By Rabbi Yair Hoffman
There is a major controversy in Borough Park over an all-female Basic Life Support First Responders Agency (BLSFRA) and Hatzalah. Hatzalah is a remarkable organization that has saved tens of thousands of lives. Ezras Nashim is an organization of female EMTs that was formed in 2012 specifically to treat and transport women who would prefer female first-responders for reasons of modesty. They have recently applied for ambulance status to operate in Borough Park and Kensington and thus join 21 other ambulance agencies registered in Kings County. Hatzalah is 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.
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 precluded from operating as an ambulance force, and rather continue to function as a BLSFRA and use the city’s 911 ambulance service for transport.
- An arrangement could be worked out so that Hatzalah could dispatch Ezras Nashim volunteers to tend to women who request women.
What Is The Halachah?
Does the possibility of causing confusion trump the valid concern of tzniyus 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 patients?
The first issue deals with the matter of tznius, modesty. There is a debate between the Rambam (Hilchos Isurei 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, Rav Shlomo Wosner, zt’l, in responsa Vol. IV Siman 167 and in his shiurim (Y.D. Siman 195), and Rav Ovadiah Yosef, zt’l, in his Taharat HaBayit (Vol. II 12, footnote 46), forbid a woman 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 medical practitioner is better. This opinion is based on the halachic positions of the Beis Yosef (195) and the Beis Shmuel (Even HaEzer 20:1).
On the other hand, the Shach, the Kreisi U’Pleisi, and the Darchei Teshuvah (Y.D. 197:8) all permit the use of a male physician when it is medically indicated.
Of course, when it is a matter of life or death, pikuach nefesh, someone searching for a medical practitioner of the same gender is considered a chassid shoteh. The question is one of planning so that it does not happen at the outset. The majority of the issues arise when it is not a matter of life or death.
Most American poskim are lenient in accordance with the Shach’s position, and that has become the normative halacha. 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 tzniyus issues the other way — in having women respond to emergency ambulance calls. Legally, medical practitioners 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 halachah 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 idea of the rights of the first over the second is found in the Gemara in Sanhedrin (32a) according to the Tur’s girsah (C.M. 272) regarding the arrival of two boats passing through a river. The Gemara 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 served.”
There is no question that Hatzalah has a remarkable track record of conscientiously serving our community in its lifesaving efforts. They serve as angels in a difficult environment and have saved and extended the lives of tens of thousands of patients. It is also an organization that has channeled unprecedented chesed.
The Meiri’s understanding of the Gemara in Sanhedrin, however, stands in contrast to the idea of “first come, first served.” He understands the words “te’unah v’she’einah te’unah” — the loaded one versus the one that is not loaded — to mean that 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 based upon this Meiri that Hatzalah would easily survive if there were two organizations, but Ezras Nashim might flounder; but then the issue arises as to whether we pasken like this Meiri or not.
It seems to this author that the Tur’s position has become the normative position in halachah, 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 Hatzalah 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 neonatal resuscitation and have completed certification programs in this area. If Ezras Nashim does not become an ambulance agency, their response time will be slower than that of Hatzalah because of various grandfather clauses in New York State law. The difference amounts to approximately six minutes according to the papers placed before the EMS board.
The fourth issue is that of chillul Hashem. We must always be on guard to avoid causing a desecration of the Divine Name. When Jewish organizations are labelled 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 important Torah directive 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 v’shalom, against Hatzalah, notwithstanding reports in the media that state otherwise.
Both organizations have Torah authorities that have written letters in support. Ezras Nashim has Rav Elya Ber Wachtfogel, shlita, Rav Wosner, zt’l, and Rav Yitzchok Zilberstein, shlita. And Hatzalah has 49 signatures on what they have planned to file. These opinions should not be negated nor dismissed.
The desire of women who wish to be treated only by medical practitioners of their own gender be taken into account. Studies in relevant medical journals show 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 the Beis HaMikdash as well as in synagogues throughout Jewish history. The subtle implication of the name is that this is an area exclusive to women, where men do not belong.
In an unofficial survey of a number of rabbanim, women and medical professionals, taken by this author, the preferred resolution to this was that some sort of cooperation between the two organizations be worked out — as in the third solution presented at the beginning of this article. One person even related that when Hatzalah was originally conceived, the idea was that a separate group of women would be formed to deal with women — like the original Shifra and Pu’ah in Sefer Sh’mos. The Pupa Rebbe’s letter highlights this concept. Skver chassidim also promulgated a women-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 that will benefit all of Klal Yisrael.
Rabbi Hoffman can be reached at Yairhoffman2@gmail.com.