Printable PDF available here. Previous years’ pieces on Parshat Mishpatim are available here and here.
Rav Kook (Ein Ayah, Gemara Berachot 60a)
Rav Acha taught that if one is about to engage in bloodletting [a basic medical procedure in pre-modern times], he should say “May it be Your will, O Lord my G-d, that this enterprise be for healing and that You should heal me. As You are a faithful G-d of healing and Your healing is truth. Because it is not the [proper] way that people should heal, but they have become accustomed to it.” [I.e., people should ideally not practice medicine, and healing should rather be left to G-d.]
Abaye objected that one should not say this. As it was taught in the academy of Rabbi Yishmael, from the verse [in Parshat Mishpatim] “And he shall cause him to be thoroughly healed” (Shemot 21:19), we derive that permission is granted to a doctor to heal. [I.e., the practice of medicine is in accordance with the will of G-d.]
The human body is a complex entity, with various organs and faculties bound together. The soul is similarly comprised of various emotional and intellectual components, which are bound together in a wondrous manner with the physical body. No person can pridefully declare that he has fully mapped out the full complexity of the human body or that he understands its full depth.
From this perspective, medical science is an ultimately unreliable discipline. Even if a doctor can heal a specific illness within the purview of his or her narrow expertise, who can assure that the treatment administered will not have undesirable and unforeseen side-effects? Perhaps these side-effects will throw the patient into disequilibrium and prove to do more harm than good. In light of our imperfect knowledge, no medical treatment can be guaranteed to be totally and unqualifiedly beneficial. This was the perspective expressed by Rav Acha, who cast aspersions on the reliability of medical knowledge. “Because it is not the [proper] way that people should heal, but they have become accustomed to it.” At the same time, experience demonstrates that medicine does frequently discover important truths that bring about healing and improve human welfare. How are we to reconcile these competing perspectives? According to Rav Acha, we must relate to medicine as a wonder of Divine governance and something that is ultimately out of our hands. We do the best we can but remain aware that our efforts are meager and our knowledge is fragmentary. Healing is ultimately in G-d’s hands. His “healing is truth,” while ours is inherently falsifiable, incomplete and liable to do more harm than good.
However, our sacred tradition contains other perspectives as well. Not all of the Sages agreed that the discipline of medicine is somehow religiously illegitimate or compromised. R. Yishmael maintained that we do not need to concern ourselves with contingencies or eventualities that lie beyond the scope of human understanding. Caution and humility are important values, but not in overabundance. A constant wariness against unforeseen consequences or side-effects undermines human initiative, and suffocates the religious imperative for humanity to improve the world – both the physical world and the inner dimension of the spirit. Man must live by the principle that הנסתרת לה׳ אלקינו והנגלת לנו ולבנינו עד־עולם לעשות את־כל־דברי התורה הזאת (Devarim 29:28) – “Hidden things are the concern of the Lord our G-d, but the revealed is for us and our children.”
R. Yishmael maintained that “a judge can only adjudicate based on what is own eyes see.” The Torah gave permission to a doctor to heal, without needing to constantly question or suspect the efficacy of his or her craft. A competent doctor does not usurp the Divine prerogative, but acts as a messenger of G-d to bring healing to His creations and improve His world. Far from being illegitimate, medical science is a Divine gift that flows down from heaven, as is every application of human intellect to the development and improvement of the world.“And he shall cause him to be thoroughly healed” (Shemot 21:19), from here we derive that permission is granted to a doctor to heal. In the words of Kohelet (7:19), “Wisdom affords strength to the wise” (Kohelet 7:19).
Food for Thought
Rambam (Commentary to the Mishnah, Pesachim 4:10): [Some maintain that seeking medical treatment indicates a lack of faith in G-d.] According to their faulty and foolish imagination, if a person is hungry and he turns to bread and eats it, undoubtedly relieving himself from that great distress, would we say that he has removed his trust from G-d? Fools, say to them, just as I thank G-d at mealtimes for providing me with something to remove my hunger and maintain me, so too we should thank Him for providing a cure that heals my illness when I use it.
