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ikra 18:5) [from which Chazal derive “and not die by them” i.e. when
human life is at stake the mitzvos are set aside], this only refers to a
situation where fulfilling the mitzvah is incompatible with the per-
son’s continuing to live and if he wants to observe the Torah he will
be unable to live. This will not be so if according to the Torah there
is a way he could live but say, the mother wants to commit suicide
if her son won’t write on Shabbos. This woman could live with the
Torah but she doesn’t want to – in such a situation we do not say that
piku’ach nefesh suspends the laws of Shabbos. In the case involving
drinking the ass’s milk too, since the patient is obligated by halachah
to drink the milk the Torah’s mitzvos pose no contradiction to his life,
so there is no piku’ach nefesh here to allow the son to drink the milk.

According to this explanation too, it is [nonetheless] possible that
in our case it will be permitted to violate Torah prohibitions in order
to prevent the young woman’s suicide since she is unable to exercise
her free will. As the physicians say, she would commit suicide over
any mishap that befalls her, therefore she is in the category of annus
in regard to fulfilling the Torah and the principle “‘And [he] shall live
by them’ – and not die by them” is applicable to her.

We encounter an example of this type of annus in the Haamek
Davar (on Shemos 4:3) who explains the Rambam’s comments (in
his Commentary on the Mishnah to Shabbos 2:5): “A person who
extinguishes a lamp from fear of gentiles, of bandits, of an evil spirit
(melancholia) is exempt but it is not permitted to do so in the first
place. However, a person who extinguishes a lamp so that a patient
will be able to sleep is exempt and it is permitted to do so to begin
with, because it is permitted to extinguish a lamp in order to save the
life of a dangerously sick patient.” This implies that non-Jews, bandits
and melancholy are not dangerous, yet a person who extinguishes a
lamp on their account is nevertheless exempt. The question is, why?
He has desecrated Shabbos – how can we exempt him in the absence
of the element of piku’ach nefesh?

The Netziv explains that a person who is gripped with fear because
of bandits or melancholy falls into the category of annus and is ex-
empt even in the absence of piku’ach nefesh.

362 1 Medical-Halachic Responsa of Rav Zilberstein