28 – Illness That Is Not Life-Threatening

01. Principles of the Halakhot of Sick People

There are three categories of sick people according to halakha:

1) a gravely ill person – one whose life is in danger;

2) a “regular” sick person – one whose whole body is ill but whose life is not in danger;

3) a “mildly” sick person – one who is ailing in part of his body or who experiences pain from a bodily ailment.

When caring for a dangerously sick person, one does everything on Shabbat that he would do during the week. All Shabbat prohibitions are overridden in order to save a life, as we saw in the previous chapter.

When caring for a regular sick person – one who is sick enough that he is forced to lie down, but whose life is not in danger – one may disregard rabbinic prohibitions, but Torah prohibitions remain in force (as will be explained in the next section).[1]

A mildly sick person or one who is bothered by ailments – that is, one who can walk around as though healthy, but experiences discomfort from a mild ailment – is subject to all rabbinic laws, and one may not even violate shvut di-shvut on his behalf. However, if he is in pain, one may do certain things for him even though they are categorized as shvut di-shvut. Specifically, one may ask a non-Jew to transgress a rabbinic prohibition for him, or a Jew may make use of a shinui to do so (SA 307:5; MB 328:3; above 9:11).

There is a specific rabbinic enactment forbidding a mildly sick person to take medicine. The poskim disagree whether this prohibition pertains to today’s medications, which are factory-made (the laws pertaining to one bothered by a mild ailment will be explained in sections 3-5).

The main idea of Shabbat is that on this day we calmly and tranquilly accept reality as it is. If we have no clean clothes, we wear dirty ones. If we forgot to cook a certain dish, we content ourselves with the food we have, or we ask a neighbor for help. If we forgot to turn on the heat, we put on a coat. If we forgot to turn on the air conditioning, we suffer a bit from the heat. Even though Shabbat laws sometimes cause suffering, they liberate us from the burden and tension of having to pay constant attention and ensure that every little detail of our lives is properly addressed. Therefore, Shabbat is a valuable gift. The feeling of faith, tranquility, and rest that results from accepting reality on Shabbat is enjoyable and uplifting.

The Sages continue this trend through their enactments, one of which is to refrain from using medicine on Shabbat. If we experience some discomfort, even if it is irritating and unpleasant, we bear it calmly, as this too is part of Shabbat rest. However, if the discomfort causes pain and negates oneg Shabbat, the Sages permitted transgressing minor rabbinic prohibitions (shvut di-shvut) to relieve the suffering. And when it comes to caring for one who is actually sick, the Sages allow us to transgress all rabbinic prohibitions, as taking care of one’s health is a mitzva.

[1]. According to most Rishonim, one may not violate a Torah prohibition for a person who is in danger of losing a limb (Rosh, Ran, Rashba, and seemingly Rambam). Others maintain that one may indeed desecrate Shabbat to save a limb (Tosafot, Rabbeinu Tam, Sefer Haaguda, and Me’iri). In practice, SA rules that one may not violate a Torah prohibition in such a case (328:17). However, according to current medical opinion, in practice, when a person’s limb is in danger, it is almost always life-threatening, as there is always the possibility of infection setting in (Nishmat Avraham 328:49). This may be the rationale of the Rishonim who are lenient in a case of danger to a limb. Melamed Le-ho’il 2:32 presents similar reasoning, as detailed in Harĥavot.

02. A Regular Sick Person

As is well known, there are two types of Shabbat prohibitions: Torah prohibitions and rabbinic prohibitions (the latter type is also called shvut). There is a principle that one desecrates Shabbat and performs even melakhot prohibited by Torah law on behalf of a gravely ill person, someone whose life is in danger. In contrast, when caring for someone who is ill but whose life is not in danger, one may not violate Torah prohibitions. However, the Sages permitted the violation of prohibitions that they themselves enacted to treat someone who is sick.

One who is bedridden due to his illness is considered a regular sick person. Even if, for some reason, he is not actually lying down, he is considered sick as long as this is the type of illness that generally causes people to lie down. Similarly, if one is suffering from pain that weakens his entire body (for example, a migraine), he is considered a sick person, even if he has not actually gone to lie down (SA 328:17). Furthermore, even if one is walking around and looks well, if it is clear that without a particular treatment he will need to lie down, one may transgress rabbinic prohibitions to prevent this from happening (SSK 33:1). If a child needs something very badly, he is considered a sick person, even if he has not gone to lie down (Rema 328:17; MB 276:6; above 24:6).

The easiest and most accepted way of taking care of a sick person is with the help of a non-Jew. As we have seen (above 25:1), under normal circumstances the Sages prohibited asking a non-Jew to undertake melakha on behalf of a Jew on Shabbat, but they permitted doing so for the sake of a sick person (Shabbat 129a). Therefore, one may ask a non-Jew to turn a light on or off for a sick person, to turn a heater on for him, to cook food for him, to travel in order to bring him medication, to press elevator buttons for him, and to administer X-rays for him. Similarly, one may ask a non-Jewish dentist to treat a patient whose toothache is causing him pain that extends throughout his body. One may ask a non-Jewish doctor to write a prescription for a sick person. One may ask a non-Jew to drive a sick person to the doctor or to the hospital. In such a case, a Jew may accompany the patient, on condition that neither he nor the sick person performs any melakha themselves.

