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Peninei Halakha > Shabbat > 27 – Sick People and Saving Lives > 07. Choosing a Hospital and Doctor

07. Choosing a Hospital and Doctor

When one must drive a gravely ill person or a woman in labor to the hospital, he should drive to the nearest hospital, in order to avoid additional Shabbat desecration. Even if there are better hospitals available, for routine matters, like births and treatment of injuries and common diseases, there is no significant difference between hospitals, so one drives to the closest one. Even if the patient or woman in labor prefers a more distant hospital because it is cheaper, has nicer rooms, or is more conveniently located for relatives who will wish to visit, since these are not medical considerations, one may not drive farther on Shabbat for any of these reasons. Similarly, if a woman is away from home for Shabbat and goes into labor, she should go to a local hospital.

When a case is more complicated and there is a medical reason to prefer a more distant hospital, one may drive there on Shabbat. For example, if the more distant hospital specializes in the treatment of the patient’s illness, or if the illness is complex, and the more distant hospital is already familiar with the patient and will therefore be able to provide the appropriate treatment more quickly, one may drive the patient there. So too, if a woman’s pregnancy is considered high-risk, and the distant hospital has a protocol in place for her needs, one may drive her there on Shabbat. Everything should be done in accordance with accepted medical recommendations. The more complicated and difficult the case, the farther one may travel to ensure the best care. Thus, if there is only a slight medical advantage, one may travel only slightly farther to gain that advantage. After all, during the week, sick people and women in labor are not advised to travel long distances to the best hospitals for every minor medical issue. So too on Shabbat, they may not travel farther to reach the best hospitals, since accepted medical recommendations do not demand it.

If a woman in labor claims that she will receive better medical care at a more distant hospital, even if her claim has no realistic basis, one may drive a bit farther in order to ease her mind, but not a lot farther. Even when one may extend the drive for a medical reason, it must remain within reason.

In general, it is preferable to go to a hospital that operates in accordance with halakha. On Shabbat, one may travel slightly farther in order to reach such a hospital. This way there will be less Shabbat desecration in the hospital, and the patient will feel more comfortable. However, one should not travel much farther for this purpose.[7]

[7]. If the more distant hospital has a medical approach that is more compatible with the patient’s or pregnant woman’s outlook (for example, a preference for natural childbirth over Caesarean sections), one may travel farther to get there. However, since this is not a clear advantage, and in most cases this difference in outlook does not come into play, one should not travel much farther to reach the preferred hospital for this reason.According to R. Eliezer Waldenberg, if there is no medical reason to prefer a more distant doctor, but the patient believes that the distant doctor is better, one must listen to the patient and call the preferred doctor, even when it involves additional Shabbat desecration (Tzitz Eliezer 13:55-56). As the Yerushalmi states: “A person does not merit to be healed by just anyone” (y. Nedarim 4:2). He also infers this from AZ 55a, which speaks of suffering resulting from the treatment of a particular doctor. Therefore, one must listen to a patient who demands a specific doctor. SSK 32:38 states similarly, as does R. Yitzĥak Zilberstein (Torat Ha-yoledet 7:2), who adds that if a woman in labor feels that the standard of medical care is better in the more distant hospital, one may travel there. He cites R. Scheinberg (n. 4) as saying that under normal circumstances, one should rely on the nearest hospital since we do not allow additional Shabbat desecration in order to put the patient’s mind at rest unless it is a situation where the Sages tell us that if we do not ease his mind, he will be in danger.

In my opinion, if there is no substantive medical reason to prefer the more distant hospital, but nevertheless the patient feels that the distant hospital is medically superior, one may travel a little farther, but not much farther. The reason for this is that for a dangerously sick person, we do everything on Shabbat that we would do during the week (Rambam; SA 328:3). However, going beyond this is overly indulgent. During the week, medical opinion is that it is proper to travel a little farther to ease the mind of a gravely ill person or a woman in labor, but that there is no need to travel much farther. A possible support for this position appears in another area of Shabbat law: during the course of a circumcision, one may cut away bits of skin that do not invalidate the circumcision, even though cutting them off on Shabbat would otherwise be prohibited by Torah law (Shabbat 133b; SA 331:2). This is because once circumcision overrides Shabbat, everything that is part of the circumcision process overrides it as well (Rashi). Thus, arguably, once one may travel on Shabbat, one may extend the trip a little to get to the hospital that the patient thinks is medically superior. However, to extend the trip greatly would mean that the patient would no longer view the extra travel as an addition to the basic trip but rather a separate trip – which may be undertaken only if it may save a life. In contrast, if the patient concedes that the more distant hospital is not medically superior, but he just has a better feeling about it, the trip should not be extended at all. See Torat Ha-yoledet ch. 7, end of n. 4. We should add that in the case of a complex illness, there can sometimes be a medical advantage if the patient is personally acquainted with a member of the medical staff.

  1. Zilberstein points out that one should not increase travel time in order to reach a hospital just because it has higher kashrut standards. However, if the more distant hospital will make a point of minimizing Shabbat desecration, it may be that it is preferable to travel to it, because of the principle (Menaĥot 63b, 72a) that it is better to transgress one melakha many times than several melakhot a few times each (Torat Ha-yoledet 7:3-4). We should add that it also may be that the sick person has more confidence in the medical staff at the religious hospital, in which case one may travel a little farther to reach it.

If a woman in labor tells an ambulance driver that she prefers the more distant hospital because she feels that it is medically superior, but the real reason for her preference is so that her family will be able to visit her, the resulting Shabbat desecration is her responsibility, since the driver has no way to know that she is lying. From his perspective, this may be a case of saving a life, on account of which one desecrates Shabbat.

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