Hatzolah and Ezras Nashim: a Halachic Analysis

By Rabbi Yair Hoffman for 5TJT.com

There is a major controversy occurring in Boro Park now between an all-female Basic Life Support First Responders Agency and Hatzolah, for those who are following the news.  Hatzolah is a remarkable organization that has literally saved tens of thousands of lives.  Ezras Nashim was an organization formed in 2012 specifically to treat and arrange for the transport of women who would prefer dealing only with females – for reasons of modesty.  They have recently applied for ambulance status to operate in Brooklyn and join 21 other ambulance agencies registered in Kings County.  Hatzalah is actually against this application of Ezras Nashim, believing that it will sow confusion among people who need emergency care. A number of Rabbis from Brooklyn have also voiced opposition to it.  The issue came to the fore at a recent hearing about the matter in Brooklyn.

WHAT IS THE HALACHA?

But what is the halacha?  Does the possibility of sowing confusion trump the very valid concern of Tznius and possible embarrassment of the women?  Are there other factors at play here?  Does the existence of a second ambulance agency jeopardize the ability of the first one to adequately provide for its patience?

Before we get to the underlying halachic issues, there are three possible resolutions to this conflict:

• Ezras Nashim could be allowed to work as a second ambulance force serving the community.
• Ezras Nashim could be disallowed to operate as an ambulance force, and rather continue to function as a BLSFRA, and use the city’s 911 ambulance service for transport.
• Something could be worked out where Hatzalah could dispatch Ezras Nashim volunteers to tend to women who request women only. Thus far, this third possibility has not been placed on the table.

And now the halachic issues:

TZNIUS

The first issue deals with the matter of Tznius, modesty.  There is a debate between the Rambam (Hilchos Issurei Biah 21:1) and the Ramban as to whether the prohibition of kirvah to a forbidden woman is a Torah prohibition or a Rabbinic one.  However, both Rav Shlomo Vosner zt”l ( responsum Vol. IV Siman 167) and in his shiurim (YD SIman 195)  and Rav Ovadiah Yoseph zt”l in his Taharat Habayit (Vol. II 12 footnote 46) forbid a women from being treated by a male physician (and presumably an EMT as well) if there is a possibility for a female one.  This is true even if there is a significant cost associated with seeing the female physician and even if the male doctor (or medical practitioner) is better.  This opinion is based on the halachic positions of the Bais Yoseph (195) and the Bais Shmuel (Even HaEzer 20:1).

On the other hand, the Shach, the Kreisi uPleisi, and the Darchei Teshuvah (YD 197:8) all permit the use of a male physician when it is medically indicated.

Of course, when it is life or death – pikuach nefesh – searching for a medical practitioner of the same gender is considered a chassid shoteh. The question is one of pre-planning so that it not happen at the outset.  When it is not a matter of life or death – is where the majority of the issues arise.

Most American Poskim are lenient in accordance with the Shach’s position, and that has become the normative halachic position.  Based upon this, some Poskim (including some of those who have signed onto the letter against the Ezras Nashim application) have ruled that there are Tznius issues the other way, in having women respond to emergency ambulance calls.  Legally, all medical people cannot refuse to attend to the medical needs of any gender.

WHO IS FIRST?

The second issue deals with the rights of the first versus the second.  There is no question in halacha that the first always has precedence over the second.  It is for this reason that a recent attempt to start a second Hatzalah organization in Williamsburg has been summarily rejected by many Poskim in Williamsburg – because it could cause serious damage to the existence of the first.

THE TUR VERSUS THE MEIRI

The idea of the rights of the first over the second is found in the Gemorah in Sanhedrin (32a) according to the Tur’s Girsah (CM 272) – regarding the arrival of two boats passing through a river.    The Gemorah uses the verse of Tzedek Tzedek Tirdof to give preference to the first to arrive.  By the same token – if the existence of a second ambulance agency would jeopardize the first – then the first one has the right to request that the second one not form.  In secular parlance, we can understand this idea as “first come, first serve.”