A regular sick person may take whatever medications he needs, since the rabbinic prohibition against taking medicine applies only to a mildly sick person (Rema 328:37; see BHL ad loc.).

If no non-Jew is available, according to Ran, a Jew may not transgress rabbinic prohibitions for a sick person. According to Rashba, however, he may, and we follow this position in practice. However, le-khatĥila, if possible, it is still preferable to arrange for a non-Jew to do whatever is necessary, or for a Jew to use a shinui, so that the prohibition will be reduced to a shvut di-shvut (above, 9:11). If there is no choice, and the sick person desperately needs care, a Jew may do rabbinically prohibited melakhot on his behalf. For example, if he needs a light turned on or off, one should do this with a shinui such as using one’s arm or leg, so that the prohibition is only rabbinic (above, 9:3). Similarly, if the sick person needs a heater or air conditioner turned on or off, one may do this with a shinui.[2]

[2]. According to Ran, the Sages’ dispensation for a sick person was limited to requesting things of a non-Jew, as stated in Shabbat 129a. In contrast, according to Rashba (and Rambam as well, according to Magid Mishneh and Tur) one may transgress all rabbinic prohibitions for a sick person. This is borne out by the law recorded in the Gemara that a sick person may nurse from an animal on Shabbat; while this is a prohibited form of milking the animal, the shinui renders the prohibition rabbinic (Ketubot 60a). Ramban agrees that all rabbinic prohibitions are suspended if there is danger to a limb. But, he continues, if there is no danger to a limb, one may only ask a non-Jew to help; a Jew may not transgress even rabbinic prohibitions in such a case. That is permitted only if a shinui is used, in which case the action is reduced to a shvut di-shvut. SA 328:17 states that Ramban’s position seems correct. The Vilna Gaon follows it as well, as do MB ad loc. 57 and SHT 396:9. In contrast, Ĥayei Adam 69:12 states that when it is impossible to use a shinui to do what is necessary, one may do it without a shinui (even though he thus transgresses a shvut rather than a shvut di-shvut). MB 328:102 concurs. Going even further, some Aĥaronim maintain that a Jew may even perform a melakha that is prohibited by Torah law with a shinui if no non-Jew is available. This is based on Rashba and his followers. (Some maintain that Ramban would agree as well, and that this can be inferred from his book Torat Ha-adam.) This is the approach of SAH 328:19; Eglei Tal, Toĥen 18; and Tehila Le-David 328:22. Since this is a rabbinic disagreement, the law follows the lenient opinion. Recent poskim who agree include: R. Shlomo Zalman Auerbach, as cited in SSK 33:18; Or Le-Tziyon 2:36, n. 4; and R. Ovadia Yosef, as cited in Yalkut Yosef 328:11. See too Orĥot Shabbat ch. 20 nn. 148-149.

All agree that one may not turn off a light so a sick person can sleep (Shabbat 30a). At first glance, since this is a melakha she-eina tzerikha le-gufah, which according to many poskim is only rabbinically prohibited (above, 9:6), Rashba and those who follow him should permit it for a sick person even without a shinui. Nevertheless, since turning off the light is more severe than other rabbinic prohibitions, the Sages forbade doing it even for a sick person (MB 278:3). Turning off a light to allow a sick person to sleep is permitted if one does so with a shinui, for example by using his arm.

Eating rabbinically prohibited food is more severe than transgressing a shvut, and a regular sick person thus may not do this (Rema, YD 155:3). However, he may eat food that was cooked by a non-Jew (SA 328:19), and he should make the regular berakhot over the food (MB ad loc. 63). One may move a muktzeh item for a sick person without using a shinui. Some are stringent and maintain that le-khatĥila one should still use a shinui (MB 328:58). Some argue that the enactment against taking medicine (out of concern that people will end up grinding ingredients) applies to a regular sick person. (See BHL 328:37, s.v. “ve-khen.”) However, in practice, we rule that the enactment applies only to a mildly sick person or to one experiencing discomfort, as described in the next section (Beit Yosef and Rema 328:37).

03. A Mildly Sick Person and One Experiencing Discomfort

If one walks around and seems to be healthy, but in fact is mildly sick or experiencing discomfort, his status is the same as that of anyone else. He must observe all the Shabbat prohibitions, including the rabbinic ones. The permission to transgress rabbinic prohibitions (as explained in the previous section) is for a regular sick person, but this permission does not extend to one who is bothered by a mild illness or ailment. Therefore, if the light is bothering him, one may not ask a non-Jew to turn it off; if he needs light, heat, or air conditioning, one may not ask a non-Jew to turn them on. Even asking a non-Jew to do these things with a shinui – which would reduce the prohibition to a shvut di-shvut – is prohibited, because all rabbinic prohibitions still apply to him (SA 328:1).

