Medical Halachah: Minyan vs Medicine

Gd-willing, I'll present a shiur on Monday night regarding the conflicts a doctor faces between taking care of patients and managing his other mitzvah responsibilities. Obviously, doctors who are taking care of patients are engaged in great service of Gd as well as Man, but how should a doctor find balance between medical mitzvot and other mitzvot?

Here are the specific questions I hope to address; feedback would be most welcome-

1. How do I choose between religious observance and non-critical patient care? Is it better to keep patients in a waiting room while praying minchah, or am I exempt from prayer? May I recite abbreviated prayers, or pray while driving? Do we differentiate for women and men?

2. How do I manage a Passover Seder while on call? What sections should be prioritized?

3. I know that I will need to see patients in the hospital on Shabbat, Yom Tov or Yom Kippur in the coming weeks. I will do my best to do so according to Jewish law regardless of which day I am in the hospital, but how do I prioritize between these special days?

UPDATE: Here is the source sheet I intend to use-
 

A core principle: One who is involved in a mitzvah is exempt from further mitzvot

1.   Talmud, Succah 25a-b

משנה שלוחי מצוה פטורין מן הסוכה...

גמרא מנא הני מילי דתנו רבנן "'בשבתך בביתך' פרט לעוסק במצוה"...

והעוסק במצוה פטור מן המצוה מהכא נפקא? מהתם נפקא דתניא "'ויהי אנשים אשר היו טמאים לנפש אדם וכו'' אותם אנשים מי היו? נושאי ארונו של יוסף היו, דברי רבי יוסי הגלילי. רבי עקיבא אומר מישאל ואלצפן היו שהיו עוסקין בנדב ואביהוא. רבי יצחק אומר אם נושאי ארונו של יוסף היו כבר היו יכולין ליטהר, אם מישאל ואלצפן היו יכולין היו ליטהר! אלא עוסקין במת מצוה היו..."! צריכא, דאי אשמעינן התם משום דלא מטא זמן חיובא דפסח, אבל הכא דמטא זמן קריאת שמע אימא לא, צריכא. ואי אשמעינן הכא משום דליכא כרת, אבל התם דאיכא כרת אימא לא, צריכא...

תניא "אמר רבי חנניא בן עקביא כותבי ספרים תפילין ומזוזות הן ותגריהן ותגרי תגריהן וכל העוסקין במלאכת שמים לאתויי מוכרי תכלת פטורין מקריאת שמע ומן התפילה ומן התפילין ומכל מצות האמורות בתורה, לקיים דברי רבי יוסי הגלילי שהיה רבי יוסי הגלילי אומר העוסק במצוה פטור מן המצוה."

תנו רבנן "הולכי דרכים ביום פטורין מן הסוכה ביום וחייבין בלילה. הולכי דרכים בלילה פטורין מן הסוכה בלילה וחייבין ביום. הולכי דרכים ביום ובלילה פטורין מן הסוכה בין ביום ובין בלילה. הולכין לדבר מצוה פטורין בין ביום ובין בלילה."

Mishnah: Those who are on a mitzvah mission are exempt from Succah.

Gemara: How do we know this? The sages taught, "'When you lie down in your house' excludes one who is involved in a mitzvah"…

But do we learn [this lesson] from this source? It is deduced from that: "'And there were men who were impure from contact with the dead' – Who were those men? The bearers of Joseph's casket, per R' Yosi haGlili. R' Akiva said they were Mishael and Eltzafan, who were involved with Nadav and Avihu. R' Yitzchak said the bearers of Joseph's casket could have purified themselves, and Mishael and Eltzafan could have purified themselves; rather, these were people involved in a body which had no one else…"!

We need both cases. From the Pesach case I would have said the exemption is limited, because they became impure before the time for Pesach, but where the time for Shema has arrived one would not be exempt [if he began a different mitzvah]. And from the Shema case, I would have said one is exempt only because there is no harsh penalty involved, like kareit, but in a case [like Pesach] involving kareit this would not be so. Both are necessary…

We have learned, "R' Chanania ben Akavyah said: Those who write Torah scrolls, tefillin and mezuzot, and their merchants, and their merchants' merchants, and all who do Heavenly work – which includes techelet merchants – are exempt from Shema, the amidah and tefillin and all biblical mitzvot, as R' Yosi haGlili said, 'One who is involved in a mitzvah is exempt from another mitzvah.'"

