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anything. We can the assume that the physician did not find the ill- and during the Holocaust, there were people who exchanged their
ness since he did not plumb the depths of the issue, and that is why we morsel of bread for a cigarette, nonetheless, during an emergency, a
consider the words of the patient. The patient knows and feels what person taps into internal wellsprings of strength and does what needs
is taking place in his body, and the physician cannot contradict him. to be done. Imagine if a physician had to perform surgery on his only
However, if the patient is complaining about a strong headache and beloved son. Would he not perform his very best, even without a
the physician knows from experience and according to the symptoms cigarette? Could he not control himself and put every ounce of effort
#
that there is no meningitis or other disease in the head, then even if into making sure the surgery is successful? A physician who knows
on very rare occasions the symptoms can be misleading, the physician his responsibilities will do his work reliably, even without smoking.
is still permitted to assume that there is no danger and to disregard Therefore, there is no place to permit his smoking on Shabbos.
the words of the patient. This is said in regard to a Jewish physician who operates out of
This applies only if the physician is absolutely certain that his view mercy, and is fully aware of the import of his work. However, if a
of the situation is correct. If he still has even a slight concern that there light-headed physician comes to perform surgery as a routine matter,
is a hidden dangerous disease, then he must heed the words of the and does not feel the life of the patient is in his hands, then perhaps
patient. For example, it is well-known that physicians often suspect he is allowed to smoke. The physician himself must weigh and decide
appendicitis because at first the symptoms may indicate that there is how urgent it is for him to smoke so that the surgery succeed.
no infection, while it later becomes evident that there is appendicitis.

In our second case, the physician examined the patient and found 1 SuMMaRy and Conclusion
no reason to refer him to hospital for further testing as a result of
his headache. It seems, based on the above, that if the physician is A Jewish physician who knows that whoever saves one life, it is as if
certain that he has taken into account every possibility of danger, and he saved an entire world, should not smoke.
based on his vast experience and medical knowledge he is confident
that there is no danger, then one does not have to heed the patient’s
words. If, however, he did not take all possibilities into account, and
he hasn’t truly plumbed the depth of the issue, then one must abide
by the patient’s wishes.
In our first case, the patient, believing he was in danger, called the
physician on Shabbos. The physician, on the other hand, is sure that
there is no danger involved. This matter resembles the Ramban in
Tractate Shabbos (129a). There it says that if a woman more than seven
days after childbirth asks for hot water on Shabbos, we do not dese-
crate Shabbos for her. Up to thirty days after the birth, she is consid-
ered a non-dangerously ill patient. The Shulchan Aruch (Orach Chaim
#330:4) rules likewise. The Ramban explains (Shabbos, there, s.v. hoh
de’omrinan) that we do not desecrate Shabbos for this woman since we
know that she has no other illness, and she herself does not claim to

268 1 Medical-HalacHic Responsa of Rav ZilbeRstein Smoking on Shabbos to improve performance 2 249