All of this applies in a case where the illness is merely irritating and uncomfortable. However, if the illness or ailment causes pain, one may relieve it by performing a shvut di-shvut. If the person suffering has a great need for light, heat, or air conditioning, one may ask a non-Jew to turn them on using a shinui, such as with his arm. However, a Jew may not do so even with a shinui, because there would still be a standard rabbinic prohibition (shvut), which applies even when there is some pain (SA 307:5; 328:25; above 9:11-12; Harĥavot).

If one’s fingernail has been torn off most of the way and is bothersome, this is considered an ailment, and one may not remove the nail even via a shvut di-shvut. However, if the torn nail is painful, one may remove it using a shinui, such as with one’s hand or teeth. Since most of the nail has already been torn off, it is viewed as if it has already fallen off, so the prohibition to tear it off completely is only rabbinic. For this reason, the Sages permitted removing a nail with a shinui if it is causing pain (Shabbat 94b; SA 328:31; above, 14:2). If the nail was not torn off most of the way but is painful, one may ask a non-Jew to remove it with a shinui, since doing so reduces the prohibition to a shvut di-shvut.

Similarly, if a splinter becomes embedded in a person’s skin and it is clear that removing it will cause bleeding, one may not remove it if it is merely irritating. However, if it is painful, one may remove it, since the prohibition of causing bleeding in this way is only a shvut di-shvut, as one does not intend to cause bleeding, and the bleeding is effected via a shinui, as a side effect of removing the thorn (see MB 328:88; above, ch. 9 n. 3 and 14:2).

04. The Enactment Against Medicine – Grinding Ingredients

The Sages further enacted that one who is bothered by an ailment or mild illness may not obtain medical treatment on Shabbat. That is, he may not ingest medicine, apply a medicinal ointment, or take any actions designed for the purpose of healing. The concern is that one who is preoccupied with alleviating the ailment will pulverize herbal ingredients to prepare a medication and thereby violate the Torah prohibition of Toĥen (Shabbat 54b and Rashi).

Thus, the Sages forbade someone with an eye ailment to drip wine or another medication to his eye (SA 328:20). Similarly, one may not apply ointment to a wound to heal it (SA 328:22). If one has a sore throat, he may not gargle with oil for therapeutic purposes. One who has a toothache may not rinse his teeth and gums with vinegar, salt water, or alcohol for therapeutic purposes. However, he may drink an alcoholic beverage in order to relieve the pain, on condition that he does not retain the liquid in his mouth longer than usual (SA 328:32).

If the ailment causes pain, one may ask a non-Jew to drip wine to his eye or apply alcohol to his painful tooth. This reduces the prohibition to the level of shvut di-shvut, which the Sages permitted if one is in pain (SA 307:5; 328:25; above, 9:11-12 and Harĥavot; according to Radbaz and R. Mordechai Benet, a Jew in pain may take medicine by himself; see n. 3 below).

The enactment prohibiting taking medicine also includes eating or drinking items that only sick people eat or drink. However, a sick person may eat or drink items that healthy people eat or drink as well, even if his intention is to use these items as medicine (Shabbat 109b; SA 328:37). Therefore, one who has a sore throat may not suck on throat lozenges, but he may suck on ordinary hard candies (SSK 34:4). Similarly, one may not drink water with flaxseed to ease constipation, but prune juice is permitted, as healthy people sometimes drink it as well.

One who experiences discomfort may do things that healthy people normally do, even if his intention is to relieve the discomfort. For example, one who has itchy skin may apply oil that healthy people apply as well (SA 327:1). One may also apply oil to one’s hands and lips, since nowadays people do so even when their skin is not chapped – to soften them or for pleasure.

If one has medicine that helps relieve his minor aches and pains, he may mix it into a drink before Shabbat, as long as no one can tell that it contains medicine. He may then drink the medicinal liquid on Shabbat (R. Shlomo Zalman Auerbach, cited in SSK 34:5).

05. Modern Medications

Some maintain that one may take modern, mass-produced medications on Shabbat for any type of ache or pain, as there is no real concern that anyone will grind anything in order to produce the medicine. However, most poskim maintain that even nowadays one who is only mildly ill or bothered by an ailment may not take medicine on Shabbat. There are two reasons for this. First, according to many, no rabbinic enactment may be nullified except by a larger and more prominent beit din than the one that passed the enactment. Second, some people still prepare household remedies, so there are cases where the reason for the enactment still applies.

In practice, as long as the ailment is merely irritating but not painful, it is proper to be stringent and avoid taking mass-produced medications. However, if the ailment causes pain, one may take medication, because some maintain that the Sages never prohibited taking medication when pain is involved. Even though many maintain that the Sages’ enactment applies even when pain is involved, in the case of mass-produced medication, where there is no concern that a private individual would try to prepare it himself, it is proper to be lenient. It is worth noting that when the technical law allows leniency, it is proper to act accordingly so as to fulfill the mitzva of oneg Shabbat.