The Wings of the Sun – Traditional Jewish Healing in Theory and Practice: After having been immersed in Rebbe Nachman’s profound and moving teachings about simchah and healing, his emphatic warnings against doctors may seem almost jarring. He urged his followers to avoid medicine even in cases of serious illness. He said that the majority of doctors have no understanding of the art of healing. Being far more likely to cause damage than to do any good, most doctors are nothing but agents of the Angel of Death (Rabbi Nachman’s Wisdom #50)…
Rebbe Nachman’s essential point in this teaching is that the true meaning of the rabbinic dictum that “the Torah gave the doctor license to heal” can be understood only in relation to the talmudic teaching that the sick person is healed “through a particular drug and a particular doctor on a particular date” (Avodah Zarah 55a). This second statement of the Rabbis defines and limits the extent of the doctor’s license to heal. Illness is seen as a heavenly decree, a “judgment.” Unless the decree is mitigated through pidyon nefesh, redemption of the soul, the illness will run its course, and only when its required duration is complete, as laid down in the decree, will the patient recover. In order for the illness to continue until a particular day and hour, the decree governs the very means by which the patient will eventually be cured: through “a particular drug and a particular doctor.” Thus if the doctor has “license to heal,” it is only as Heaven’s agent to release the patient from the decree of illness when its duration is complete. The doctor is like a prison warden who is given the key to open the cell only after the sentence has run its course. The only other circumstance in which the doctor has license to heal is when the decree against the patient has been revoked or mitigated through pidyon nefesh.
Rebbe Nachman’s response to the objection that many people receive medical treatment and recover is that the treatment itself is an incidental factor. The essential reason why the patient recovers is that the decree has reached its end, and therefore a heavenly-ordained chain of events ensures that his body heals. On the other hand, as long as the heavenly decree is in force, no matter what the patient or the doctors may try, nothing will avail. This would explain the common phenomenon of patients who wander from doctor to doctor in search of a cure, but nothing seems to help – until one day, often unexpectedly, a cure comes about through some quite simple remedy, or even spontaneously.
Shaar HaMitzvot (Parshat Ekev p. 60): Once a man came to the Ari and said that for two days he had been suffering intense pain in his shoulder. The Ari looked at him and said the reason for the pain was that instead of reciting the Grace after Meals directly after washing his hands at the conclusion of his meal (mayim acharonim), he had paused to study some Mishnah. The Rabbis said, “Recite the blessing directly (teikhef) after washing” (Berakhot 42a). TeiKheF, had turned into KaTeF), a “shoulder,” and this was why he felt the pain in his shoulder.
Permission Given to a Doctor to Heal (Rabbi Dr. Benjamin Gesundheit, MD PhD): It should be noted that the Posekim decided the law in accordance with the position of Rabbi Yishmael: Rif (Berakhot 44a), Maimonides (Hilkhot Berakhot 10:21), Rosh (Berakhot 9, no. 21), Tur and Shulchan Arukh (Orach Chayyim 230:4) codify only part of the talmudic passage in Berakhot 60a: “One who goes in to have his blood let should say: ‘May it be Your will, O Lord, my G-d, that this operation may be a cure for me, for You heal without payment.’ And when he goes out, he should say: ‘Blessed are you, O Lord, who heals the sick.’” The continuation of the prayer (“and may You heal me, for You are a faithful healing G-d, and Your healing is true”) and the Gemara’s explanation (“since men have no power to heal, but this is the common practice”), they all omit from their rulings. Rabbi Yishmael’s opposition (“A man should not speak thus…”) was accepted as law.
Questions for Discussion
- As noted above, poskim decided the law in accordance with the position of Rabbi Yishmael. Does this mean that Rav Acha’s position is decisively rejected, or are there elements of truth to his position?
- Is it a Torah value to take care of your health?
- Rav Kook states that “Caution and humility are important values, but not in overabundance.” Can you think of examples that illustrate this point?
- Why does the Torah need to give explicit “permission” to a doctor to heal? Why wouldn’t it be permitted by default?
- See Rebbe Nachman quoted in “Food for Thought” above. Why does he disagree with Rav Kook?
- Why do a disproportionate amount of Jews go into the medical profession?
