MEDICATIONS ON SHABBOS
(Part 1)

One of several Rabbinic decrees that our Sages enacted in order to guard the sanctity of Shabbos concerns the use of medications. In the opinion and experience of the Rabbis, easy access to medicine could lead to the transgression of certain Shabbos Labors. While issuing the decree, however, the Rabbis were bound by the halachic principle of being as lenient as possible with those suffering pain or distress. Thus, they established guidelines for determining when it is permitted to take medication on Shabbos and when it is not. Towards the end of this discussion, we will list many common conditions which normally require medication and how they are dealt with on Shabbos.

EXPLANATION OF THE RABBINIC PROHIBITION

To determine when one is allowed to take medicine on Shabbos for non-life-threatening conditions, we must focus on two separate halachic considerations. First of all, we must ascertain that none of the thirty-nine Shabbos Labors is being transgressed in any way, either Biblical or Rabbinic. For instance, we cannot prepare medication by either grinding raw material or mixing it; we cannot buy medication at a drug store; we cannot put on a light to see where medication was stored, and so on. In this regard ­ in determining that there is no transgression of the thirty-nine forbidden Shabbos Labors ­ there is no difference between this Shabbos prohibition and any other.

However, the prohibition against using medication on Shabbos is also governed by a Rabbinic decree against using medication on Shabbos even when no forbidden Shabbos Labor is performed. The Rabbis prohibited unrestricted use of medication on Shabbos for fear that it would lead to the violation of one of the thirty-nine Shabbos Labors. The Labor which concerned the Rabbis most was Grinding, since grinding some substance is a prerequisite for almost every medicinal preparation.(1)

Once the Rabbis prohibited using medicine on Shabbos, they included in this prohibition any kind of treatment or procedure which could involve the use of medicine - even if medicine was not actually being used. The classic example in the Shulchan Aruch is the prohibition against the old-time remedy of sweating for medicinal purposes.(2) Sweating can be induced in one of two ways: 1) by taking certain medicines which are prepared by grinding, and 2) by performing certain types of exercises. Even though exercise is totally unrelated to taking medicine and cannot possibly lead to Grinding, it is still forbidden to exercise on Shabbos(3) since one could also induce sweating by the first method ­ taking certain medicines which are prepared by grinding.(4)

If, however, the goal of the treatment or procedure can only be achieved without the use of medicine, then it is permitted to avail oneself of that treatment or procedure. For example, it is permitted to press on a bump with a knife, since the goal, which is to reduce or prevent swelling, cannot be achieved by taking medicine. Similarly, braces may be worn on Shabbos because there is no medicine for aligning teeth properly.

Included in the Rabbinic prohibition are only actions which heal a wound or alleviate pain. If the action merely serves to protect a wound from infection(5) or to shield a healed wound from being re-injured,(6) it is allowed. It is permitted, therefore, to clean and bandage a wound or to pour hydrogen peroxide over it.

The Rabbinic prohibition includes medications only. Food and drink, however, are permitted even when they are being consumed for medicinal purposes. It is permitted, therefore, to drink tea for a sore throat, to eat almonds to relieve heartburn and to chew vitamins which serve as a food supplement.(7)

QUESTION: Why did the Rabbis suspend the prohibition against taking medicine when one feels weak all over or bad enough to lie down?

DISCUSSION: The Talmud rules that the Rabbis suspended many of their decrees for a person who can be classified as "ill," even if not dangerously so. Thus, for example, it is permitted to instruct a non-Jew to do anything which a patient may require on Shabbos, since instructing a non-Jew is a Rabbinic prohibition. Since taking medication on Shabbos is a Rabbinic prohibition, it is suspended when the patient can be classified as "ill." The poskim agree that when one has fever, feels weak all over or feels bad enough to require bed rest, he can be classified as a "patient not dangerously ill" and he is permitted to take medications.(8)

Since "requiring bed rest" and "weak all over" are subjective terms, it is up to each individual to determine his personal pain threshold.

Consequently, one who feels that he must lie in bed for his condition may take medication on Shabbos even though other people in the "same" condition would not go to bed. There is no requirement to be overly stringent when judging the degree of illness.(9)

In addition, healthy infants and babies until the age of three(10) (and according to some poskim even older children till the age of six(11) or nine(12) are also halachically classified as "patients not dangerously ill," which means that the Rabbinical prohibition against taking medication is suspended. They are permitted to take all forms of medicine,(13) provided that no Biblical prohibitions are transgressed.

QUESTION: Nowadays, when medicine is always prepared at a pharmacy, there is no longer any fear that using medicine will lead to Grinding. Why, then, is this Rabbinic prohibition still in effect?