Therefore, if one is bothered by an ailment of the eyes or ears, he should not use drops. However, if the ailment causes him pain, he should use the drops. The same applies to a runny nose: if it is merely irritating, one should not use nose drops, but if it causes pain, he should. Similarly, one may take sleeping pills to relieve insomnia, since without them he will suffer pain. Perhaps we can suggest that if one is pained to the point that he would be willing to walk a kilometer in order to get medicine, it indicates that he is truly suffering and may thus take mass-produced medications. However, if he thinks it is unnecessary to go to that much trouble, it indicates that he has a mere ailment, and he should thus refrain from taking medicine.[3]

[3]. Ketzot Ha-shulĥan (§134, Badei Ha-shulĥan 7) states the argument for leniency based on the fact that nowadays people do not prepare medicine by themselves. However, for the two reasons I presented above, it is inclined to be stringent. Tzitz Eliezer 8:15:15 states that it depends on the rationale for the enactment against medicine. If the concern is specific – that in order to prepare the medicine, people will end up grinding the ingredients – then there is room for leniency. In contrast, if the concern is more general – that as part of dealing with medical issues, people will end up violating various transgressions – then the prohibition stands even nowadays. Tzitz Eliezer concludes by inclining toward leniency. She’arim Metzuyanim Ba-halakha 91:2 also inclines toward leniency. Many oppose them and prohibit taking mass-produced medicine on Shabbat, including SSK 34:3; Igrot Moshe, OĤ 3:53; R. Ovadia Yosef, Halikhot Olam vol. 4, Tetzaveh §19; and Or Le-Tziyon 2:36:9. Nevertheless, when great pain is involved, R. Ovadia is lenient, even if the sick person is not bedridden. SSK 34:3 rules stringently, stating in n. 7 in the name of R. Shlomo Zalman Auerbach that the entire enactment is relevant only when there is pain, because that is when one would end up grinding medication. Nevertheless, SSK 33:16 permits taking sleeping pills in order to relieve great pain.

Some are lenient concerning all medicine, even for regular pain. This is the opinion of R. Mordechai Benet, who argues that sometimes the Sages were permissive when one is in pain, even in a case resembling a melakha she-eina tzerikha le-gufah (SA 328:28; above, 14:2); certainly, then, they would permit taking medicine in a case of pain. Minĥat Shabbat 91:1 and She’arim Metzuyanim Ba-halakha 91:3 take this position as well. Radbaz 3:540, appearing earlier than any of them, states that the prohibition on taking medicine is even less severe than a shvut di-shvut. Therefore, when any pain is involved, one may be lenient.

Thus there are two disagreements here: 1) Does the enactment apply to mass-produced medicine? 2) Does it apply to people who are in pain? It is true that in each of these disagreements, most poskim feel that one should be stringent. Nevertheless, since these disagreements concern a rabbinic prohibition, one who is lenient has an opinion to rely upon. Furthermore, in a situation where there are two reasons to be lenient, such as if the medicine is mass-produced and the person is in pain, then it is a twofold doubt that affects oneg Shabbat. Accordingly, one may be lenient even le-khatĥila. (We should add that when the medication simply relieves pain but does not cure the illness, some poskim maintain that it is not considered medication for purposes of the rabbinic enactment. See Tzitz Eliezer 8:15:15:21 as well as 14:50, and Yalkut Yosef 328:52.)

06. Medications Taken in Regular Doses

If one began taking a medication during the week, and it must be taken for several days consecutively so that skipping the Shabbat dose will harm its effectiveness, he may continue taking the medicine on Shabbat. This is because some maintain that the rabbinic enactment does not apply to dosing that began before Shabbat (R. Shlomo Kluger). When dealing with mass-produced medicine, one may rely on this opinion even le-khatĥila, and one may take such medicine even when he is not in pain.

Similarly, a woman who is taking birth control pills or medication to help her maintain a pregnancy may continue taking this medication on Shabbat as well.[4]

If one takes daily vitamin supplements or weight loss pills to improve his health, he may continue on Shabbat as well.

[4]. Some permit anyone who has started taking a medication before Shabbat to continue taking it on Shabbat, as they maintain that the Sages’ enactment was not meant for such a case. Since he has already started taking the medicine on Friday, he has enough time to prepare whatever amount he needs for Shabbat, and there is no concern that he will need to grind anything (R. Shlomo Kluger, Sefer Ha-ĥayim 328:25). Some are lenient only when a medication must be taken every day for at least a week, and skipping a day could be harmful (R. Shlomo Zalman Auerbach). See SSK ch. 34 n. 77 and Orĥot Shabbat 20:124. Even if the medication is not mass-produced, there is room for leniency, since the disagreement concerns a rabbinic law; certainly, then, one may be lenient when the medication is mass-produced.

SA 328:37 rules that a healthy person may eat food that sick people eat to help them get better. According to this, a healthy person may take vitamins and diet pills on Shabbat. However, according to MA and MB ad loc. 120, a healthy person may not do this in order to improve his health. Igrot Moshe, OĤ 3:54 takes this stringent opinion into account for a weak person, but permits a healthy person to take vitamins prophylactically. This is also the opinion of R. Ovadia Yosef, Halikhot Olam vol. 4, Tetzaveh §41. Nevertheless, if a sick person wishes to be lenient, he may rely on Tzitz Eliezer (cited in the previous note), which rules leniently because people do not grind medicine themselves anymore. Certainly, then, one may be lenient if he takes the vitamins daily, as we explained above.

