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Healing

 

I. Permission to Heal

Publication of volume 4 of Verapo Yerapei, the Torah journal of the Einstein Medical School Synagogue, and the occurrence of the title in last week’s Torah portion started me thinking about the obligation to heal (on which Jonathan Ziring’s article in the journal touches). The Gemara (Bava Kamma 85a-b) deduces from the obligation of an assailant to pay for his victim’s medical treatment that a doctor has permission to heal those in need. However, elsewhere the Gemara (Sanhedrin 73a) considers healing a form of returning a lost object, returning the patient’s body, which is obligatory. The contradiction between healing as a permitted activity and a requirement begs for resolution.

One possible approach is that without the permission there can be no obligation. Why do we need any permission to heal? Is there not a fundamental requirement to save life because of piku’ach nefesh and a prohibition to stand by idly as someone dies (Lev. 19:16)? Rashi (Bava Kamma, ad loc., sv. nitenah) states that medical treatment ostensibly undermines God’s plan. If God wants someone to be ill or die, absent permission we would be restrained from defying His will. However, once medicine becomes permitted by the Torah, it becomes obligatory.

Ramban (Toras Ha-Adam, Sha’ar Ha-Sakanah 6; Commentary to Lev. 26:11) offers two reasons why the Torah needs to permit healing. The second follows Rashi, as above. This approach is entirely consistent with Ramban’s comments elsewhere, requiring people to submit to God’s plan even absent a specific halakhic obligation (see this post: link).

II. Dangerous Healing

However, Ramban’s first answer is entirely different. Medical treatment is inherently risky and uncertain. Even proven treatments sometimes encounter complications that threaten the patient’s life. Without Torah permission, we would be unallowed to endanger a patient with risky procedures. Despite the piku’ach nefesh mandate to save life, without this permission we would not be allowed to potentially cause more harm, such as hastening death, in trying to save life.

With Ramban’s second answer, we can explain why the Torah had to give permission and to obligate healing. We could answer as we did above for Rashi: once treating a patient becomes permitted, it becomes obligatory. But perhaps we can take a different approach. The risks of different medical treatments are dissimilar. Some are very risky, some less, some nearly without any risk at all. Would it really be forbidden to give someone an aspirin for a headache when the risk of negative reactions is minimal. While there is still some risk, it pales in comparison to the everyday risks we regularly take in the course of our lives. Perhaps we can say that the Torah permitted, but never obligated, risky medical procedures (however that may be defined). Treatment with little risk is obligatory. And what about piku’ach nefesh? The permission and obligation include even non-lethal illness while piku’ach nefesh and associated obligations only apply to life-threatening situations (see Tzitz Eliezer vol. 5 Ramas Rachel no. 20).

III. Different Levels of Healing

An alternative explanation that I have not seen elsewhere can take an opposite approach. Perhaps the obligation to heal only applies to illnesses that threaten permanent functioning. The source of this obligation is returning a lost body, just like a lost item. If you have to return someone’s watch, you certainly also have to return his arm or leg. But this teaches us nothing about healing an illness that does not permanently threaten bodily function. (Although nowadays, with our knowledge of the lethal threat posed by infection, the distinction is largely, but not entirely, theoretical. See Nishmas Avraham vol. 1 328:49)

If the above is correct, we are required to restore, or prevent loss of, someone’s life or limbs. However, medical treatment for temporary ailments are permitted but not obligatory. We can also explain why either of these Talmudic derivations are necessary when we have a clear obligation to save lives. Piku’ach nefesh only applies to healing life-threatening illness. For all lesser threats we need other sources for the obligation to heal.

Maharatz Chajes (Glosses to Bava Kamma 85a) notes that Rambam cites the obligation to heal from the mitzvah to return a lost object (Commentary to Nedarim 4:4; Mishneh Torah, Hilkhos Nedarim 6:8) but never quotes the “permission” to heal. Torah Temimah (Ex. 22 n. 148) infers that the Rambam sees these two derivations as contradictory. Either we are permitted or obligated to heal, not both. To the Rambam, all medical treatment is a requirement, regardless of severity. We are required to help others and dismiss thoughts of any divine plan.

 

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Gil Student

Rabbi Gil Student is the founder, publisher and editor-in-chief of Torah Musings.

 
The opinions and facts here are presented solely by the author. Torah Musings assumes no responsibility for them. Please address religious questions to your rabbi.
 

