“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.