07. Injections, Intravenous Infusion, and Nursing

Sometimes, a regular sick person needs an injection or intravenous (IV) infusion on Shabbat. Since a subcutaneous injection does not necessarily cause bleeding, halakha views it no differently from other types of medicine: it is permitted for a sick person. If one is not sick but is in pain, he may ask a non-Jew to administer the injection.

However, a Jew may not administer an intravenous injection or infusion on Shabbat, because doing so causes bleeding, which some maintain is prohibited by Torah law. Thus, as long as the person is not dangerously ill, one should defer to this stringent opinion. If a port was installed beneath the skin (with a catheter surgically inserted into a vein) before Shabbat, one may attach an IV bag to it on Shabbat, even when there is no danger to life (see SSK 33:7). A non-Jew may administer an intravenous injection or infusion to a regular sick person.

If a wound or a needle needs to be disinfected with iodine or peroxide, one may not apply the disinfectant using cotton wool or a bandage, because squeezing liquid out of them is prohibited on account of Seĥita. Rather, one should pour the iodine or peroxide directly onto the surface that needs to be disinfected. Alternatively, one may apply it with a tongue depressor or synthetic, non-absorbent material.

If one knows before Shabbat that he will have to administer an injection on Shabbat, it is preferable that he prepare and disinfect the syringe and needle before Shabbat. If he forgot to prepare in advance, or if it was medically inadvisable to do so, he may prepare the shot on Shabbat, as this does not involve a Torah prohibition (see SSK 33:8-10).

A nursing woman whose breasts are engorged may express or pump her excess milk on Shabbat, on condition that she pumps it in such a way that the milk goes to waste, such as into the sink or into a container with soap in it so that the milk is immediately ruined. It is true that expressing milk on Shabbat in order to feed a baby is prohibited by Torah law as a tolada of Dash (SA 328:34; above, 10:17). However, when the milk goes to waste, the prohibition is only rabbinic, and to relieve pain the Sages permitted it (SA 330:8). One may use a manual pump for this purpose or an electric pump attached to a timer that was set before Shabbat. On Shabbat, when the timer activates the pump, the nursing woman may use it to pump her milk (SSK 36:22 n. 63). If the doctors believe that it is necessary for a baby to have breast milk, and the mother tries not to miss any opportunity to pump during the week, then she may also pump on Shabbat for the baby, as this is a case of saving a life (see SSK 36:22 and n. 67).

08. Ointments and Compresses

Even when using medicine is permissible, one may not apply topical medication (such as creams or ointments) to a bandage or a wound. If one applies ointment and smoothes its surface to spread it, he violates Torah law, as Memare’aĥ is a tolada of Memaĥek (Shabbat 75b; above, 18:6). It is also forbidden to place the ointment onto the body or the bandage without spreading it, out of concern that one will end up spreading it. Even if the bandage was prepared with ointment before Shabbat, one may not place it on the wound on Shabbat, out of concern that he will end up spreading it (SA 328:25).

However, to alleviate or prevent pain, the Sages allow one to place ointment directly on a wound or bandage, though one who does so must be careful to avoid spreading it. If the ointment was in a tube, he should place the tube directly on the wound. If it is in a container, one may apply the ointment using a tongue depressor or a spoon. The primary concern is that it should not be spread. When the bandage is placed on the wound, the cream will spread out along the sides. Nevertheless, as long as one does not smooth the surface intentionally, this is not prohibited (SSK 33:14; above, section 5).

Similarly, if one is in pain, he may place medicated cream on his skin and rub it in until it is completely absorbed. This is because as long as one wants all the cream to be absorbed, it is not considered Memare’aĥ. However, if one wants part of the cream to remain on the surface of the skin to make it smooth, applying the cream is prohibited by Torah law (Da’at Torah 328:26; R. Shlomo Zalman Auerbach cited in SSK ch. 33 n. 64; based on MA 316:24 and MB ad loc. 49; see above, 14:5, and Harĥavot).

If one is suffering from great pain that is weakening his entire body, he is considered a sick person, and one may treat him with compresses. Cloths that were dampened before Shabbat may be used for this purpose. If necessary, one may wet a completely clean cloth on Shabbat to use as a compress (see above, 14:4 and n. 2). In any case, he must take great care not to wring out the compress, whether in order for the water to reach the sore spot or in order to clean it after use (SSK 33:19; see Harĥavot here and above, 12:8, 10).

09. Adhesive Bandages, Cloth Bandages, and Treating Wounds

One may use an adhesive bandage (“Band-Aid”) to protect a wound or a sensitive area from the friction caused by clothing or other objects. Even one who is bothered by a mild ailment may do so, since an adhesive bandage does not cure but merely protects (SA 328:23).

Although one may not affix an adhesive bandage to paper or the like because of the prohibition of Tofer, affixing one to the body is not prohibited, because Tofer does not apply to the human body. Besides, adhesive bandages are meant to remain on the body for only a short time.

