Taking Pills on Shabbos
Q. Last Shabbos I had a slight headache and my Rabbi told me that I should not take medication. But in the past, I was allowed to take antibiotics. What is the distinction and guidelines for when medication may be taken and when it may not be taken on Shabbos?
One of the Rabbinic prohibitions on Shabbos, is the Gezeira on acts of Refuah - medical treatments, healing and medication. The sages forbade acts of Refuah on Shabbos because it may lead to the violation of the Biblical prohibition of crushing or grinding herbs, which was the standard way of making medications in that time[1].
Whilst this concern does not apply to most of today’s medications as they are pre-made, once enacted, Rabbinic decrees remain in force even if the reason behind them is no longer applicable. Additionally, even today, there are still some natural remedies that are made in this fashion[2].
The scope of this Gezeira includes all forms of healing treatments, including; medications, ointments and even massages and compresses. This article will focus specifically on taking oral medications.
In cases of Pikuach Nefesh - life-threatening situations or illness, all of the laws of Shabbos are suspended and may be overridden[3]. Medication may be obtained in any manner necessary and can be taken or administered without any question. This is true even if the situation is not certainly life-threatening, but is possibly or potentially life-threatening[4]. Likewise, if not medicating now on Shabbos could potentially lead to a life-threatening situation in the future, all treatments will also be permissible. An example of this may be the risk of an infection spreading. Even if the infection is localised and not presently life-threatening, if left untreated, the infection can spread and become life-threatening.
When it comes to non-life-threatening conditions, there are different levels of restriction on what acts of Refuah may be done, how they should be done and by whom. This will depend on the classification of the ailment or condition as outlined below.
Incapacitating Illness
The sages did not apply their Gezeira to someone who is in the category of a Choleh She’ein Bo Sakanah. In this case, the use of medication will be permissible[5].
This is defined as someone who has an incapacitating illness that affects the entire body and would normally cause the sufferer to have to go lie down. This also includes weakness of the entire body. Severe pain[6] that would necessitate lying down, also falls into this category, even if the pain is localised. Even if the person remains active but would in normal circumstances go and lie down, they will be considered a Choleh She’ein Bo Sakanah[7]. Examples would include; Migraine headaches, flu, severe cramps or severe muscular pain.
Generally, the Shulchan Aruch rules that treatments for a Choleh She’ein Bo Sakanah must be done either by a non-Jew or with a Shinui – in an irregular manner[8]. Rav Moshe Feinstien applies the requirement of employing a Shinui even when taking medication. However, based on the ruling of the Alter Rebbe, a Shinui is not required when taking oral medication[9]. If medication is not available, one may send a non-Jew to travel to procure it.
Ailments
A person who has localised pain that is not intense enough to weaken the entire body, or if they suffer from a Meichush Be’alma – a low-level discomfort or ailment, may not take medication on Shabbos. This is the precise scenario where the sages enacted and applied their Gezeira. Examples would include a runny nose, headache or stomach ache, stiff neck, muscle pain and hay fever.
If the pain or ailment is significant enough, it could fall under the category of Choleh She’ein Bo Sakanah discussed above and the use of medication will be permitted.
Whether one’s condition is classified as a Choleh She’ein Bo Sakanah who may take medication, or a Meichush Be’alma who may not take medication, is a matter of personal[10] and subjective assessment. One need not be overly-strict in assessing their condition.
The Halacha rules that children are always classified in the category of a Choleh She’ein Bo Sakanah[11] and medication may be taken even for minor ailments. Many Poskim apply this leniency only up to the age of three. Others extend the leniency until the age of six or nine[12].
A woman within the first 30 days from childbirth is also automatically considered in the category of a Choleh She’ein Bo Sakanah[13] and medication may be taken as necessary.
Other Considerations
In the cases where medication is permitted or when it is prohibited, there is no difference between whether it is in liquid, tablet or capsule form.
If one is permitted to take medication, pills may be cut or crushed if required. This is because the medication was previously crushed when it was manufactured and we apply the principle Ein Tochen Ahar Tochen, that something which has been ground once is not subject to further grinding[14]. Care must be taken to avoid tearing writing when removing the pills from their packaging.
Vitamins
The Poskim debate whether vitamins fall under the Gezeira against Refuah on Shabbos or not. Rabbi Moshe Feinstein maintains that since their use is not to heal, but rather to increase or enhance nutrients, they are not subject to the Gezeira[15], unless they are being taken specifically for healing. Rabbi Shlomo Zalman Auerbach classifies vitamins as medication[16]. One can be lenient with children, especially since children’s vitamins are flavoured and could be considered like a candy.
Sleeping Pills
Rabbi Eliezer Waldenberg in his responsa Tzitz Eliezer[17], considers sleeping pills to be a healing treatment for a medical condition. This is also the view of Rabbi Moshe Feinstein[18]. Rabbi Shlomo Zalman Auerbach maintains that since they do not actually treat any illness, they are not subject to the Gezeira. If a person suffers greatly from insomnia to the extent that they would be categorised as a Choleh She’ein Bo Sakanah, all authorities would permit their use. The same dispute would apply to the use of diet pills.
