Dr. Betzalel Perel - if have questions 0508685987

Hilchot Shabbat:

We will learn to judge based on the action, how it’s done, and who it’s for if we can do it or not.

Mishnah avot melachot: list of melachot that are asur דאורייתא. Also the things that are a step away from the issur itself are asur דאורייתא.

“Dash,” we won't actually do this in the hospital but the concept of removing the seed from the grain might be something that would have to happen in the hospital. ”Dash” for the modern person now has more to do with getting liquid out of an absorbent material

“Boneh” is anything electric in the hospital in modern times, (closing a circuit). Which is something we will come into contact with very often.

Cutting and tearing as well.

It is important to know what is a melacha deoryta so we can know and notice what we can’t do, when it comes to different levels of saving lives on shabbat we are much more lenient on דרבנן. So knowing which is which will allow us to do more. In majority of cases, regardless of if it is saving a person's life, we would be allowed to break derabanan to do nursing actions.

How to determine if something is pikuach nefesh: could the situation realistically snowball into the person's life really being in danger? (דמיון לא רחוק) What would happen if they waited until after shabbat? Are we making up the risks in order to not have doubts and have good reason to break shabbat? If it was tuesday, would you have also driven to the hospital (rav shlomo zalman auerbach), if yes then you can go on shabbat.

Important Terms:

דרגות חולי בשבת

*Who is the patient and why do they need something

*What melacha am I being over, to what degree, for whom

איסורי דרבנן

• "שבות" - איסור דרבנן that was made as a fence to protect us
• גרמא - פטנט basically a way to get around the issur deoryta but still only works for things that you need and therefore have a reason to use on shabbat
• אמירה לנכרי can do anything on shabbat by telling a non jew
• מלאכה שאינו גמורה if don't do the full action, the normal way, with full intention, so that exactly what you want to happen happens then it doesn't count as a דאורייתא.
• In our normal lives it doesn't really matter if something is דרבנן versus דאורייתא because we need to keep it no matter what but in the hospital when we are working it is easier to be over on derabanan issurs however need to think twice before going over a deoryta
• שבות - The rabbis added a lot of issurim as a fence to protect us from doing an issur deoryta
  • Example touching/picking up things that are מוקצה
  • Example telling a goy to do a melacha for us, it isn't דאורייתא but the rabbis said we don't do that
  • Taking drugs is איסור דרבנן to prevent people from picking plants and things, very weak דרבנן melacha though.
• גרמא - Writing is an av melacha (from the torah and therefore can't do it on shabbat unless patient in danger)
  • Can be hard to know if the patient is in danger and if to write and what can write (we can לצמצם, and not write extra words)
  • Can take these things that are איסור תורה and להפוך to an איסור דרבנן called a פטנטי - גרמא
    • With electronics there is a way to make a פטנט that goes around the איסור (shabbat timers on machines before shabbat allowed, moving the timer pieces on shabbat to cause it to turn on earlier is not allowed for a normal reason, but if you do it with a bit of a shinoy then it is okay because you need it. Like an asthma machine or an electric breast pump, because you aren't turning it on immediately). Not always clear that it is a גרמא and not all poskim hold by all the גרמאs that are out there, need to ask if you can לסמוח and if you can then it isn't an issur from the torah and is allowed
• אמירה לנכרי - If there is a non jew available in the hospital it is okay to ask them to do anything for you. In a normal circumstance you can ask them to do things for you by hinting. In a medical - sick person situation you are allowed to tell them what to do directly.
• מלאכה שאינה גמורה- there are 3 things that makes an action a complete melacha and an איסור torah and if one of them isn't true it makes the melacha דרבנן and not דאורייתא
  • בכוונה- have in mind and the intention to be doing the melacha for the normal purpose of the melacha
    • so like shaving a patient for the sake of being able to put on EKG stickers or for a surgical procedure wouldn't be בכוונה because that's not normally why we shave
  • כדי שתתקיים- the melacha is done so the result will stick (meaning will stay as its done for an extended period of time, so like writing in the frost on a window wouldn’t be considered מתקיים because it will disappear)
    • There are special shabbat pens with ink that will disappear after a few hours so you can write with them on a paper and it won't be an איסור דאורייתא
    • Also writing on a computer without printing wouldn't be an איסור דאורייתא because the words are not considered מתקיים
  • בדרך המקובלת- the melacha is being done in the normal way (this is very important)
    • In order for an איסור to be Assur Deorayta, it needs to be done in the normal way. Every time you do a melacha in a way that is not the regular way, you have turned the איסור from דאורייתא to דרבנן.
    • The שינוי doesn't need to be ridiculous, you don't need to stand on your head. It just needs to be done in a way that is annoying or weird enough that you wouldn't have done it that way during the week.
      • For example using your left hand if you are a righty and vise versa or using the back of your hand ect. Even holding the pen weirdly
      • Walking backwards to a door that opens from motion or holding the tag to open the door in a different then normal way
      • Answering the phone in the miyun is allowed because be something extremely important
      • Don't do stitches with a שינוי please
      • Allowed to do gluco-check without a שינוי because patient could be in danger
      • Allowed to take a blood sample with a vacutainer with a שינוי, the vacutainer is a gramma, and you can put in the needle with a שינוי (holding it weird (but safe))
      • Putting in an IV (blood comes out) a big machloket, do you need/benefit from the blood? (according to the rabbi of sharei tsedek its דרבנן) really depends on the patient

