pikuach nefesh on shabbos - value education

This is a semi -halachic analysis.  As with all halacha I ever write, I put forth the standard disclaimer regarding my lack of halachic authority.

The halacha is that pikuach nefesh is docheh shabbos - If there is danger to life, then it is not only permissable, but it is obligatory to violate the shabbos

Not only vadai pikuach nefesh, but even safek pikuach nefesh is docheh shabbos.  Thus, if you see a person drop suddenly on shabbos and you're not sure if they face a life threatening issue, you should still violate the shabbos to ensure their safety (eg. taking them to a hospital, etc.)

The question becomes, how far does it go - is anything and everything a safek pikuach nefesh?  I don't know if people have thought about this much, but from the (thankfully) few situations I've been in it always makes me nervous that I don't really know how to tell if something is pikuach nefesh or not such that we should be mechalel shabbos.

What if someone experiences symptoms that seem most likely to not be anything dangerous, but there is a definite possibility that there is a real sakanah here - (I'm no doctor, so my examples are probably bad, but lets say one has a persistent pain in the stomach that could just be nothing or perhaps it is appendicitis. The point is that the safek is not a safek hashakul - its not 50-50 that this is life threatening, but rather, the odds seem to point to it not being life threatening, despite the possibility that it is indeed dangerous.)  If we say that it doesn't have to be 50-50 to save, then how far do we go: 90-10, 99-1, 99.999-0.001?

 If there is a community in which there is an epidemic disease spreading, can they eat on yom kippur to protect themselves against the possible life threatening danger of falling ill?

If one hasn't yet received a standard vaccination (no epidemics, just normal circumstances) can one take it on shabbos or should they wait till after shabbos?

If someone does research in medical techniques to treat cancer, can they work on shabbos since their research may ultimately save lives - and the quicker its done, the sooner lives can be saved?

I don't think the halacha is the same in each of those cases - all I'm trying to show is how amorphous the concept of safek pikuach nefesh is.

One approach that I recall R Twersky quoting once to limit the principle of pikuach nefesh being docheh shabbos is that we only apply said principle when there is a "choleh lifanecha" - an actual person we can identify whose life we are trying to save.  By the medical research question, there is no choleh lifanecha - these techniques are being developed to treat unknown people at some unknown time in the future.  I don't remember if R Twersky also used this principle in the second example concerning eating on yom kippur, possibly arguing that since you aren't ill yet, there is no choleh lifanecha to be mattir achilah on yom kippur.

The problem with this approach is that it doesn't seem to have any source- and it would seem to limit the principle of pikuach nefesh docheh shabbos in cases where common sense says it shouldn't be limited, eg. case 2.

R Shlomo Zalman Auerbach, quoted in a footnote at the beginning of the 32nd perek of shemiras shabbos kehilchasah and originally in a teshuvah (chelek 2:37) I saw today in minchas shlomo, seems to have a different approach:

ולענין עיקר הדבר מה נקרא ספק פקו"נ ומה לא, ועד איפה הוא הגבול, גם אנכי בעניי הסתפקתי טובא בזה, אלא שמצד הסברא נלענ"ד דכל שדרך רוב בני אדם לברוח מזה כבורח מפני הסכנה ה"ז חשיב כספק פקוח נפש וקרינן ביה בכה"ג וחי בהם ולא שימות בהם, אבל אם אין רוב בני אדם נבהלים ומפחדים מזה אין זה חשיב סכנה, קצת דוגמא לכך הרכבת [זריקת] אבעבועות לילדים, אע"ג דמצד הדין אפשר שצריכים באמת להזדרז ולעשותו בהקדם האפשרי אם הרופא אומר שכבר הגיע הזמן לעשותו, אך אעפ"כ אין רגילין כלל לעשותן בבהילות ובזריזות, ולפיכך אף אם באמת יש בזה קצת סכנה הו"ל כמ"ש חז"ל והאידנא שומר פתאים ד' וחלילה לחלל שבת עבור כך, משא"כ אם אחד נמצא במקום כזה שיודע ברור שאם לא ירכיב עכשיו את האבעבועות בשבת יצטרך לחכות ד' או ה' שנים, כיון דבזמן מרובה כזה ודאי נבהלים ומפחדים לשהות, אפשר דשפיר חשיב כפקוח נפש ודוחה שבת.   +עי' שש"כ פל"ב הערה ב'.+

