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pacemaker will endanger him, then even on a weekday, one does 1 AnsweR to Question 1
not insert it if the opinions are divided about the need for the
pacemaker. In this case, it is preferable to do nothing. Your question is based on what the Rishonim wrote in Tractate Be-
itzah (22a): According to Torah law, it is permitted to desecrate the
2. If the second physician, who believes a pacemaker is not nec- second day of Yom Tov in the Diaspora for a non-dangerously ill
essary, re-examines the patient and finds further indications or patient, because healing is similar to providing necessary utensils for
proofs supporting his view that the patient is not having a heart eating which is permitted on Yom Tov. The Torah says (Shemos 12:16):
attack, he should not insert the pacemaker. For example, if a “Do for yourselves,” i.e. for all your needs, on Yom Tov. The Rabbanim,
blood test shows no enzymes, or no changes appear on the elec- however, prohibit the violation of prohibitions for the needs of the
trocardiogram (EKG) and on serial EKG’s, or there is lots of air patient, as explained in the Ramban (ibid, in Beitzah in his Milchamos
in the abdomen, and the evidence indicates that the pain is com- 11a in the pages of the Rif). [The view of Baal Hama’or and the Tosfos
ing from the stomach and not the heart, the second physician is (ibid, s.v. hevi) is that according to the basic halacha, the needs of the
not allowed to desecrate Shabbos and to insert the pacemaker. patient are permitted, although we do not practically rule this way.]
In all of the above cases, it is likely that the first physician would According to this, one can say that the Rabbanim permitted violation
agree, based on these findings. of Rabbinic prohibitions for a patient on the second day of Yom Tov
based on the fact that healing is like providing one with the utensils
This is especially so when the second physician usually tends for essential food, and on the second day of Yom Tov, the Rabbanim
to concur with the opinion of the first, and yet this time he is did not make a decree about Rabbinic prohibitions. In any event, it is
inclined to believe that the chest pains stem from the abdomen. only permitted to heal a patient from Chutz la’aretz (outside Israel),
Therefore, he is allowed and even obligated, based on his own but not a resident of Eretz Yisrael, for whom the second day of Yom
opinion, not to desecrate Shabbos. Tov is like a regular weekday. This is similar to the fact that it is pro-
hibited for a person from the Diaspora to cook food (ochel nefesh) for
3. If the physicians disagree on a factual matter which does not a resident of Eretz Yisrael on the second day of Yom Tov.
require judgment, such as: One physician says that a woman
gave birth on Shabbos, so that seven days later (the next Shabbos) However, one can also say that the reason we allow this is that for
she is no longer considered in danger and one does not dese- important needs, the Sages were lenient on the second day of Yom
crate Shabbos for her. The second physician claims that she gave Tov. For example, it is permissible to bury someone on that day (Shul-
birth after Shabbos night and is therefore still in the first seven chan Aruch, Orach Chaim #496:2), and certainly not because burial
days after childbirth and we desecrate Shabbos for her. In such a is like providing the utensils for essential food, but rather because it
case, our Rabbanim differ in opinion. Rav Chaim Berlin posits is a great need. For the same reason, our Sages permitted treating a
that it is forbidden for the first physician to desecrate Shabbos patient on this day. Therefore, there is no difference between treating
for her, since it is clear to him that his colleague is mistaken a Diaspora patient or one who is a resident of Eretz Yisrael.
and there is no possibility of faulty judgment here. According It seems to me, that this depends on a difference of opinion be-
to the Even Shoham, if there is no other physician who can pro- tween the Rishonim. The Ran (Beitzah 11b, in the pages of the Rif, s.v.
vide the needed assistance, he should desecrate Shabbos. This ki) and Rashba (Beitzah 22a, s.v. hoh) both write that since the Sages
is because the beis din, when in doubt as to which physician is permit painting an eye on the second day of Yom Tov, it follows that

360 1 Medical-HalacHic Responsa of Rav ZilbeRstein Physician from abroad in Eretz Yisrael 2 349