סכנת איבר

• A patient who comes with chest pain until we know what the patient has its considered a סכנת חיים if it is an event that can’t get to life danger then can't go over torah איסור
• The next stage is to go over a דרבנן for cuts and broken bones ect that aren't life threatening
  • Best case scenario is to have non jews work on shabbat
  • Losing hearing isn't life threatening but it can be they lose hearing in that ear considered סכנת איבר but it is farfetched to say that it is life threatening (people live full lives that are born deaf)

חולה שאין בו סכנה

• Patient who isn't in danger חולה שאין בו סכנה

1. חולה בכל גופו שנפל למשכב non localized unwell, feel poorly, like the flu when you just feel bad/sick/unwell but can’t point where (that without medication would have to lie down)
   1. There is no clear line when you are allowed to take medicine for this kind of pain and when you are not. It is a personal feeling.
2. Pain in a certain limb that is weakening his whole body…?
3. Life sustaining needs for a small child

• Because there is no clear line where the patient stands do on דרבנן and with a שינוי if possible לכתחילה but if it's the time of need מצב דחק if not possible to do with a שינוי can do without a שינוי
  • בית חולים is a מצב דחק
• Shmirat shabbat kehilchata says you can do melacha even דאורייתא for a חולה שאין בו סכנה on shabbat with a שינוי but only בדיעבד not לכתחילה
  • Taking vitals of a patient that comes in that isn't in danger turn the machine on through a שינוי
• Any patient coming to the hospital can be considered a patient that isn't in danger and not מיחוש therefore a patient that comes in and is completely healthy we can treat them with a שינוי
• Asking a non jew to do something is allowed completely (in a hospital setting without hinting and is the easiest solution because it's the least חמור of the דרבנן. After that we move to doing things with a שינוי

