Medicine, Healing and the Jewish Tradition

Despite early theological objections, Jewish law views the practice of medicine as a mitzvah.

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Reprinted with permission from the author's book Jewish Living: A Guide to Contemporary Reform Practice, published by the UAHC Press (Union of American Hebrew Congregations), 2001.

The practice of medicine is a mitzvah, a fundamental religious obligation incumbent upon the Jewish people.

While this statement might strike us as obvious and unexceptional, the attitude it conveys is far from unanimous in Jewish tradition. The Torah never explicitly commands us to practice medicine, and some biblical passages are highly critical of physicians and those who resort to them. This negative attitude stems, in large part, from the fact that for much of its history, medical "science" was not far removed from the arts of black magic, which the Bible condemns in no uncertain terms.

 

Theological Objections to the Practice of Medicine

Yet there are weighty theological objections to medicine as well, and these have to do with the Bible's conception of God as Creator of the universe and therefore the Source of both sickness and health. If God is the cause of all that happens to us, it stands to reason that illness is a sign of divine displeasure, a punishment for our misdeeds. And if such is the case, the proper response to illness is not medicine but prayer and repentance. Do we not read that "I am Adonai, your healer" (Exodus 15:26)? Does this verse not teach us that all healing belongs to God? If so, then to employ the services of a physician in search of a natural cure for disease betrays a lack of faith in the mercy of Heaven.

Thus, the biblical author criticizes King Asa of Judah because "in his illness he sought not God but rather physicians" (II Chronicles 16:12). The Talmud contains statements in a similar vein. According to one legend, King Hezekiah wins praise for hiding away a medical book as a means of encouraging the people to turn to God, and not to physicians, for healing. Elsewhere, the Talmud suggests that human beings committed a serious error when they began to practice medicine; "they should instead have learned to seek God's mercy." Perhaps this is what the Mishnah has in mind when it declares in no uncertain terms that "the best physician is deserving of hell."

This point of view finds a powerful expression in the commentary of Rabbi Moshe ben Nachman (13th-century Spain), known as Nachmanides or Ramban, to Leviticus 26:11. God, Ramban tells us, offers us an existence entirely distinct from that which is the lot of all other peoples, whose lives are governed by the normal workings of nature. Israel, by contrast, is to receive blessings and suffer curses as a direct result of its success or failure in keeping God's covenant.

Nowhere is this distinction more evident than in the area of medicine and health. For God's people, disease will occur not because of natural causes but because we have transgressed against the Torah. Illness comes upon us as a punishment for our wickedness; its cure is effected when we repent of our evil and take up the mitzvot once more. Such a community has no need of physicians; "what place do doctors have in the house of those who perform God's will?"

Unfortunately, Ramban continues, our ancestors did not have sufficient faith to sustain this state of affairs. When they became ill they consulted physicians, preferring natural medicine to the spiritual regimen prescribed by the Torah. For this reason, "because medicine became a habit with them," God annulled Israel's exemption from the laws of nature.

From then on, we have had no recourse but to consult the doctor when  we become sick, for "the door that does not open to mitzvot must open to the physician." Since we have determined to resort to physicians, the Torah grudgingly permits them to practice their art. Yet were we to return and walk fully in God's ways, we should have nothing to do with them.

In Defense of Medicine

Nonetheless, despite these objections, the bulk of Jewish thought assumes a positive and affirming attitude toward the practice of medicine. This is demonstrated most clearly by the many rabbinic scholars, including Nachmanides, who were physicians and who wrote medical literature.

It is expressed, too, by the tradition's. spirited defense of medical practice against the theological criticisms described above. Yes, God is our Healer. But since the Torah does not require us to depend upon miracles, all those passages which seem to condemn the practice of medicine must be interpreted otherwise.

King Asa's sin, we are told, was not that he consulted physicians but that he placed his reliance entirely upon them, forgetting that the physician is God's agent in the treatment of disease and that the patient must pray for healing as well as go see the physician. If King Hezekiah put away a medical text, says Maimonides, the book must have contained forbidden or dangerous lore which the unlearned might misuse; the king could not have been so foolish as to oppose the practice of medicine itself. If the Mishnah states that "the best physician is deserving of hell," this refers either to one who injures or kills his patients as a result of his arrogant refusal to consult with other doctors, or to one who refuses to treat those who cannot afford to pay.

As for Nachmanides' essay on Leviticus 26:11, some authorities reject his theory outright, while others note simply that today we are forbidden to ignore medicine and the rest of the laws of the natural world. Therefore, the Talmud instructs that "one who is in pain should go to the physician" and forbids a scholar from living in a town where no doctor is available.

The Torah, it is true, does not explicitly command us to practice medicine. On the other hand, it does instruct that one who causes a bodily injury to another must see to it that the injured person receives medical treatment (Exodus 21:19). From this verse, rabbinic tradition derives that a physician is permitted to practice medicine in the first place. This permission is essentially a "license" which allows the physician to engage in his craft without fear that he thereby frustrates the will of God.

Medical Practice as Mitzvah

Jewish law, however, understands the permission to practice medicine as a mitzvah, a requirement to do so. Some authorities derive this requirement from the general rule concerning the preservation of life, or pikuah nefesh. This rule itself is based upon Leviticus 18:5: "These are the mitzvot which one shall do and live by them," to which the Rabbis add: "and not die by them."

By this, they meant two things: that the performance of virtually any other mitzvah may be set aside if it is found to endanger life; and that the Torah itself sees the preservation of life as its highest goal, so that we are commanded to take all reasonable action, including the practice of medicine, necessary to protect our lives.

Others see medicine as an aspect of the duty to rescue those in danger: "Do not stand idly by the blood of your neighbor" (Lev. 19:16).

Whatever its textual source, the status of medicine as mitzvah is unquestioned in Jewish religious thought; "whoever delays its performance is guilty of shedding blood."

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Rabbi Mark Washofsky

Rabbi Mark Washofsky, Ph.D., is associate professor of rabbinics at Hebrew Union College-Jewish Institute of Religion in Cincinnati, Ohio, and serves as chair of the Responsa Committee of the Central Conference of American Rabbis.