Wednesday, June 10, 2009

Pikuach nefesh - is depression?/R' Moshe Feinstein

In my comments to a previous post, I made the assertion that Rav Moshe Feinstein is cited incorrectly by Rav Zilberstein. While it is true that both say that depression can endanger life - it seems that they do not agree as to how. The following seems to suggest that Rav Moshe labels pikuach nefesh as something which leads to suicide or clearly diminishes ones life while Rav Zilberstein seems to feel that any major psychological pressure itself decreases life.

Igros Moshe(O.H. 5:18): Shulchan Aruch (O.C. 306:9): “It is prohibited to ask a non‑Jew to travel outside of the techum on Shabbos to notify the relatives of the deceased to come and to eulogize him. However concerning a terminally ill person who asks that his relatives be notified it is definitely permitted.” The Levushei Serad says that it is permitted to pay a non‑Jew to travel so that the sick person won’t become severely agitated (tiruf daas) since this is included in the category of pikuach nefesh which permits violation of Shabbos. However I have not found any basis to permit this for the sake of a terminally ill person to prevent him from getting severely agitated (tiruf daas) – except for a rabbinic prohibition. I am astounded that the Levushei Serad said that it is permitted because of pikuach nefesh. His explanation that tiruf daas (severe agitation) is a sickness which endangers the person. That is only so for a healthy person who might come to commit suicide because of his agitation. However for a terminally ill person (shechiv m’rah) there is no basis to be concerned for this and therefore this is not considered pikuach nefesh. However more thought is needed as to what the actual halacha is in this case.


  1. Very depressed people have been known to kill their loved ones in order to "spare them" from the pains of living.

    A link between anti depressants and mayhem has been known for several years now.

  2. I believe that "Tiruf Daas" in the teshuvos does not mean "severe agitation" but that is specifically means a disruption in one's mental state and judgment to the point that a person would be unable to care for his basic needs, and which therefore leads to one or both of the following consequences.
    1. The person is likely to die or become seriously ill in a very short period of time because of the inability to stay nourished, take medications, care for his basic hygiene, pay bills and therefore maintain a safe place to live, etc.
    2. The person's judgment is so disrupted that he would be adjudicated as a shoteh le-kol davar al pi halakha.
    Either of these will render someone a choleh she-yesh bo sakkana, and therefore treating that person's mental illness will be an act of pikuach nefesh. (Often, both of these will be true simultaeneously.)

    I believe that Reb Moshe is saying that in the case of a shechiv me-rah, since the person is dying in any case from a medical illness, then we are not going to prevent him from becoming a choleh she-yesh bo sakana by treatment his medical conditions.

    I highly recommend Rabbi M. Fabrbstein's book on this, "Mishpetei HaDaas." I have never seen a rov who has such an excellent grasp of the medical metziyus. And his explanations of all the categories is so clear. I think that the first chapter or an English translation of the first chapter is accessible through the Schlessinger Institute's website. That website is a great resource for medical halakha articles. I promised you his chapter on mental illness and choleh she-yesh bo sakkana. Bli neder I will get that to you.

  3. Another clarification:

    In cases of mental illness, the halakhic status of the treatment )(i.e., is it or is it not pikuach nefesh) depends on whether the that person's mental condition is so severely compromised that he is a danger to himself. This could be either due to suicide risk, or inability to care himself. It does not depend on diagnosis. For example, some patients being treated for depression are not at risk for suicide and others are at high risk for suicide. Some patients with bipolar disorder have never been psychotic and have continued to function highly in their careers, etc., while others with bipolar disorder have been a severe danger to themselves and others.

    Rabbi Zilberstein is most certainly aware of this and would not adjudicate the treatment of alol patients as pikuach nefesh regardless of the severity of illness. It is hard to tell from an article or a specific teshuva what type of mental symptoms will be considered sakana by a given posek. What article or teshuva demonstrates his lenient attitude toward pikuach nefesh.

  4. Even if one is only to frame a depressed individual as a choleh sh'ein bo sakanah, great latitude can be given with regard to shabbat. One would be permitted to do an issur derabanan b'shinui (and possibly even an issur deoraitta b'shinui according to some poskim and depending on the need). This framing is quite accurate to my experience of individuals suffering depression, are not suicidal, but may be in danger of hurting themselves.

  5. Nachum Klafter said...

    I believe that "Tiruf Daas" in the teshuvos does not mean "severe agitation" but that is specifically means a disruption in one's mental state and judgment to the point that a person would be unable to care for his basic needs, and which therefore leads to one or both of the following consequences.
    The term means either confused or forgetful or seriously upset. I just looked at the Nishmas Avraham to Shulchan Aruch (306:9). The Mishna Berura based on Magen Avraham says that a very sick person who requests that a non-Jews cross the techum to notify relatives to come to give eulogies for him it is permitted so that he doesn't have tiruf daas. In other words one can violate a rabbinic prohibition to prevent him from getting in a state of tiruf daas. Others permit violation of Torah laws to prevent tiruf daas. Rav Shlomo Zalman Auerbach is cited as saying "Do we permit bringing a newspaper or novel in a place which has no eiruv for the sake of calming a sick person. This requires further study."

    Thus in this case we are concerning with agitation - not with confusion or mental lapses.

    As we saw with Rav Moshe it seems to be a dispute whether this conditon of tiruf daas permits violation of rabbinic laws or even Torah laws.


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