תופר - sewing

• Using stickers comes from the מלאכה of תופר and partially קורע
• But not all stickers are created equal - need to pay attention to witch מלאכה you are going over when pulling a sticker off the sheet and sticking it back on
  • Using velcro on shabbat is not considered sewing and opening it back up is not considered ripping. Because it is temporary
  • Removing a sticker from the sticker sheet is not considered ripping because it was created to be ripped off of the paper it's created to be temporarily there however putting the sticker onto a regular piece of paper that can’t be removed from that piece of paper it is considered חיבור and is אסור דאורייתא need to change it into דרבנן by putting it on in a שינוי or asking a non jew
    • Like putting the sticker onto the paper of the patient's file, that will be permanent. In shaarei tzedek on shabbat they have a non jew there to put the sticker on the file. But can put it on the tik if need be with the back of your hand (not in a normal way) = שינוי
  • הדבקות ביניים/זמנית - things that are only needed for a certain amount of time
    • Example putting a sticker on the שקית נוזלים because you only need it for a certain window of time even though you arent removing the sticker when throwing out the bag it is still considered זמנית
    • Same thing with tape that we use for a bandage. It will only be there for a certain amount of time - not permanent. (it is made to be removed)
      • Putting tape on gauze even though removing it together is still considered זמנית
    • Putting a ידון on a patient is allowed because it can be סכנת חיים and can cause a mix up
      • Putting a ידון on the father of a newborn baby is that סכנת חיים?
  • כפתורים) - חיבורים זמניים מותרים)
  • Opening packages that things come in - gauze, needle, set, bandages, etc.
    • Tearing open a package would be קורע but we treat it like cracking a nut, we are doing it to get to the thing inside and not for the sake of ripping. In all of life there is no problem to tear open a package as long as not doing it for the sake of tearing.
  • Separating letters on packaging when tearing something open can be going over איסור מוחק. It is a big מחלוקת and there are people on both sides. But when we are in the hospital we go with the פוסקים that are the most lenient and we have no problem tearing things between letters.
  • Breaking apart plasters that are stuck together is a problem (and all things separated by perforation)
    • At home open without breaking them apart (or break apart before shabbat is ideal) but becomes a problem in the hospital when everything comes stuck together
      • Have a nurse on thursday or friday rip apart all the things before shabbat to avoid this issue if not enough open with a שינוי as בדיעבד

טיפול בפצע

• Stopping bleeding is not a melacha. Possible melachas include:
  • קורע -ripping the cotton (gauze stacks are not attached to each other)
  • דש -> סחיטה squeezing the cotton when using it to put pressure on a bleed is ok. It is not ok to dip the cotton in a cleaning solution and then put it onto the wound.
  • תופר - if the stitching isn’t life saving or preventing life threatening risk (very challenging question and lots of מחלוקת) only do when there is קצת סכנה and not for aesthetics but allowed to להדביק פצעים and no issues of תופר and do it without הגבלות
  • מחתך - tearing on a perforated line/to a specific size
    • Do not need to bandage a wound for it to heal, we just do it to protect it ect. But its not needed
    • The problem arises when needing to cut the tape or gauze to put on the פצע
    • Cutting a piece of tape (plaster) is being over on 2 מלאכות the melacha of מחתך וקורע
      • Can do it with a שינוי, or ask a non jew or can do it before shabbat and put it on a paper that comes off easily
      • The problem is the חיתוך not the הדבקה
  • Using medications where there isn’t illness
    • Ointments - the problem is smoothing the area so for cosmetics that is an issue but for a medical reason there isn't an issue to put on an ointment as long as you don’t smooth it out. It gets confusing when doing it at home so allowed in the hospital even without a שינוי but can't rub it in

Preparing and giving medications on shabbat

PO

• טוחן - in the hospital allowed to do it because pills are a powder that are squished together so breaking it apart is not really considered טוחן, because it was already ground
• מחתך - are we allowed to break a pill in half? Yes, for the same reason we can grind it. we are allowed to cut it so no issue with preparing pill medications on shabbat. Because we don't want the shape of a pill cut in half, we want the amount that half a pill gives us.
• Also we previously said that cutting letters to take out the pills is also allowed on shabbat
• There are some people who think cant take pills on shabbat but need to explain that no actually you are allowed to even when there isn't סכנה (with a חולי )
• Vitamins, minerals, supplements: are they a nutritional supplement (and therefore considered food) or a medication?
• If have a medication that you take everyday allowed to take on shabbat as well
• Also don't want people to suffer on shabbat so allowed to take pain medications but should think twice if really need it at home
• לישה - (kneading) adding water to a dry thing to make a paste dry things to make paste (most medications, you add water and the powder turns into liquid so it isn't really a problem of לישה). There are some instances (making a cast) where you pour water on the powder/solid and it makes it into like a doughey thing that you can spread and that could be problematic.

