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In these situations, I did not find a way to permit sending the 11 Menachos (72a) we find that it is permissible to cut the intestines of
patient to the distant hospital, and the physician is obligated the meat for burning on the altar, even though one could do so after
to send the patient to the close hospital even if he will have to Shabbos, because once Shabbos was suspended for the slaughtering,
pay for the expenses. And our Father in Heaven will surely pay this becomes permitted as well.
back the physician doubly. According to those who rule that This novel thought is found in the words of the Maharsham as
one must spend up to one fifth of one’s assets to save a life, the well (in the introduction to Magen Avos of Rav Banet). He discusses
physician in our case would not have to pay more than one fifth whether it permissible to salt the meat that has been slaughtered
of his assets. for a patient on Shabbos, thus violating a number of prohibitions of
disjointing and selecting, or whether it is preferable to cook the meat
Regarding the second question:
as it is, and to feed the patient blood that was cooked (which is a
A dangerously ill patient asks a civilian physician to write a referral Rabbinic prohibition) rather than salting the meat on Shabbos. He
for him on Shabbos to a distant hospital which is affiliated with his cites one wise man who posited that it is probably right to permit eat-
health insurance plan, although there is a closer, private hospital. Here ing blood that was cooked with a few olives rather than transgressing
too, the answer is as explained above. If the distant hospital is better, several more prohibitions. This is similar to what we find in Tractate
one should refer him to there even on Shabbos. If the close hospital is Menachos (63b), where it states that one should rather sift over and
better, then one should speak to the patient’s heart and convince him over again (which is one Shabbos prohibition) rather than doing many
that he need not worry about the money because Hakadosh Baruch different prohibitions. The Maharsham rejected this position, because
Hu will repay the patient for his Shabbos expenses. As our Sages said the prohibition of eating is more stringent, as Tosfos writes (Gittin 7a,
(Tractate Beitzah 15b): “I cry for you, my children, and I will pay” (see s.v. hashta) regarding the animals of pious men. Furthermore, con-
Yalkut Shimoni, Nechemiah, Remez 1071). suming blood that was cooked is closer to a Torah prohibition and
If the patient insists that the physician refer him to the distant more stringent than other Rabbinic prohibitions (see Tosfos, there).
hospital of his kupat cholim in order to spare him the expense, the Nevertheless, it seems from the Maharsham that this principle also
physician probably has no allowance to write a referral on Shabbos, applies to pikuach nefesh, and it is preferable to repeat one prohibition
and the driver is also not allowed to drive him to the distant place. on Shabbos many times rather than increasing the variety of prohi-
I heard from my father-in-law, Rav Y. S. Elyashiv zt”l, that logi- bitions. The same idea is stated in Nachal Eshkol (p. 115, 12). See also
cally, if the patient refuses to be hospitalized in the closer hospital Keren Orah (Shabbos 137a), who explains that this preference is only
because he cannot overcome the ostensible difficulty of paying, then Rabbinic.
the physician is allowed to sign the referral slip to the distant hospital The Sha’agas Aryeh (#59) explains the ruling of the Shulchan Aruch
in order to save the foolish patient’s life. Likewise, the driver is also (Yoreh De’ah #266:14). The Shulchan Aruch rules that it is prohibit-
obligated to drive him to the distant hospital, because even this type ed to divide the mitzvah of circumcision between two mohelim on
of patient must be saved. Even though the patient could have saved Shabbos, whereby one does the circumcision and the second does
his own life without desecration of Shabbos, if he refuses to do so, the p’riyah. The Sha’agas Aryeh explains that this is because it says in
then one is obligated to desecrate Shabbos in order to save his life. Tractate Shabbos (133b): If one circumcises a baby on Shabbos, so long
This is a novel thought. We know that if a poor man refuses to live as he hasn’t completed the circumcision, he can go back and finish
on his own assets and wants be sustained by others, Rav Yehudah the job by removing remaining skin tags. If he has completed the cir-

326 1 Medical-HalacHic Responsa of Rav ZilbeRstein Traveling to Distant Hospital for Medical Records 2 319