MEDICATIONS ON SHABBOS

One of several Rabbinical 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 may 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 RABBINICAL 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 Rabbinical. Obviously, 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 Rabbinical 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 is 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: a) by taking certain medicines which are prepared by grinding, and b) 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 swelling, cannot be arrived at by taking medicine. Similarly, braces may be worn on Shabbos because there is no medicine for aligning teeth properly.

Included in the Rabbinical 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 Rabbinical 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: 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 Rabbinical 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(8), the general consensus is to reject this argument. Some of the reasons offered are as follows:

Generally, a Rabbinical decree, once enacted, is not repealed even when the reason behind it no longer applies(9).
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.
In underdeveloped countries, people have never stopped preparing medicines in their own homes.
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 Rabbinical decree. Although all the poskim agree that we may not do away with the Rabbinical 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)(10).

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

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 Rabbinical prohibition. Since taking medication on Shabbos is a Rabbinical 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 medications are permitted to be taken(11).

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. As stated earlier, there is no requirement to be overly stringent when judging the degree of illness(12).

In addition, healthy infants and babies till the age of three(13) (and according to some poksim even older children till the age of six(14) or nine(15)) 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(16), provided that no Biblical prohibitions are transgressed.

LIST OF AILMENTS AND CONDITIONS

Note: Our discussion is limited to adults who are in non-life threatening situations. When in doubt whether or not a situation is life-threatening, consult a rav and/or a doctor.

• abscess - may be squeezed to relieve pressure from pus, even if some blood is secreted in the process(17).
• allergies (mild) - medication may not be taken.
• angina - all medications are permitted.
• asthma - all oral and/or breathing medications may be taken(18).
• athlete's foot - all medications are prohibited.
• back or neck brace - may be put on or removed(19).
• bedridden(20) due to pain - all oral medications may be taken.
• bee sting - the stinger may be removed and the area may be washed with ice water, lemon juice or vinegar, etc. The area may not be soaked, however, in those liquids(21).
• bleeding (slow) - pressure may be applied to a cut to stop bleeding. Sucking or squeezing out blood is prohibited(22).
• broken bone - a non-Jew may be asked to do anything necessary, e.g., make a phone call, drive a car, take x-rays or put on a cast. [If a non-Jew is not available, some poskim permit a Jew to do these actions if they are done with a shinui, in an abnormal manner(23).]
• cold (running nose) - medication may not be taken.
• cough - medication may not be taken. If the cough may be an indication of pneumonia or asthma, medication is permitted.
• cuts and abrasions (minor wounds) - may be washed or soaked in water. Hydrogen peroxide may be poured over a cut. It is not permitted, however, to soak absorbent cotton or paper in such a solution and then wash the wound with it. The wound may be covered with a non-medicated band-aid(24).
• diabetes - all oral medications may be taken.
• dried (or cracked) lips - it is prohibited to apply chapstick or any other medication, liquid or otherwise.
• dried (or chapped) hands - It is prohibited to rub them with either oil, ointment (Vaseline) or lotion. One who regularly uses a pourable, liquid lotion or oil on his hands (whether they are chapped or not) may do so on Shabbos, too, even if his hands are chapped(25).
• ear infection - all medications are permitted. Cotton balls may be inserted(26). Even if the infection is no longer present, the prescription begun during the week must be continued until finished in order to avoid a relapse.
• eye inflammation - eye drops (or ointment) may be instilled in the eye. If the eye is not inflamed but merely irritated, no medication is permitted(27).
• fever - all oral medications may be taken. A conventional thermometer may be used(28). If a person is suffering from high-grade fever, a non-Jew may be asked to do whatever the patient needs in order to feel better(29). If the cause of the fever is unknown, a doctor should be consulted.
• headache - medication may not be taken. If the headache is severe enough so that one feels weak all over or is forced to go to bed, medication may be taken. One who is unsure if he has reached that stage of illness may be lenient and take pain relieving medication(30).
• heartburn - Foods which will have a soothing effect may be eaten. Some poskim permit taking anti-acid medication while others are more hesitant. In a severe case, one may be lenient(31).
• insect repellent - liquid or spray repellents may be used(32).
• migraine headache - all oral medications may be taken.
• nosebleed - the bleeding may be stopped with a tissue or a napkin. If none is available, a cloth napkin may be used(33).
• retainer - may be inserted and removed(34).
• rheumatism - It is prohibited to bathe in therapeutic hot springs(35).
• scab - it is permitted to remove a scab as long as blood is not drawn from the wound(36).
• sore throat - medication may not be taken. Gargling is prohibited(37). Drinking tea or any other hot drink, or sucking a candy, is permitted even if the intention is for medicinal purposes(38). See also 'strep throat'.
• sleep disorder - There are conflicting views among contemporary poskim whether it is permitted to take sleeping pills or no-doze pills(39). One who is weak all over or is bedridden may take these pills. Cotton balls may be used as ear plugs. It is questionable if it is permitted to use pliable ear plugs, which are made from a wax-like material that must be spread to fill the cavity of the ear(40).
• sprains - If the patient is not experiencing severe pain, nothing may be done. If the patient is experiencing severe pain, medication may be taken and a massage may be given. A makeshift splint may be applied, provided that no Shabbos Labors are transgressed.
• splinter under the skin(41) - may be extracted with the fingers, or with tweezers or a needle. If, unavoidably, a little blood is secreted in the process, it is of no consequence(42).
• stitches - a non-Jew is allowed to stitch any wound(43), even if the stitching is done only for cosmetic reasons(44).
• stomach cramps - Unless one is in severe pain or weak all over, it is prohibited to take a laxative or castor oil. Prune juice or any other food or drink is permitted. A hot water bottle is permitted when one experiences strong pains(45).
• strep throat - all oral medications may be taken. Even if the infection is no longer present, the prescription begun during the week must be continued until finished in order to avoid a relapse.
• sunburn (ordinary) - medications are not permitted.
• sweating - it is permitted to sprinkle baby powder on those parts of the body which are perspiring(46).
• swelling - It is permitted to press a knife, etc. against the skin to prevent or minimize swelling(47). It is permitted to wash or soak the swollen area in water(48). It is permitted to place a compress49, ice (placed in plastic bag) or any frozen item over a swollen area(50).
• toothache - a slight toothache may not be treated with painkillers, but one is permitted to drink whiskey, etc., provided that it is swallowed immediately(51). A severe toothache (to the point where one feels weak all over) or gum infection may be treated with oral medication. If the tooth needs to be extracted, a non-Jew may be asked to do so(52).
• weak all over - all oral medications are permitted to be taken.

