1.It is permitted to desecrate Shabbat for the needs of a patient in a life-threating situation, even if the particular need does not involve life-threatening danger¹. Accordingly, it is permitted to desecrate Shabbat in order to mitigate suffering. This is correct not only when the patient can be saved, but even when it is clear that he will not survive. Other prohibitions are also suspended in order to relieve the suffering of a patient in a life-threating situation².

2.Even when the parameters that can be measured indicate that an illness does not pose life-threatening danger, if the patient suffers pain in internal organs, one may rely on the opinions that maintain that pain itself is considered dangerous³.

1. Shulḥan Arukh, Oraḥ Ḥayyim 328:4; 330:1. We will not address the question of whether it is permitted to desecrate Shabbat for every need of a patient in a life-threating situation. See Mishna Berura, 328:14; Yeḥaveh Da’at, IV:30; Nishmat Avraham, Oraḥ Ḥayyim 328:16; Shemirat Shabbat KeHilkhata, 32:24–6. See also Rabbi Yair Frank, “Settling the Mind – the Wishes of a Patient and his Mental State as a Consideration for Desecrating Shabbat on his Behalf,” Assia 16 (1999), pp. 171–91.

2. two different situations: (a) Suffering in a situation in which it is clear that the patient will not survive and treatment is geared only toward the relief of suffering (this case will be addressed later in this footnote); (b) Suffering in a situation in which it is clear that the patient is not in life-threatening danger (see the next footnote). However, in practice, it is virtually impossible to distinguish between suffering and life-threatening danger. Terrible suffering is usually indicative of life-threatening danger, or at least the possibility of life-threatening danger. Furthermore, even when there is no hope for recovery, the prevention of suffering might at least extend the patient’s life. Even from a medical perspective, pain is part of the illness that the doctor must treat (see footnote 84). The patient’s spirit and mental resilience are also important factors, since they enable him to cope with his disease, and decline as pain increases.

   With regard to the first situation, poskim dispute whether suffering or pain are considered a dangerous illness in their own right that sanction Shabbat desecration and the suspension of other prohibitions. It can be inferred from the Gemara’s discussion in Avoda Zara (28a), which deals with the definition of an illness that threatens the teeth in conjunction with potential Shabbat desecration, that pain itself is considered a dangerous illness. The Gemara rules that Shabbat is desecrated for great pain, even if the illness itself is not necessarily dangerous. However, poskim disagree over the practical conclusions that can be inferred from this discussion. The Shulḥan Arukh (Oraḥ Ḥayyim 328:3) rules: “This applies only if one of the internal organs is impaired on account of an injury or a bubble and the like, but pain is not considered an injury.” These comments imply that suffering alone does not amount to a dangerous illness, and we do not desecrate Shabbat on its account. According to the Beiur Halakha (ibid., s.v. VeDavka), only in the case of teeth is mere pain considered dangerous. By other internal organs, this would not be the case. This is also indicated by the Arukh HaShulḥan (Oraḥ Ḥayyim 328:21). In contrast, several Aḥaronim maintain that any pain in the internal organs constitutes a dangerous illness; see Shevut Yaakov, II:70; Imrei Yosher, II:43, 4; Shevet HaLevi, VI:30, 2. See also Nishmat Avraham, Oraḥ Ḥayyim 328:17; Encyclopedia of Medicine and Halakha, vol. 7, “Shabbat,” p. 449. In practice, even when it appears that the illness does not pose life-threatening danger, if the patient suffers from pain in internal organs, we may rely on the lenient opinions.

3. In Shemirat Shabbat KeHilkhata (third edition, Jerusalem, 2010, chapter 32, footnote 157; and in the 1979 edition, footnote 150), RabbiYehoshua Neuwirth cites the opinion of Rabbi S. Z. Auerbach who was unsure whether Shabbat should be desecrated in order to administer a morphine injection since it is clear that morphine does not cure the patient, but only soothes his pain. He notes that it is possible that it is permitted to desecrate Shabbat for this reason, based on the consideration that severe pain can also endanger a person. Nishmat Avraham (Oraḥ Ḥayyim 328:17) adds to this and cites the position of Rabbi S. Z. Auerbach, that when it comes to a patient in life-threatening danger, anything that refreshes and calms him possibly results in ḥayyei sha’a and therefore his pain must be treated in all situations. Rabbi Feinstein also writes (Iggerot Moshe, Ḥoshen Mishpat, II:73, 9) that it stands to reason that any form of pain management will prolong life temporarily, even if doctors are unaware that it is effective. Other prohibitions are also overridden on account of suffering – Rabbi Feinstein (ibid.) permits the violation of the prohibition against castration in order to ease the pain of a patient suffering from an incurable cancer; see also Nishmat Avraham, ibid.