Jewish Law - Articles - Dental Emergencies on the Sabbath


Dental Emergencies on the Sabbath Rabbi Moshe David Tendler and Dr. Fred Rosner	Dental Emergencies on the Sabbath^* by Rabbi Moshe David Tendler and Dr. Fred Rosner Rabbi Tendler is Professor of Talmud, Rabbi Isaac Elchanan Theological Seminary; Professor of Medical Ethics of Biology, Yeshiva University; Rabbi, Community Synagogue, Monsey, New York Dr. Rosner is Director, Department of Medicine Queens Hospital Center Affiliation of Long Island Jewish Medical Center; and Professor of Medicine, Health Sciences Center, State University of New York at Stony Brook Introduction It is axiomatic in Judaism that human life is of infinite value. The preservation of human life takes precedence over all biblical commandments and rabbinic enactments except three: idolatry, murder and incest.¹ In order to preserve human life, all ritual laws, save the above three, are suspended for the overriding consideration of saving a human life.² How does the practicing dentist apply this basic principle when confronted with an emergency or potential emergency on the Sabbath? What constitutes a dental emergency requiring the dentist to set aside all Sabbath laws to treat his patient? Under what circumstances may the dentist open his office on the Sabbath, turn on the lights, prepare and apply medications, cements, fillings and their like, use the drill, incise an oral abscess, and perform other therapeutic procedures for his suffering patient? Abrogation (Hutra) or Suspension (Dechuya) of the Sabbath One of the most renowned halachic controversies concerning medical care on the Sabbath is the question whether danger to life (pikuach nefesh) or potential danger to life completely sets aside the biblical laws and rabbinic rules and regulations pertaining to the Sabbath (hutra), or whether this danger only suspends them (dechuya). This famous controversy of whether the Sabbath is hutra or dechuya for pikuach nefesh is more theoretical than practical. Theoretically, if the Sabbath is hutra, it is as if the Sabbath does not exist and, therefore, the Jewish dentist may act in accord with standard dental procedures in treating his patient with pikuach nefesh on the Sabbath similar to that which he would do on a weekday for that patient. (Of course, even if Sabbath is considered hutra, this would apply only to care of the patient; it does not mean, for example, that the dentist could smoke a cigarette just because he is taking care of a critically ill person.) If the Sabbath, however, is only dechuya - suspended or set aside only for the pikuach nefesh situation - the dentist would have to limit himself to those dental procedures absolutely essential to take care of the dental emergency. However, it is clear from the codes of Jewish law, including the Shulchan Aruch ³ and Mishneh Torah,⁴ that a physician or dentist must perform all acts required for the care of his patient (kol tzorchei choleh) and not limit himself exclusively to those things which would remove the danger to life (pikuach nefesh).⁵ The medical or dental practitioner must do everything that he would ordinarily do for his patient on a weekday. Thus, from a practical standpoint, this major distinction between hutra and dechuya is irrelevant once the patient's condition has been classified as pikuach nefesh.⁶ A second theoretical difference between hutra and dechuya is in the use of a non-Jewish dentist who is equally competent. If the Sabbath is hutra for pikuach nefesh, there is no need to send the patient to the non- Jewish dentist and the Jewish dentist himself can treat the patient on the Sabbath as if the Sabbath were non- existent. If, however, the Sabbath is dechuya, or only temporarily suspended for pikuach nefesh, there is no need for the Jewish dentist to transgress the Sabbath and the patient can be cared for by the non - Jewish dentist. However, contrary to this line of reasoning, our Sages rule that even if the Sabbath is dechuya for pikuach nefesh situations, the most competent Jewish medical or dental practitioners and not a non-Jew should care for the patient. Maimonides ⁷ clearly states that "when such things have to be done [to save a life on the Sabbath]... they should not be left to heathens, minors, slaves or women, but should be done by adult and scholarly Israelites." Thus, if an illness is classified as pikuach nefesh, it is not proper to refer the patient to a non-Jew. There is no distinction in this regard in practice between hutra and dechuya. The author of Mishnah Berurah ⁸ concurs that this is the accepted halachic practice. A real