Le-khatĥila, one should try not to attach the ends of the adhesive bandage to each other and to avoid using an adhesive bandage to keep a cloth bandage in place. This is because some maintain that these cases are rabbinically prohibited, as sticking one item to another in such a manner resembles Tofer. If necessary one may be lenient and rely on those who maintain that since adhesive bandages are affixed temporarily, for a short period of time, one may do so just as one may tie a temporary knot that lasts only a short time.[5]

One may not cut a bandage or adhesive bandage to size, and one who does so violates the Torah prohibition of Meĥatekh (MB 322:18; above 15:10). If a bandage is too long, one should wrap it around the injury multiple times rather than cutting it. If one knows that he may need to bandage wounds on Shabbat, he should prepare bandages of various sizes before Shabbat. It is also good to prepare methods of fastening them with safety pins or an elastic sleeve, since it is preferable le-khatĥila not to use an adhesive bandage in order to keep a cloth bandage in place.

One may use a butterfly bandage to hold together the edges of a cut. This is because of two lenient opinions. First, some maintain that there is no prohibition of Tofer when it comes to the body. Second, some say that this type of bandage cannot qualify as sewing, since all it does is hold closed the edges of the cut, helping the wound close up on its own (SSK 35:25; see Harĥavot 27:2:4).

In order to stop bleeding, one may use a bandage (using a permissible method of tying) or antihemorrhagic sprays or powders (like Dermatol). These measures are not considered medicinal; they simply stop the bleeding (see SA 328:29). Additionally, one may place iodine on a wound in order to prevent infection (SSK 35:13).[6]

One may clean blood with a bandage or paper towel, even though this will color them red. Similarly, one may bandage a wound that has been treated with iodine, even though the color of the iodine will stain the bandage or paper towel. This is because this “coloring” is in fact a manner of soiling the material. Additionally, none of these items (bandage, paper towel, body) are meant to be dyed (SAH §302, Kuntres Aĥaron; MB 303:79 and 320:58; above 18:5).

If an adhesive bandage is irritating, one may remove it. When doing so, le-khatĥila one should try to avoid ripping out hairs, because of the melakha of Gozez. If there is no alternative, one may remove the adhesive bandage even if it is clear that this will rip out hairs, since one does not want this to happen and it is simply an ancillary effect of his action (SSK 35:30).

[5]. We saw above in ch. 13 n. 9 that according to Rabbeinu Yoel, Ra’avya, Rashbam, and others, the laws of Tofer are similar to the laws of Kosheir, and thus there is no prohibition of sewing something that will last for less than a week. Rabbeinu Peretz and Mordechai disagree, arguing that the two melakhot are not analogous, and the rabbinic prohibition of Tofer applies even to temporary attachments. In times of need, one may rely on the lenient authorities; see there. This is also the opinion of Tzitz Eliezer (8:15 and in the summary, 14:14-15). R. Shlomo Zalman Auerbach (cited in SSK ch. 35 n. 67) adds that even when the cloth bandage is later thrown away together with the adhesive bandage so that they stay attached for an extended period of time, this is not considered a permanent attachment, since it serves no purpose. We also saw above in ch. 13 n. 9 that it is not prohibited to remove the plastic strips protecting the adhesive on the tapes of a disposable diaper. The same applies to removing the plastic strips protecting the adhesive of an adhesive bandage.

[6]. Orĥot Shabbat ch. 20 n. 250 expresses surprise at SSK’s permission to use Dermatol, maintaining that it is indeed medicinal. R. Shlomo Zalman Auerbach seems to maintain that Dermatol and iodine are not meant to heal, but simply to stop bleeding and prevent infection. In any case, even if they do heal, someone who is suffering would be permitted to use them, as I pointed out here in section 5 and n. 3.

10. Opening Medicine Packages

When it is permissible to take medicine but it is packaged in plastic, paper, or cardboard, one may tear open the packaging in order to get to the medicine. Those who are stringent make sure to destroy the packaging, rendering it unusable for storing the medicine (above, 15:12). It is preferable to avoid tearing words on the packaging. Be-di’avad, if it cannot be opened without tearing words, it may still be opened, because one’s intention is not to erase the letters, and the “erasing” happens through a destructive action (as explained above, 18:3).

When one may take pills that are inside a sealed plastic container, he may remove the cover, even though doing so breaks the temporary plastic seal connecting the cover to the container. This is not considered making a kli, because the container and cover were already finished products; they were simply attached to the plastic seal (above 15:13-14).

11. Measuring for Medical Purposes and Using a Thermometer

When medically necessary, one may use a regular mercury thermometer to take someone’s temperature. One may also use a manual blood pressure monitor. Although without a significant need one may not measure things on Shabbat, as this is a weekday activity, it is nevertheless permitted for a mitzva or medical need (SA 306:7 and 328:43; above 22:6). It is also permitted to shake down a thermometer so that the mercury contracts (SSK 40:2).

Some rule leniently and permit a sick person to use a thermometer strip, which displays body temperature upon being placed on one’s forehead’s. They maintain that this is not considered Kotev since the numbers are already imprinted on the strip, and the temperature merely makes them visible for a short time, after which they disappear (Yeĥaveh Da’at 4:29). Others maintain that using this type of thermometer is rabbinically prohibited, considering it temporary writing (SSK 40:2). Since it is a rabbinic law, one may be lenient in a case of necessity (Tzitz Eliezer 14:30; see Harĥavot 18:4:4).

