Wednesday, June 14, 2006

Medical Halacha Not a College Subject

I feel that I am forced to make a point regarding a problem that I have struggled with for years and despite my wishing otherwise, does not seem to be disappearing. These comments as well as an accompanying article may be met with shock and indignation and may even be labeled a diatribe, but are vital for the ultimate success of this society with all its tremendous potential. "Medical halacha" is not a subject to be taken in college, to serve as intellectual stimulation for doctors, or to be discussed as a matter of opinion. Like all halacha, it is the will of G-d, which is not to be determined by untrained individuals or to be taken lightly. Questions of halacha, certainly those that involve severe prohibitions such as shabbos are not to be classified as "thought provoking" or to be based on what someone "thinks is reasonable" or even to be based on hearsay without a personal response from recognized poskim. There is only one way to deal with such question of halacha on a practical level --to ask and be prepared to accept the answer from a recognized posek. Of course there is room for learning and discussion of the underlying basis of a psak, but only after the psak is delivered by a posek. For this society to realize its potential, the members and postings on the blog must reflect this- it is one thing to discuss a sugya or request source material and another to request comments and thoughts regarding a psak. If R. Willig or R. Schachter were to respond to all queries on the blog, that would be acceptable, but until that happens we must recognize our place and be prepared to submit ourselcves to the ramifications of a psak from our posek.
-Akiva Bergman

See linked documents Medicinethoughts.doc


At 12:12 AM, Anonymous Anonymous said...

I think we'll be waiting a long time before RHS and RMW start posting to a blog.

At 10:02 AM, Anonymous David said...

I am unsure why this is unique to "medical halakhah" - such caution applies to all areas of life, as halakhah pervades them all.

Perhaps a disclaimer of: Nothing posted by this website in any way is meant to be a pesak halakhah, would be appropriate. I hope that most people assume this, but it can't hurt to be careful.

At 1:08 PM, Blogger NMHSblog said...

Thank you for your suggestion, David. A note has been placed in the description of the blog.

-NMHSBlog Moderators

At 5:14 PM, Blogger Charlie Hall said...

The point that all practical questions of halachah should be posed to a competant halachic authority is very well taken and I agree 100%. I would add the usual disclaimer when we examine source material we must realize that by definition it reflected the situation of the particular people involved, at that time, and might or not reflect our own situations today.

Regarding what we post here, please note that in my own case I am neither a rabbi nor a physician and the reader of my comments to this or any other blog should have that in mind. My background is in biostatistics and epidemiology so I am qualifed to make expert comments in those fields only.

At 4:45 PM, Anonymous Michael Oppenheim, MD said...

I echo all the comments above agreeing with the fundamental premise that everything here should be "lemidrash velo lema'aseh".

Having said that, I would venture to suggest that perhaps the need to understand the halachic basis for any questions and ultimately any pesak halacha is even greater here than in other disciplines. The challenge for those dedicated to both halacha and medicine is to be able to recognize when new science / technology might pose an halachic question; without a fundamental understanding of the sources from which medical halachic decisions arise, the ability to understand that a new situation may pose a halachic question is impaired. The subtleties of how ancient sources and (seemingly!) ancient, irelevant situations relate to contemporary situations is critical to recognizing what modern techniques/therapies might have issues.

At 3:57 AM, Anonymous Anonymous said...

I'm unclear:
Is all of Torah only to learn and not to get anything halacha l'maaseh out of it? Are we to go running to our Rabbi every time we have a shaila that is obvious what the answer is?

I think that the answer is quite obvious - one must know enough to be able to diffrentiate between a shaila that he can answer on his own, and between a shaila that is beyond his league.