distinction between hutra and dechuya might be the performance of an act on the Sabbath in an unusual manner (shinuy) thereby changing the offense from a biblical to a rabbinic transgression. If the Sabbath is hutra for pikuach nefesh, the dentist may perform all acts necessary to treat his patient in the same manner he would perform them on a weekday. If, however, the Sabbath is only temporarily set aside for pikuach nefesh, it would seem preferable to use a shinuy to perform all therapeutic acts on the Sabbath in order to lessen the transgression from a biblical to a rabbinic offense. What is a shinuy for a dentist? If a right-handed dentist performs root canal work with his left hand, that might be considered a shinuy, but this is obviously highly impractical. The definition of shinuy requires that the act be performed in a less competent manner than usual so that either the results of the act are less good or the method is more difficult. Rabbi Abraham Borenstein, known as A'vnei Nezer, in the introduction to his work Egley Tal, specifically states that a shinuy is when the outcome of an act is less successful or the method of doing the act is particularly tedious. If neither definition applies it is not a shinuy. Turning the light on with one's elbow or starting the dental drill with one's knee is not a shinuy, according to Rabbi Moshe ' Feinstein,⁹ because the shinuy of using one's elbow or knee is an act (turning on the light or starting the drill) that does not affect the , electrical contact that sets into motion the forbidden activity. It is, therefore, usually not feasible for a dentist to employ a shinuy that is halachically valid in the direct care of his patient with pikuach nefesh on the Sabbath. In practical terms for the dentist, therefore, there is no distinction between hutra and dechuya. Once a situation has been classified as pikuach nefesh, the Jewish dentist is obligated to do everything necessary to care for his patient on the Sabbath and that should be his only concern. Definition of Pikuach Nefesh (Danger to Life) A frequent halachic question in dentistry is whether or not the presence of an abscess is considered to be pikuach nefesh requiring incision and drainage on the Sabbath. The halachic definition of pikuach nefesh is not the same as the medical-dental definition of danger to life. Halacha sets a higher standard of risk-benefit, i.e., a lower level of risk or danger than that set by medicine is classified as pikuach nefesh by the halacha. Thus, any internal sore from within the lips and mouth, including the teeth, is halachically considered to be a situation of pikuach nefesh,¹¹ if that sore might lead to an actual or potential danger to life. Our Sages were especially cognizant of the fact that any infection in the mouth is potentially dangerous because of the direct circulatory connections between the oral cavity and the brain. The fact that total asepsis in the mouth is nearly impossible to achieve is compensated by G-d's creation of protective enzymes, antibodies, and other host defense systems which protect the body from sepsis secondary to the bacterial flora of the oral cavity. The fact that any "significant" infection or inflammation or abscess in the mouth can today be treated prophylactically and/or therapeutically with antibiotics in no way eliminates the classification of that abscess or infection as pikuach nefesh requiring the dentist to treat it on the Sabbath. Thus, conditions such as tooth abscesses, jaw swellings, gum infections and their like are all defined in the category of internal sore (makah shel chalal) for which Sabbath laws must be put aside in favor of the most effective and expeditious dental care. A cancre sore or a broken orthodontist's wire or a mild tooth discomfort and their like are not considered to be pikuach nefesh although one could stretch the above reasoning ad adsurdum and say that any scratch or pimple in the mouth could lead to infection, abscess formation, and brain infection. What is called pikuach nefesh must be "significant" pathology. Man is mortal and every human being is subject to an occasional scratch or pimple on his body. "All is by the hand of Heaven except colds and fevers"¹² means that every person can have an occasional cold and/or fever. The norm or baseline is not perfection. A cold or minor sore are not pathologic conditions to be classified as pikuach nefesh. However, a well-established infection in the mouth is clearly a case of pikuach nefesh. Categories of Illness Other Than Pikuach Nefesh There are four classic halachic categories of illness in relation to the suspension of Sabbath laws: pikuach nefesh (danger or possible danger to life), choleh she'ayn bo sakanah (ill person but without danger to life), meychush be'alma (minor discomfort), and chesron eyver (chance of loss of function of an organ or limb). Elsewhere,¹³ one of the authors of this essay provides an analysis which suggests that there is a fifth category - choleh she'ayn bo sakanah im tzar gadol (ill person without danger to life but with great pain or discomfort).