What is the Jewish Attitude Towards Medicine?

Responsa in a Moment: Volume 1, Issue No. 3, November 2006

In Memory of
Brenda Kaufman Berman z”l
On her twelfth yahrzeit
3 Shevat 5766

Yoreh Deah 336:1

Question: It says in the Torah “for I the Lord am your healer” (Exodus 15:26). If so, why do Jews practice medicine and consult doctors? Why don’t we simply pray to God to heal us like Christian Scientists? (I have been asked this question a number of times. This responsum is based upon the Annual Brenda Kaufman-Berman Memorial Lecture, which I gave at the Schechter Institute on January 29, 2006. Brief references refer to the Bibliography at the end of the Responsum).

Responsum:

A story is told of the Jewish mother of an American President who receives a call inviting her to Air Force One. She hangs up the phone. Her friend asks: “Who was that?” She replies: “You know my son the doctor? That was his brother”.

This joke illustrates the high regard which Jews have for doctors. This point was reiterated by Sherwin Nuland in his new biography of Maimonides. He begins his book with the following probably apocryphal story:

Imprisoned in a tower in Madrid , disabled by syphilis and further weakened by an abscess in his scalp, the French King Francis I asked of his captor, the Holy Roman Emperor Charles V, that he send his finest Jewish physician to attempt a cure. At some point soon after the doctor arrived, Francis, in an attempt at light conversation, asked him if he was not yet tired of waiting for the Messiah to come. To his chagrin, he was told that his healer was not actually Jewish but a converso who had long been a baptized Christian. Irate, Francis dismissed him and arranged to be treated by a genuine Jew, brought all the way from Constantinople ( Maimonides, New York, 2005, p. 3)

Nuland also points out that during the Arabic period, approximately half of the Jewish doctors were also rabbis (ibid., p. 12). Finally, in the first half of the fourteenth century, only 5% of the population of Marseilles was Jewish, but they accounted for 43% of the city’s physicians (ibid., p. 14). Indeed, Maimonides, Ramban and Ibn Ezra whom we shall quote below were all doctors.

Therefore, this question and this responsum may seem superfluous, but they are not, as we shall see below.

In general, there are three basic approaches in Judaism to our question:

1) It is forbidden to practice medicine because “I the Lord am your healer” (Exodus 15:26).
2) It is permitted to practice medicine.
3) It is a mitzvah to practice medicine.

We shall study nine specific approaches to our topic, which fit into a continuum between a prohibition and a mitzvah .

I) We Should Pray to God and Not Use Doctors

The bible and rabbinic literature state repeatedly that God makes people sick and that He is the one who heals. “If you will heed the Lord your God diligently.Then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the Lord am your healer” (Exodus 15:26). “I deal death and give life, I wounded and I will heal” (Deut. 32: 39). “He injures, but He binds up; He wounds but His hands heal” (Job 5:18).

A similar attitude is found in Rabbinic literature: “A person does not injure his finger below unless it is decreed above” (Hullin 7b). A snake says: “If I was not told by Heaven to bite, I would not bite” (Yerushalmi Peah, Chapter 1, 16a bottom). Hanina ben Dosa, a talmudic wonder-worker said: “The snake does not kill; sin kills” (Berakhot 33a and parallels).

That is why in the Bible, when someone became ill, the main response was prayer. Abraham prayed to heal the house of Avimelekh (Genesis 20:17-18). Moses prayed to heal Miriam (Numbers 12:13). Elijah prayed to heal the widow’s son (I Kings 17: 17-24) and Elisha prayed to heal the bitter waters (II Kings 2: 19-22). Prayer was also used to heal the son of the Shunamite woman (ibid. 4: 18) and to heal King Hezekiah (ibid . 20: 1-11).

In the rabbinic period, when someone got sick, people would pray (Berakhot 55b), fast (Tosefta Taaniyot 2:15, ed. Lieberman p. 335) and give tzedakah (Bava Batra 10b).