I heard a beautiful explanation from R' Avigdor Nebenzahl of a Gemara in masechet Berachot:
ואמר רבי חייא בר אמי משמיה דעולא גדול הנהנה מיגיעו יותר מירא שמים דאילו גבי ירא שמים כתיב (תהילים קיב) אשרי איש ירא את ה' ואילו גבי נהנה מיגיעו כתיב (תהילים קכח) יגיע כפיך כי תאכל אשריך וטוב לך אשריך בעולם הזה וטוב לך לעולם הבא ולגבי ירא שמים וטוב לך לא כתיב ביה:
How does one explain such a gemara?
Rav Nebenzahl explained it (I think he quoted the Gr"o, but I'm unsure) that the Yerei Shamayim is one who is constantly running to a Rov to ask shailos. One who enjoys his own work is one who can pasken on his own (each person the shailos that he can handle)...

At 6:05 PM, Anonymous Noam Stadlan said...

I agree with the previous poster. Rav Nebenzahl in his book "Thoughts for the month of Elul" goes into even more detail as to how the ideal is to pasken for oneself. Obviously not everyone is educated or qualified to do so, but that should not limit anyone from learning the relevent sugyot and trying to figure out what the derech should be.

At 3:39 PM, Blogger Yonatan Spolter said...

I very much appreciate Akiva Bergman's comments regarding halachic observance and the practice of medicine. I am about to start my second year of medical school and have been waiting for a forum such as this to begin to address these complex issues. It is important for orthodox physicians to begin to address these issues as pertinent instead of using the "everybody does it" excuse. I was once talking to a resident in a non-shomer shabbos program. He justified his venture by stating that he would not be happy in any other specialty. Why was he willing to placate himself with such an excuse? Would someone practicing any other profession use such an excuse? I doubt that they would. I hope that this forum will be a starting point for us to advance the cause of adherence to halacha among orthodox physicians, residents, and medical students. The mere fact that we are engaging in this type of dialogue is an important beginning to this process.


Yonatan Spolter

At 4:42 PM, Anonymous noam stadlan said...

I agree that this is a good forum. I would cautiously suggest that you may want to refrain from prejudging those of us who went through non-Shomer Shabbat residencies. Medicine is not like other professions, especially from a Halachic perspective. You have an obligation to heal, if you can. There is the concept of pikuach nefesh doche Shabbat. There are a number of ways for non-shomer Shabbat residencies and Orthodox practice to coexist. Of course you can find opinions that they can't coexist, depending on the posek.

If you think about it, halachic problems dont start with residency and Shabbat. There are issues with cadaver dissection(nivul ha-met, lo talin), examining patients(yichud, negiah), and many other points, large and small. Depending on which posek you hold by, you may find halachically viable ways to fulfill your career ambitions, and, you may not. However, on many issues you should understand that there is no halachic unanimity as to what is acceptable and what is not.

At 10:38 PM, Anonymous Avi said...

1) Nonetheless halacha isn't a shmorg. Although some issues have debate amoung the poskim, one should always establish a posek and stick to their rulings (le'lekula and le'chumra).

2)Regarding those who have completed/are in residencies which required shabbos call. There is no prejudice here. However, I would be interested to know how the challenge went? Were you able to navigate the straights of Shemirat Shabbos (even doctor on wards are obligated) and Pikuach nefer (certainly docs are obligated)?

At 10:23 AM, Blogger Yonatan Spolter said...

I would like to clarify something that I wrote in a previous response. I do not mean to criticize anyone who has participated, or is participating in a residency in which they work on shabbos. That was not the point of my comments and I apologize if it sounded that way. The point I was trying to express is my surprise at the matter of fact attitude that is taken towards the serious issue of shabbos desecration by some in the medical profession. While there is definitely room for someone to consult with their posek and arrive at a psak that they can/should work on shabbos, it is totally unacceptable for one to ASSUME that it is alright to do so based on one's own justifications. It is especially difficult to understand how physicians are willing to rely on justifications that no other proffesionals would dare to use (See above post). I am not, however, in opposition of one who has discussed the issues with their posek and come to a well though out conclusion, whatever that conclusion may be.

Yonatan Spolter

At 5:23 PM, Anonymous Michael Oppenheim, MD said...