There is no question that Hatzolah has a remarkable track record of serving our community in its life-saving efforts.  They are literally angels in a very difficult environment and have saved and extended the life of tens of thousands of patients.  It is also an organization that has channeled unprecedented chessed.

The Meiri’s understanding of the Gemorah in Sanhedrin, however, stands in contrast to the idea of “first come first serve.”  He understands the words “te’unah vesh’ainah te’unah” the loaded one versus the one that is not loaded – the one that is loaded takes precedence as trumping the one who is first.  In other words, if one can stand the pressure while the other cannot – the one that cannot goes first.  Otherwise, everything else being equal, the first to arrive goes first.  One could perhaps make an argument that Hatzolah would easily survive if there were two organizations, but Ezras Nashim might flounder – based upon this Meiri, but then the issue arises as to whether we Paskin like this Meiri or not.

It seems to this author that the Tur’s position has become the normative position in halacha – rather than that of the Meiri.  [This is notwithstanding the Rambam Hilchos Sanhedrin 21:6].  The matter, however, should be brought to our leading Poskim.

WHO IS BETTER?

There is no question that Hatzolah has and will retain a faster response time than any other new ambulance service.  This is due to a number of factors, beyond the scope of this article.  Often response time is key.  Should this be a factor?  On the other hand, most of the Ezras Nashim EMTs have had non-mandatory extensive training in neo-natal resuscitation and have completed certification programs in this area.  If Ezras Nashim does become an ambulance agency, their response time will be slower than that of Hatzolah because of various grandfather clauses in New York State law.  Now the difference amounts to approximately 6 minutes according to the papers placed before the EMS board.

CHILLUL HASHEM

The fourth issue is that of Chillul Hashem.  We must always be on guard to avoid causing the media to make a desecration of the Divine Name. When Torah organizations are labelled by the media as “misogynistic” Heaven forbid – this is a chillul Hashem.  On this account, it is necessary for all parties involved to strive as much as possible not to be the source of a desecration of Hashem’s Name in any action that one embarks upon.  The media is notorious for attempting to portray anything that a Torah organization does in a negative light.  Sometimes, in our attempt to do what is right, we can inadvertently trample upon this very important Torah value of avoiding chillul Hashem.

This author has read the entire application of Ezras Nashim to the EMS board and can state that there is no accusation, chas veshalom, against Hatzolah, notwithstanding reports in the media – otherwise.

Both organizations have Torah authorities that have written letters in support of them. Ezras Nashim has Rav Elya Ber Wachtfogel Shlita, Rav Wosner zt”l, and Rav Yitzchok Zilberstein shlita.  And Hatzolah has 49 signatures on what they have planned to file.  These opinions should neither be negated nor dismissed.

It is this author’s opinion that the desires of women who wish to be treated only by their own gender be taken into account, somehow.  Studies in the relevant medical journals show that showed that 8.4% of women actually prefer a male ObGyn, while 53.2% prefer a female ObGyn, and 38.5% have no gender preference.

As a parenthetic note, the very name “Ezras Nashim” has a double entendre that has been missed by the New York dailies.  The standard definition of the Hebrew means “assistance for women.”  But there is a second meaning too.  Ezras Nashim is the designated area for women in both the Beis HaMikdash as well as synagogues throughout Jewish history.  The subtle implication of the double entendre is that this is an area exclusive to women – where men do not belong.

In an unofficial survey of a number of Rabbonim, women, and medical professionals, taken by this author – the overwhelming preferred resolution to this was that some sort of cooperation between the two organizations be worked out – as in the third resolution presented at the beginning of this article.  One person even related that when Hatzolah was originally conceived, the idea was that a separate group of women be formed to deal with women – like the original Shifra and Pu’ah in Sefer Shmos.  The Pupa Rebbe’s letter highlights this concept.  Skver Chassidim also promulgated a women’s only EMT program a while ago.

It is this author’s opinion, after speaking to some legal experts, that it is highly unlikely that the EMS board will deny the application.  If this is the case, then perhaps efforts should be made to come up with a compromise where all of klal yisroel will benefit.

The author can be reached at [email protected]