All of these sources say that prayer heals but they do not explicitly oppose doctors or medicine. But one biblical verse implies that prayer is preferable to medicine. King Assa became very ill in his leg “but ill as he was, he did not turn to (lo darash) God but to physicians” and he then died (II Chronicles 16:12 ff.). In the Bible, “darash et hashem” means to turn/to seek/to pray to God (See Deut. 4:29; Hosea 10:12; Amos 5:4-6; I Chronicles 16:11; 28:9; II Chronicles 12:14; 14:3, 6; 15:2; 15:12; 22:9; 26:5 and see Brown, Driver, Briggs, A Hebrew and English Lexicon of the Old Testament, Oxford, 1959, p. 205, s.v. darash). The implication is that he died because he only turned to physicians and not to God.

A few statements opposed to medicine can also be found in rabbinic literature. The Mishnah (Kiddushin 4:14) says “tov shebarofim l’gehinom” – “the best of physicians to hell” while Avot D’rabi Natan (Version A, Chapter 36, ed. Schechter p. 108) says that “Seven do not have a place in the world to come: a clerk, a scribe, tov shebarofim – the best of physicians, a judge in his city, a magician, a hazzan, and a butcher”. The simple meaning of these sentences is not clear. Were these passages opposed to all doctors because they are usurping God’s role as healer or because doctors sometimes kill their patients or are they opposed specifically to the best physicians who harm their patients out of arrogance?  (See the commentaries of Rashi, Tosfot Ri Hazaken and Maharsha to Kiddushin 82a; Ramban, Torat Ha’adam, ed. Chavel in: Kitvey Ramban, Vol. 2, Jerusalem, 1964, p. 43; Preuss, p. 26; Judah Goldin, The Fathers According to Rabbi Nathan, New Haven, 1955, p. 151).

Another passage (Pesahim 56a = Berakhot 10b) says that “King Hezekiah did six things and the Sages thanked him for three.he buried sefer refuot (a book of remedies) and they thanked him”. Rashi explains in Berakhot that he buried a book of remedies “so that they should ask for mercy”. In other words, the Sages thanked him because they preferred prayer to medicine.

In the middle ages, a number of prominent rabbis followed this approach. Ibn Ezra, who was a physician in Spain (1092-1167), says in his commentary to the above-quoted verse (Exodus 15:26) that “I am the Lord your healer.you have no need of a physician, just as I cured the bitter waters ibid ., v. 25) which physicians are unable to cure”. So too, on the verse about one person who injures another and “must pay for his idleness and his cure” (Exodus 21:19), Ibn Ezra says that “allowing doctors is the opinion of one rabbi in the Talmud (see below), but in my opinion one must rely directly on his Creator “. He further states that this verse means that one may heal an injury which one person inflicts upon another, but only God may cure an internal disease . A similar opinion appears in Rabbeinu Bahya’s thirteenth-century commentary to Exodus 21:19. Interestingly enough, this is also the approach of Christian Science which was founded by Mary Baker Eddy in 1879. They use dentists and optometrists and they also use doctors for setting broken bones, but when someone is sick, they only use prayer (The New Encyclopedia Britannica, 15th Edition, Micropaedia, Vol. 3, Chicago, 1974, p. 279).

II) People Do Not Have the Right to Heal, But it is Their Custom to Do So

This approach is found in a famous passage in the tractate of Berakhot (fol. 60a at bottom):

A person who goes in to bloodlet says: “May it be your will Oh Lord my God that this procedure cure me, for you are a loyal healer and your healing is true, for people do not have the right to heal but it is their custom to do so” (see Muffs and Preuss for this translation).

This prayer is aware of approach No. I which opposes medicine and doctors. It is therefore apologizing for going to a bloodletter for healing. It states that God is the true healer, but people are nonetheless accustomed to go doctors and bloodletters.

