World of the Sages: Regarding doctors

Rabbi Haim Shmuel was once visited by a sick disciple who told him that the doctors had despaired of providing him with a remedy for his ailments.

Short prayers of supplication and thanksgiving traditionally accompany our every step. The Talmud suggests a prayer for someone who goes to a blood letter for curative purposes: "May it be Your will, God my Lord, that this therapy should serve me as a remedy, and that You should heal me, for You are God the faithful healer and it is your remedy that is genuine." Before beginning this medical procedure, the patient turns to the Almighty beseeching divine assistance. The suggested prayer concludes by bemoaning the supposed need for medical experts instead of turning directly to the Almighty: "While it is not the place of people to seek medical treatment, but so they have thus accustomed themselves" (B. Berachot 60a). This expression of lament is dismissed by another talmudic sage on the basis of a biblical passage. The Torah discusses a case in which two people quarrel and one strikes the other causing injury. Among other payments, the biblical verse requires the aggressor to pay for the medical expenses of the victim. From this we derive that permission is granted to physicians to provide medical treatment. Thus there is no place to regret the use of doctors. Commentators explain that this is a clear rejection of the approach that suggests that God caused the ailment, let God provide the cure and we should have no part in the process (Rashi, 11th century, France). Furthermore, even though the biblical source deals with a wound inflicted by humans, we do not say that only such an injury may be treated by doctors; medical attention can be sought even for ailments that have no traceable human cause (Tosafot, 12th-14th centuries, France-Germany). The commentators discuss the nature of this license granted to physicians. According to one approach, the role of physicians is a necessary evil. In an ideal world, states the scholar and physician Nahmanides (13th century, Spain-Eretz Yisrael), we would turn only to God for remedies. Our lowly spiritual state deems doctors a essential part of our lives. An alternate approach states that once permission is granted to doctors to provide medical care, it becomes a holy obligation and is classified as a mitzva. This line is espoused by Maimonides (12th century, Cairo), himself a well-known and much sought-after physician. This position is adopted by the codifiers who further state that physicians who decline to provide treatment are in effect spilling the blood of the ill and they are enjoined to go to all extents to heal the sick (Shulhan Aruch YD 336:1). What, however, are the boundaries of this right cum obligation? Firstly only qualified physicians may provide care, and indemnity for causing damage during treatment is granted only for officially licensed doctors. Moreover, the right to provide treatment is granted to the most qualified physician present; other doctors must defer to their most capable colleague (ibid). A story is related about a sick person who came to the famed hassidic master and legal authority, Rabbi Menahem Mendel Schneersohn of Lubavitch (1789-1866), known by the title of his halachic works Tzemah Tzedek (righteous scion), a moniker that has the same numerical value as his name. The ailing visitor told the hassidic master that the doctors ruled that there was no hope for his recovery. The Tzemah Tzedek replied: "According to our sages, the biblical verse teaches that physicians have the right to heal. Where physicians are unable to provide a remedy, they are like any other person and have no special authority or license to state an opinion." A colorful later hassidic master reacted in a similar fashion. Rabbi Haim Shmuel of Checiny (1843-1916) was an ardent lover of the Land of Israel. He had a penchant for clocks and the 24 clocks in his house were all set to the time in the Holy Land. On Shabbat and before prayers, he only spoke Hebrew, and when he would hear someone speaking negatively about the Land of Israel he would admonish him for repeating the sin of the spies who had brought an unfavorable report back to the Jewish people. Rabbi Haim Shmuel was once visited by a sick disciple who told him that the doctors had despaired of providing him with a remedy for his ailments. He responded: "Physicians have the right to heal, not - heaven forfend - to cause the sick to give up hope!" Returning to the talmudic passage, a prayer of thanksgiving is also prescribed for once the sick have recovered: "Blessed are You, God our Lord, king of the world, the free healer." According to another version the passage, the blessing should end with the words "...the one who heals the living" (Rabbenu Hananel, 11th century, Kairouan). A third, popular variation prefers the words "...the one who heals the sick" (Behag, ninth century?, Babylonia; and others). While health is obviously desired for our physical existence, one hassidic master put a spiritual spin on the quest for good physical condition. Rabbi Avraham Haim of Zloczew (d. 1848) was a scion of a well-known rabbinic family, a student of the famous early hassidic masters and a forebear of later halachic greats. This pious leader commented on our passage in his work which is primarily a compilation of the thoughts he received from his teachers. While the doctor has the right to heal the ailing, the sick themselves are obligated to do all in their power to ensure and restore good health. Indeed there is a biblical directive, echoed later in the prophets, to conscientiously look after ourselves (Deuteronomy 4:15; Joshua 23:11). When the body is weak, the soul also suffers and our service of the Almighty is hindered. Perhaps we could add that the word used in these verses is nefesh, a term employed in later texts to refer to the soul. In order to guard our nefesh, we are enjoined to turn to physicians and seek remedies for our physical ailments, for only with a fit body can we embark upon spiritual pursuits and maximize the potential of the nefesh. The writer is on the faculty of Pardes Institute of Jewish Studies and is a rabbi in Tzur Hadassah.