Question: My physician prescribed certain medication in the form of pills that I am to take daily, twice a day. The question is, what am I to do as regards the Sabbath – may I take the pills or must I skip taking them? There is also a question, since I am diabetic, that skipping a day’s dosage might prove harmful. Should I take them on the Sabbath or not?
Name withheld on request
Answer: Yours is a question that comes up very often in our times, especially as medicine has made such advances. People are living longer due to the fact that many diseases that were considered deadly in earlier times are now treated with medications or other intervention. The killer heart disease can be successfully treated today, just as many cancers can be cured if caught early enough. Yet there is the normal reaction of the G-d-fearing Jew to wish to avoid any possibility of Sabbath violation in the course of his/her treatment.
In truth, as regards the patient-physician relationship, it is generally understood that the patient turns to his health professional for guidance. If the physician is well known for his professionalism, is caring of his patient’s needs and demonstrates respect for his patient’s religious beliefs, there should be no question but to follow doctor’s orders. Be aware that diabetes is a serious condition not to be treated lightly.
Regarding matters of health like yours and other serious diseases, though it is important to consult your rabbi to ascertain whether there is the possibility of a Sabbath desecration with the use of a particular remedy, a wise rabbi will usually defer to the physician where there is a chronic disorder. Yet your question has validity. Let us turn to our sages as we seek advice in this matter.
The Talmud (Shabbos 140a) tells of a medicinal remedy for asthma that required being dissolved in warm water. R. Acha b. Yosef, who suffered from asthma, went to Mar Ukva for counsel. He advised that he drink three weights of hilith [the remedy that the Gemara described above] on three [consecutive] days. He then prepared it and drank it on Thursday and Friday, then, realizing that the next day was the Sabbath, he went to the Beis HaMedrash to inquire as to his further action. They replied either in the name of the school of R. Adda or in the name of the school of Mar the son of R. Adda: ‘One may drink a kab or [even] two kabs without fear [of transgressing the Sabbath]. R. Acha replied I did not come to ask regarding drinking, rather my question is regarding dissolving it [in liquid in order that I may drink it]. After consulting with others, he was directed to R. Chiya b. Abin, who answered in the name of Rab who said: ‘He may dissolve it in cold water and place it in the sun [to heat it]. He asked whether this is only in accord with the view that one may dissolve or even according to [the more stringent] view that one may not. They answered that this ruling applies even according to the stringent view, for since he began to drink [on Thursday and Friday] he may continue even on the Sabbath, for if he does not do so he might endanger himself. The obvious implication is that such activity is permissible only in a life-threatening condition. Now as to your query: Is yours a life-threatening condition that would justify overriding the laws of the Sabbath?
We turn to the responsa of HaRav Yosef Shalom Eliyashiv, zt”l (Kovetz Teshuvot, Siman 40, ruling cited in the name of HaRav Shlomo Kluger; Sefer HaChayyim, Siman 328:10), which noted the following distinction. The Talmudic citation deals with a case where some preparation is necessary to enable the medicine to be effective. Indeed, there is a position that to dissolve medicine even in cold water was a rabbinical prohibition. In such a situation the Sages permitted the process only when a cessation of using the medicine would generate a danger to one’s life. Thus, if there is no direct danger to life or limb it would seem to incur a Sabbath violation.
However, taking pills on the Sabbath is a qualitatively different matter. In today’s day and age the patient need do nothing to the pills themselves. Indeed, the only concern is the general gezerah – edict – prohibiting the use of medicine due to the apprehension that one may grind the ingredients to make the medicine [s’chikat sam’manim]. Now, since, the patient is not doing any prohibited action to the medicine itself, coupled with the fact that he will be commencing his new drug regimen during the weekday, there is every reason to permit him to continue to do so on the Sabbath. Further, it might be reasonable to assume that in such a situation the Sages would never have imposed any restrictions. For even if it were a biblical injunction, “Pikuach Nefesh docheh et ha’Shabbat – where there is danger to life and limb one’s treatment overrides the Sabbath.”
This is not to say that there aren’t views that are more stringent in this matter (such as the view of HaRav Joseph B. Soloveitchik, zt”l, Nefesh Horav, p.173: 15), yet we find that both HaRav Yehoshua Neuwirth in his Shemirat Shabbat KeHilchatah (chap. 34 n. 76), as well as the Piskei Teshuvot (328, n. 100), cite the Minchat Shabbat (commentary on the Kitzur Shulchan Aruch, 91:9) who also quote the Sefer HaChayyim of HaRav Shlomo Kluger, who all agree that if one started treatment before Shabbat, it can be continued on Shabbat, and that medicines that are not prepared by grinding can be taken under such circumstances. Rav Neuwirth also cites the Chazon Ish, quoted in the Imrei Yosher (Mo’ed 99), as taking this position. Further, he also quotes the Shenot Chayyim (also by Rav Shlomo Kluger) to this effect. It is thus obvious when it is a matter relating to one’s health we might well opt for leniency.