III) A Combination of Prayer, Sacrifices and Doctors

The third approach is found in the book of Ben Sira which was written in Hebrew in the Land of Israel ca. 170 BCE. The Hebrew original was lost for 900 years until it was rediscovered in the Cairo Genizah by Solomon Schechter. Ben Sira states in Chapter 38 (verses 1-15, ed. M. Z. Segal, p. 243) that people should honor doctors becase God gave them wisdom and they should not refuse medicines which come from the earth and exhibit God’s power. When a person gets sick he should “pray to God for he will heal”, offer sacrifices “and also give a place to the physician.for there is need of him too” and one should not oppose him.

Unlike, the Talmud (approach No. II), Ben Sira does not reluctantly allow people to go to doctors. He says that when a person is sick, he should pray, offer sacrifices and call a doctor. This is not a grudging compromise; it is a recommendation.

IV) ” From Here We Derive That a Physician Has Permission to Heal”

In two places in the Talmud ( Berakhot 60a and Bava Kamma 85a), we find the following passage:

It was taught in a baraita in the academy of Rabbi Yishmael: ” Verapo yerapeh – and he shall verily cure him”. [Why the double verb?] From here we derive that a physician has permission to heal.

We might have expected that the rabbis would derive from the double verb in this verse that it is a mitzvah to heal. But in light of the opposition to doctors and medicine which we saw in approach No. I, these rabbis felt that they needed to give doctors permission to heal.

Indeed, Tosafot (to Bava Kamma , ibid .) adds a comment which is in direct opposition to Ibn Ezra and Rabbeinu Bahya cited above. Tosafot asks: why couldn’t we learn permission to heal from “verapo” by itself? They reply: because then we would say that doctors can only heal an injury which one person inflicts upon another, but if one heals a disease which comes from heaven, he seems to contradict the heavenly decree. Therefore the double verb comes to teach us that this too is permitted.

It is worth nothing that this famous Talmudic statement was not codified by the Rif, Rosh and Rambam, the three pillars of medieval codification.

V) “Permission to Do a Mitzvah”

In the Shulhan Arukh ( Yoreh Deah 336:1) written in Safed ca. 1550, Rabbi Yosef Karo rules as follows:

The Torah gave the doctor permission to heal, and it is a mitzvah , and it is part of pikuah nefesh , and if he avoids healing, he is spilling blood [=a murderer].

This is a difficult passage. First it says that healing is permitted , then that it is a mitzvah , and then that a doctor who avoids healing is a murderer ! R. Yosef Karo did not create this contradiction. He copied it from the Tur (R. Jacob ben Asher, ca. 1270-1340; Yoreh Deah ibid .) who copied it in turn from the Ramban’s monograph on mourning Torat Ha’adam (ed. Chavel, Kitvey Ramban , Vol. 2, Jerusalem, 1964, p. 42).

The Ramban, R. Moses ben Nachman ( Spain and Israel , 1195-1270) wrote that the Talmud says that doctors have permission to heal in order to say that it is not forbidden lest they harm someone or so that they shouldn’t say that God smote and He heals like the verse in II Chronicles about King Assa. “But this permission is ‘reshut d’mitzvah’, ‘the permission to do a mitzvah ‘, because it is a mitzvah to heal and part of pikuah nefesh “. He then quotes many talmudic passages about pikuah nefesh.

The Ramban was clearly torn by contradictory sources. According to Berakhot = Bava Kamma the Torah gives the doctor permission to heal, but according to Yoma 82a and other sources “experts” (=doctors) feed a person on Yom Kippur because of pikuah nefesh. So the Ramban invented a new halakhic category of reshut d’mitzvah, permission to do a mitzvah, which was then codified by the Shulhan Arukh despite the internal contradiction.

VI) A Sage May Not Live in a City Without a Doctor

A baraita in Sanhedrin (17b) states:

Any city lacking these ten things, a Sage may not live there: a Bet Din. a basket for tzedakah .a synagogue, a bath house, a latrine, a doctor, a bloodletter, a clerk, a butcher, an elementary school teacher.

