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

186 1 Medical-HalacHic Responsa of Rav ZilbeRstein Relationships Among Physicians 2 203