsa of Rav ZilbeRstein
study also showed that women sick with cancer who received
emotional support in addition to the standard treatment
remained alive much longer, in a statistically significant way,
compared to women who only received the standard treatment.
Some facts we can learn from the above: 1. The will to live is related
to a lower death rate. 2. An optimistic outlook on life, encouragement,
strength and support from family and the medical staff- all of these
increase the chances of the patient’s recovery and significantly increase
the percentage of survival. 3. If the patient himself wants to live, and
harbors positive thoughts and expectations, then “The spirit of man
nourishes his illness.” In other words, he then has the greatest chance
of emerging from his medical predicament.
Faulty relationships between the medical staff treating the patients
sully the entire atmosphere. This is automatically sensed by the pa-
tient, causing him fear and disquiet, and increasing his worries about
his illness. His outlook about his disease and the chances of his being
healed will become pessimistic.
In my opinion, it is forbidden to admit patients to such a depart-
ment, not on Shabbos and not on a weekday. I will bring a number
of citations from the book “Ahavah, Refuah VeNissi,” by Dr. Berney
Segal. The author deals with the subject of neuropsychoimmunolo-
gy. He explains that “There are biological mechanisms in our bodies
which determine whether we live or die. The mental attitude affects
the condition of the body, through the central nervous system, the
hormonal system, and the immune system. Emotional calm sends a
message to the body ‘to live,’ while depression, fear and unresolved
conflicts send a message ‘to die.’” On page 13 he also writes that “I
know patients whose relationships with their physicians kill them.”
A study in the United States conducted by a cardiologist from San
Francisco shows a reduction in complications after a heart attack due
to patients’ prayers. (p. 17)
In summary: A calm and pleasant environment in the intensive
care unit positively influences and hastens the recovery of the patient.
Relationships Among Physicians 2 205