¹⁴ This category is tantamount to chesron eyver in that it is permissible for such a patient to waive all rabbinic prohibitions in addition to telling a non-Jew to do the act (amira le'akum).¹⁵ Pikuach nefesh has already been discussed in the previous section of this essay. Choleh she'ayn bo sakanah ¹⁶ refers to a patient who is suffering from an illness which does not constitute a danger to life or limb but is serious enough or painful enough to make the patient feel that he would rather be in bed (mutal lemishkav). A patient with a bad toothache due to an exposed nerve but without infection should be classified in this category. For such a patient to whom there is no danger to life, therapeutic intervention on the Sabbath may only set aside the rabbinic prohibition to telling a non-Jew to do the act (amira le'akum). The treatment should, therefore, be provided by a non-Jew. Meychush be'alma refers to minor discomfort for which the taking of any medication is a rabbinic prohibition. Our Sages were concerned that because of discomfort, the person may overact (bohul al gufoh) and allow himself some unwarranted leniencies in Sabbath observances. Chesron eyvor refers not to the loss of an organ or limb but to the loss of normal function of a limb.¹⁷ This category of medical condition is halachically classified in between pikuach nefesh and cholelr sheayn bo sakanah. The Avnei Nezer exemplifies chesron eyver as an orthopedic problem such as a torn ligament or muscle which, if not repaired on the Sabbath, would result in the patient's walking with a limp. Chesron eyver does not require actual loss of the limb. Loss of a Tooth as Chesron Eyver Is a tooth in the category of chesron eyver for which a Jew can set aside all rabbinic prohibitions on the Sabbath? The third opinion in the Shulchan Aruch ¹⁸ concerning chesron eyver is the ruling we follow, namely, a Jew is allowed to waive rabbinic prohibitions in order to preserve a limb or its function. If a patient presents to the dentist on the Sabbath following trauma with two avulsed adult teeth, one could argue that halacha considers this situation as chesron eyver requiring the immediate reimplantation of those teeth. Teeth are not cited in the Mishnah in Oholoth which lists the 248 eyvorin (limbs or organs) of the body. However, teeth can be halachically classified as eyver based on A'vnei Nezer's definition of chesron eyver cited above. Less than the normal use of a limb is chesron eyver. Since the jaw is an eyver and the absence of teeth interferes with its proper functioning, and since the reimplantation of those teeth would restore the proper functioning of the jaw, the traumatic avulsion of teeth represents a situation of chesron eyver. If this analysis is correct, it is permissible to reimplant an adult tooth on the Sabbath provided one does not violate any biblical (d'oraitha) prohibitions. A non-Jew is obviously very helpful in this situation because whatever he does for the Jewish dentist on the Sabbath is only rabbinic and not biblical in its implications. In the absence of a non-Jew, is the Jewish dentist permitted to drill, mix paste or cement, cut wires, apply wax, make dental impressions, turn on lights etc., on the Sabbath in order to reimplant a traumatically avulsed tooth? Each of these activities must be evaluated as to whether it involves one or more biblical or rabbinic prohibitions. A Practical Suggestion Which activities in the sophisticated modern dentist's office would be classified as rabbinic prohibitions on the Sabbath which may be waived for the sake of chesron eyver? Turning on lights on the Sabbath, according to many rabbinic authorities, is a biblical offense. Mixing cement or paste is a biblical offense known as lishah. Lishah (kneading) is the mixing of water and fine particles to form a dough or paste. There is no shinuy possible with lishah since the end result is the same, i.e., the making of a paste or cement. Pre-made cements in tubes that can be squeezed out, if available, might be acceptable for Sabbath use. Another method is for two people to make the cement together employing the suggestion