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19:16). Since the Director of the department asked him to join the people to suspect he had taken a bribe. Perhaps this is no different
consultation in order to hear his opinion, if he refrains from doing than a person who is required to pay from his own money in order to
so, he may be cursed like the people of Meroz. As it says, “Cursed is save the life of his friend.
Meroz …because they did not come to the help of the Lord” (Shoftim However, according to what we wrote above, in the name of my
5:23). In other words, someone who is able to help save lives but does father-in-law, Rav Y. S. Elyashiv zt”l, the mitzvah of returning a lost
not do so, is cursed. Likewise, one who is able to testify for the benefit object to its rightful owner does not obligate giving the patient the
of his friend but does not testify, is liable in the Heavenly court (see very best treatment. It therefore seems to me that the same should
Baba Kamma 56a). This applies all the more so in our case. apply here. If he admits the patient to the ICU, the director will find
The lack of payment should not be a reason for refraining from himself in an unpleasant situation with a cloud of suspicion hovering
healing another. One is obligated to save lives even without getting over his head. This will certainly affect his functioning as a doctor. It
paid. Moreover, the same would apply even if such a question would is well known that a good atmosphere between the physicians is vital
arise regarding a worker. For example, if a plumber who was hired to to the proper treatment of the patients. Therefore, he may refrain
fix a pipe was presently dealing with the same problem while working from sending the patient to the ICU (as long as there is no concern
for a much greater expert, he is obligated to express his opinion to his of pikuach nefesh).
employee. Since he hired him and will pay him to do the job, he can-
not refrain from expressing his opinion in order to receive payment 1 SuMMaRy and Conclusions
privately. He must be faithful to his employees.

1. A physician who works in a hospital where the treatment is
1 SuMMaRy and Conclusions adequate should not send patients to another hospital where
the treatment is better, unless it is a case of pikuach nefesh.
1. If the dangerously ill patient will receive proper treatment from 2. If he works in a Kupat Cholim clinic or a private practice, it is
the intern, who will consult his superiors, then they should permissible and proper for him to send a patient to the hospital
transfer him to unit A. If the intern does not understand, and where he studied, if the level of medical care is equal to that of
will not know how to present the question to his superiors, then others hospitals.
the emergency-room physician should do everything possible to 3. Even if there is a medical institution that provides better medi-
transfer the patient to a reliable doctor.
cal care, a physician is allowed to refer his patient to the hospital
2. The orthopedist should agree to treat all patients presenting where he studied and where he feels connected and is presently
with problems of the hand. If the hospital pressures him to studying as well, provided that this hospital delivers adequate
work additional hours, he should refer those patients to his care. This only applies if there is a concern that he himself will
private clinic. be harmed if he does not refer there, and that other patients will
3. If the treatment in the present ward is okay, one is not obligated suffer because of it. However, if there is no such concern, it is
to tell the patient that in hospital B, the care is much better. If certainly a mitzvah for the physician to transfer his patient to
the treatment the present hospital is unreliable, he is obligated the best possible place.
to tell him. 4. If providing the best care will cause the physician to be sus-

200 1 Medical-HalacHic Responsa of Rav ZilbeRstein Referring Patients to Experts 2 189