loose translation / summary: a safek pikuach nefesh is defined by whatever people perceive as dangerous.  thus, since people don't perceive it as a sakanah to delay a vaccination, it is prohibited -- chalilal la-kel that we should be mattir -- recieving a vaccination on shabbos, even though there is a certain element of danger in every day that you delay getting vaccinated.  In any case that people perceive as dangerous, however, even if the danger is very remote and there is no "choleh lifanecha", we still are michalel shabbos because we view it as a safek sakanas nefashos.

Thus, the litmus test that a person has to use to determine whether something falls into the category of pikuach nefesh is to ask themselves how they would react during the week.  If during the week, they would react as if this were sakanas nefashos, then they have license to do so on shabbos as well, (almost) irregardless of any objective determination of safek sakanas nefashos.  The purpose of this test is almost an honesty check - are you being mechalel shabbos right now because you just don't care about kedushas shabbos, or because you really perceive this situation as one of safek sakanas nefashos?  To answer this question, you think about how you would perceive this situation without shabbos as a factor - if even then, you would react as if it were a case of pikuach nefesh, then you have license to do so on shabbos as well.

So to answer our original q:  how is one supposed to know when they should be michalel shabbos for pikuach nefesh.  One answer is that we should take the time to learn some basic medical knowledge so that we can be more confident in ourselves if any situation comes up.  But according to r shlomo zalman, there's something else that needs to be done thats critical in hashkafah as well.

The chiddush of r shlomo zalman is that halacha isn't interested as much in the "what" of what you're doing but more in the "why".  We don't ask - is there an objective safek pikuach nefesh.  Rather, we ask, why is this person being mechalel shabbos - is this situation really perceived as a sakanah, or is it that this person just doesn't care enough about kedushas shabbos.  If a person cares enough, he can't be wrong - even if objectively this situation isn't a safek sakanas nefashos, this person cares so much about shabbos that if he was mechalel shabbos, it must be that he really perceived this situation as one of sakanas nefashos - and therefore it was muttar to be mechalel shabbos.

(This ties to what I believe is a general yesod in kol hatorah kulah that the tzurah of an action one does is often more important than the action itself - the way you do something defines an action even more than what you are actually doing.)

So according to r shlomo zalman, the education we need to be more confident in knowing when we should be mechalel shabbos for pikuach nefesh isn't primarily an intellectual one; rather it is to instill within ourselves an appreciation for and a deep caring for kedushas shabbos - only then can we have any confidence that when we feel the need to be mechalel shabbos for pikuach nefesh, its because we actually perceive this case as one of pikuach nefesh and not just because we aren't makpid chas vishalom on kedushas shabbos.

Truth be told, this argument works the other way as well.  While I personally feel that for me, the idea of the sanctity of human life is much more obvious than that of shabbos, we do hear of cases where people rachmana litzlan are not mechalel shabbos even to save lives - and people die because of it.  For them, the problem is the opposite- they know intellectually that pikuach nefesh is docheh shabbos, but they have not properly instilled within themselves how great the value of the sanctity of human life is, and thats what they need to work on to make the right choices.

There is no better way to conclude this idea than with the words of the rambam concerning pikuach nefesh on shabbos, and the values the torah represents in general:

כשעושים דברים האלו אין עושין אותן לא ע"י נכרים ולא ע"י קטנים ולא ע"י עבדים ולא ע"י נשים כדי שלא תהא שבת קלה בעיניהם. אלא על ידי גדולי ישראל וחכמיהם. ואסור להתמהמה בחילול שבת לחולה שיש בו סכנה שנאמר אשר יעשה אותם האדם וחי בהם ולא שימות בהם. הא למדת שאין משפטי התורה נקמה בעולם אלא רחמים וחסד ושלום בעולם.

The halacha that pikuach nefesh is docheh shabbos is not only a din in pikuach nefesh, but also in shabbos, and also in kol hatorah kulah:  אין משפטי התורה נקמה בעולם - rather, רחמים וחסד ושלום בעולם.