שימוש במכשירים חשמליים בשבת Using communication devices on Shabbat in emergency medicine

Due to their general nature, your questions cannot be answered in a detailed fashion.

2. For general answers, I suggest you see what Prof. Avraham Steinberg and Rabbi Yigal Shafran have written. In particular, see R. Shafran’s article on working for Magen David Adom on Shabbat and Yom Tov in Assia 59-60, pp. 98-104.

The following has been excerpted from Prof. A. S. Abraham’s handbook Halachot for the Physician on the Sabbath and Festivals (Jerusalem: The Schlesinger Institute, 1995):

6. Although throughout this book we have written that whenever one has to set aside Torah prohibitions for a seriously ill patient, one should try and do so through a gentile or in a manner different from that used on a weekday, this ruling is only according to the Rama (11) and the Mishna Berura (12). However according to the Rambam (13), the Shulhan Arukh (14) and the Taz (15), one should personally do whatever is necessary for the benefit of a seriously ill patient and in the normal manner as on a weekday. This latter ruling, however, applies only to acts directly affecting the patient’s needs. Acts which are not part of the actual and immediate treatment of the seriously ill (or possibly seriously ill) patient—such as writing in the patient’s chart, recording his temperature, pulse, etc., or turning off the light so that he may sleep—may, even according to this opinion, only be done by a gentile or, if by a Jew, in an indirect manner (16).

19. All ancillary investigations that may help in the diagnosis or treatment of a seriously ill or possibly seriously ill patient should be performed on the Sabbath, even if they involve setting aside Torah prohibitions. Therefore one may draw blood from a patient, X-ray, do a cardiogram, etc. On the other hand one is not permitted to perform “routine” tests (for example an ECG or chest film) unless there is even the slightest suspicion of relevant pathology. When drawing blood, only the amount necessary for diagnosis and treatment may be withdrawn (see “Blood taking,” paragraphs 28-31 [pp. 17-19]).

20. One may use electrical instruments in order to examine a seriously ill or possibly seriously ill patient. Thus the examination of the throat, ear drums, fundus are all permitted. The instrument should be switched on by a gentile, or by the physician in an unusual manner (using the dorsum of the finger or hand) unless time is of the essence (see paragraph 6 [p. 4]). A gentile should be asked to switch off the instruments at the end of the examination or the physician should switched them off (in an unusual fashion using the dorsum of the finger or hand), if it is likely that they will be needed again that Sabbath (41). This includes battery-operated instruments (42).

21. During endoscopic or bronchoscopic examination it is permitted to photo- graph the findings, using camera, tape, or video, if necessary for future follow-up comparisons, even if these will not be used that Sabbath. This is not, however, permitted for teaching purposes. The films may not be developed on the Sabbath (43) unless they are needed for immediate patient care on the Sabbath itself. Biopsies may be taken as usual and put into the appropriate media (44).

22. One may wash instruments such as endoscopes and bronchoscopes after use in order to prevent clotting of remaining blood within the instrument. Where possible, however, a gentile should be asked to do so.

23. It is permissible to perform an ECG on a patient who may be seriously ill, preferably using a computerized model. Where possible, this must be done by a gentile or the machine activated in an unusual manner (using the dorsum of a finger or hand). Jelly for good electrical contact may be used as required (45).

It is similarly permissible to perform cardiac angiography on such a patient where the indication is urgent and the procedure cannot be safely postponed until after the Sabbath.

24. All urgent X-rays, CTs, MRIs or radio-nuclide scans may be done as necessary, for a seriously ill or possible seriously ill patient, in order to substantiate or negate a diagnosis, or to treat, for example to perform a controlled drainage procedure. If possible the light in the viewing box should be turned on by a gentile or in an indirect manner (dorsum of hand or finger). The screen should not be extinguished after use.

25. One may carry out ultrasound examinations or vascular studies (Duplex, etc.) on a patient who may be seriously ill; the findings may be photographed if necessary for follow-up. Jelly for good electrical contact may be used as required (see note 45).

26. When using a microscope to examine a urine, blood or sputum smear, or any other fluid for a seriously or possibly seriously ill patient, it should be switched on in an indirect manner (using the dorsum of the hand or finger). The intensity of light should be regulated by changing the distance of the condenser from the slide and not by changing the intensity electrically. Preparation of the slide which involves drying it above a naked flame, fixation, and staining of the specimen are all permissible for the diagnosis and/or treatment of a seriously or possibly seriously ill patient, although, where possible, this should be done by a gentile.

27. Investigations such as X-rays or ECGs may not be carried out on the Sabbath for routine or medico-legal reasons only, but should be delayed till after the Sabbath. However if there is any possibility whatsoever that their performance may help in the diagnosis or treatment of a seriously or possibly seriously ill patient, they must be carried out.

Notes:

Mishna Berura 328:14, 35.11-13..