We have learned, "Those who travel by day are exempt from Succah by day, and are obligated at night. Those who travel at night are exempt from Succah at night, and are obligated by day. Those who travel at both day and night are exempt from Succah day and night. Those who travel for a mitzvah are exempt during day and night."

What if he can fulfill both mitzvot?

2.   Ran Succah 11a ואיכא

העלו בתוספות דלא פטירי אלא היכא שאם יקיימו מצות סוכה יבטלו ממצותיהן ואמרינן בגמרא [דף כו א] דרב חסדא ורבה בר רב הונא כי הוו עיילי לשבתא דריגלא לבי ריש גלותא הוו גנו ארקתא דסורא ואמרי אנן שלוחי מצוה אנן ופטרינן בכה"ג נמי הוא דאי מטרדו בקיום מצות סוכה הוו מפגרי ממצותן. ולא נ"ל כן דפשטא דמילתא לא משמע כן

Tosafot suggested that one is exempt only if fulfilling Succah would cause him to be unable to fulfill his other mitzvah. The gemara mentions that Rav Chisda and Rabbah bar Rav Huna travelled to the Exilarch's house for the Shabbat of the holiday and slept along the shore in Sura, saying they were en route to a mitzvah and therefore exempt; Tosafot says that this is only where involvement in Succah would have caused them to be delinquent from their mitzvah. This does not appear correct to me, though; the language does not indicate that.

3.   Talmud, Berachot 30a

והיכי מצלי לה? רב חסדא אמר מעומד, רב ששת אמר אפילו מהלך. רב חסדא ורב ששת הוו קאזלי באורחא, קם רב חסדא וקא מצלי. אמר ליה רב ששת לשמעיה, מאי קא עביד רב חסדא? אמר ליה קאי ומצלי. אמר ליה אוקמן נמי לדידי ואצלי, מהיות טוב אל תקרא רע.

How does one recite [the wayfarer's prayer]? Rav Chisda said: While standing. Rav Sheshet said: Even while travelling.

Rav Chisda and Rav Sheshet were travelling, and Rav Chisda halted to pray. Rav Sheshet said to his servant, "What is Rav Sheshet doing?" He said, "He has halted, and he is praying." Rav Sheshet said, "Halt me, too, and I will pray; given the chance to be good, do not be called bad."

4.   Talmud Yerushalmi, Berachot 1:2

כותבי ספרים תפילין ומזוזות מפסיקין לק"ש ואין מפסיקין לתפילה ר' חנינ' בן עקביה או' כשם שמפסיקין לק"ש כך מפסיקין לתפילה ולתפילין ולשאר כל מצותיה של תורה

Those who write Torah scrolls, tefillin and mezuzot stop for Shema and not for the amidah. R' Chanina ben Akaviah said: Just as they stop for Shema, they stop for the amidah, tefillin, and all other biblical mitzvot.

5.   Shulchan Aruch Orach Chaim 38:8

כותבי תפילין ומזוזות הם ותגריהם ותגרי תגריהם וכל העוסקים במלאכת שמים, פטורים מהנחת תפילין כל היום, זולת בשעת ק"ש ותפלה. הגה: ואם היו צריכים לעשות מלאכתן בשעת ק"ש ותפלה, אז פטורין מק"ש ותפלה ותפילין. דכל העוסק במצוה פטור ממצוה אחרת אם צריך לטרוח אחר האחרת, אבל אם יכול לעשות שתיהן כאחת בלא טורח, יעשה שתיהן.

R' Yosef Karo: Those who write Torah scrolls, tefillin and mezuzot, and their merchants, and their merchants' merchants, and all who do Heavenly work are exempt from tefillin all day, other than during Shema and the amidah.