DISCUSSION: Although a minority of contemporary poskim are inclined to be lenient with medication on Shabbos nowadays because of the change in technique,(14) the general consensus is to reject this argument. Some of the reasons offered are as follows:

1. Generally, a Rabbinic decree, once enacted, is not repealed even when the reason behind it no longer applies.(15)

2. There are several homeopathic remedies, such as natural herbs and spices, which are still prepared at home and require grinding. In fact, these types of medications are gaining popularity.

3. In underdeveloped countries, people have never stopped preparing medicines in their own homes.

4. Some modern-day medication may lead to other Biblical Labors, such as Smoothing or Kneading.

In spite of the above, there are some poskim who feel that nowadays we can be somewhat more lenient when interpreting the Rabbinic decree. Although all the poskim agree that we may not do away with the Rabbinic decree altogether, we may, nevertheless, find some room for leniency in case of severe distress or pain (even if the pain is localized and does not require bed rest).(16)

Similarly, several poskim rule that while it is prohibited to begin taking medication on Shabbos unless the person is classified as "ill," still it is permitted to continue taking medicine begun before Shabbos for an ongoing condition which requires daily medication.(17) Other poskim do not agree with this leniency.(18)

In next week’s column we will list various ailments and conditions and what can be done about them on Shabbos.

Rabbi Neustadt is Rav of Young Israel in Cleveland Heights. He may be reached at 216-321-4635 or at jsgross@core.com

FOOTNOTES:

1 Mishnah Berurah 327:1.

2 O.C. 328:42.

3 When the purpose of the exercise is to work up a sweat, see Beiur Halachah, ibid. If the purpose of the exercise is to work up an appetite, it is questionable; see Sha'ar ha-Tziyun 301:9. If the purpose of the exercise is to lose weight for health reasons, it may be prohibited, since weight loss can be (partly) accomplished by taking pills. If the exercise is for pure enjoyment, it may be permitted according to the basic halachah, although it may be considered uvda d'chol, "a weekday activity." A rabbi should be consulted.

4 Mishnah Berurah 328:130.

5 O.C. 328:23, as explained by Harav S.Z. Auerbach (Shemiras Shabbos K'hilchasah 35, note 17). [See Tzitz Eliezer 11:37, who permits drinking certain oils (like castor oil) to aid in the elimination process.]

6 O.C. 328:27. See Igros Moshe O.C. 3:54.

7 Note, however, that the purpose of many vitamins is not to serve as a food supplement but rather to strengthen a weak body or to relieve certain symptoms. In the opinion of many poskim, those vitamins may not be taken on Shabbos; see Igros Moshe O.C. 3:54, Minchas Shelomo 2:37 and Shemiras Shabbos K'hilchasah 34, note 85, quoting Harav S.Z. Auerbach. See, however, Tzitz Eliezer 14:50, who takes a more lenient approach concerning vitamins on Shabbos.

8 Entire paragraph based on O.C. 328:17 and 37 and Mishnah Berurah, ibid. [Note that although Shulchan Aruch rules that a shinui is required for Rabbinic prohibitions to be suspended, the general consensus of the poskim is that this restriction is waived when taking oral medication. When using other medications, however (such as ointment), it is proper to employ a shinui; see Mishnah Berurah 328:85 and 130.]

9 See Tzitz Eliezer 14:50-7 and 17:13.

10 Chazon Ish O.C. 59:4, Harav S.Z. Auerbach in Nishmas Avraham 328:54, and Harav Y.S. Elyashiv in Eis Laledes, pg. 57, quote the age of 2-3.

11 Tzitz Eliezer 8:15-12.

12 Minchas Yitzchak 1:78. In the final analysis, it all depends on the strength and maturity of the child.

13 Rama O.C. 328:17. Note, however, that not all of a baby's needs are exempt from the prohibition against medication; see, for instance, Mishnah Berurah 328:131 and 330:36. See Tehillah l'David 328:24, who deals with this difficulty.

14 The complex preparation that manufacturing modern medicine entails is another reason for leniency, since it may be argued that the Rabbis were fearful that "simple" and quick Labors such as Grinding would be transgressed; they did not fear that someone would engage in the lengthy and involved processing required today.

15 See Igros Moshe O.C. 2:100 for a general explanation of this rule.

16 See Minchas Shabbos 91:9; Ketzos ha-Shulchan 134:7; Chelkas Yaakov 4:41; and Tzitz Eliezer 8:15-15. See also Minchas Yitzchak 3:35, who permits taking aspirin for a headache when one is in severe distress.

17 Rav Shelomo Kluger (Sefer ha-Chayim 328:10 and Shenos Chayim 1:152); Minchas Shabbos 91:9; Chazon Ish (oral ruling, quoted in Imrei Yosher on Moed 97); Harav S.Z. Auerbach (Shemiras Shabbos K'hilchasah 34, note 76 and Tikunim u'Miluim); Harav Y.S. Elyashiv (Koveitz Teshuvos O.C. 40); Tzitz Eliezer 8:15-15:14.

18 Da'as Torah 328:37; Igros Moshe O.C. 3:53.