1. In determining what is considered a situation of pikuach nefesh, it is best to follow the determination of a religious doctor who understands the severity of violating Shabbat, as well as the importance of saving a life. Nevertheless, as is evident from the previous halachot we have learned, if a religious doctor is not easily available, any doctor should be followed if they determine that the situation requires violating Shabbat (Biur Halachah 328:10; R. Yitzchak Zilberstein, Torat Hayoledet, ch.50).

2. If no doctor is available, then even one who does not have medical expertise can be followed if they suspect that a danger to life exists and have some knowledge of the matter (Shulchan Aruch 328:10; Mishnah Berurah). Even if there is a doctor available, but the patient disagrees with the doctor as to whether it is necessary to violate Shabbat, we generally listen to the doctor (Biur Halachah 328:10). If the patient says that he requires a certain medicine but the doctor says that treatment will be harmful, we listen to the doctor (Radbaz 4:66). In all of these cases, if there is any good reason to believe that the patient is more knowledgeable than the doctor, we might listen to the patient. For example, if the doctor is a general one without specific expertise concerning the condition of the patient, and the patient insists that his regular doctor prescribes a different treatment and is knowledgeable about the details, we may listen to the patient with respect to violating Shabbat, though each case must be judged on an individual basis.

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Dedicated by Fran Broder as a zechus for everlasting peace in Eretz Yisrael in the merit of learning Hilchos Shabbos.