R' Moshe Isserles: If they need to do their work during Shema and the amidah, they are exempt from Shema, the amidah and tefillin, for one who is involved in a mitzvah is exempt from other mitzvot if he would need to strain to fulfill the other mitzvah. If he can fulfill both without strain, though, then he should fulfill both.

Two possible limitations

6.   Rabbeinu Nisim (14^th century Spain), Succah 11a ואיכא

ודאי בשעה שהאבדה משומרת בתיבתו לא מפטר

Certainly, when the lost object is guarded in his safe then he is not exempt.

7.   R' Yaakov of Lissa (18^th century Poland), Netivot haMishpat, Choshen Mishpat 72 Biurim 19

החיוב מוטל על כל אדם ליתן צדקה, אבל אין חיוב ומצות עשה מוטל על שום אדם להיות גבאי צדקה, דאם היה מצות עשה להיות גבאי היו כל ישראל מחוייבים להיות גבאים

All are obligated to give tzedakah, but there is neither obligation nor mitzvah for any particular person to be a tzedakah collector. Were there such a mitzvah, all Israel would be obligated to become collectors.

8.   Rashi to Succah 26a

תגריהן - הלוקחין מהן כדי למכור ולהמציאן לצריך להם

"Their merchants" – Who purchase from the scribes, to sell them and make them available to those who need them.

9.   R' Avraham Gombiner (17^th century Poland), Magen Avraham 38:8

משמע דאם עושה כדי להשתכר בו לא מקרי עוסק במצוה וצ"ע בנדרים דף ל"ג משמע דמחזיר אבידה הוו עוסק במצוה אע"פ שנוטל עליו שכר וי"ל דהתם אינו נוטל אלא שכר בטלתו א"נ התם עיקר כוונתו להשיב אבדה אבל הכא עיקר כוונתו להשתכר

It sounds as though one who sells them for profit is not called "involved in a mitzvah". This requires examination, for Nedarim 33 sounds like one who returns a lost object is called"involved in a mitzvah" even if he is paid! Perhaps that is different because he is only paid for time lost from work. Alternatively, his main intent is to return the lost object; merchants intend to profit, primarily.

Applications

10.      R' Dr. Avraham Sofer Avraham (21^st century Israel), Nishmat Avraham Orach Chaim 38:6

כותב הגר״י זילברשטיין שליט״א: רופא או אחות אעפ״י שכל עבודתו הוא רק עבור שכר, גם רופא כזה הוא משיב אבידה - ואין לך משיב אבידה גדולה מזו – ולכן מכיון שבשעת עבודתו הוא אינו מתכוין לשכר כלל אלא עוסק בסתם לשם ריפוי החולה, וטיפולו (וה״ה אחות) הוא עצם המצוה, יש לו דין כעוסק במצוה.

R' Yitzchak Zylbershtein wrote: Even though doctors and nurses are paid for their work, still, they are like people returning lost objects – and there is no greater restorer of a lost object! Therefore, since he does not think about profit at all while working, but is only involved in healing the patient, and his care, or that of a nurse, is the mitzvah itself, he has the status of one who is involved in a mitzvah.

11.      R' Yisrael Meir Kagan (20^th century Poland), Biur Halachah Orach Chaim 38 הם

המסחור בעניני תפילין לא נזכר בשום מקום למצוה ואפילו אם נאמר דמה שהוא מוכר לאיזה אדם הצריך תפילין הוא בכלל עוסק במצוה עכ"פ בשעה שהוא קונה התפילין מהסופר כדי לסחור בהם אין שם לע"ע עצם פעולת המצוה כלל בהמעשה גופא

Commerce in tefillin is never considered a mitzvah. Even if selling it to someone who needed tefillin would be considered 'involvement in a mitzvah', still, when the merchant buys them in order to sell them he is not actively involved in a mitzvah with that action.

12.      R' Avraham Gombiner, Magen Avraham 93:5

וא"צ להתפלל מנחה שתים כיון דבשעת חובתו היה פטור מן הדין

He need not recite minchah twice; during the obligation, he was legally exempt.

