Moked Harav: – Where It’s Never a ‘Bad Time’ for Medical/Halachic Queries

To cover a full day at Moked Harav is above and beyond the scope of this article. What we did manage was to follow the “regular” happenings of “just another day in the office.”

A regular day for Rabbi Yisrael Pinchas Tirnauer, founder and chairman of Moked Harav, begins at 6 a.m., with a shiur Daf Yomi in his shtiebel in Ramot Polin in Yerushalayim. That is followed by Shacharis and breakfast, and then off to his little office, small in size (a little basement storeroom of barely dalet amos), but with enormous scope of activity.

So how did it all evolve?

It started from my own experience and initiative, explains Rabbi Tirnauer. I was once with my wife in the hospital and we had a very serious halachic she’eilah, a she’eilah of pikuach nefesh, and we needed an answer within minutes to know how to proceed. The regular Rabbanim are not fluent in these she’eilos and, as one can presume, to reach one of the senior poskim — at the time both Harav Elyashiv and Harav Wosner were still with us — who can give an answer right away is next to impossible. It was a harrowing experience until we finally got the answer and knew what to do.

(Rabbi Tirnauer notes that the actual she’eilah and psak are irrelevant, as well as any halachos mentioned within this article; they should not be relied on under any circumstances.)

So after that experience, I thought to myself that this is a thing that is lacking for Klal Yisrael. I am no askan, but after seeing the need, I jumped into the deep end.

On the one hand, there are so many Rabbanim, so many organizations, but a number for one to call in cases of medical issues, many of which demand immediate response, simply doesn’t exist. These she’eilos might not arise every hour of the day, but when one has a she’eilah in these issues, he needs a psak – and he needs it NOW.

I went with this brainstorm to a number of Rabbanim who all agreed it was a much-needed thing. And from there it took off.

The Rav chosen to be the nasi of Moked Harav International Halachah-Medical Hotline was Hagaon Harav Moshe Shaul Klein, shlita. He is one of the foremost poskim today, and his knowledge in the medical field is amazing. He was a very close talmid of Harav Wosner, zt”l, and is known for his achrayus in psak. He hand-picked a group of Rabbanim to serve on the Moked Harav staff, all of whom he knows on a personal basis. The supervising Rav of Moked Harav is Harav Yosef Hofner, Rav of the Maayanei Hayeshuah hospital in Bnei Brak, who himself is a talmid of Harav Klein, Harav Nissim Karelitz and Harav Yitzchak Zilberstein.

The members of the Presidium of Moked Harav are the Geonim: (Israel) Harav Yitzchak Silberstein, shlita; Harav Shimon Baadani, shlita; Harav Naftali Nussbaum, shlita; and Harav Yisroel Yitzchak Mendelson, shlita; (United States) Harav Yechiel Michel Steinmetz, shlita; (England) Harav Ephraim Padwa, shlita, (Belgium) Harav Aharon Shiff, shlita.

Baruch Hashem, looking back at the close to three years of activity, we can clearly see how this idea was grabbed by many and has taken off. One shudders to think how many of these she’eilos would’ve been left without the correct psak, if not for Moked Harav.

We have Rabbanim for each halachic department, each with their expertise. The experienced and expert poskim are available at all times, day or night, to field inquiries by phone or email, in Hebrew, English or Yiddish. The Rabbanim are all experts in medical issues, and each one has a specific area that he specializes in.

The Hotline is active 24 hours a day, six days a week.

In this little office here, I can see every call that comes in (not the caller, the call!), who picked it up, what topic it was about, how long it took until they received a response. At times, the Rabbanim put me on the line as well, to connect with the doctors, or the hospitals, to find out more information. Not everyone fully understands the depth of the medical detail in their she’eilah, and all these things can have an impact on the psak.

Before we continue, an interesting she’eilah comes in. We are several days before Rosh Hashanah. A lady calls in, and says she has trouble standing for long periods of time. Her question is that she does want to stand, but for which parts of davening must she stand, and when can she sit.

Another question comes in from a teenager. He takes pills on a daily basis for acne. Can he take the pill over Rosh Hashanah?

Back to Rabbi Tirnauer: If we’re dealing with pills, it is important to note that there are many she’eilos on the kashrus of pills. The halachah varies if the pills are in a capsule, as well as what the pills are for. Each detail is relevant to the halachah.

