Rabbi Bernard Fox



“If he gets up and goes outside under his own power, the one who struck him is absolved.  He shall only pay for his lost time and he shall provide for his healing.”  (Shemot 21:19)

Parshat Mishpatim outlines many of the laws regulating liability for causing harm to a person or his property.  If a person harms another individual he must make restitution to the injured party.  Our pasuk indicates two of the forms of restitution.  The injured party is entitled to be reimbursed for his lost wages.  The person causing the injury is also responsible for all medical expenses.

The Talmud comments that from this passage we learn that it is permitted for a medical professional to provide medical care.[1]  The commentaries are concerned with an obvious problem with this comment.  According to the Talmud, it is not self-evident that a physician is permitted to provide treatment to those that are ill.  In other words, the Talmud implies that without the express instructions included in this passage, we would assume that it is not permitted to provide medical treatment!  Why would we assume that medical treatment would not be appropriate? 

Rashi explains that the comments of the Talmud are not limited to a physician that provides care for an injury inflicted by another individual.  Instead, the comments of the Talmud must be understood in a more general sense.  The Talmud is telling us that a physician is permitted to provide treatment even in a case in which the patient has become spontaneously ill.  Based on this understanding of the Talmud’s comments, Rashi identifies the issue with which the Sages are grappling.  We might assume that a spontaneous illness is an expression of Hashem’s will.  Hashem wishes the person to be stricken with this illness. Consequently, the person’s recovery should also be left to Hashem.  By providing medical treatment, the physician is usurping Hashem’s role and interfering with His plan.  According to the Talmud, we are not to make this argument.  Instead, the physician is permitted to provide treatment.[2]

According to Rashi, the Talmud is telling us that we are not to assume that we should leave to Hashem the recovery of a person who is ailing.  Instead, it is appropriate to provide medical treatment.  However, Rashi’s comments raise an additional question.  Rashi is asserting that without the direct instructions of the Torah permitting medical treatment, we would reason that the recovery of the person should be left to Hashem.  The Torah tells us that this reasoning is somehow incorrect.  But Rashi does not provide any indication of why the Torah does permit the physician to provide treatment.  In other words, Rashi identifies the prima-facie reasoning for denying treatment.  He does not identify the flaw in this reasoning.  Rashi just tells us that the Torah rejects this reasoning.

Nachmanides discusses this issue.  According to Nachmanides, this discussion in the Talmud provides an insight into the Torah’s understanding of the role of providence.  Nachmanides explains that the Torah expects us to conduct ourselves in accordance with the natural laws.  The laws of the Torah are constructed to be observed within the framework of the natural law that Hashem created to govern His universe.  Torah law does not contradict or ignore the laws of nature.  Therefore, the Torah does not prohibit a physician from providing medical treatment.  Neither does the Torah regard such treatment as inappropriate.  Instead, we are to live our lives in a manner that is consistent with the natural laws that govern the universe.  We are to care for our health properly and medical treatment is appropriate when we are ill.[3] 

Kitzur Shulchan Aruch further develops Nachmanides’ comments.  He explains that based on Nachmanides’ reasoning it is incumbent upon a person who is ill to seek the treatment of a physician and it is prohibited to not seek this treatment.  He explains that there is a well-known principle that we are not permitted to rely on miracles.  A person who does not seek medical treatment violates this principle.

Kitzur Shulchan Aruch explains that there is another reason for requiring a person who is ill to seek medical treatment.  This second reason is also based on a comment of Nachmanides.  Nachmanides points out that the Torah does promise that Hashem will care for those who are righteous.  Nachmanides explains that Hashem does perform miracles for the righteous.[4]    Kitzur Shulchan Aruch explains that a person who refrains from consulting a physician and instead relies on Hashem’s intervention is making the implicit assumption that he is a righteous person deserving of a miracle.  Kitzur Shulchan Aruch points out that this is a shockingly haughty attitude.  The Torah distains haughtiness and requires that we conduct ourselves with humility.  Humility demands that we do not regard ourselves as tzadikim – as righteous people deserving of a miracle from Hashem.[5]

This discussion suggests an important question.  According to these authorities it is appropriate – even required – for a person who is ill to seek medical treatment.  What is the role of prayer?  If we are expected to conduct ourselves within the laws of nature and we are prohibited from relying on Hashem’s intervention, why pray?  When we pray are we not asking Hashem to intervene – on our behalf – in His natural order?  Are we not asking for a miracle? 

