Do the Ashkenazim follow the p’sak of the Rama with regards to pikuach nefesh?

In the last shiur we mentioned the Rama [1] who says that provided there are no adverse effects to the patient, one should deal with pikuach nefesh b’shinui, e.g. with the back of one’s hand, or if possible, request a gentile to violate the Shabbos.

The Taz [2] however argues and says that when a Jew’s life is in danger, even if a gentile is present he should not be used and the Jew should be speedy and save a life.

The Mishna Berura [3] cites the Taz, which implies that he favors this opinion and indeed when a Jew’s life is in imminent danger, a Jew should do all that is possible and as quickly as possible to save another Jew’s life.

Does that disqualify the use of a gentile or doing anything b’shinui?

Not exactly. We must differentiate between an imminent life threatening situation, where every minute counts, in which case we say that a Jew should deal with the situation and not dally and between a case of pikuach nefesh where the patient is not in any immediate danger, in which case one may request a gentile to violate the Shabbos and one should do a shinui if possible.

For example, a newborn baby is placed beneath a heater in order to provide the heat the child had in the mother’s womb. This heater must be turned on Shabbos for the baby, but it can easily be done by asking a gentile to turn it on or by activating the switch b’shinui.

A patient must be taken for a CAT scan, which involves wheeling him from his room to the CT room. Although he must ride the elevator, there is no need to press the button in the normal manner and there is nothing wrong in asking a gentile to press the button instead of a Jew.

One of the reasons not to use a gentile is because people are liable to think that only a gentile may be used for pikuach nefesh. If so, they may think the same when turning on the heater for the newborn baby?

Correct, and the same problem exists when turning it on b’shinui.

Rav Shlomo Zalman Auerbach ztz”l writes [4] that when doing it b’shinui one should announce to people in the vicinity that halachically one may do it in the normal manner when there is a possibility that doing it b’shinui will be cause for a delay in treating the patient.

We can say the same when using a gentile for the abovementioned examples.

The bottom line is that when the threat is immediate a gentile must not be used nor should anything be done b’shinui, but when there is no rush one can request that a gentile do the deed or try and do it b’shinui. Even in the latter case it is expected that there be no adverse effects to the treatment because a Jew did not do it or because of the shinui.

Can you provide a few examples of the above?

• When it is necessary to call a doctor or an ambulance on Shabbos, one should lift the phone receiver b’shinui – with one’s elbow etc. or turn on the phone and dial with a spoon in one’s hand, because this is called a shinui. Some situations cause panic and one’s wits are not always in control to remember these things. If however one can calculate one’s moves and it is not a dire emergency, a shinui should be implemented.
• The lights in the patient’s room must be turned on in order for the doctor to examine the patient. In most cases it suffices to turn on the lights with one’s elbow and thus avoiding an issur d’oraisso.
• A patient requires the insertion of an intravenous feed. There is reason to believe that this involves an issur d’oraisso because blood is drawn purposely through the needle to see whether the needle has indeed entered the vein, and drawing blood for a purpose involves the melacha of Netilas Neshama.  I do not suggest that an IV be inserted b’shinui (unless one practices on one’s own arm) but it is possible to ask a gentile to do it if there is no rush.

In certain countries one must sign a document before surgery. This is permitted on Shabbos as well in a case of pikuach nefesh but obviously there is no rush in the actual signing. Therefore, if one is able to sign with one’s left hand one must do so because it downgrades the action from a d’oraisso to a d’rabanan.