When Halachically required, oral contraceptive pills may be taken on Shabbos.
Ongoing Treatment
If a condition requires ongoing medicating and treatment began on a weekday, some Poskim permit continuing to take the medication on Shabbos[19]. Many Poskim[20] take a stricter approach and do not allow this for a מיחוש בעלמא – a minor ailment.
A Practical Tip
Medication or pills may be mixed into food or drink before Shabbos and then taken on Shabbos in all cases, even for a Meichush Be’alma. This is because once mixed into food or drink, it simply looks like the person is eating or drinking regular foods. Since it is not recognisable that the action is being done for the purpose of Refuah, it will be permitted[21].
In the merit of guarding Shabbos, may we all be blessed with good health and a Refuah Shleimah for all of those who need one.
_____________________________
[1] Shabbos 53b. Shulchan Aruch Orach Chaim 328:1
[2] There is a minority view that the Gezeira no longer applies today. See Ketzos Hashulchan. This is used as another factor or consideration to be able to rule more leniently in certain cases.
[3] Yoma 83a. Shulchan Aruch Orach Chaim 328:2. Shulchan Aruch Harav 328:2
[4] Yoma 83a. Shulchan Aruch ibid
[5] Orach Chaim 328:17
[6] Ta”z Orach Chaim 328:24
[7] Based on Ram”o Orach Chaim 328:17, Darkei Moshe 328:10
[8] Shulchan Aruch Orach Chaim 328:17, Shulchan Aruch Harav 328:19
[9] Shulchan Aruch Harav 328:19 following Magen Avraham 328:44
[10] See Shulchan Aruch Harav 328:12
[11] Ram”o Orach Chaim 328:17
[12] There is a minority view that considers one to be a child for this purpose up until Bar or Bas Mitzvah age.
[13] Shulchan Aruch Harav 330:6
[14] Shulchan Aruch Harav 321:10
[15] Orach Chaim 3:54
[16] Shulchan Shlomo 328:1
[17] 9:17:2:40
[18] See Ketzos Hashulchan who is lenient based also on the fact that nowadays household medication would not lead to crushing.
[19] Rav Shlomo Kluger, Chazon Ish and Rav Elyashiv
[20] Shemiras Shabbos Kehilchasa in the name of Rav Shlomo Zalman Auerbach, Rav Moshe Feinstein and Tzitz Eliezer
[21] Ketzos Hashulchan 338:30 and Shulchan Shlomo 328:36
One of the Rabbinic prohibitions on Shabbos, is the Gezeira on acts of Refuah - medical treatments, healing and medication. The sages forbade acts of Refuah on Shabbos because it may lead to the violation of the Biblical prohibition of crushing or grinding herbs, which was the standard way of making medications in that time[1].
Whilst this concern does not apply to most of today’s medications as they are pre-made, once enacted, Rabbinic decrees remain in force even if the reason behind them is no longer applicable. Additionally, even today, there are still some natural remedies that are made in this fashion[2].
The scope of this Gezeira includes all forms of healing treatments, including; medications, ointments and even massages and compresses. This article will focus specifically on taking oral medications.
In cases of Pikuach Nefesh - life-threatening situations or illness, all of the laws of Shabbos are suspended and may be overridden[3]. Medication may be obtained in any manner necessary and can be taken or administered without any question. This is true even if the situation is not certainly life-threatening, but is possibly or potentially life-threatening[4]. Likewise, if not medicating now on Shabbos could potentially lead to a life-threatening situation in the future, all treatments will also be permissible. An example of this may be the risk of an infection spreading. Even if the infection is localised and not presently life-threatening, if left untreated, the infection can spread and become life-threatening.
When it comes to non-life-threatening conditions, there are different levels of restriction on what acts of Refuah may be done, how they should be done and by whom. This will depend on the classification of the ailment or condition as outlined below.
Incapacitating Illness
The sages did not apply their Gezeira to someone who is in the category of a Choleh She’ein Bo Sakanah. In this case, the use of medication will be permissible[5].
This is defined as someone who has an incapacitating illness that affects the entire body and would normally cause the sufferer to have to go lie down. This also includes weakness of the entire body. Severe pain[6] that would necessitate lying down, also falls into this category, even if the pain is localised. Even if the person remains active but would in normal circumstances go and lie down, they will be considered a Choleh She’ein Bo Sakanah[7]. Examples would include; Migraine headaches, flu, severe cramps or severe muscular pain.
Generally, the Shulchan Aruch rules that treatments for a Choleh She’ein Bo Sakanah must be done either by a non-Jew or with a Shinui – in an irregular manner[8]. Rav Moshe Feinstien applies the requirement of employing a Shinui even when taking medication. However, based on the ruling of the Alter Rebbe, a Shinui is not required when taking oral medication[9]. If medication is not available, one may send a non-Jew to travel to procure it.