13.      R' Dr. Avraham Sofer Avraham, Nishmat Avraham Orach Chaim 93:2

רופא שהתחיל לנתח או לראות חולים במרפאתו אחרי זמן מנחה ולא גמר עד שעבר זמן התפלה חייב להתפלל ערבית שתים

If a doctor begins to operate or to see patients in his clinic after the (earliest) time for minchah, and he does not finish until the time for prayer has passed, then he must pray maariv twice.

14.      Talmud, Berachot 20b

וחייבין בתפלה דרחמי נינהו

Women are obligated in prayer, for it is [a request for] mercy.

15.      R' Dr. Avraham Sofer Avraham, Nishmat Avraham Orach Chaim 93:1

שמעתי ממו״ר הגרי״י נויבירט שליט״א שרופא פטור מתפלה, לא רק בזמן שהוא בודק ומטפל בחולה (אפילו שאין בו סכנה) אלא גם בזמן שהוא עסוק בכתיבה בתיק החולה ואפילו בזמן שהוא כותב מכתבי שחרור, כי כל זה מוגדר כעוסק במצוה

I have heard from my master R' Yehoshua Neuwirth that a doctor is exempt from prayer not only when he is examining or treating a patient – even without danger to life – but even when he is writing in the patient's record, and even when he is writing release documents. All of this is "involvement in the mitzvah."

16.      R' Yisrael Meir Kagan, Biur Halachah Orach Chaim 38 אם

וכן החופר קבר למת פטור מכולם אע"פ שנח מעט שגם בשעת נוחו נקרא עדיין עוסק במצוה שעי"ז יתחזק כוחו לחזור ולחפור

So, too, one who digs graves is exempt from all of these even when he rests for a bit; during his rest he is called 'involved in a mitzvah', for through this he regains strength and returns to dig.

17.      R' Yisrael Meir Kagan, Mishneh Berurah 640:11

ואם הוא חולה שיש בו סכנה נראה דיש להקל גם בשעה שא"צ לו

In caring for a dangerously ill patient, it appears that one should be lenient even when the patient does not need him.

18.      R' Yisrael Meir Kagan, Mishneh Berurah 640:10

ואם יש שני משמשים וא"צ לשניהם בבת אחת צריך לאכול אחד בסוכה בעת שימושו של השני

If there are two caretakers and they are not needed simultaneously, one must eat in the succah while the other works.

19.      R' Yisrael Meir Kagan, Mishneh Berurah 70:18

ואם יכול להפסיק לק"ש ואח"כ לחזור ולגמור צרכי צבור בלא טורח יפסיק.

If one can stop for Shema and then return and complete communal needs without strain, he should stop.

Things people say on their deathbeds

[This week's Haveil Havalim is here]

The other day I heard someone use the old line, "No one ever said on their deathbed, 'I wish I'd spent more time at the office.'" (I've seen it attributed to Paul Tsongas, but I don't know that he originated it.) I've been at deathbeds, and I can tell you that this is false.

The facile nature of popular aphorisms should come as no surprise; this is only one of many pieces of 'wisdom' which don't stand up to examination. Like, "Your mind is like an umbrella – it only works when it's open." Who says? Maybe your mind is like a bottle-cap – it only works when it's twisted. Or your mind is like bulghur wheat - it only works when it's cracked. Or your mind is like a fire door – it only works when it's closed. Or your mind is like a seat belt – it only works when it's buckled… But back to our point.

People do say, "I wish I'd spent more time at the office", just in different words. They say, "I wish I had provided for my wife." They say, "I wish I had been a better role model for my kids' work ethic." They say, "I wish I had made a mark on the world."

So why do we devalue the time spent at the office?

Maybe it's because we disconnect the effort from the results, because the effort can be so frustrating, or because the effort does not necessarily lead to the results in any case, or because the effort itself [lining up widgets, managing accounts, calculating risks] seems meaningless. So we value the results, and we reject the process.