There are days when we have more “basic” she’eilos, but when a serious pikuach nefesh she’eilah comes in, it usually goes to Harav Moshe Shaul Klein.

A story, from back in the early days of Moked Harav.

I had tried several times to meet a well-known businessman with extensive connections. I wanted to ask him to help us forge ties with various companies which would sponsor conferences and workshops for Rabbanim and doctors or printed advertising, and the like.

Naturally, the man was extremely busy, and our meeting was postponed twice.

I finally arrived at his office for the scheduled meeting. I entered and found him talking on two phones — one pressed to each ear — and he was completely preoccupied.

I should note that he doesn’t know me at all, and had no idea what I wanted. He hadn’t even heard about our organization.

He tells me: “You’ve come at a very bad time. My brother-in-law has been in the hospital for a long time. The cancer has metastasized all over his body. Now the doctors are debating whether to connect him to a heart-lung machine. The machine will prolong his life, but it will involve a lot of suffering for him. The doctors have left the decision to the family, who don’t know what to do. Who can undertake to make such a decision?! Of course we’ve asked Rabbanim, because this is a question of life and death that only leading poskim can decide. But all the Rabbanim have directed us to Rav Moshe Shaul Klein. ‘Only he can pasken,’ they say. I’ve been trying to reach him for two hours already, with no success.”

“Do you know why I’ve come here to meet with you?” I asked him.

“No, I don’t,” he snapped impatiently. “I explained to you that it’s not a good time right now.”

I placed on his desk our brochure with the phone number 02-502-0202 and asked him to dial. He did, doubtfully. He explained to the operator that he had a question of pikuach nefesh, and within a few minutes, he had a psak. The man I had come to meet conveyed the response to his family, tensely waiting in the hospital.

He put down the phone in shock and said to me, “Do you realize what just happened? It’s not for naught that our meeting was twice postponed. Hashgachah sent you here at the crucial moment! Now, please explain to me what your organization is, how it works and what you need from me. But you don’t have to tell me why it was established. I understand that very well. I promise to help you in any way I can.”

That was when I really felt a “smile from Heaven.”

Another she’eilah comes in from America: A 102-year-old lady, who has been hospitalized for a while, is no longer responding to treatment. Can they administer morphine, as it slows down the breathing, and it might bring her closer to, chas v’shalom… The doctors are no longer willing to continue treating her; what are they allowed to do.

I ask Rabbi Tirnauer how the families can stand firm against the doctors’ requests.

He explains that obviously it is easier in Israel, where the hospital system recognizes halachic considerations. It is harder overseas.

There are many operations that have she’eilos d’Oraisa.

Actually, one of the innovations of Moked Harav has also been raising awareness that she’eilos are involved in many medical decisions. Many people who call in are surprised to hear the psak and say that they only called to double-check something that they were sure was permissible, and now they learn that it’s actually a problem.

The ultimate goal of Moked Harav?

May Hashem help that our ultimate goal be realized – that we can close down the Hotline as there will be no more sick people! But until that time, we are here and will continue to be available for halachic advice all day, every day.

On Shabbos and Yom Tov does the Hotline work?

According to the ruling of Harav Moshe Shaul Klein, we are “closed” on Shabbos.

What is important to point out is that there are those who think that going to the hospital on Shabbos, unless it’s a real case of pikuach nefesh, is better not done. That is incorrect, and it is vital that people realize that in any case of the slightest she’eilah, one can – and should – call Hatzolah or whatever local service there is in their neighborhood. The feeling that they are being machmir in shemiras Shabbos is totally wrong, and at times comes at a very expensive price. Rav Hofner asks again and again that we publicize the words of the Mishnah Berurah in Hilchos Shabbos, that if one delays tending to a medical issue on Shabbos, he might be considered shofech damim, a murderer!

Rabbi Tirnauer notes another incoming call, which was directed to the mental health division of Moked Harav. A Mashgiach calls about a bachur in his yeshivah who davens for many hours, a serious case of OCD. What parts of davening can he tell the bachur that he need not daven, as the bachur has agreed that if he has a shorter nusach, davening will take him less time.