General Notes:

It is commonly accepted among the majority of poskim that the Rabbinical restriction against taking medications on Shabbos applies to Yom Tov as well(53). The poskim agree, however, that on the second day of Yom Tov(54) and on Chol ha-Moed(55) it is permitted to swallow any medication, even for the most minor of ailments. No shinui is required.

On Shabbos, a pill may be split in half(56) (even on a dotted line(57)) ground into small pieces(58) or dissolved in a cup of liquid(59).

Sometimes (as described above) a medication may not be taken on Shabbos, but not taking it could lead to aggravating a condition to the point where the medication would become necessary and permitted. In such a case, one is allowed to take the medication in order to avoid this eventuality. For example, one who has a headache which, if untreated, tends to escalate to a migraine, may take medication before the migraine sets in(60).

One who suffers from two conditions - one for which he may take medication on Shabbos and another for which he may not - may take medication only for the former(61).

When ointment is permitted to be applied on Shabbos, it is forbidden to first smear the ointment on a gauze square. Rather, before Shabbos a gauze square with ointment on it should be prepared and then placed on the skin on Shabbos(62). If this was not done, the ointment may be squeezed directly from the tube on to the wound and a bandage placed over it. Whatever shinui can be made should be employed, so as to serve as a reminder not to inadvertently spread ointment on the skin ("smoothing"), which is prohibited(63). [If this is impractical, there is a minority view that permits smearing ointment directly on the body provided that all of the ointment is absorbed into the skin and nothing remains on the surface. One should only rely on this leniency under extenuating circumstances.]

FOOTNOTES:

1 Mishnah Berurah 327:1.

2 O.C. 328:42.

3 When the purpose of the exercise it 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, it is 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. A rav 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 and Shemiras Shabbos K'hilchasah 34, note 85, quoting Harav S.Z. Auerbach. See, however, Titz Eliezer 14:50 who takes a more lenient approach concerning vitamins on Shabbos.

8 The complex preparation entailed in manufacturing modern medicine 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.

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

10 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.

11 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 Rabbinical 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.]

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

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

14 Tzitz Eliezer 8:15-12.

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

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

17 O.C. 328:28 and Mishnah Berurah 89.

18 See The Journal of Halacha and Contemporary Society # 6, pg. 47 for a full discussion of how to treat asthma on Shabbos.

19 Based on ruling of Harav S.Z. Auerbach in Tikunim u'Miluim 34, note 111.

20 Even if he is capable of getting out of bed and walking around, but presently he is in bed due to his pain, he is considered as bedridden; Aruch ha-Shulchan 328:19.

21 See Mishnah Berurah 328:141,142. Obviously, one who is allergic to a bee sting must do everything necessary to avert danger.

22 Mishnah Berurah 328:147.

23 This is the view of Shulchan Aruch Harav 328:19 and Eglei Tal (Tochen 18). Some poskim (Harav S.Z. Auerbach, quoted in Shemiras Shabbos K'hilchasah 33, note *17) rule that one may rely on this view, especially when there is "danger to a limb". Note, however, that Mishnah Berurah and Aruch ha-Shulchan and the majority of the poskim do not agree with this leniency.