IM/IV

• הזרקות don’t want blood to come out and would prevent it if could
• when doing an IM injection there isn't blood coming out and don't have the intention of spilling blood so allowed to give injections on shabbat. You have to לשאוב the area to make sure you are not in a blood vessel, but we do this not because we want blood but because we want to make sure there isn't blood. So it is allowed.
• Allowed to give injections on shabbat
• Spilling blood is not allowed on shabbat however if its needed for פיקוח נפש (or for a different reason, we don’t want the blood) allowed to do it (glucocheck on shabbat is allowed considered סכנת חיים)
  • There is a בדיקה for newborn babies (PKU +other genetic diseases) that doesn't need to be done at a specific time, (not before 36 hours) so can wait until after shabbat to do it (that's what’s done in Shaarei tzedek)

גוזז - to shear

• Hair removal is assur on shabbat however if are removing the hair for a reason other than wanting to remove the hair it becomes a דרבנן איסור and therefore can do it in the hospital on shabbat
  • For example if need to shave someone to do an EKG or before surgery the goal is not to shave the person or collect the hair for some purpose or other, the goal is to do the test or surgery so its allowed on shabbat so a it becomes not an issur from the torah but דרבנן and b if it is a סכנה

כותב ומוחק - to write and erase

• Writing two characters is counted as the av melacha
• Any sign that means something is considered a letter and counts as writing
• Writing is אסור דאורייתא on shabbat, in any shape or form (symbols and dots ect.)
• Using a חותמת is also writing as well as printing a paper (EKG) with symbols
  • It is important to write as little as possible on shabbat
  • Can’t use the same שינוי for every way of doing the melacha. Stamping left handed isn’t a שינוי, nor is typing with your left hand
• In an urgent scenario like in an emergent surgery you just do things without thinking and that’s fine. But after the fact when there is still writing to do, now we need to think. Usually the time that you’re writing would be the time after the פעולה is done which makes things more complicated. So you would need to find a way to make the melacha derabanan
• Writing that isn't going to last is an איסור דרבנן however not according to all poskim
• Don't have time to write on the keyboard with a שינוי so most poskim say you can do it because its a כתב שאינו מתקיים as long as you are not printing it and there are poskim that say it is complete writing and need to be careful even better to do it with a שינוי if possible
  • Relevant for electronic writing
• There is a shabbat pen that disappears after a certain amount of time (not a pen that could be erased a pen that erases by itself if we leave it alone)
  • These pens are considered כתב שאינו מתקיים even if it will erase after a week and therefore can use it on shabbat in the hospital for example for writing on מדבקות for the IV or to write down during anamnesis (patient interview/collecting medical history)
  • These pens are אסור דרבנן so only allowed to use it in the hospital not in general
  • Also use this pen with a שינוי even better
• Can also use a normal pen and do it with a שינוי which changes it to an איסור דרבנן which is allowed easier then if it is דאורייתא
• Printing out a paper by pressing the print button is כתיבה דאורייתא, also printing out the EKG
  • Can get around this by doing it with a שינוי (back of the hand/knuckle)
• The third way is to ask a non jew to write it for you
  • This is the best and most wanted solution but it is not always possible

צובע - dyeing

• Shoe polishing and polishing is prohibited because of the dye.
• Make-up is prohibited due to צובע.
• There is no prohibition on removing make-up or nail polish. (could be דש\סחיטה but not dyeing)
  • There is no opposite of צובע like writing and erasing
  • Allowed to clean up blood not considered צובע
• Colouring in the lines is צובע, making the lines is writing
• It is allowed to clean blood with a handkerchief because it is a "דרך לכלוך".
• Carrying out a corona test also involves dyeing or any other tests that work the same way
  • Creating a פס and cant due unless a specific need
  • Allowed to do a סטיק שתן but if they print it then not allowed to print best is to do it and then look with your eyes but to put it into a machine that will print is writing and…. שינוי?

