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3. Assuming that I will be held responsible for this additional 11 such as severe head injuries, intestinal bleeding or a compound bone
payment, am I still obligated to refer the soldier to the closest
hospital?
On my end, there is no additional desecration of Shabbos involved
in sending the patient to Tzerifin, being that the referral is prepared
beforehand.
Dr. Perl Bezalel
Medical Commander
1 AnsweR
Before we answer, we will describe a similar question, which may
apply to a civilian physician.
A dangerously-ill patient who lives near a private hospital asks a
physician for a referral to a more distant hospital associated with his
health care provider (kupat cholim). This referral will spare the patient
the higher cost of hospitalization on Shabbos in the closer hospital.
Is the physician permitted to fulfill his request? If he refers him to
the more distant hospital, the patient will undoubtedly transgress the
prohibition of starting his engine many times over on the way to the
hospital on Shabbos. The physician will also violate the prohibition of
writing, with every letter of the referral that he writes. Why would
this be permitted when it is possible to hospitalize the patient in the
closer hospital? Shabbos is only suspended for pikuach nefesh and not
for danger to one’s money!
Let us first deal with the case of the military physician.
The doctor must carefully consider what is of greater benefit to the
patient. If the distant hospital is better from a professional medical
viewpoint, the physician should send the patient there on Shabbos or
on a weekday. If the closer place is better, then the physician should
send the patient to the closer place (on condition that the physician
will not have to pay for the hospitalization from his own money.) It
is forbidden for the physician to take budgetary considerations into
account. His only concern should be for the patient’s life and health.
The above words apply only to patients in very difficult situations,
322 1 Medical-HalacHic Responsa of Rav ZilbeRstein
fracture. For simpler cases, such as a patient with high fever, or possi-
ble pneumonia, where the patient needs an x-ray, the above question
is extremely relevant. It would seem that when it comes to an x-ray or
treatment for pneumonia, there is no great difference between hospi-
tals. The patient will, more or less, receive the same treatment in any
hospital. Therefore, on Shabbos it would be prohibited to send him to
the more distant hospital because there is no allowance to travel on
Shabbos in order to save on monetary expenses. Shabbos is suspended
for danger to life but not for danger to one’s money. Therefore, in such
a situation, we would send the patient to the closer hospital.
The physician is exempt from paying the monetary expenses
caused to the army because of Shabbos, because the obligation to pay
for the expenses of Shabbos is born by all of Am Yisrael. “Let us go to
greet the Queen Shabbos because it is the source of blessing!” Clearly,
the military authorities will not obligate the physician to pay for the
expenses caused by Shabbos.
We still have to consider how the physician should act when
the military authorities require him to send the patient to a distant
hospital on Shabbos, for budgetary considerations without medical
justification. Is he obligated to send the patient to the closer hospital
if he will definitely have to pay for it, and he cannot afford these high
expenses?
In this case, the physician should do as follows:
On Friday, he should fill a number of referral slips to the distant
hospital and sign his name on them. He should also write the date,
and a number of common illnesses. On Shabbos he should fill in only
the name of the patient, with his left hand, and a shinui. If someone,
Heaven forbid, requires referral to a hospital on Shabbos, the phy-
sician should give the driver the prepared referral slip to the more
distant hospital. The driver will then be forced to take the patient to
the distant hospital, because the closer hospital will not accept him
without a referral. And even if he had written a referral to the closer
hospital and would thereby minimize the transgressions of a more
distant travel, still, if he does not do that he is not causing the driver
Where should a person go on Shabbos? 2 323