24 Some poskim (oral ruling by Harav M. Feinstein; Harav S.Z. Auerbach in Tikunim u'Miluim, pg. 58; Harav C.P. Scheinberg, quoted in Children in Halachah, pg. 88; Az Nidberu 7:34,35) permit removing the protective tabs from a band-aid, while other poksim (Minchas Yitzchak 5:39-2; Harav Y.S. Elyashiv, quoted in Machazeh Eliyahu 70) are stringent. It is proper to prepare band-aids for Shabbos use by peeling off their protective tabs and re-sealing them before Shabbos. Once they have been prepared in this fashion, they may be used on Shabbos (Tzitz Eliezer 16:6-5).

25 Based on O.C. 327:1.

26 It is prohibited to tear cotton balling on Shabbos; Shemiras Shabbos K'hilchasah 35:19 and Tikunim u'Miluim; Minchas Yitzchak 4:45.

27 O.C. 328:20. See also Eglei Tal (Tochen 17).

28 O.C. 306:7. Before using it, the mercury may be shaken down.

29 Mishnah Berurah 328:46, 47.

30 See Ketzos ha-Shulchan 138, pg. 100; Minchas Yitzchak 3:35; Be'er Moshe 1:33; 2:32.

31 See Ketzos ha-Shulchan 138, pg. 98; Tzitz Eliezer 8:15 (15-21); Az Nidberu 1:31; Shemiras Shabbos K'hilchasah 34:4.

32 Shemiras Shabbos K'hilchasah 14:31; Shalmei Yehudah, pg. 179.

33 Mishnah Berurah 328:146.

34 Harav S.Z. Auerbach, quoted in Shemiras Shabbos K'hilchasah 34:29. See Tikunim u'Miluim for the reason that it is not considered mesaken.

35 Mishnah Berurah 328:137.

36 O.C. 328:22 and Mishnah Berurah 90.

37 O.C. 328:32.

38 O.C. 328:37.

39 See Minchas Yitzchak 3:21, Tzitz Eliezer 9:17, Be'er Moshe 1:33 and Shalmei Yehudah, pg. 176 for the various views.

40 Harav S.Z. Auerbach (Tikunim u'Miluim 14:39) permits their usage while Harav Y.S. Elyashiv (Shalmei Yehudah, pg. 179) and Az Nidberu 3:21 do not.

41 If the thorn or splinter is under a fingernail, it may be considered dangerous.

42 Mishnah Berurah 328:88 and Sha'ar ha-Tziyun 63.

43 See Nishmas Avrohom, vol. 4, O.C. 340 who quotes Harav S.Z. Auerbach and Harav S. Y. Elyashiv as ruling that stitching a wound may be a Biblically prohibited activity. Accordingly, only a non-Jew may do it, unless it is a life threatening situation.

44 Ibid. See also Shemiras Shabbos K'hilchasah 33, note 23 and 35, note 62.

45 Mishnah Berurah 326:19. The same halachos apply to one who suffers from diarrhea.

46 Shemiras Shabbos K'hilchasah 34:12.

47 Mishnah Berurah 328:124.

48 Tzitz Eliezer 8:15 (15-12).

49 In order to avoid several possible prohibitions, only paper towels or napkins should be used and care should be taken not to squeeze them

50 Harav S.Z. Auerbach (Tikunim u'Miluim 34, note 87); Be'er Moshe 1:33-18.

51 O.C. 328:32. It may not be retained in the mouth longer than usual, nor may one rinse his mouth with it and then spit it out.

52 Rama O.C. 328:3. See Tzitz Eliezer 9:17 (2-11).

53 Mishnah Berurah 532:5. There is a minority opinion that permits taking medications on Yom Tov, see Tzitz Eliezer 8:15 (16) who quotes this opinion and rules that when in distress one may rely on this view.

54 Mishnah Berurah 496:5.

55 O.C. 532:2.

56 Harav S.Z. Auerbach, quoted in Shemiras Shabbos K'hilchasah 33:4.

57 Harav S.Z. Auerbach, quoted in Nishmas Avraham, vol. 5, pg. 225.

58 Rama O.C. 321:12.

59 See Mishnah Berurah 320:34,35.

60 Shemiras Shabbos K'hilchasah 34:16.

61 Igros Moshe O.C. 3:53.

620 Shemiras Shabbos K'hilchasah 33:14.

63 Chazon Ish O.C. 52:16.

Weekly-Halacha, Copyright © 2000 by Rabbi Neustadt, Dr. Jeffrey Gross andProject Genesis, Inc.

Rabbi Neustadt is the principal of YavneTeachers' College in Cleveland, Ohio. He is also the Magid Shiur of a dailyMishna Berurah class at Congregation Shomre Shabbos.

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