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will be longer as a result, something the administration of the 7 take away from the quality of care given to others, the hospital is not
hospital is demanding that the director of the clinic avoid?
1 Question 5
A seriously ill patient went to a physician privately and booked an
appointment for a number of days later. This physician also works in
the hospital and serves as the Associate Director of the department.
He has known the patient for a number of years and already began to
review the patient’s file. Before the appointment date, the patient was
hospitalized. The department arranged to consult with the Director,
who casually asked his associate director to join. The staff presented
the case to the director, who suggested a solution. The associate di-
rector, who knows the patient well, thinks this is the wrong solution.
Should he express his opinion despite the fact that he was not
asked for it? Some points to consider are the following: a) It is pos-
sible that he is making a mistake. b) If he is correct and they follow
his instructions and the patient is healed, she will not return to him
and he will suffer a financial loss. c) The Director of the department
is paid for the consultation.
Dr. Uriel Levinger, Expert in internal medicine, Beilinson
Hospital, Petach Tikvah
1 AnsweR to Question 1
I heard from my father-in-law, Rav Y. S. Elyashiv zt”l, that if a patient
is receiving adequate treatment, and the hospital doesn’t give him even
better treatment, so as not to cause harm to the other patients, they
have not committed a sin. This is not a violation of the Torah prohi-
bition “Do not stand idly by the blood of your fellowman,” (Vayikra
19:16) since this patient is being cared for properly. [While the Birkei
Yosef (Yoreh De’ah #336:4) writes that “the patient is obligated to re-
quest the most expert physician, and if not, he is wounding himself,”
these words apply to the patient. The hospital, on the other hand, is
obligated to all the patients. If giving one patient the very best will
194 1 Medical-HalacHic Responsa of Rav ZilbeRstein
obligated to do so.]
In Responsa Iggros Moshe (Choshen Mishpat, Vol. 2 #73) he writes
that if there are two patients, one with a short life expectancy (chayei
sh’aah) and the other with a longer life expectancy (chayei olam), and
there is only one bed available in the intensive care unit (ICU), one
should give it to the patient who has a chance to live longer. However,
if the other patient with a short life expectancy was already given the
bed, he acquires it and one cannot take it from him in order to give it
to the other patient.
In view of the above, if the seriously ill patient can be treated well
by an intern (A) (especially since the intern is in touch with an ex-
pert) then we do not transfer him to the more experienced resident
in unit B. Even though physician B has more experience and will pro-
vide better treatment, being that the seriously ill patient’s presence in
the unit may impact negatively on the other patients, we transfer the
patient to unit A.
The Gemara explains in Tractate Yoma (56b) that because of the
Kohen Gadol’s weakness on Yom Kippur, he will not sense that a note
was placed before him, and this will cause serious problems. We sus-
pect that the Kohen Gadol, who was a strong person, will mess up on
the instructions. (We can see that truck drivers who stay awake all
night can tragically come to accidents and killing people.) Certainly,
then, if a physician stays awake all night, he will be incapable of prop-
erly caring for dangerously-ill patients the following morning.
One can ask: What would happen if another patient would come
to the emergency room? Certainly physician B would treat him, if his
unit was in line for admitting patients, as explained in the question.
He would not claim, in such a situation, that he is busy with other
patients and must devote himself to their care. Why then can’t he
take a patient even when it isn’t his technically his turn? Perhaps if a
situation is not possible, it’s different, and we do not bring proof from
the impossible to the possible.
Had the hospital asked for the Torah view on this, they would
probably have been advised to transfer two mildly ill patients from
unit B to unit A, freeing up the more experienced resident to deal with
Division of Work in Hospital 2 195