of shenayim she'osu (see below). Pushing wax into a crevice is a biblical offense known as memachek (smoothing or waxing). Cutting a wire with one's left hand if one is right-handed constitutes a shinuy but is not practical. Starting the dentist's drill by turning on the motor on the Sabbath may or may not constitute a biblical offense. Most authorities rule that if the motor has no heating element, starting it on the Sabbath would only be classified as a rabbinic prohibition and permissible for a situation of chesron eyver. Obviously, it is rather difficult for a dentist to function on the Sabbath by suspending only rabbinic but not biblical prohibitions. A practical suggestion for dentists who must treat a patient with chesron eyver or choleh she'ayn bo sakanah im tzaar gadol is the intriguing approach of two people performing a single act. Shenayim she'osu converts every prohibited act on the Sabbath into a rabbinic prohibition. Rambam clearly states ¹⁹ that whenever two persons jointly do work that can be done by each one of them alone, they are exempt, and it does not matter if each one does a different part of the work, or whether both do the work together from beginning to end. It is a functional practical solution.^19a Shenayim she'osu is like a shinuy and considered to be a technical avoidance of a biblical prohibition. If the dentist and an attendant or family member or other bystander simultaneously start the drill, only a rabbinic prohibition is involved, which is waived for chesron eyver on the Sabbath. Once the drill is running, the dentist can operate it alone until the procedure is completed. Some authorities consider starting a dentist's drill to be a rabbinic prohibition if there is no heat or electricity involved in starting the motor, but only if it is an air compressor. However, according to some authorities, starting a motor involves the biblical transgression of converting a useless non-functioning machine into a functioning drill (metaken manah). Manipulating or cutting into gums and other soft tissue in reimplanting avulsed teeth is known as mechatech basar be'alma and is permitted. Concerning rabbinic prohibition (issurei d'rabbanam), we have been taught that the Rabbis did not enact prohibitions in the fare of severe pain (bemakom tza'ar lo gazru bo rabbanan). These considerations, combined within the definition of chesron eyver cited above, may allow the dentist to function comfortably within halacha to restore the function of a tooth on the Sabbath. This is an often-overlooked category of illness on the Sabbath - no danger of life but great pain. For this category, a Jew may transgress rabbinic but not biblical prohibitions on the Sabbath as discussed above.²⁰ Dental Abscesses The Talmud ²¹ considers the piercing of an abscess with a pin to relieve the turgidity and pain and evacuate the pus on the Sabbath (mapis mursa) to be a rabbinic prohibition. However, the incision and drainage of an abscess and the insertion of a drain requires the expertise of a physician (ma'aseh uman) and is, therefore, classified as a biblical prohibition. Thus, the opening of an abscess to remove pus can be either a rabbinic or biblical offense if performed on the Sabbath, depending upon how it is done. In dentistry, an oral abscess is nearly always categorized in halacha as pikuach nefesh and, therefore, all therapeutic measures necessary to treat the abscess must be employed in the most expeditious manner possible. Although medically the incision and drainage of a dental abscess can be postponed until after the Sabbath and the patient given antibiotics, the difference between the medical and halachic definition of pikuach nefesh is such that once the condition is categorized as pikuach nefesh, definitive treatment must be instituted promptly and not postponed because of the Sabbath. Dental Anesthesia The administration of an injection by a physician on the Sabbath might involve the biblical prohibition of "wounding" (chavalah) because the physician first aspirates before giving the injection to avoid injecting directly into a blood vessel. If blood is , aspirated into the syringe, that would constitute an act of chavalah. However, for the dentist, giving an injection of a local anesthetic in the mouth is only a rabbinic act and, therefore, permissible for chesron eyver as defined earlier in this essay. In dentistry, injections are mainly for pain relief and even if they induce some gum bleeding, it is considered unintentional (davar she'ayn miskaven) and not in the category of pesik reysho (dialectic term for an absolutely unavoidable result