Vebbe Rebbe

Medicinal Alternatives According to Halacha On Shabbos

Q: My infant has conjunctivitis. A pediatrician I saw in shul on Shabbat morning suggested expressing mother’s milk directly into the eye over standard eye drops (although he was totally fine with either system or beginning treatment at night). Is that permitted on Shabbat? [Note: this was answered orally on Shabbat and transcribed afterward.]

A: According to the great majority of authorities, human nursing, not only milking a cow, is a Torah violation, at least in many cases. We obviously allow a baby to nurse on Shabbat, but usually it is the baby who performs the very important, “problematic” act. Is it permissible for a woman to express milk for her baby’s needs, classically, or, in this case, for medicinal purposes?

It is easiest to say it is forbidden. The Shulchan Aruch (Orach Chayim 328:34) says that a nursing mother may not express milk into a cup to feed her child (it is permitted to express to relieve an oversupply in a manner that the milk is immediately lost). However, there are instances where expressing milk is permitted, which may shed light on our case.

The Shulchan Aruch (OC 328:35) rules that a woman may express milk (into the baby’s mouth - Mishna Berura 328:112) in order to interest him to nurse. Most understand that this is not a level of need that we can consider life threatening, so why is it permitted? Similarly, the Shibolei Haleket (123, see Beit Yosef, OC 328, and (slightly altered) the Rama, OC 328:35) says that a woman may not squirt someone who is under the influence of a strange malady because there is neither danger nor extreme pain. This implies that it would be permitted if there were such pain. Why?

The Magen Avraham (ad loc. 40) and Mishna Berura (ad loc.:113) explain the implied leniency by saying that this expressing is a melacha she’eina tzricha l’gufa (=mstlg), which usually means that the object that the Shabbat violation produces is not itself used in a classical, positive way. Once reduced to a rabbinic violation, it is then permitted on Shabbat to relieve significant pain (see Shabbat 107a; Ketubot 60a). While it is difficult to understand how mstlg applies there, it is hard to dismiss an approach posited by such prominent proponents, and this seems apply to our case (realize that even non-illness needs of a small child are equivalent to those of sick adults (Rama, ibid.:17)). In fact, the Kaf HaChayim (328:209) says, based on the above, that a woman may express milk into the ear of someone with a serious earache (assuming it has therapeutic value).

The Tosefet Shabbat (328:59), not seeing a mstlg in the above, suggests that expressing milk from a woman in a way other than nursing is an unusual form of mefarek, and thus rabbinic, similar to a person “nursing” from a cow (Ketubot 60a). Such reasoning would also make this case permitted. While the Mishna Berura is skeptical of this approach, the Magen Avraham’s explanation and leniency that he cited and this one are the main explanations of the Shulchan Aruch’s accepted leniency for expressing (see Sha’ar Hatziyun 81).

Other possible grounds for leniency may be related to the small amount of milk that will be expressed and the fact that it is being used immediately (see Yalkut Yosef, OC 328:(35)). This respondent has thought of at least one other novel approach that would apply to this case (but it is not sufficiently developed to share in this forum).

We have seen significant grounds to permit the pediatrician’s suggestion although it is far from unanimous (see Ketzot HaShulchan 138:30, for one; we have also spoken to important poskim whose initial reaction was to not allow it). Since the eye is an area where halacha tends to be liberal about the possibility of danger (Shulchan Aruch, ibid. 9) and we are also very careful regarding such a young baby, we would be lenient at the “bat of an eye” if there was any urgency to the suggestion. However, you indicate that other effective medicinal alternatives exist and the doctor does not think that it is of even remote importance to favor mother’s milk. Therefore, it is halachically preferable, because of doubt and because it is better to avoid the rabbinic mefarek when there are good alternatives, to not use the system of expressing mother’s milk on Shabbat.

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