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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 fracture. For simpler cases, such as a patient with high fever, or possi-
hospital? ble pneumonia, where the patient needs an x-ray, the above question
On my end, there is no additional desecration of Shabbos involved is extremely relevant. It would seem that when it comes to an x-ray or
in sending the patient to Tzerifin, being that the referral is prepared treatment for pneumonia, there is no great difference between hospi-
beforehand. tals. The patient will, more or less, receive the same treatment in any
Dr. Perl Bezalel hospital. Therefore, on Shabbos it would be prohibited to send him to
Medical Commander 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
1 AnsweR a situation, we would send the patient to the closer hospital.

Before we answer, we will describe a similar question, which may The physician is exempt from paying the monetary expenses
apply to a civilian physician. caused to the army because of Shabbos, because the obligation to pay
A dangerously-ill patient who lives near a private hospital asks a for the expenses of Shabbos is born by all of Am Yisrael. “Let us go to
physician for a referral to a more distant hospital associated with his greet the Queen Shabbos because it is the source of blessing!” Clearly, 20818_efi-ab - 20818_park-C_efi-ab | 11 - A | 18-08-20 | 13:46:25
health care provider (kupat cholim). This referral will spare the patient the military authorities will not obligate the physician to pay for the #20818_efi-ab - 20818_park-C_efi-ab | 11 - A | 18-08-20 | 13:46:25
the higher cost of hospitalization on Shabbos in the closer hospital. expenses caused by Shabbos.
Is the physician permitted to fulfill his request? If he refers him to We still have to consider how the physician should act when
the more distant hospital, the patient will undoubtedly transgress the the military authorities require him to send the patient to a distant
prohibition of starting his engine many times over on the way to the hospital on Shabbos, for budgetary considerations without medical
hospital on Shabbos. The physician will also violate the prohibition of justification. Is he obligated to send the patient to the closer hospital
writing, with every letter of the referral that he writes. Why would if he will definitely have to pay for it, and he cannot afford these high
this be permitted when it is possible to hospitalize the patient in the expenses?
closer hospital? Shabbos is only suspended for pikuach nefesh and not In this case, the physician should do as follows:
for danger to one’s money! On Friday, he should fill a number of referral slips to the distant
Let us first deal with the case of the military physician. hospital and sign his name on them. He should also write the date,
The doctor must carefully consider what is of greater benefit to the and a number of common illnesses. On Shabbos he should fill in only
patient. If the distant hospital is better from a professional medical the name of the patient, with his left hand, and a shinui. If someone,
viewpoint, the physician should send the patient there on Shabbos or Heaven forbid, requires referral to a hospital on Shabbos, the phy-
on a weekday. If the closer place is better, then the physician should sician should give the driver the prepared referral slip to the more
send the patient to the closer place (on condition that the physician distant hospital. The driver will then be forced to take the patient to
will not have to pay for the hospitalization from his own money.) It the distant hospital, because the closer hospital will not accept him
is forbidden for the physician to take budgetary considerations into without a referral. And even if he had written a referral to the closer
account. His only concern should be for the patient’s life and health. hospital and would thereby minimize the transgressions of a more
The above words apply only to patients in very difficult situations, distant travel, still, if he does not do that he is not causing the driver

322 1 Medical-HalacHic Responsa of Rav ZilbeRstein Where should a person go on Shabbos? 2 323