מערכות חשמל ומחשוב - electric systems

• there are so many electrical devices and need to know how to use them on shabbat
• Most machines it is obvious why we can't use them and it's an איסור תורה
  • Heaters, driving (the ignition ignites..) - בישול/starting a fire
  • Lots of electric devices that heat up when used even though that’s not the goal
• The ones that are not heat producing are assur because of בונה, you're closing a circuit and therefore “completing the building project” according to the chazon ish
  • To turn on the light, need a patient that is in danger of losing their life, or needs to do it with a שינוי
  • Starting a BP machine…
  • Easy to do things with a שינוי so just do it that way always so wont be a ספק
• Sephardim are lenient and say turning on electrical systems are דרבנן but ashkenazim say that it is an אסור דאורייתא
• These only apply to turning on an electronic machine that is currently off. Meaning only the beginning action, using a machine that is already on is less problematic according to some poskim
  • something very new because didn't exist before, some poskim just won't say anything on them, so basically not that much written on them and therefore we can rely on the poskim that say you are allowed if needed
• Connecting it to the outlet is the main problem but ללחוץ על כפתור on a machine that is already on is not a problem. (And ‘sleeping/battery saver mode’ still counts as on)
• We now live in a modern world where everything is changing to be electronic (BP machines, Temperature checks, weight, ect.)
• What about a machine that isn't on in the first place
  • What about a warmer for a baby? (old style that is for sure lighting fire when turning it on)
    • The baby is not considered חולה שיש בו סכנה but it's our choice, for the specific patient and if we think there is a סכנה then we can
    • But can also turn it on with a שינוי (ex: back of the hand or knuckle)
  • Cart to check vitals
    • Turning the machine on from off is going from 0-100. If it wasn't asleep.
  • Turn off button for calling bell
    • The bell always has electricity running through it, when the patient pressed it he didn’t turn the machine on from off. Derbanan. Now the nurse has to turn off the bell - איסור דרבנן to turn it off. Have to determine if turning it off is needed - we say yes because how else would the patient let us know the next time he is having a problem. And even if the noise is disturbing the nurse from treating the patients properly
    • In order to keep the routine of our work we are allowed to go over איסורי דרבנן (one rabbi says this, didn't catch the name)
  • Machine that reads urine cultures (dipstick) - turn it on and it prints the results - a challenging question because there’s בונה from electricity and כתיבה from the printing
    • If we use a שינוי to turn on the machine from the beginning everything is considered דרבנן and therefore we would be allowed (turn on with the back of the hand or knuckle)
  • Door to exit the trauma unit - electric automatic door.
    • If it is an emergency so of course can leave through the door. In a non emergency time how can the person leave the room? We can say that there is always electricity in the door opening mechanism. Clicking the magnet just releases the electricity. Another opinion - can wait until someone who needed to get in or out used the door and go with them. And lastly, can leave by opening it with a שינוי because in some cases it won't be reasonable to be stuck in the room with some connection to it being because they need to care for other people. Can leave if get another ambulance call. It all is based on personal feeling, don’t make stuff up but there can be more excuses than direct need of a patient.
    • Every use of an electrical door needs to have a real reason to use it, as long as you can give a real reason for why, you are allowed, if you can't then you are stuck
    • Every answer is your own שיקול דעת and you have to decide for yourself if its a מוצדק reason to use it or not
    • Not religious person opens the door for you - if they did it because they needed to to save a life then for sure. If they did it stam we can’t benefit from them breaking shabbat.
  • Turning on the faucet of the sink by turning it on electronically
    • For the needs of a patient then you can
  • Opening the כספת for the narcotics - with a fingerprint
    • Grab the finger of the other nurse to bring to the scanner ect. Be creative
• Using חשמל is the easiest מלאכה to switch it from being דאורייתא to being דרבנן (just do it with a שינוי, no excuses)
• Most electronics actually have a way to do it without using the electronics but need to know where those parts are (there is a manual handle to sit the bed up, or to turn on the sink ect.)
  • Also the rabbis don't want us to go backwards in time because can cause issues so don't just stam not use the electronics if we need to
• Electric safe
  • Can't really open it with a שינוי because it needs a fingerprint. So you need to make stuff up, such as holding your finger with the other hand and bringing it to the scanner.
• Most things can do with a שינוי and just do it that way just in case so won't come to a time where accidentally went over on a איסור דאורייתא

Taking care of a non jew on shabbat

• Important question: Basic halacha would for sure say we are not allowed to break shabbat in order to save a non jew on shabbat. But because that would not be okay for a multitude of reasons - goes against personal belief and would destroy the image of jews in front of the rest of the world, we do save the lives of non jews on shabbat. But in truth it is more complicated and we sort of ignore it day to day.

