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19:16). Since the Director of the department asked him to join the
consultation in order to hear his opinion, if he refrains from doing
so, he may be cursed like the people of Meroz. As it says, “Cursed is
Meroz …because they did not come to the help of the Lord” (Shoftim
5:23). In other words, someone who is able to help save lives but does
not do so, is cursed. Likewise, one who is able to testify for the benefit
of his friend but does not testify, is liable in the Heavenly court (see
Baba Kamma 56a). This applies all the more so in our case.
The lack of payment should not be a reason for refraining from
healing another. One is obligated to save lives even without getting
paid. Moreover, the same would apply even if such a question would
arise regarding a worker. For example, if a plumber who was hired to
fix a pipe was presently dealing with the same problem while working
for a much greater expert, he is obligated to express his opinion to his
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
privately. He must be faithful to his employees.
1 SuMMaRy and Conclusions
1. If the dangerously ill patient will receive proper treatment from
the intern, who will consult his superiors, then they should
transfer him to unit A. If the intern does not understand, and
will not know how to present the question to his superiors, then
the emergency-room physician should do everything possible to
transfer the patient to a reliable doctor.
2. The orthopedist should agree to treat all patients presenting
with problems of the hand. If the hospital pressures him to
work additional hours, he should refer those patients to his
private clinic.
3. If the treatment in the present ward is okay, one is not obligated
to tell the patient that in hospital B, the care is much better. If
the treatment the present hospital is unreliable, he is obligated
to tell him.
200 1 Medical-HalacHic Responsa of Rav ZilbeRstein
people to suspect he had taken a bribe. Perhaps this is no different
than a person who is required to pay from his own money in order to
save the life of his friend.
However, according to what we wrote above, in the name of my
father-in-law, Rav Y. S. Elyashiv zt”l, the mitzvah of returning a lost
object to its rightful owner does not obligate giving the patient the
very best treatment. It therefore seems to me that the same should
apply here. If he admits the patient to the ICU, the director will find
himself in an unpleasant situation with a cloud of suspicion hovering
over his head. This will certainly affect his functioning as a doctor. It
is well known that a good atmosphere between the physicians is vital
to the proper treatment of the patients. Therefore, he may refrain
from sending the patient to the ICU (as long as there is no concern
of pikuach nefesh).
1 SuMMaRy and Conclusions
1. A physician who works in a hospital where the treatment is
adequate should not send patients to another hospital where
the treatment is better, unless it is a case of pikuach nefesh.
2. If he works in a Kupat Cholim clinic or a private practice, it is
permissible and proper for him to send a patient to the hospital
where he studied, if the level of medical care is equal to that of
others hospitals.
3. Even if there is a medical institution that provides better medi-
cal care, a physician is allowed to refer his patient to the hospital
where he studied and where he feels connected and is presently
studying as well, provided that this hospital delivers adequate
care. This only applies if there is a concern that he himself will
be harmed if he does not refer there, and that other patients will
suffer because of it. However, if there is no such concern, it is
certainly a mitzvah for the physician to transfer his patient to
the best possible place.
4. If providing the best care will cause the physician to be sus-
Referring Patients to Experts 2 189