R' Elchanon (kovetz hearos siman 23) discusses whether it is permitted for a person to put themselves into a situation where they will have to use pikuach nefesh to permit an issur. He proves from the Ba'al Hameor who forbids leaving on a ship within 3 days of Shabbos because it is likely that you will find yourself in a situation of pikuach nefesh and have to be mechalel shabbos, that it is only an issur derabonon but not deoraysa (if it would be an issur deoraysa it should not matter if it is within 3 days or more than 3 days). Once it is only an issur derabonon, we can be matir for shalom bayis. Therefore, one would be allowed to have relations with a women for whom it is dangerous to become pregnant, even though after relations she will use a 'moch' to prevent pregnancy (i am not sure about the statistical success rate associated with this form of birth control). This explanation would be necessary if we learn the gemara to be speaking about a moch after relations (tosafos in the name of rabbeinu tam) and would be an issur if not for pikuach nefesh. But, according to Tosafos who explains that these 3 women MUST use a moch, which implies that other also are allowed to bec. there is no issur for her to remove the shichvas zerah with a moch after tashmish, we don't need to come onto the heter of pikuach nefesh. Rav Elchonon second guesses his proof, that perhaps there is an issur deoraysa to put oneself into a situation where pikuach nefesh will have to push off the issur and no proof can be brought from the ba'al hameor bec. he may hold that shabbos specifically is "hutrah" for pikuach nefesh (but other issurim which are only "dechuya" there would be an issur deoraysa to lichatchila put oneself into a situation where they will have to rely on the license of pikuach nefesh).
At the end he cites a magen avrohom (o.c. 248) who questions whether one who intentionally put themselves into a situation of pikuach nefesh should rely on it to be docheh shabbos. R' Elchonon explains that by not relying on the heter it comes out retroactively that he did not do an issur by placing himself in that situation. R' moshe has a teshuva where he adamantly disagrees and says that one must use the heter of pikuach nefesh to be docheh shabbos and save their life.
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The following comment is for learning purposes only (r' moshe in the very next teshuva screams about one who printed heterim for birth control in a journal, so i imagine that a blog is really a less appropriate forum for pesak halacha).
i just went through r' moshe's teshuva (even haezer 1:63) on mechanical forms of contraception (to the exclusion of the pill). His assumption is that the machlokes r' meir and chachamim is only for minor sakana, but for a real concern of sakan even chachamim agree to be matir. There are 2 approaches in understanding shitas rashi regarding the heter of using a moch at the time of tashmish rather than saying to abstain entirely. 1. there is an issur for him to be motzi shichvas zerah on a moch bec. it is the equivalent of being motzi on "wood and stones", but the mitzvah of onah is considered a significant purpose and therefore if there is no alternative to have tashmish any other way, the hotza'as zerah is not levatala. 2. there is no concern of being motzi zerah on "wood and stones" bec. it is the derech of tashmish. but, the concern is that there is an issur on her to be mashchiz his zerah after tashmish, and we extend the issur to not allow during tashmish bec. of a gezeira, but in a case of sakana we allow a moch during tashmish.
The moch of the gemara is similar to a diaphragm type device and therefore would be permitted acc. to everyone in a situation where it is a sakana to get pregnant. the question is, what about a condom?
Based of the first rationale, in a situation where it is dangerous for a women to get pregnant, he says that a condom would also be permittes since the mitzvah of onah will make it considered purposeful rather than l'vatala. But, acc. to the second rationale, the primary heter is based on it being derech tashmish, but using a condom is not derech tashmish and therefore assur. In a situation where a diaphragm type device isn't possible, he allows one to rely on the first approach. Furthermore, r' chaim ozer considered a condom to also be derech tashmish and would even be permitted acc. to the second approach (but r' moshe disagrees).
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