The poskim disagree about whether one may perform a medical test on Shabbat that causes color to appear. Some prohibit this on account of Tzove’a. Others permit it, as one is not interested in the color, only in the test result. Le-khatĥila one should be stringent, but when necessary he may be lenient, since this is a case of uncertainty regarding rabbinic law (see SSK 33:20, and Harĥavot).

12. Permitted Actions

On Shabbat, one may perform therapeutic treatments that are not normally done with the aid of medications. Since there is no concern that one will come to grind ingredients, such treatment is not included in the prohibition of medicine on Shabbat. However, if there is no real need, even such treatment is prohibited because it is a weekday activity. But as long as a real need exists, for example when one is in pain, it is permissible (SA 328:43; MB ad loc. 136).

Therefore, one may apply pressure to an injury with a utensil or his hand to prevent swelling, as this is a type of therapeutic action that is not normally done with medications (Ĥayei Adam 69:5; MB 328:144; SHT ad loc. 104). Similarly, one may apply ice to an injury in order to prevent swelling and reduce the pain, because this is not normally done with medicine (SSK 35:35 and n. 92).

If one’s eyes hurt, he may do eye exercises on Shabbat, because there is no medication that substitutes for these exercises. If one’s eyes do not hurt, but he wants to strengthen his eye muscles, the exercises have the same status as physical therapy exercises: if one needs to do them several times daily, one may do them on Shabbat as well (as explained in the next section).

One may place an orthodontic retainer in one’s mouth on Shabbat, as no medication can straighten one’s teeth (SSK 34:29).[7]

One who has a stomach ache or an earache may place a hot water bottle on the affected area to relieve his pain (MB 326:19). Ice may also be used to relieve pain (SSK 33:15).[8]

One who has an earache may put cotton in his ears. This is not considered medicinal, since it does not heal the ear, but simply protects it from the wind (SA 303:15; SSK 34:9). One who wishes to soothe his throat may swallow a raw egg, as this is not considered a medicinal act (SA 328:38). One may put talcum powder into one’s shoes to absorb sweat and foot odor or to soothe his feet. However, one who has athlete’s foot may not put medicated powder in his shoes. If he is in pain, though, he may (section 5 above).

[7]. SA 328:43 states that someone in pain may perform actions to alleviate an illness that is not normally treated with medication. Such treatments were not included in the Sages’ enactment, since there is no concern in these cases that one will end up grinding ingredients for medicine. MB ad loc. 136 clarifies that when there is no pain, one may not administer such treatments because it is a weekday activity. Along the same lines, SA 306:7 permits measuring for the sake of a mitzva or for a medical need, even though measuring is normally considered a weekday activity. MB ad loc. 36 explains that healing the body is itself a mitzva. At first glance it would seem that placing a retainer in one’s mouth should be prohibited because it is a weekday activity, as it does not alleviate pain. However, R. Shlomo Zalman Auerbach (cited in SSK ch. 34 n. 113) explains that it seems reasonable that the prohibition on weekday activities does not apply when results are seen only after a long period of time. This is also cited in Orĥot Shabbat 20:154. I maintain that administering treatments is considered a prohibited weekday activity only when not necessary. Since they can wait, undertaking them on Shabbat is considered a weekday activity. However, when there is a real need, then even if there is no pain involved, it is not considered a weekday activity. This can be inferred from the position of Radbaz and those who follow him (above, n. 3), namely, that the enactment banning medicines is less severe than a shvut di-shvut, which is itself permitted when pain is involved (above, 9:11). When it comes to treating sick people, the prohibition on weekday activities is even less severe than the ban on medication (as explained in MB 328:136).

[8]. Shabbat 40b states that one may not place a container of hot water on a person’s stomach, due to the risk of spilling. Rashi and Ran explain that this is the reason for the prohibition on Shabbat as well, but Tosafot state that it is forbidden on Shabbat because of the ban on medicine on Shabbat. It would seem that according to Rashi and Ran, if the hot water bottle is sealed well, one may use it on Shabbat, whereas according to Tosafot it is still prohibited. MB 326:19 states that one may be lenient if there is a great need. Based on what we said in section 5, nowadays, when medicine is mass-produced, one may be lenient concerning all medicine for one in pain.

13. Physical Therapy, Massage, and Acupuncture

Physical therapy exercises are often meant to restore function to limbs or muscles that have atrophied as a result of injury or paralysis. If it is not strictly necessary to do the exercises on Shabbat, one should not do them then, because this is a weekday activity. For example, if one is not always careful to do the exercises regularly during the week, one may not do them on Shabbat. Even if no equipment is used, since these exercises are undertaken with professional guidance, they are considered a weekday activity. One should instead exercise on Friday before Shabbat begins, and on Saturday night after Shabbat ends. However, if the exercises are indeed necessary for the patient, and during the week he takes care to do them several times a day, he may do them on Shabbat as well. One may even use equipment, as long as it does not require electricity to operate. These exercises have the same status as pills that must be taken for several consecutive days: one may take them on Shabbat as well (n. 4 above; Nishmat Avraham 328:93 in the name of R. Shlomo Zalman Auerbach).