14 Responses

  1. Jonathan Ziring says:

    First, thank you for the shout out. Second, a source that I do not cite in my article, though one that makes a similar point to yours, is found in the comments of R. Shlomo Kluger (Chochmat Shlomo Choshen Mishpat 426:1). He argues that if there is non-life threatening case, one done not have to save another person if will cause him degradation, as that is an exemption by the laws of Hashavat Avedah. However, when there there is potential loss of life involved, Lo Taamod (which functionally is similar to pikach nefesh)also applies which has no such exemption. [The Achronim dispute the implications of this piece.]

  2. Mr. Cohen says:

    Shulchan Aruch, Chelek Orach Chaim, Siman 230, Sif 4:

    Before undergoing a medical procedure or before taking a medicine, say [this prayer]:

    “May it be Your Will, HaShem my G_d,
    that this thing should be for me a healing,
    because you heal for free.”

    After a medical procedure or medicine, say [this thanks]:

    “Blessed be the One Who heals the sick.”
    IN HEBREW: Baruch Rofeh Cholim.

    The Bair Haitiv commentary ( Sif Katan 5) points out that even though a strictly literal reading of this Shulchan Aruch refers to an obsolete medical procedure known as blood-letting, the true intention of the text refers to any medical procedure or medicine.

    The Mishnah Berurah commentary ( Sif Katan 6) repeats the words of Bair Haitiv and then teaches that you should not believe that the medicine is what really heals, but instead you should believe that healing comes from G_d, and through this prayer we establish our trust in Him and request from Him that it [the medicine] should accomplish healing.

    The Kaf HaChaim commentary ( Sif Katan 18) points out that G_d heals for free, which is not true of human [doctors].

  3. c says:

    Did you pick winners for books yet?

  4. Anonymous says:

    Worth mentioning is the Ibn Ezra’s opinion. Only visibile or external injuries are permitted to be treated. Systemic or internal illnesses should be left to God.

  5. mycroft says:

    “The Kaf HaChaim commentary ( Sif Katan 18) points out that G_d heals for free, which is not true of human [doctors].”

    Of course forgotten is that like Rabbonim. physicians are NOT allowed to get payed for sechar limud.

  6. Mycroft:

    Most doctors I know go into great debt for their primary limud

  7. Noam Stadlan says:

    I would phrase it not only in terms of risk, but also in terms of specific prohibitions that are ‘vioalated’ in order to heal. For example surgery in a different context is chavala. Giving medicine in a different context is poisoning. There are issues of yichud and erva. Therefore, although there is an obligation to save lives, it is necessary to have permission to ‘violate’ these issurim.
    In addition, the patient has an obligation to seek and follow medical advice- u’shmartem nafshoteichem me’od. Halacha has a very paternalistic approach to medicine/ healing, with personal autonomy applying only within certain parameters.

  8. Hirhurim says:

    Noam: Excellent points about the prohibitions of specific medical treatments. I wonder if the Ramban meant that but said it in different words.

    On whether a patient has an obligation to seek treatment, that is the subject of Jonathan Ziring’s article. I believe he points out that it is a matter of debate among the poskim. Certainly the Ramban disagrees. The teshuvah of the Tzitz Eliezer to which I link in this post also discusses it.

  9. avi says:

    I think it’s important to mention the gemorah which essentially says that doctors are killers, and the last thing you want to be in life is a doctor. Personally, I think that changes the conversation entirely.

    Medicine has gone a long way from being the toss of a coin to being a bit more reliable. However, I recently was reading about the fact that most drug studies today do not follow good scientific procedure.

  10. Noam Stadlan says:

    Thanks. I am aware of the various shitot but my impression is that the obligation to seek healing is the majority opinion. (And certainly the one that would keep me the busiest). Is the article online?

  11. Y.Aharon says:

    I fail to understand the supposed distinction between promoting the healing or alleviation of a possibly transitory condition vs. a permanent injury. In both cases, the restoration of the subjects health is achieved or quickened. The analogy (via a kal vachomer)to the return of a lost object still holds. If I find my neighbor’s animal wandering, I am obligated to bring it back to the owner even if I can anticipate that the animal will ultimately find its way home, or that the owner will exert himself and locate the animal.

  12. Avi:

    “recently was reading about the fact that most drug studies today do not follow good scientific procedure.”

    Link please

  13. mycroft says:

    ” Abba’s Rantings on February 14, 2013 at 8:28 am

    Mycroft:

    Most doctors I know go into great debt for their primary limud”
    I am just quoting halacha.
    Since you opened the door -name a field where the payoff per dollar spent on education is even in the same ballpark as that for medical field. I do not believe this type of discussion is appropriate for Hirhurim. A discussion of the ethics to treat those who can’t maybe-but not income of a lay profession.

 
 

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