of an act). Furthermore, the dentist has no need for that blood; on the contrary, he would prefer that the injection cause no bleeding at all. For all these reasons, the giving of an oral injection of a local anesthetic on the Sabbath by a dentist is considered to involve only a rabbinic prohibition. Returning Home After A Dental Emergency When a dentist has completed the treatment of a dental emergency on the Sabbath he should close his office but not turn off the lights. Shutting off the drill is permitted if otherwise a considerable financial loss might be incurred (hefsed mamon) and the dentist might be reluctant to treat another patient on the Sabbath in the future. If a dentist is called to the hospital on the Sabbath Eor a dental emergency, the halachic rules of his returning home are the same as Eor a physician or emergency medical technician returning from a medical emergency. This subject has been described in detail elsewhere.²² , ²³ A dentist should not drive his own car home from the scene of a dental emergency (office, hospital, etc.) but should take a taxi or have his car driven by a non- Jewish driver to minimize the Sabbath prohibitions involved. Miscellaneous Dental-Halachic Issues 1. Dental prostheses, fillings, bridges and tevilah (ritual immersion). Dental fillings and all permanent (i.e., functional) dental prostheses are not an impediment or barrier (chatzitzah) between a person and the water of a ritual immersion bath (mikvah). Tevilah may be performed without the removal unless they have been improperly placed and must be removed and corrected by the dentist. Tevilah must be postponed until such correction is made. For example, a filling that is interfering with chewing and must be corrected by the dentist, or a bridge that is painful because further correction must be made on the device, must be fixed before tevilah.²⁴ The terms temporary and permanent are often misinterpreted since the main halachic criteria relating to chatzitzah is whether or not the filling or prosthesis is functional. If a woman has a permanent filling which is too high and cannot chew on it because it bothers her and it hurts, she cannot go to mikvah until it is ground down. On the other hand, if she has a temporary cement filling which is fully functional, she is allowed to go to mikvah since it is classified as part of the body. If the filling is not functional, it is considered a chatzitzah whether made of gold, cement or plastic. If it is functional, it is considered as part of the natural growth process of the tooth and is not a chatzitzah. Semipermanent orthopedic dental devices are to be discouraged unless absolutely necessary because of the halachic problems concerning tevilah which they raise. Sutures do no hinder tevilah by their presence.²⁵ Plastic teeth and tevilah is discussed by Rabbi Feinstein.²⁶ In summary, all permanent bridgework, or cemented or wired (i.e., permanent) braces do not constitute an interposing barrier (chatzitzah) and therefore do not hinder the regular process of tevilah. However, removable dentures, removable braces, removable bridges and the like must be removed before tevilah. The application of a surgical dressing to the gums during extensive gum work may require a delay in the time of tevilah. Rabbinic consultation should be sought in such cases as each case must be adjudicated based upon the particular circumstances of that case. 2. Separate Dentures for Passover? Separate dentures are not required for Passover or for milchig ("milk foods") and fleishig ("meat foods"). Since food that is eaten does not usually reach a degree of temperature or heat that surpasses the pain threshold, no absorption of food by the teeth is considered to occur. Therefore, separate dentures for "meat" and "milk" foods are not required. It is recommended, however, that someone with false dentures should not chew hard chametz on the day before Passover eve because of a legal rabbinical technicality based upon the effect of pressure in causing absorption.^26a Because of the unusual severity of Passover law, the false- denture-user is advised not to chew hard chametz from noon of the day before Passover eve onwards. He does not, however, have to procure a separate set of dentures for the Passover holiday. If dentures or bridges are removable, they should be soaked for a twenty-four hour period prior to the holiday after careful brushing to remove all particulate matters.