Ailments
A person who has localised pain that is not intense enough to weaken the entire body, or if they suffer from a Meichush Be’alma – a low-level discomfort or ailment, may not take medication on Shabbos. This is the precise scenario where the sages enacted and applied their Gezeira. Examples would include a runny nose, headache or stomach ache, stiff neck, muscle pain and hay fever.
If the pain or ailment is significant enough, it could fall under the category of Choleh She’ein Bo Sakanah discussed above and the use of medication will be permitted.
Whether one’s condition is classified as a Choleh She’ein Bo Sakanah who may take medication, or a Meichush Be’alma who may not take medication, is a matter of personal[10] and subjective assessment. One need not be overly-strict in assessing their condition.
The Halacha rules that children are always classified in the category of a Choleh She’ein Bo Sakanah[11] and medication may be taken even for minor ailments. Many Poskim apply this leniency only up to the age of three. Others extend the leniency until the age of six or nine[12].
A woman within the first 30 days from childbirth is also automatically considered in the category of a Choleh She’ein Bo Sakanah[13] and medication may be taken as necessary.
Other Considerations
In the cases where medication is permitted or when it is prohibited, there is no difference between whether it is in liquid, tablet or capsule form.
If one is permitted to take medication, pills may be cut or crushed if required. This is because the medication was previously crushed when it was manufactured and we apply the principle Ein Tochen Ahar Tochen, that something which has been ground once is not subject to further grinding[14]. Care must be taken to avoid tearing writing when removing the pills from their packaging.
Vitamins
The Poskim debate whether vitamins fall under the Gezeira against Refuah on Shabbos or not. Rabbi Moshe Feinstein maintains that since their use is not to heal, but rather to increase or enhance nutrients, they are not subject to the Gezeira[15], unless they are being taken specifically for healing. Rabbi Shlomo Zalman Auerbach classifies vitamins as medication[16]. One can be lenient with children, especially since children’s vitamins are flavoured and could be considered like a candy.
Sleeping Pills
Rabbi Eliezer Waldenberg in his responsa Tzitz Eliezer[17], considers sleeping pills to be a healing treatment for a medical condition. This is also the view of Rabbi Moshe Feinstein[18]. Rabbi Shlomo Zalman Auerbach maintains that since they do not actually treat any illness, they are not subject to the Gezeira. If a person suffers greatly from insomnia to the extent that they would be categorised as a Choleh She’ein Bo Sakanah, all authorities would permit their use. The same dispute would apply to the use of diet pills.
When Halachically required, oral contraceptive pills may be taken on Shabbos.
Ongoing Treatment
If a condition requires ongoing medicating and treatment began on a weekday, some Poskim permit continuing to take the medication on Shabbos[19]. Many Poskim[20] take a stricter approach and do not allow this for a מיחוש בעלמא – a minor ailment.
A Practical Tip
Medication or pills may be mixed into food or drink before Shabbos and then taken on Shabbos in all cases, even for a Meichush Be’alma. This is because once mixed into food or drink, it simply looks like the person is eating or drinking regular foods. Since it is not recognisable that the action is being done for the purpose of Refuah, it will be permitted[21].
In the merit of guarding Shabbos, may we all be blessed with good health and a Refuah Shleimah for all of those who need one.
_____________________________
[1] Shabbos 53b. Shulchan Aruch Orach Chaim 328:1
[2] There is a minority view that the Gezeira no longer applies today. See Ketzos Hashulchan. This is used as another factor or consideration to be able to rule more leniently in certain cases.
[3] Yoma 83a. Shulchan Aruch Orach Chaim 328:2. Shulchan Aruch Harav 328:2
[4] Yoma 83a. Shulchan Aruch ibid
[5] Orach Chaim 328:17
[6] Ta”z Orach Chaim 328:24
[7] Based on Ram”o Orach Chaim 328:17, Darkei Moshe 328:10
[8] Shulchan Aruch Orach Chaim 328:17, Shulchan Aruch Harav 328:19
[9] Shulchan Aruch Harav 328:19 following Magen Avraham 328:44
[10] See Shulchan Aruch Harav 328:12
[11] Ram”o Orach Chaim 328:17
[12] There is a minority view that considers one to be a child for this purpose up until Bar or Bas Mitzvah age.
[13] Shulchan Aruch Harav 330:6
[14] Shulchan Aruch Harav 321:10
[15] Orach Chaim 3:54
[16] Shulchan Shlomo 328:1
[17] 9:17:2:40
[18] See Ketzos Hashulchan who is lenient based also on the fact that nowadays household medication would not lead to crushing.
[19] Rav Shlomo Kluger, Chazon Ish and Rav Elyashiv
[20] Shemiras Shabbos Kehilchasa in the name of Rav Shlomo Zalman Auerbach, Rav Moshe Feinstein and Tzitz Eliezer
[21] Ketzos Hashulchan 338:30 and Shulchan Shlomo 328:36