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1 AnsweR Chinese women around an important event in their lives. This
study also showed that women sick with cancer who received
If a doctor works in Hospital A himself, and sends patients for emotional support in addition to the standard treatment
treatment in a different place, then he is discrediting his job. Even remained alive much longer, in a statistically significant way,
if it is for the benefit of the patients to receive outstanding care in compared to women who only received the standard treatment.
a different place, the physician receives his salary from Hospital A,
which provides adequate care, and he should therefore not violate Some facts we can learn from the above: 1. The will to live is related
the instructions of his superiors. If it is a case of pikuach nefesh, such to a lower death rate. 2. An optimistic outlook on life, encouragement,
as if he knows that in Hospital B the patient has a better chance of strength and support from family and the medical staff- all of these
survival, or a greater chance of living longer, then “there is no wisdom increase the chances of the patient’s recovery and significantly increase
nor discernment nor advice against the Lord” (Mishlei 21:30; Berachos the percentage of survival. 3. If the patient himself wants to live, and
19b). harbors positive thoughts and expectations, then “The spirit of man
nourishes his illness.” In other words, he then has the greatest chance
If the physician works for the Kupat Cholim, or in his own private
clinic, he is allowed to repay the kindness of Hospital A, where he of emerging from his medical predicament.
grew and developed. Therefore, if he has a choice of referring to two Faulty relationships between the medical staff treating the patients
equally good hospitals, he should send his patients to the hospital sully the entire atmosphere. This is automatically sensed by the pa-
where he studied. tient, causing him fear and disquiet, and increasing his worries about
A partial source for this can be found in the words of the Har Tzvi his illness. His outlook about his disease and the chances of his being
(on the Tur, Choshen Mishpat #7). He deals with the case of a dayan healed will become pessimistic.
who was asked to magistrate between an institution and a private In my opinion, it is forbidden to admit patients to such a depart-
individual, the institution being the place where the dayan himself ment, not on Shabbos and not on a weekday. I will bring a number
learned most of his Torah and became certified. The dayan wanted to of citations from the book “Ahavah, Refuah VeNissi,” by Dr. Berney
know whether he was permitted to judge this case. In response, the Segal. The author deals with the subject of neuropsychoimmunolo-
author brought the words of the Shitah Mekubetzes on the Gemara, gy. He explains that “There are biological mechanisms in our bodies
(Baba Kamma 92b) which states that a person should not throw a which determine whether we live or die. The mental attitude affects
stone into a well that he drank from. This indicates that if a person the condition of the body, through the central nervous system, the
benefits from a certain source, he should not do anything that may hormonal system, and the immune system. Emotional calm sends a
cause damage to it. This can apply to our case as well. The difference message to the body ‘to live,’ while depression, fear and unresolved
between the two, however, is that while here there was a chance of conflicts send a message ‘to die.’” On page 13 he also writes that “I
actually harming the institution, in our case, the physician would know patients whose relationships with their physicians kill them.”
simply be preventing the hospital where he studied from profiting. A study in the United States conducted by a cardiologist from San
Moreover, we would still need to determine whether the obligation Francisco shows a reduction in complications after a heart attack due
of showing gratitude applies when doing so would affect others, such to patients’ prayers. (p. 17)
as the patients. In summary: A calm and pleasant environment in the intensive
All this would apply when the treatment provided by the two care unit positively influences and hastens the recovery of the patient.

184 1 Medical-HalacHic Responsa of Rav ZilbeRstein Relationships Among Physicians 2 205

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