²⁷ 3. Kohen (Priest) Studying Dentistry Under the usual academic conditions, a kohen is not permitted to study dentistry. Because of the requirement in United States medical schools that students take anatomy and pathology courses, it is impossible for a kohen to attend medical or dental school. Even if the assumption is made that most, if not all, cadavers are non - Jewish, ritual defilement of a kohen still occurs upon contact (maga) or by carrying (massa) of any dead body. The halachic distinction between Jew and Gentile concerns ritual defilement on being present in the same room with a cadaver (tumat ohel). The same objections expressed concerning medical school apply to dental school. The latter curriculum also includes anatomical dissection which is forbidden to a kohen, irrespective of whether the cadaver is Jewish or non-Jewish. If, however, the dental student can avoid actual dissection and attend only as an observer, and if his early dentistry training does not include a human skull with its dentition, then there may be dispensation for a kohen studying dentistry. This possible restricted permissibility rests upon the fact that in the present era we follow the lenient halachic ruling that a non-Jewish corpse does not convey ritual defilement to people in the same room who do not have direct contact with it. Unlike the physician, the dentist is not usually involved with dying patients, death certificates, the mortuary, etc. which pose seemingly insoluble problems to a physician who is a kohen.²⁸ 4. Training in Hospitals with Sabbath Obligations Is a physician or dentist obligated to seek training or employment or attending physician status at a hospital where there is minimum or no conflict between hospital policy and Sabbath observance? The answer is that a physician or dentist must seek association with the most reputable and prestigious hospital possible to insure excellent training and continuing education. Jewish law requires that the physician or dentist acquire maximum skill and competence to practice his chosen profession. Therefore, he should forego personal comfort and convenience of training in a hospital that is sympathetic to his religious needs in favor of a hospital that will provide him with the best possible training, provided that he is certain of this fortitude in maintaining all halachic requirements, despite the less favorable environment. However, if the superior training is to be acquired at the price of Sabbath desecration, even of rabbinic ordinances only, the physician or dentist must forego the educational advantages of the prestigious hospital.²⁹ Conclusion The classic Codes of Jewish Law rule that "for any internal sore (makah shel challal) that is from the lip or teeth inward, and the teeth themselves are included, one must desecrate the Sabbath." Thus, conditions such as tooth abscesses, jaw swelling, gum infections, and the like, are all classified in the category of "internal sore." In such cases, the Sabbath laws must be put aside in favor of the most effective and expeditious dental care. Oral surgery requiring postoperative care is certainly classified as a danger-to-life situation (pikuach nefesh) for which the Sabbath must be desecrated. However, if the patient suffering from a dental condition has only a mild discomfort without much associated pain, no Sabbath law may be desecrated. If there is danger of loss of function (chesron eyver), rabbinic but not biblical prohibitions may be transgressed. If there is moderate pain but no real danger, only the prohibition of telling a non-Jew to act (amira le'akum) is suspended. In cases of extreme pain, the same rules that govern chesron eyver apply. The dentist has all the obligations of a medical practitioner in cases classified as pikuach nefesh. Notes [BACK] * This article originally appeared in the Journal of Halacha and Contemporary Society, Number XIV, and is posted on this site with permission of the Journal's publisher (Rabbi Jacob Joseph School). [BACK] Rambam Mishneh Torah, Hilchot Yesodei Hatorah 5:2. [BACK] Ibid. Hilchot Shabbat 2:1. [BACK] Shulchan Arurh, Orach Chayyim 328:4. [BACK] Mishneh Torah, Hilchot Shabbat 2:1. [BACK] Mishnah Berurah 328:14 and the commentaries of Biur Nalacha and Be'er Hetev there where the question is discussed as to whether or not the Sabbath should be desecrated for something whose omission would not constitute a danger to life. Authorities supporting both opposing viewpoints are cited. [BACK] Although Rambam (Hilchot Shabbat 2:1) rules that the Sabbath is only suspended (dechuya) and not completely set aside (hutra) if human life is in danger, he nevertheless clearly states that whatever a skilled physician considers necessary should be done for the patient on the Sabbath. Rabbis Joseph