Getting to and from a shift on shabbat (driving)

• Every time you press on the gas in the car it sends oil to the motor and is lighting fire
  • Could be electric vehicle is more like the previous topic and less complicated
• Turning on headlights, turning off the engine, locking and unlocking the car.
• Every action in the car is an איסור תורה so basically the only way to use a car on Shabbat is for פיקוח נפש where there is סכנה. Drive the shortest route possible and try to avoid turning on any lights that you don't have to.
  • If there is any doubt then probably you shouldn't drive.
  • Need to drive in the shortest route possible
  • Also avoid as much as possible, so don't need the AC, so don't turn it on, don't turn on the music
  • If you are pregnant and about to pop and know that it's a possibility you will need to drive to the hospital on shabbat, prepare the car before shabbat, park it in the correct direction, make sure the radio is off, the lights won't automatically turn on when open the door ect. To avoid as many דאורייתא איסורים as possible, leave the AC on before (should turn on when turn on the car) but only if you will really need
  • What you can do with a שינוי you should do, so turning on the car, hold the key weird but stepping on the gas or turning the steering wheel please DO NOT do that with a שינוי
• Going to work on shabbat as a nurse - getting to the hospital on shabbat is a lot of actions that go over an איסור so try to avoid it as much as possible - maybe have a predetermined הסעה however if cant get one then allowed to travel by themselves
• Parking the car
• If a nurse is on כוננות can't get a הסעה because its not needed מראש however can go drive by themselves but what about going back home? If she doesn't go back with her car then if she needs to come back then she won't be able to so allowed to go home
• If can make the car fully חשמלי then it is easier to not be over on a דאורייתא so thats your reason to get a tesla :P
• Going there even if there is הסעות but if you get stuck and need to you are allowed to go in your car (could get a מונית there is a number of a taxi that is a goy 5826666 - every nurse should have the number of a non-jew who drives a taxi - there is one for ירושלים - allowed to give cash money it is דרבנן)
• The problem is getting home - it isn't פיקוח נפש
  • Nurse can be on the כוננות of the ישוב she lives on so the journey home can also be פיקוח נפש
  • But if this is not usually the case, which it probably isn't, we will give people the option to return to their home if they left because of פיקוח נפש. But what about the דאורייתא? This person cannot come back in their own car if the car is gas powered and there is no way around דאורייתא.
  • To say that they won't work because they cant come home - more for volunteers
  • Because when started it was פיקוח נפש, just like going into war, so can go back
    • In some cases it is okay to allow it but it is an המצאה because then they wouldnt come in an emergency because they won’t want to come in the first place if they can't go back so some rabbanim allow them to go back home but its a מחלוקת and not something simple we can say that they can go back home
    • The teacher said he hasn't encountered a nurse that has a התר to drive back home after her משמרת on shabbat (can go back in a הסעה or a taxi)
    • To go home needs to be דרבנן therefore needs to be with a non-jew driving
    • Need to talk to a rav personally with your reasons and your specific situation to get a התר to drive yourself back home - can not give a blanket statement on this
    • Going there can say to drive but going home can’t - very individual

יציאה מחוץ לתחום

• Leaving the eruv/traveling a specific distance - איסור דאורייתא to go past 2000 amah (12 mil), (14.4km according to the חזון איש), from the city limit. There are those that say it is only דרבנן - sometimes need to get a התר to leave even with a non-jew can be איסור דאורייתא
• Have the same questions with driving and all the same dilemmas - going there versus going back
• Speak to your local orthodox rabbi, (LOR), if where you live is outside of the תחום
• Telling a non-jew to do something is better than a שינוי but can get real annoying real fast for both you and the people around you.

**in General you need to decide based on your own דעת what you can and can't do on shabbat based on what we learned in this class and if you have any other questions you aren't sure about then ask your Rav

Test: 15 multiple choice questions, cannot use your notes