In the secular world this isn't a big deal, because devaluing work isn't a big deal so long as you do the work. But I think the same phenomenon exists in many Jews' attitude toward Judaism, where it's religiously dangerous. To Judaism, the process, the mitzvah, is often more important than the results, and shorting the process is the same as shorting the result.

Example: People run out of minyan before its over, or, if they are tzaddikim gemurim with endless resources of patience, the moment it's over. [I'm guilty of this, too, although that's generally because I can't be late to drop my kids off at school and arrive at the beis medrash.] We value what comes from davening – the connection to Gd, the reality check of where we are as Jews, the feeling of humility – but we devalue the work/mitzvah that brings us there, even though that work has inherent value.

Example: People want to learn Torah in the most expedient, quickest way possible. They want their children to learn in the most efficient way, so that they will be able to pack in other studies. We want to know, we want our children to know – but the process itself is not valued. For many, Talmud Torah is valued as a means to an end, not an end unto itself.

So it's fine if people don't say, "I wish I'd spent more time at the office" - that's not the end of the world, as long as they work. But if Jews don’t say, "I wish I'd spent more time at minyan," "I wish I'd spent more time learning Torah," there will be problematic consequences.

I visit chabad.org on Shabbos

(No, I don’t, but you’ll see what I mean in a few paragraphs.)

“Thou shalt not study Torah,” beginning at midday today, erev Tisha b’Av, as part of our mourning for the Beit haMikdash.

As the gemara (Taanit 30a) explains, “One may not learn Torah, Neviim or Ketuvim, or study mishnah or talmud, midrash, halachot or aggadot.” There are permitted exceptions, principally for sad topics and study related to mourning, but the overall theme is that Torah learning is a joyous experience, so we don’t engage in it on Tisha b’Av.

[I wonder if this law is not also related to the aftermath of the Golden Calf. Per the midrash, when the Jews received the Torah they also received special crowns. After the Golden Calf, HaShem instructed them, “Remove your crown” (Shemot 32:5-6), apparently a reference those crowns. “You have sinned; you don’t deserve to don the glory of Torah.”]

Many of us take this law lightly; how could Gd punish a Jew for studying Torah?

And we have other such limitations on Torah study. We are not to think about Torah in the bathroom, or when inappropriately dressed. We are taught that it is sinful to study Torah without first reciting birchot hatorah, the special blessings for Torah study. And for all of them, there are those who ignore them; how could Gd punish a Jew for studying Torah?

It reminds me of the Jew who studies the parshah every Shabbat by reading divrei torah on torah.org, or ou.org, or chabad.org.

Were this Jew not reading divrei torah on-line, he would likely be engaged in some other activity that I consider desecration of Shabbat – shopping at the mall, driving to a park, talking on the phone, flipping channels on TV. In that sense, it’s better that he read divrei torah, I suppose.

Again: How could Gd punish a Jew for studying Torah?

I suppose it comes down to our sense of ownership of Torah, our feeling that we have a certain right to evaluate and set priorities among its various imperatives. A mitzvah is only a mitzvah when the Torah defines it as a mitzvah.

Perhaps a good Tisha b’Av example of this is in the Kamtza/Bar Kamtza story (Gittin 55b-56a, and see also the version in Eichah Rabbah), when the sages are seated at a feast and Bar Kamtza is embarrassed by the host.

The sages don’t protest, because they think it’s better to be humble (see the Eichah Rabbah version, especially). But the Torah’s priority is to protect Bar Kamtza, who is being attacked.

And perhaps the same thing happened with the rabbis in the Brooklyn/New Jersey scandal of this past week. Maybe they thought they were helping generate tzedakah money, maybe they had some other justification for committing these financial crimes. [I am NOT justifying it; my point is that people who set their own priorities get into trouble.]

When we set our own priorities, we get skewed results and rationalizations. Better to hold off on Torah (other than the permitted parts) during Tisha b’Av, remove the crown, absorb the intense reality of exile, and get started on rebuilding the Beit haMikdash.

[Of course, the big problem is when skewed-view human beings try to define the Torah’s objective priorities… implementation is harder than theory…]