This passage contradicts the above-quoted passage from Avot d’rabi Natan (see Section I) which says that some of these people – including doctors – have no place in the World to Come. In any case, this baraita clearly does not oppose medicine or merely permit it; it says that a good city must have a doctor.

VII) A Doctor Helps God Heal the Sick

This approach is found in two beautiful parables from the middle ages. The first is found in Midrash Shmuel (ed. Buber, Cracow, 1893, p. 54; cf. Midrash Temurah in J. D. Einstein, Otzar Midrashim, New York , 1915, pp. 580-581). According to Zunz, this midrash was edited in the eleventh century and is already quoted by Rashi:  (Yom Tov Lipman Zunz and Hanokh Albeck, Hadrashot B’yisrael B’hishtalshelutan Hahistorit, Jerusalem, 1947, p. 133).

It happened that Rabbi Ishmael and Rabbi Akiba were strolling in the streets of Jerusalem with another man. They encountered a sick person who said to them, “My Masters, tell me with what should I be healed?” They told him: “Take such-and such until you are cured”. The person who was with them said to them:

“Who afflicted this man with sickness”?

They said: “The Holy-One-blessed-be-He.”

He said to them: “And you interfered in an area which is not yours! He afflicted and you heal?”

They said to him: “What is your occupation?”

He said to them: “I am a farmer, as you can see by the sickle in my hands.”

They said to him : “Who created the field and the vineyard?”

He said: “The Holy-One-blessed-be-He.”

They said to him: “And you interfered in an area not yours? He created these and you eat their fruit?”

He said: “Don’t you see the sickle in my hand? If I did not go out and plow the field, cover it, fertilize it, and weed it, nothing would grow!”

They said to him: “Fool! Could you not infer from your occupation that which is written, ‘as for man, his days are as grass’ (Psalms 103:15). Just as with a tree, if it is not fertilized, plowed, and weeded, it does not grow, and if it already grew but then is not watered, it dies; so the body is the tree, the fertilizer is the medicine, and the farmer is the doctor.” ( Midrash Shmuel 4:1).

The second parable is found in the Zohar ( Ha’azinu , p. 299), which was edited in Spain in the early thirteenth century. It comes in a comment on the verse “He found him in a desert region, in an empty howling waste” (Deut. 32:10):

This dessert is a symbol of diseases which are kelipot which God gave us methods to overcome .The wise physician goes to the patient, who is captive in the prison of diseases, and frees him. And if you say: perhaps it is forbidden for the physician to do so, for God is the one who ordered to put the sick person in that dessert, the prison of diseases? If so, how may a person strive against God’s decision? It is not so, for it is the Creator’s will that the physician free the prisoner from the physical prison.and if he cannot, the physician should try to give him a recipe for healing the soul. And if he does so, [God] will bless this physician both in this world and the next.

VIII) A Sick Person Must Call a Doctor, But He Should Continue to Trust in God

Unlike approach No. 2, which grudgingly explained that people go to doctors, Rabbi Hayyim Yosef David Azulay (the Hida, 1724-1806) ruled that

today, a sick person may not rely [on] miracles and must follow the way of the world and call a doctor to heal him. And it is not in his power. to say that he is greater than the pious ones throughout the generations who were healed by doctors, and it is almost forbidden [not to call a doctor] either because of yohara [haughtiness] or because of relying on a miracle. Rather he should follow the common custom of being healed by a doctor, but he should not rely on the doctor but pray to God with all his heart and trust in Him.

IX) It is a Mitzvah for a Doctor to Heal People

This is the approach of Maimonides which he states in at least four places in his writings. He first addressed the issue in his commentary to the Mishnah ( Nedarim 4:4) which he completed in 1168 at the age of 30. The Mishnah says there that if Reuven took a vow that he will not derive any benefit from Shimon, Shimon may still heal him. Maimonides explains that this is “because it is a mitzvah , that the doctor is required by law to heal Jewish patients [as the Sages said] ‘and you shall return it to him’ (Deut. 22:2) – this comes to include his body” (Also see Maimonides, Mishneh Torah, Hilkhot Nedarim 6:8; Commentary to Mishnah Pesahim 4:10; Shemonah Perakim, Chapter 5).