There are also questions related to mental health issues for shidduchim, Rabbi Tirnauer adds. The questions are generally what to tell the other side before beginning the shidduch, what to say when things become more serious and what need not be told. The answers vary from case to case, obviously.

There are numerous she’eilos that came in during the many hours we spent in the Moked Harav office that cannot be printed in Hamodia for understandable reasons, both from a medical privacy point of view and because many of the topics aren’t appropriate for all readers.

As per the instructions of Harav Moshe Shaul, there are some topics – that don’t need an immediate response – that we should no longer answer. A hotline isn’t meant to be in place of one’s local Rav, who knows the family on a personal basis.

How many she’eilos come in on any given day?

There is no minimum and no maximum. Understandably, ahead of Tishah B’Av and Yom Kippur, there are many more she’eilos regarding the fast. We add dozens of Rabbanim for the days before the fast.

(Rabbi Tirnauer goes back on the computer to the week of Tishah B’Av. An average of 783 [!] she’eilos a day in the days building up to Tishah B’Av.)

In general, to be able to rule on a case when someone with a medical issue needs to fast on Tishah B’Av, the Rav needs to learn the full details of the case. We try to get the Rav in direct contact with the doctor.

Ahead of Yom Kippur we printed a list of guidelines for women in various situations with regard to fasting. The point that is echoed in these guidelines is that on Yom Kippur the most important thing is to fast, even if it comes at the expense of davening. There are many who might not “feel comfortable” with the thought of not davening Kol Nidrei or Ne’ilah, but the Torah says that one must fast on Yom Kippur, not daven. A man called up and asked what he should do with the kids on Yom Kippur, as his wife needs to stay in bed all day. The Rav told him that he should stay at home and tend to them, even at the expense of davening with a minyan.

Are you in contact with the hospital system in Israel?

We have very good connections with the hospitals and the kupot cholim (health maintenance organizations). We receive she’eilos all the time from hospitals, whether from patients who want to learn about the eruv at the complex, the elevators for Shabbos, the kashrus at the hospital, or from Kohanim in regard to tumas meis, and for this we refer them to the hospital Rav, and we also get calls from the Rabbanim when they have serious questions of pikuach nefesh.

Moked Harav also works in tandem with the Maayanei Hayeshuah hospital, which understands and caters to the chareidi community, being a fully Halachah-based hospital.

As part of manning the phone lines, at times I note that the family members are at a loss in their situation and I try to involve local askanim, whichever hospital the patient might be in.

The Meuhedet HMO has hosted many of our events, and has sponsored the printing of newsletters that we publish before the Yamim Tovim.

We are interrupted by yet another she’eilah. A child with Down Syndrome who needs to be in the hospital over Rosh Hashanah – the father is asking what tests can they perform on Rosh Hashanah. Another call regarding an elderly mother, asking which medicines can be given in her situation.

There is an important halachah that many people aren’t aware of, and we have publicized this a number of times. When the doctors give morphine to elderly patients, if the nurses give even a drop more than the doctors prescribe, it is a serious halachic problem, as morphine causes the breathing to slow down, and ultimately this can be considered hastening the passing of the patient.

The innovations and teamwork that we hope to attain are endless.

What are your dreams and aspirations for the future?

That everyone, all over the world, know the phone number of Moked Harav: (972-2) 502-0202, and that we also take questions by email: mh025020202@gmail.com.

We are currently also trying to expand Moked Harav to be a worldwide organization. The dream is to get Rabbanim from all over America to join and thus we can have an organization that will be available for any she’eilah with local expertise. Rabbanim can help bring into the equation doctors and specialists for any case, at any time.

A few weeks ago, a call came in at 10 a.m. from a woman calling about a she’eilah of basar b’chalav, while she was cooking. The Rav answered her she’eilah, and then pointed out that this is a medical phone line, not for general she’eilos. She explained that she knew that, but because she was in New York, cooking for Yom Tov at 3 a.m., she had no local Rav to ask, so she called Moked Harav in Israel, as they would have the number of an Israeli Rav to give her.

Ultimately, Moked Harav International Halachah-Medical Hotline is a unique and revolutionary project with nothing comparable to it anywhere in the world, and we hope to be able, b’ezras Hashem, to magnify our services, so that — may no Yid ever need it, but if chas v’shalom he does, he should receive the most professional halachic-medical psak, in the quickest time possible.