Along For the Ride

Among the common Halachic questions that arise in cases of patients who need to be taken to the hospital on Shabbos, aside from those regarding methods of transport and the specific Halachos about traveling in or operating a vehicle, is whether someone may accompany the patient. Various scenarios arise in this context, each with their own nuances, and we will discuss some of the main cases and the rulings given by the Poskim.

In general, the Poskim assume that when a patient must be taken to the hospital on Shabbos, he is considered a Choleh sheYesh Bo Sakana even if he is attended by a medical team, and a family member (or another trusted person) may join him. Likewise, if the family member is elsewhere and the patient is taken to the hospital without a relative or acquaintance, one may call the family member to meet the patient there.

There are two main approaches utilized by the Poskim to explain this Halacha:

1. The presence of a family member may help or improve the patient’s treatment by providing important information or advocating for the patient.
2. Even in cases where the presence of family members does not directly affect the treatment, if the patient is frightened or worried that he may not receive proper care, the presence of a family member can calm him and ease his anxiety.

When examining the Teshuvos of leading contemporary Poskim, we find some differences in emphasis between these reasons, and these distinctions are significant. A few examples follow:

The Shemiras Shabbos Kehilchasa (40:82) rules that a relative (or any trusted person) may accompany a patient with a life-threatening condition on the trip to the hospital, even if someone already in the vehicle can provide any necessary medical assistance. A family member may also travel independently to the hospital to be with the patient if this is necessary for the patient’s medical care – for example, if he can provide important information relevant to the patient’s treatment. Accordingly, one must assess whether this individual will, in fact, be able to assist the patient.

R’ Shmuel Wosner zt”l (Shevet HaLevi 8:65) asserts that if an elderly person was taken to the hospital on Shabbos without accompaniment, one may desecrate Shabbos (even violating Issurim d’Oraisa) to inform his family if it relates to the patient’s treatment. For instance, the family may consult a specialist who is better equipped to help save the patient’s life. This consideration is particularly pertinent for elderly patients, as some physicians may be more inclined to assess the prognosis as less favorable and decide against pursuing aggressive treatment options. According to R’ Wosner, the leniency would apply only to a relative who can meaningfully influence the patient’s treatment – for example, by arranging for a specialist or advocating to the medical team on the patient’s behalf.

R’ Nissim Karelitz zt”l (Chut Shani 4, p242–243) rules that when a patient with a life-threatening condition must travel to the hospital on Shabbos,  it is permissible to be Mechalel Shabbos to inform his family about his condition so they can come stay with him. This is because he may need the assistance or judgment of a family member in making treatment decisions. In addition, the mere presence of family members may lead to the patient receiving better care.

These two considerations add to the ones above: The emphasis is on the relative’s ability to make decisions and assist in discussions, as well as the effect that a family member’s presence can have on the quality of care. In this regard, the presence of adult relatives often influences a patient’s treatment, since a patient with no visitors may not receive the same attention from his care team as one with concerned companions at his bedside.

R’ Yitzchak Rubin Shlit”a (Orchos Shabbos 20:28) explains that this only applies when the patient needs an escort, as is the case with children or with weak or debilitated patients. This may also be pertinent in circumstances where issues arise that necessitate judgment that the patient may not be capable of exercising. He further points out (footnote 34) that R’ Shlomo Zalman Auerbach Zt”l ruled that one should accompany a patient to see the doctor since one may be able to urge the doctor not to delay.

The Nishmas Avraham (second edition, 1, p. 236), citing R’ Yehoshua Neuwirth, states that in the case of a life-threatening situation, family members may violate Shabbos to reach the hospital, because it is obvious that the treatment of a patient who has a relative at his bedside is superior. See also Igros Moshe (O.C. 1:132) and Or l’Tzion (2:36:23), who discuss accompanying a woman in labor and limit the leniency to cases where she requests the escort and is afraid without it.

The Biur Halacha (278, s.v. l’Chabos) rules that the concept of “Yisuvei Da’ata” (settling a patient’s mind) applies to anyone in a life-threatening condition, not only to a woman in labor, and it is permitted to violate Shabbos for him.

On this basis, the Poskim permit a family member to come on Shabbos to be at a patient’s bedside, since the presence of a relative beside the patient serves to calm and reassure him.^[1] In such a case, the permission to desecrate Shabbos applies even if the patient himself does not request it (Shemiras Shabbos Kehilchasa, ibid.).^[2] However, this reason alone is insufficient to justify Chillul Shabbos when the patient is unconscious, since he will not be reassured by having someone at his side when he is in that condition.

Another practical implication concerns a patient who has been hospitalized for an extended period and is not expected to undergo any medical treatment on Shabbos. If he asks that his family be called so he will not remain alone, it would appear that one should not violate Issurim d’Oraisa to call the family, but Issurim d’Rabbanan would be permitted, such as asking a non-Jew to call them or drive them. The rationale is that, in many cases, when hospitalization is prolonged and the patient’s condition remains stable, family members are not required to support or enhance treatment, and the need to reassure the patient is less relevant.^[3]

We should also note that if the patient is at risk of delirium, and the presence of family members at his side reduces that risk (as commonly occurs with elderly patients, particularly those with dementia), haGaon Rav Asher Weiss Shlit”a rules that one may instruct a non-Jew to call the family.

If there are reasonable grounds to believe that remaining alone could be dangerous for a patient and might lead to Sakana, a Jew may desecrate Shabbos to call family members.^[4] The Shevet haLevi (ibid.) explains that in any case where there is a real concern that the patient could be endangered without his relatives present, there is room to permit even an Issur Torah.

[1] See Kovetz Igros Chazon Ish (1:141), Igros Moshe (O.C. 1:132); Shemiras Shabbos Kehilchasa (40:82, 32:26), and Chut Shani (4, p244).

[2] See also Orchos Shabbos (p20, footnote 32).

[3] In this regard, see the Shemiras Shabbat Kehilchasa (32:25, & 38:3) and Shevet haLevi (ibid.). Shemiras Shabbos Kehilchasa (38:21) also states that, according to the Har Tzvi (Y.D. 293), a Jew may join a non-Jew in traveling by car.

[4] See the Aruch haShulchan (306:20) and Chut Shani (4, p245).