Sforno discusses this issue in his commentary on Parshat VaYetzai. The Torah explains that Rachel – Yaakov’s wife – was unable to conceive.  However, in response to her prayer, she conceived and gave birth to Yosef.[6]  Sforno observes that Hashem only responded to Rachel’s prayers after she had endeavored to do everything in her own power to conceive.[7]  In other words, Hashem responded to prayers that were accompanied by personal endeavor and initiative – not to prayer alone.

Sforno’s analysis suggests an explanation of the role of prayer.  We do not replace with prayer our own efforts to assure our well-being.  Instead, prayer accompanies our efforts.  We do not pray in place of our own endeavors; we pray for the success of these endeavors.

Rabbaynu David Kimchi’s – Radak’s – comments on a related issue further develop this theme.  He indicates that although, in seeking Hashem’s aid we are asking for His intervention into the natural law, we should seek to minimize this intervention.  He explains that when Hashem deems it necessary to perform a miracle, He does so minimally.  He also prefers to hide His work.  Hashem regards hidden miracles are preferable to astounding wonders.  Radak cites various examples to prove his point.  Hashem commanded Shmuel the prophet to anoint David as the new king of Bnai Yisrael.  Shmuel realized that Shaul – the current king – would feel threatened.  He would make every effort to stop him from fulfilling his mission.  Hashem instructed Shmuel to conceal his intent from Shaul.  Hashem would make sure that Shaul did not stop Shmuel from fulfilling his mission.  But the Almighty preferred to do so by quietly working behind the scenes.  He wished to avoid an open confrontation that would require an explicit miracle.  Radak summarizes his thesis.  Hashem prefers to clothe His miracles within the pattern of natural events rather than overtly overturn natural patterns.[8] 

Similarly, when we pray, we acknowledge that all of our efforts cannot assure the recovery of the person who is ill.  Only Hashem can assure this recovery.  But even in seeking Hashem’s intervention, we are required to minimize the necessary intervention.  We must make every possible effort to seek the appropriate treatment for the person who is ill and then we pray to Hashem for the success of these efforts.  Through combining our personal endeavors with prayer, we are seeking to minimize any necessary intervention.

Why are minimal interventions into the laws of nature preferable to overt miracles?  Gershonides deals with this issue.  Gershonides explains that we are troubled by this question because we are impressed by miracles.  However, miracles are not nearly as impressive as the laws that govern the universe.  We take for granted the majesty of the universe.  Here I am typing out this article.  My fingers move across the keys of my keyboard.  I take this function for granted.  But let us consider this phenomenon for a moment.  Are a finger and its function so simple?  Can a MIT engineer create a manipulative machine that is as efficient as a finger?   What about a simple spider?   How many brilliant engineers does it take to make a mechanical spider?  And these are just a few of G-d’s most simple inventions.  His universe full of wonderful inventions and the laws He created to govern their functions.

Any miracle – at some level – interrupts the operations of the natural universe.  Gershonides explains that Hashem did not create the most possibly perfect universe just so He could turn around and interrupt its perfect functioning.  Hashem seeks to avoid miracles – interruptions of nature.  When He must interfere with nature, He does so minimally.  And He preserves as much of the existing patterns of nature as possible.[9]

Similarly in seeking medical treatment we emulate Hashem.  Just as Hashem seeks to minimize His miracles, we are required to minimize our dependency on His intervention into His natural laws on our behalf.  We are required to do all in our power to help ourselves.  We only seek Hashem’s assistance in assuring the success of these efforts. 




[1] Meschet Baba Kamma 85a.

[2] Rabbaynu Shlomo ben Yitzchak (Rashi), Commentary on the Talmud, Mesechet Baba Kamma 85a.

[3] Rabbaynu Moshe ben Nachman (Ramban / Nachmanides), Commentary on Sefer VaYikra 26:11.

[4] Rabbaynu Moshe ben Nachman (Ramban / Nachmanides), Commentary on Sefer VaYikra 26:11.

[5] Rav Shlomo Ganzfried, Kitzur Shulchan Aruch 192:3.

[6] Sefer Beresheit 30:22.

[7] Rabbaynu Ovadia Sforno, Commentary on Sefer Beresheit, 30:22.

[8] Rabbaynu David Kimchi (Radak), Commentary on Sefer Shmuel I, 16:2.

[9] Rabbaynu Levi ben Gershom (Gershonides), Commentary on Sefer Beresheit, p 91.