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sume the reeds offered adequate protection. If not, then she certainly
would have attained the solid wood, for nothing comes before pikuach
nefesh, and certainly not money. We learn from here that one is not
obligated to give the very best and most reliable treatment, even if his
reasoning is in order to save money.
When Yaakov Avinu came to meet his brother Esav, he placed the
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maidservants and their children first, then Leah and her children, and
finally Rachel and Yosef (Bereishis 33:2). The commentators question
how it was permissible for him to differentiate between blood and
blood. How could he put Rachel and Yosef, whom he loved most,
at the very end, and the others up ahead? We would think that since
they were all in danger, he should have thrown a dice to decide who
goes first. The Darash Moshe and others dealt with this question.
According to the above principle, we can perhaps explain as
follows: Yaakov himself walked at the front of the line in order to
wage war with Esav himself, should Esav attack him (Bereishis 33:3).
Yaakov was very powerful, as explained in Rashi (Bereishis 29:10), and
it seemed that if he fought, they would all be saved. Saving Rachel
and Yosef was more significant to him, and saving Leah and her six
children was more important to him than saving the maidservants
and their children. Since in essence he had taken proper measures
to save them all, it is possible that he was allowed to be extra careful
regarding those he loved most.
The Birkei Yosef (Yoreh De’ah #336:4) warns the patient that he is
obligated to seek out the most expert physician. If not, he is wounding
himself. Because nowadays there are physicians who are not experts
at all, and they can cause great damage or even murder. Accordingly,
in our case, it is in the patient’s interest to request the best possible
physician.
However, the Tzitz Eliezer (Vol. 5, Ramat Rachel #22) says that the
Birkei Yosef probably refers to physicians who have not been licensed
in their field. Perhaps in his times there was not enough scrutiny
by the authorities, and people did as they pleased. As the Shi’urei
Berachah (on the Birkei Yosef, Yoreh De’ah #336:1) writes, Rabbanim
should make young aspiring doctors aware of the halacha that “there
186 1 Medical-HalacHic Responsa of Rav ZilbeRstein
atmosphere can make up for the lack of expertise and advancement. In
other cases, a competitive and stressful atmosphere may bring about
deaths despite the availability of advanced resuscitative equipment in
the ICU. This is what research has shown.
Dr. Avi Rubenstein, expert neurosurgeon
1 Consultant 2
7
I am aware that a negative atmosphere can impair the treatment given
to babies in the NICU. If the atmosphere is peaceful and coopera-
tive, then when the physician is tired, the nurses can help care for
the young patients. As a result, the patients receive the best possible
care despite the doctor’s exhaustion. If the atmosphere is fraught with
tension, however, then the nurses are liable to trip up the physician
and thereby endanger the lives of the premature babies.
Dr. Meshulam Hart, expert pediatrician and allergist,
Bnei Brak
1 Consultant 3
In my opinion, a peaceful atmosphere among the hospital staff is ex-
tremely significant. It influences both the cardiac patient and his fam-
ily. Primarily it dispels anxiety, fear and phobias that appear during
the patient’s difficult hours.
It is likely that two physicians who don’t get along will not discuss
things with each other. If a doubt arises about how to treat a particu-
lar patient, they will not deliberate on the proper course of treatment
together. This will undoubtedly cause harm to the patient.
Dr. Chaim Koznitz, expert in heart diseases and intensive
care, Beilinson Hospital, Petach Tikva
1 Consultant 4
A patient’s recovery is built on two separate things:
One- cooperation between the medical staff, which enables each
Relationships Among Physicians 2 203