In other words, Maimonides does not think that a doctor is permitted to heal (No. IV above) but rather that he is required to heal, as a mitzvah . He derives this from a midrash on a verse about lost property. Not only must we return our neighbor’s lost animal, but we must return our neighbor’s body i.e. save his life. This midrash occurs in three places in rabbinic literature but none of them explicitly mention doctors or medicine (Bava Kamma 81b; Sanhedrin 73a; Sifrei Devarim, piska 223, ed. Finkelstein, p. 256). Maimonides either used poetic license or he relied on a midrash which has not reached us.

Maimonides approach was adopted by many medieval and modern rabbis who ruled that a doctor is required to heal patients as a mitzvah.

1. X) Summary

In conclusion, we have seen three major approaches to doctors and medicine in our tradition:

1) The bible, many talmudic sources and some medieval sources said that God afflicts and God heals and those who are ill should simply pray to God (Nos. I-II). This approach all but disappeared after the Talmudic period.
2) Tanna d’vey Rabi Yishmael said that doctors are permitted to heal the sick (No. IV) and Ramban and the Shulhan Arukh extended this to ” reshut d’mitzvah “, permission to do a mitzvah” (No. V).
3)A Baraita ruled that a Sage may not live in a city without a doctor (No. VI). A medieval midrash and the Zohar added that a doctor helps God heal the sick (No. VII) and therefore a person must call a doctor when he is sick (No. VIII). This trend reached its apex in Maimonides, who ruled that doctors are required to heal and that it is a mitzvah (No. IX). It is this approach which gained the upper hand and that is why there are so many Jewish doctors!

David Golinkin
Jerusalem
Isru Hag Sukkot 5767

Bibliography

Rabbi J. David Bleich, Judaism and Healing: Halakhic Perspectives, New York, 1981, Chapter 1

Rabbi J. David Bleich, Proceedings of the Association of Orthodox Jewish Scientists , Volume 6 (1980), pp. 11-64

Rabbi Hayyim David Halevi, Responsa Mayyim Hayyim, Part 2, Tel Aviv, 1995, No. 62

Rabbi Norman Lamm, Journal of Halacha and Contemporary Society 8 (Fall 1984), pp. 5-13

Yohanan Muffs, Love and Joy: Law, Language and Religion in Ancient Israel , New York and Jerusalem, 1992, p. 115

Jacob M. Myers, The Anchor Bible, II Chronicles, New York, 1965, p. 95

Julius Preuss, Biblical and Talmudic Medicine, New York , 1978, pp. 22-26

Fred Rosner, Modern Medicine and Jewish Ethics, second revised and augmented edition, Hoboken and New York , 1991, Chapter 1.

Dr. Sylvan Schaffer, Journal of Halacha and Contemporary Society 8 (Fall 1984), pp. 101-117

Rabbi Byron Sherwin, Jewish Ethics for the Twenty-First Century, Syracuse , 2000, pp. 13-34

Avraham Steinberg, Hilkhot Rofim U’refuah al pi Shu”t Tzitz Eliezer, Jerusalem , 1978, pp. 7-25

Rabbi Moshe Weinberger, Emek Halakha : Assia , Volume 1, Jerusalem, 1986, pp. 11-34

Rabbi Yehoshua Yagel, Barkay , 4 (5743), pp. 60-68

Noam Zohar, Alternatives in Jewish Bioethics, Albany , 1997, pp. 19-36

All four volumes of Rabbi Prof. David Golinkin’s Responsa In A Moment – Halakhic Responses to Contemporary Issues as well as other books by the author are available for purchase from the Schocken-JTS Press Bookstore.