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cumcision, he can no longer go back. The reason is that as long as he 1. If the distant hospital is better, one should send the patient there
has not finished, the act of circumcision is viewed as one desecration even if it requires a lot more desecration of Shabbos. If the closer
of Shabbos. If he finishes and then goes back, it is viewed as a sepa- hospital is better, one should send the patient to the closer one
rate desecration of Shabbos. Likewise, if the procedure is performed even on weekdays (but on condition that the physician will not
by two mohelim, there are two desecrations – the one who did the be obligated to pay. There is no allowance to obligate someone
circumcision and the one who did the p’riyah. Since the circumcision else to pay for better care for the patient.) Those responsibe for
could be done through one desecration of the Shabbos, there is no this will probably understand that it isn’t reasonable to obligate
allowance to desecrate Shabbos a second time. the physician to pay.
We can learn from this in regard to physicians as well. If a physi- 2. If the hospitals are equally professional and provide comparable
cian desecrates Shabbos by beginning the treatment for a dangerously levels of care, and the physician will have to pay for sending the
ill patient, he himself should complete the treatment. By allowing a patient to the closer hospital on Shabbos, the physician should
second physician to complete the treatment, he would be desecrating prepare referral slips to the more distant hospital before Shab-
Shabbos twice instead of one time.
bos. On Shabbos, he should use his left hand to fill in the patient’s
name, and then hand the referral to the driver. In this way, when
1 SuMMaRy and Conclusions the driver travels to the distant hospital, he is not guilty of any
sin, since the closer hospital will not accept the patient without
If a dangerously ill patient has to urgently get to the hospital on Shab- a referral.
bos, and his medical record with all the details of his illness and treat-
ments is in the more distant hospital, he should travel to the more 3. It is probable that even if they would accept the patient in the
distant hospital. Even though he will be using more fuel, it is still closer hospital without a referral, there is still no Torah prohi-
preferable to do so than to transgress various prohibitions of writing, bition for the driver to travel to the distant hospital (as long as
blood drawing, and the like, in the closer hospital. he does not pass by the closer hospital on his way.) Ultimately
he is traveling on Shabbos to save the life of a patient. Therefore,
the physician does not have to lose money by sending him to the
closer hospital.
4. If all the following three conditions are met, then I have not
found a way to permit sending the patient to the distant hospi-
tal:

a. The distant hospital is no better than the close one or the
illness does not require a better hospital.

b. The closer hospital will admit the sick soldier even without
a referral.
c. The way to the distant hospital passes by the closer hospi-
tal.

320 1 Medical-HalacHic Responsa of Rav ZilbeRstein Where should a person go on Shabbos? 2 325