"....V'Rapoh Y'Rapeh - and he [who harms another] shall pay the medical
expenses. (Shmos 21:19)
"Tanna D'Bei Rebbe Yishmael: From here [we learn] that permission is
granted the doctor to heal." (Babba Kamma 85a)
When G-d chooses to strike a person with illness, it is the Divine will
that he suffer pain and hardship. The Torah must give special dispensation
allowing a doctor to alleviate his patient's pain, as he endeavors to cure
the disease, otherwise, by what right does he interfere with G-d's plan?
The advisability of seeking medical assistance to resolve health-related
issues is a subject of debate among the Rishonim. In our shiur this week,
we will present two different approaches to this question, and explain the
appropriate extent of worldly efforts that man should expend on his own
The Ramban describes the situation of Klal Yisrael while in their glory:
"When the Jewish people were whole and perfect, they did not direct their
matters according to nature at all, not in regards to their physical
selves, nor in regards to their land. Not as a group, nor as individuals.
For Hashem blessed their bread and water, and had removed all sickness from
their midst, until there was no need for doctors, nor for them to guard
themselves at all according to medical advice, as it says: 'For I am G-d
who heals you.'
"And this what the righteous individuals did during the times of prophecy,
even when sin brought about illness, they did not inquire of doctors, but
only of prophets (as Chizkiyah did when he took ill)......and what place is
there for doctors in the home of one who does G-d's will...."
"....and if they would not have chosen the path of medicine, man would take
ill in accordance with the punishment for his sin, and be healed with the
will of G-d. But, they followed medicine, and Hashem left them to natural
"And this is their intent when they said: 'V'Rapoh Y'Rapeh - From here [we
learn] that permission is granted the doctor to heal.' They didn't say that
permission is granted to the sick person to be healed, but rather, if one
takes ill and comes to be healed, for he has taken the path of medicine and
is not one of the congregation of G-d whose portion is life, the doctor is
not obligated to forbid himself from treating him...."
"....but for G-d to find favor with the ways of man, he should not involve
himself with doctors." (Ramban, VaYikra 26:11)
The Rambam apparently takes a different approach.
"The book of medicines was a book whose subject was to cure oneself with
things that the Torah did not allow one to be cured with....and when man
corrupted their ways, and were curing themselves with those things,
Chizkiyahu HaMelech removed and hid it."
"And I have elaborated on this subject, because I have heard, and others
have explained, that Shlomo [HaMelech] authored a book of cures. When any
person took ill, or occurred any sickness to a person, his intent was to
that book, and he did everything it says therein, and was then cured. When
Chizkiyahu saw that people were not relying on G-d, he removed this Sefer,
and hid it."
"Listen, now, how deficient that opinion is, and how mistaken. How can they
attribute such foolishness to Chizkiyahu? According to their light-headed
and mistaken view, a man who was hungry, and went to eat bread, undoubtedly
would be cured from that strong sickness - hunger. If so, he despairs from
relying on G-d? Rather, we say to them: Listen, fools - just as we
acknowledge G-d when we eat for providing what satisfies me, and removing
my hunger, that I may live and be sustained, so too, I acknowledge Him for
providing a cure that heals my sickness when I take ill...." (Rambam,
Commentary to the Mishna, Pesachim, Chapter 4)
These two opinions appear to be in total contrast.
The Ramban states that those who look towards G-d should not inquire into
medicine, and doctors have no place in a Jewish home.
Rambam, on the other hand, holds this approach to be foolish, with medical
assistance no different than normal nutrition. Acording to his view,
pursuit of good medical care is not a sign of deficient faith, rather, it
is advisable to take medical help, and then acknowledge G-d who has
provided the cure.
Let us now explain why, actually, there is no disagreement at all.
It is inconceivable that matters of fundamental faith should be the subject
of rabbinic dispute. In nearly every instance, the argument that appears to
be irreconcilable merely expresses two sides of the same coin, different
perspectives that disagree only on the definition of prevailing circumstance.
The current case is a classic example.
On a certain level, man would have no need for food or drink, no
requirement to heed the laws of nature. Moshe Rabbeinu, a flesh-and-blood
human being, climbs Har Sinai to receive the Torah, and for forty days he
stays atop the mountain. Taking no food or water, he still descends in
With this, the Rambam does not disagree.