Karo (Keseph Mishneh), Nisson Girondi (Ran), and Solomon ben Adret (Rashba) are also of the opinion that the Sabbath is only suspended (dechuya) for danger to life. However, Rabbi Moshe Isserles (Ramo) in his Responsa no. 76 states that the Sabbath is completely set aside (hutra) if human life is in danger. [BACK] Mishneh Torah, Hilchot Shabbat 2:3 [BACK] Mishnah Berurah 328:37. [BACK] Personal communication. [BACK] Mishneh Torah, Hilchot Shabbat 2:5. [BACK] Shulchan Aruch, Orach Chayyim 328. [BACK] Ketubot 30a. [BACK] Tendler, M.D. Bet Yitzchak, Yeshiva University Press, 1987. [BACK] a) The Talmud (Ketubot 66) states that he who pierces an abscess on the Shabbat - if in order to rause the pus to come out of it - is free from punishment (end it is permitted). See also the commentary of Tosafot there, s.v. ve'im lehatzi which states that the Talmud is certainly concerned with a patient in pain but where there is no danger to life; nevertheless, the Rabbis did not enart a preventive measure to prohibit rabbinic "work" on the Shabbat even if performed by a Jew. See also Shabbat 107a. b) The Talmud (Ketubot 60a) states that a man suffering from pain in the chest (literally: groaning) may suck (goats) milk (directly from the goat) on the Sabbath (even though the release of milk from the animal's udder resembles the plucking of a plant from its root, or the "unloading" of a burden which is ordinarily forbidden on the Sabbath). What is the reason7 - continues the Talmud - because sucking is an "unusual" method of "unloading" against which, where pain is involved, no preventive measure was enacted by the Rabbis (even though the ]ewish patient himself sucks the milk and does not ask a nonJew to secure the milk for him). c) Shulchan Aruch, Orach Chayim, no. 328:28 also rules that it is permitted to pierre a boil on the Sabbath to express the pus therefrom. Mishnah Berurah no. 328:28 cites the opinion of Tosafot that the permissive ruling is due to the fact that where pain is involved, the Rabbis did not enact a preventive measure. d) Shulchan Aruch, Orach Chayim no. 328:33 also rules that a person suffering from pain in the chest is permitted to suck milk directly from a goat on the Sabbath because where pain in involved, the Rabbis did not enact a preventive measure. The author of Mishnah Berurah (ibid.) cites the explanation of Rabbi Nisson Girondi (Ran) that "although the rule in regard to patients in whom there is not danger to life is to tell a non-Jew to perform the act, here (in the case of chest pain] it is different because the cure for the patient's ailment is that he suck [the milk) himself." This means that if there is pain and suffering and the relief thereof cannot be provided by an act of a non-Jew, it is permissible for the Jew to do it himself even if there is no danger to life (pikuach nefesh) or danger about the loss of function or an organ or limb (rhesron eyver). e) One should add that on the second day of Yom Tov it is permitted for a Jew(ess) to personally apply medication on his (her) eyes even though on the Eirst day oE Yom Tov this act can only be performed by a non-Jew. Similarly, for a11 other rabbinic rules, the Rabbis allowed such acts to be performed by Jews on the serond day of Yom Tov (Shulchan Aruch, Orach Chayim 496:2). [BACK] Tosafot on Ketubot 60a and Shulrhan Arurh, Orach Chayim 328:28. [BACK] Shulchan Aruch, loc. cit. [BACK] Responsa Avnei Nezer, introduction to Egley Tal. [BACK] Shulchan Aruch, loc. cit. [BACK] Mishneh Torah, Hilchot Shabbat 1:15. [BACK] 19a. R. Moshe Feinstein used this rationale in dealing with the problem fared by the Israeli army concerning the intermittent running of the tank air-conditioner on Shabbat. [BACK] See Note 14. [BACK] Ketubot 66, Shabbat 3a and 107a. [BACK] Responsa Iggerot Moshe, Orach Chayim, Part 4 no.80. [BACK] Rosner, F. and Wolfson, W. "Returning on the Sabbath from a life-saving mission." Journal of Halacha and Contemporary Society no. 9, Spring 1985, pp.53-67. [BACK] Responsa Iggerot Moshe, Yoreh Deah no.97. [BACK] Ibid. Yoreh Deah, Part 2 no. 87. [BACK] Ibid. no. 88. [BACK] 26a. Rabbi Aron Felder in Oholei Yeshurun [p. 82, parag. 33, note 200]. See also Tzitz Eliezer, 9:25. [BACK] Rosner, F. and Tendler, M.D. Practical Medical Halachah, New York, Feldheim, 1980, p. 86. [BACK] Shulchan Aruch, Yoreh Deah 369, 371 and 372:2 and the commentary Dagul Mir'vavah on 372:2. [BACK] Rosner and Tendler. loc. cit. p. 116.
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Dental Emergencies on the Sabbath*

by Rabbi Moshe David Tendler and Dr. Fred Rosner

Dental Emergencies on the Sabbath^*