One may do gentle stretches to loosen his back or neck or to refresh himself. This is not considered medicinal, nor is it considered a weekday activity. However, one may not do calisthenics, which maintain or improve one’s fitness, as they are a weekday activity (see above, 22:8).

One may not give a professional massage to someone who is experiencing discomfort in his back or another limb. Since such aches are treated with pills and ointments, their treatment is included in the rabbinic enactment against medicine on Shabbat. In addition, a professional massage is considered a weekday activity. Nevertheless, if the ailment is truly painful, one may give a professional massage in order to relieve it. As we have already seen (section 5), since medications today are generally mass-produced, one who is in pain may use such medications. Certainly, then, one may provide treatments that do not involve medication at all. Furthermore, the prohibition on weekday activities does not apply when pain is involved.

One may always give a non-professional massage. Since it is not professional, it is not considered medicinal, nor is it considered a weekday activity. Even a professional masseur may give his family members a non-professional massage that is meant to be soothing. Since they are not in pain and the massage is not done in a therapeutic context, it is not prohibited.

Acupressure is a treatment in which one applies pressure to various parts of the head or body in order to relieve pain and restore the health and vitality of the body and its limbs. When there is no great need, one may not perform it on Shabbat, both because of the enactment against medicine and because it is a weekday activity. However, one who is in pain may undergo acupressure, either manually or with an instrument designed for this purpose.

One may not administer acupuncture on Shabbat even for one who is in pain, because the needles are muktzeh meĥamat ĥesron kis. However, a patient who needs acupuncture very badly may be treated. As we already have seen (n. 2 above), the Sages suspended their enactments for the sake of caring for a sick person. Even for a sick person, acupuncture is only permitted on condition that the treatment will not necessarily cause bleeding, which is prohibited by Torah law.

In circumstances where a professional may provide treatment (of pain or illness) on Shabbat, he may not accept payment for his services. However, if he provides treatment during the week as well, the Shabbat payment may be subsumed within the weekday payments (above, 22:12). When a professional is summoned to provide treatment on Shabbat, one may not discuss the arrangements for subsuming his fee. Rather, one may say that after Shabbat they will discuss the details that they may not discuss on Shabbat. This is because when necessary, the Sages permitted alluding to such matters (above, 22:3, 10).

14. Seeing a Non-Observant Doctor

If a sick person whose life is not threatened needs to see a doctor on Shabbat for an examination or treatment, he should try to visit a religious doctor who knows how to avoid melakhot that are prohibited by Torah law. If he goes to a Jewish doctor who normally desecrates Shabbat, there is a concern that he will cause the doctor to desecrate Shabbat. For example, the doctor might turn on a light in order to examine him, write down his personal information, or write a prescription for him. We have already seen that only rabbinic prohibitions are suspended for the sake of caring for a sick person who is not dangerously ill, but Torah prohibitions remain in force. Furthermore, just as one should give preference to an observant doctor, one should also give preference to a hospital that operates in accordance with halakha. In hospitals that do not operate in accordance with halakha, he may encounter Jewish staff members who will transgress Torah prohibitions on his account.

If it is not possible to see an observant doctor or visit a hospital that operates in accordance with halakha, one may see a non-observant doctor as long as he requests that the doctor refrain from desecrating Shabbat by Torah law on his account. If the doctor insists on writing in the normal fashion or on doing other melakhot that are prohibited by Torah law, the patient should forgo the treatment to avoid aiding Shabbat desecration. Under pressing circumstances, when the exam and treatment are extremely urgent, the patient may rely on the lenient position and accept treatment from this doctor.[9]

[9]. R. Shlomo Zalman Auerbach (cited in SSK ch. 40 n. 32) says that when one is entitled to treatment covered by his health fund or HMO, he is entitled to go to the hospital and is not responsible to prevent the doctor from violating Torah prohibitions. Just as a creditor has a right to bring his debtor to court even if the debtor threatens to curse him, blaspheme God, and swear falsely, the creditor may still takeakeucedalized painstch this to Bactine or a  him to court. Similarly, one may accept the medical treatment to which he is entitled. SSK 40:10 rules this way in practice. This ruling can be combined with that of Shakh, which maintains that one does not have to worry about aiding the Shabbat desecration of a non-observant Jew who desecrates Shabbat regularly. However, according to Ĥavot Yair and most poskim, the prohibition of aiding Shabbat desecration applies even to him (Pitĥei Teshuva, YD 151:3).

In any case, many are stringent here because in practice, one who sees a non-observant doctor on Shabbat indeed causes him to sin. The Torah commands us to reprove our fellow Jew in order to help them avoid sin. Yet here the patient is aiding the Shabbat desecration of the doctor. Those who are stringent include Zivĥei Tzedek, OĤ 2:19; Ben Ish Ĥai in Rav Berakhot, ma’arekhet lamed, 3; and Yesodei Yeshurun. See Harĥavot.