As we find on Yuma 84, even a question of preserving life takes precedence over Shabbos. The Ramban writes that refraining from violating Shabbos in such a case isn't even middus chassidus. In fact, one who avoids violating Shabbos on this account and dies is considered as though he had thrown his own life away, G-d forbid.
However, that which constitutes a threat to life for one person does not necessarily hold true for another person. Rav Chaim Soliveitchik zt”l told Rav Boruch Ber zt”l "A Rav must be clever." Rav Boruch Ber, applied this statement to discerning what is truly life threatening since establishing the parameters of genuine need demands great insight.
Rav Gedaliah Moshe Goldman zt”l, the Rebbe of Zvhil, spent over seven years in
“You are free to leave as soon as you sign your release forms,” he said.
The Rebbe struggled with himself. On the one hand, it is forbidden to write on Shabbos. On the other, perhaps this is a case of pikuach nefesh and he must sign! After a moment’s consideration, the Rebbe concluded that his situation was not life-threatening; after all, he had survived until now. He refused to sign.
“You’re not signing the release?” exclaimed the incredulous commandant. “That’s fine with me. As far as I’m concerned, you can sit here forever!”
The commandant then turned to the elderly Jew and said, “You are free to go as soon as you sign your release form.”
He too refused to sign, but the Rebbe intervened.
“I am prepared to sign for my companion so he can go free,” he exclaimed.
The commandant was perplexed. “I don’t understand. Why can you sign for your friend’s release, but not for your own?”
The Rebbe answered, “I can’t sign for myself since I may only violate the Shabbos if my life is clearly in danger, and I don’t believe that it is. He, however, is elderly. He has no chance of surviving if he remains here much longer. Therefore I must certainly sign to save his life.”
The commandant was dumbfounded. “You’ll sign for him, but not to save yourself? That’s incredible! You can both leave without signing!”
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