Page 277 - 20818_park-c_efi

20818_efi-ab - 20818_park-C_efi-ab | 9 - A | 18-08-20 | 13:46:24 | SR:-- | Cyan
20818_efi-ab - 20818_park-C_efi-ab | 9 - A | 18-08-20 | 13:46:24 | SR:-- | Black
#20818_efi-ab - 20818_park-C_efi-ab | 9 - A | 18-08-20 | 13:46:24 | SR:-- | Yellow
20818_efi-ab - 20818_park-C_efi-ab | 9 - A | 18-08-20 | 13:46:24 | SR:-- | Magenta
#
sicians had differing opinions about whether this man is ill and needs 9
Non-emergency Tracheal Tube inserted into an to eat on Yom Kippur, or is healthy and allowed to fast, we would
Elderly Person for Future Benefit certainly heed only the advice of the expert, since it is prohibited for
the other doctor to practice medicine in his presence. However, if it
1 Question 1 is clear that he is ill and they differ in opinion about whether or not
fasting will cause danger to his life, then they each have the right to

I was on the night-shift in the emergency room when an elderly state their opinion. The less experienced physician is also licensed to
woman came in with her daughter. She had dangerously-high fever practice medicine, and in making this type of decision, the expert has
and very low blood pressure. After initial treatment to stabilize her no advantage over him. As the Rama states (Orach Chaim #618:6): If
vital signs, I had difficulty persuading the nursing care staff to put a man becomes so weak that it appears to most people that it would
her into a trauma room to continue treatment. Unfortunately, the endanger him to fast, we feed him [on Yom Kippur].
attitude towards the incapacitated elderly is lacking. There is far less The Shulchan Aruch (Yoreh De’ah #336) teaches: “A person should
eagerness to save their lives than the lives of young people with new, not practice medicine unless he is an expert and there is no greater
acute diseases. one than he.” Does this imply that a doctor should close his clinic if
there is a greater doctor than he in the city? Likewise, halacha states
The blood-test results of oxygen saturation and acid concentration that it is forbidden for a Torah scholar to rule on a case if there is a
reveal that, at this stage, it is not yet necessary to artificially respirate greater Torah scholar in the city. Should the officers that were ap-
the patient. The condition requires constant re-evaluation over time pointed over hundreds, fifties, and tens cease working if there is an
to see how she handles the infection. Her blood pressure has stabi- officer appointed over a thousand in town?
lized and she is no longer in any immediate danger. A Torah scholar is permitted to issue rulings in cases where the
At this stage, I considered whether to hospitalize her as is, or to halacha is clear and obvious. Likewise, a physician can practice medi-
insert a tube in her windpipe (tracheostomy). On the one hand I was cine in cases where the course of treatment is fairly simple and obvious.
concerned that in case she would require artificial respiration in the The Gemara in Avodah Zarah and Yevamos refers to a case where one
ward, she would not receive it from the physician on duty. In addition, rules based on a comparative situation, which requires great wisdom.
a patient on an artificial respirator requires more supervision and For this type of case, it is forbidden to rule if there is someone greater
more effort than all the others. Hospital protocol dictates that such than he in the city. Likewise, in medicine, when a diagnosis is not ob-
a patient receive a lot more personal attention, periodic check-ups, vious, it is forbidden for the less experienced physician to get involved
and dedicated private care in a room near the nurses’ station, with and make a diagnosis with consulting the expert. Consider the case of
constant observation. On the other hand, a tracheostomy may cause the four-year-old boy who was brought to the hospital complaining
abnormalities in cardiac rhythm, vomiting, and infection, and is only of abdominal pain. The physician on duty diagnosed inflammation
performed under clearly emergency conditions. Therefore, the perfor- of the appendix. Based on this diagnosis, the boy underwent surgery,
mance of this procedure superfluously does not garner the physician at which time it was clarified that the diagnosis was in error and the
any respect from his colleagues, if there was a possibility of making correct diagnosis was inflammation of the bowel and severe liver in-
do without it. fection, gastroenteritis and hepatitis. As a result of this misdiagnosis
and unnecessary surgery, the boy developed high fever and hemolysis.
Ultimately I decided that since her condition at present is stable,
The kidneys were damaged to the point that they were lost, and the

254 1 Medical-HalacHic Responsa of Rav ZilbeRstein Physician Versus an Expert Physician 2 263