For a man such as this, turning to doctors at a time of crisis would betray
a lack of faith. Fully aware of the all-encompassing nature of Divine
providence, he knows that any pain he endures is a Divine summons to
repentance, and the answer to his problem lies squarely in G-d's hand. A
call to the doctor can mean only that he hopes to bypass G-d's will. As
Yonah, who attempts to flee G-d's wrath, he too tries to ignore His
incessant demand, and for this he deserves the critique of the Ramban.
The average person however, is far from Moshe Rabbeinu.
Most of us are quite aware of the nature of a physical existence, cognizant
of every pang of hunger, all discomfort and pain. Would it be right to
expect G-d's supernatural assistance, a miraculous salvation from illness
and distress? Do we ourselves ever rise above the natural pull of of
worldly desires, or ignore the call of our bodily needs?
Were we to rely solely on a miraculous Divine salvation, we would be
deluding only ourselves. Because we have previously jettisoned that type of
relationship, we are unworthy of direct intervention. Suddenly pretending
to be on a higher grade would be fraudulent, and would not accurately
reflect our spiritual consciousness. To act as if we expected Divine help
rather than medical assistance would not be a true service of G-d, but one
that mirrored our false view of ourselves. A true approach to G-d must be
complete and internally held, compatibable with the beliefs, values, and
behavior of our everyday existence.
This is the Rambam's objection.
While agreeing in principle with Ramban's admonition, he still holds that
this approach is for present-day fools. Claiming to be spiritual saints,
they abhor the use of artificial support, professing total belief in Heaven
above. But, in all actual likelihood, they merely hope to save the cost of
the doctor's billings, for they never were known to sacrifice much else to
further G-d's will.
Both Rambam and Ramban are totally correct, for they address different
situations. While the righteous man relies only on the help of Hashem, the
vast majority of individuals must direct their daily affairs in accord with
natural law, turning to the expert for technical subsistence, while
recognizing that success and achievement remain in G-d's hands.
All the above brings us to an important conclusion.
Man has the ability to determine the level of Divine providence and
intervention he will see in his own life.
Every man lives in his own world, a spiritual dimension of hs own creation.
For this reason, man is referred to as a 'Tzelem Elokim' - the Biblical
name of Creation - for he manifests the image of G-d as Creator.
Man lives with his own G-d, and if he chooses to ignore Heaven's hand,
aware only of the chance circumstance of a natural world, G-d will deal
with him accordingly, revealing a universe that operates by chance, subject
to the random whims of statistical occurrence.
On the other hand, the man who is aware of G-d's omnipotent control, who
recognizes all failure and pain as a Divine call to improve his ways, will
deserve a clear and direct relationship with Hashem. His prayers will be
answered and his repentance noted.
It is little wonder then, that present day skeptics can openly deny G-d's
presence. Having opted to play the percentages, providence mirrors their
choice, a cruel world of innocent victims, where nature knows no favorites.
On a practical level, modern man has no recourse other than the ardent
pursuit of medical assistance in times of distress. To believe otherwise is
to invite disaster, for in his personal life, he will be unable to match
the standard of a world beyond nature.
At the same time, he dare not forget that his physical efforts are a mere
charade, an offering to the devil, but the secret of success is still
firmly in Divine control.
A number of years ago, a couple I am acquainted with was experiencing
serious infertility problems. They chose to visit a reknowned specialist in
After treating them without success, he called them in for consultation.
"Perhaps, you should consider adoption", he suggested.
"Tell me, doctor", the yound husband asked, "Were we to have children
normally, would you consider it to be a miracle?"
"No, two-percent chance", was the doctor's response.
This young man was a great believer in Hashgacha Pratis. After hearing the
doctor's opinion, he reassured his wife that there was nothing to fear, for
in the absence of any need for miraculous intervention, their situation was
no different than any other couple.
"Does G-d need to respond to percentages? If He wills it, we will have
children, and if He refuses, we won't, is there any other way that children
are brought into this world?"
Yes, we need to seek out good doctors, and certainly, we must work hard to
support our families, but we dare not be fooled: our worldly efforts are a
gallant facade. Concealed beneath the mask of our world, the awesome
presence of G-d drives all of life towards a different sort of goal.
"....for man has no portion in the Torah of Moshe Rabbeinu unless he
believes that all our matters and happenings are completely miraculous,
there is no nature or ways of the world, whether as a community, or as
individuals. Rather, if one fulfills the Mitzvos, he will find successful
reward, and if he violates them, his punishment will cut him off,
everything by Heavenly decree...." (Ramban, Shmos 12:16)
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