Wednesday, June 15, 2011

Class: Medical Imaging on Shabbat

[Update - June 19: The audio for the shiur and the source sheets (with updated vignettes) are now available on-line here.]

I'm in preparations for our next Medical Halachah shiur, this Sunday morning. As those of you who have read previous posts on this series know, this is meant to be a practical, halachah-oriented series (as opposed to a series on abstract cases like separating conjoined twins), especially as it is given for CME credit.

The topic is "Medical Imaging on Shabbat". Here are the vignettes I plan to use; feedback would be helpful.

Vignette #1 – Alan, 11, is standing on the sidewalk on Shabbat when he is struck by a bicycle. He falls to the ground, and suffers what seems to be a fractured wrist. May he undergo an X-Ray on Shabbat? Does the answer change if he was struck by an automobile? Does the answer change if this is a digital X-Ray?

Vignette #2 – Susan, 56, presents in the emergency room in mid-winter, on Shabbat, with a bad cough, fever and chest pains. The symptoms look like pneumonia. May the physician order a chest X-ray in order to rule out lung cancer? What about a CT scan?

Vignette #3 – Janet, 35, is undergoing IVF. Her schedule requires ultrasounds on Day 4 and Day 6 of her second week of injections. Assuming Janet can arrive at the hospital without violating Shabbat, is she permitted to have the actual ultrasound?

10 comments:

  1. looks fascinating. What type fo feedback you interested in? Im sure ur already looking at the obvious Medical sefarim--dr. steinberg's etc ? Brad

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  2. case one and case 2 should be combined--ask the question about ct scan vs digital x-ray and separately ask about sakanas eiver and guf and mi'yad versus long term. one variable at a time if possible--that's how'd i'd do it. But you know better than me. Brad

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  3. Shalom RosenfeldJune 15, 2011 at 4:20 PM

    1&2: As my father's posek says:

    DO. LIKE. TUESDAY.

    3: much more complicated

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  4. Here's some thoughts from an engineering perspective:

    Xray tubes are similar to a radio tube; they have a glowing filament. So they are like an incandescent bulb which everyone agrees cannot be switched on on Shabbat. So it wouldn't make a difference whether the xray is being taken with a digital sensor versus film (was that the basis of comparing the two? ie. image on a screen vs developing film?). Maybe use of a gramma switch might help. The issue I think is whether the limb is in danger and whether it could just as well be treated without the xray or not.

    In case #2, I believe xrays are routinely done with these symptoms to rule out pneumonia, not to rule out cancer. But since suspected pneumonia could start to be treated with antibiotics without the xray, I would think the xray could wait. I don't see the difference between xray and CT scan; both use xrays and have the hot filament issue.

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  5. Thanks, all.

    Brad-
    I differentiate because of issues of following standard procedure - and distinguishing between global standard procedure and the physician's personal standard procedure.

    Shalom-
    Ah - but whose Tuesday? (See my comment to Brad.)

    Michael-
    The digital/film difference is regarding the definition of כתיבה.

    Re: CT/X-Ray - See my comment to Brad above.

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  6. With regard to three Rav Asher Weiss states it can be performed by a non-Jew,if it couldn't be performed prior to Shabbat.
    Techumin 23.
    One and two are dependent on that the sickness of the "evor" can lead to safek pikuach nefesh ex.systemic infection and there for would be permissible.

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  7. In one with regard to an automobile there,in my opinion, is no question everything should be done because other injuries may be detected because of the impact of the car as opposed to the bicycle.
    But if any question we are machmir in pikuach nefesh.
    Rav Chaim Brisker was asked why are you so makil with regard to health issues.He stated I am not-I am machmir in pikuach nefesh.

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  8. Shalom RosenfeldJune 16, 2011 at 7:50 AM

    Michael -- great point. My impression is the discussion had centered around whether making an x-ray image is "writing"; I hadn't thought about the analogy from an x-ray tube to an incadescent bulb -- but isn't there talk about solid-state x-ray machines?

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  9. Shalom, AFAIK solid state Xray is still experimental and produces low energy level beams. Not enough for medical diagnostics at this point in time.

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  10. daat y-
    Make sure to see the articles by R' Weitzman and R' Lau there as well.

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