Regarding those who have completed/are in residencies which required shabbos call. There is no prejudice here. However, I would be interested to know how the challenge went? Were you able to navigate the straights of Shemirat Shabbos (even doctor on wards are obligated) and Pikuach nefer (certainly docs are obligated)?

As one who trained in such a program, let me share a few potential 'gotchas' (all of which can generally be worked around if you plan carefully) which one can think about when evaluating programs requiring Shabbos call.

- Death Certificates: There is often pressure for rapid signing of death certificates to allow funeral homes and etc. to claim a body. In some hospitals, it is the job of the intern or resident to sign the death certificate. Mitigation: There is, to my knowledge, no requirement that the person signing be a physician in attendance at the death. Asking a non-Jewish trainee to sign is OK from a legal standpoint (check w/ your posek re: amirah le'akum implications, as in this case there is no 'choleh' here!)

- Discharge Prescriptions: Very complicated question of the status of the choleh being discharged and type of melacha allowable; also would vary by the specific illness and possibly even the types/purposes of medications being prescribed. Mitigation: Advanced preparation of prescriptions if often feasible (though sometimes one may not know the discharge plan or scripts the days before); certain very common scripts can be kept as pre-written stock and one might be able to have the clerk stamp the scripts with patients addressograph card; alternative is your friendly neighborhood non-Jewish resident (Amira L'akum plays here, but at least this is on behalf of someone meeting some level of choleh, albeit possibly not yesh bo sakanah if they are being discharged. Speak w/ Posek for parameters).

- Discharge Summary: The discharge summary which is prepared at the time a patient is discharged is primarily for hospital purposes, not the patient's. Mitigation: Check with the hospital during interviews regarding the policies; most allow a 24 hour window (or greater) for preparation. You just need to be sweet enough to convince the ward clerks to hold the charts on the floor for you until after Shabbos!

Note that I am not sharing this to potentially dissuade anyone from considering such a program; I trained in one (with advice from a Rav) and would likely do it again. I am writing this only because my sense from reading this blog is that most of the participants are in early stages of training and may not know all of the situations which will arise and one should prepare for. A few questions during the interview process may help identify where these 'workarounds' will and will not be feasible.

On a related note, Avi, I applaud your description as "residencies which required shabbos call". I find the vernacular term 'non-shomer shabbos residency' a bit loaded if not intrinsically judgemental. Though I grant that the alternative: 'residency which requires shabbos call but in which one is still fully compliant with the halachos of Shabbos' is a mouthful! :-)

At 5:30 PM, Anonymous Michael Oppenheim, MD said...

One more comment I forgot to include -- the easiest way to avoid Amirah La'Akum is to discuss with whomever you know will be on call with you in advance what situations will be problematic for you, so that they will either jump in or respond to circumspect hints (i.e. 'gee, you know they are calling me about Mr. Jones' death certificate). There are logistic limitations with this (e.g. the person needs to be working very nearby, etc.). My best month was with a certain non-Jewish resident who was so helpful that she would respond to these situations without my needing to ask!

At 10:16 PM, Anonymous Avi said...

Thank you for your detailed response to my question. I think you made great point that I would like to echo. For our pre-resident readers: Know what you are getting into before you start!
A Radiology attending told me that her residency required her to take call on shabbos and in addition to ER coverage she was often asked to read left over out-patient films (very hard to justify on shabbos). Initially, she tried many excuses to get out of it-- feeling very uncomfortable. Eventually the evasion tactics became too difficult and she simply resigned to reading the out-pt films. I wonder how she would have ranked this programs had she been aware of this requirement?

Regarding your personal experience: I have found one constant factor that almost every resident that has had a "good" experience in a program that does arrange a shabbos schedule for them has had. A reliable shabbos goy (co-resident). Without the luck of having a very understanding and accomidating gentile resident who is willing to switch calls and do shabbos melachot for you keeping shmiras Shabbos on the wards is practically impossible.
Unfortunately this can;t be figured out in advance.


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