Opinion & Comment
The Patient's Right to Avail Himself of Medical Service

Verapo yerapeh (Shemos 21:19) -- From here we learn that doctors are permitted to heal."

One who injures another person is required to pay the medical expenses of his victim. "And he shall indeed heal him." Chazal derived from here the Torah's sanction for medical practice (Bovo Kama 85a).

Why would we imagine that without the Torah's permission, a person would be forbidden to seek medical help? Why is it that without explicit allowance, he would be doomed to die without outside aid?

Rashi notes that indeed, the Torah introduces a very innovative idea: "And do we not maintain that it is Hashem Who afflicts to begin with, and it is He Who brings succor? By seeking medical intervention, we are tampering with Divine destiny; it is as if we are defying the will of our Creator and taking matters into our own hands. Would a person dare presume to do such a terrible and futile thing?"

Such action must surely be interpreted as rebellion and be considered out of human bounds. Therefore the Torah deemed it necessary to declare explicitly that involvement with medicine is permissible and is not considered defying the will of one's Creator.

The Baalei Hatosofos add that the words "And he shall verily heal" come to teach us two allowances since the sanction is presented in a double form of "Verapo yerapeh." Had it merely come in the single form, we might think that the Torah was allowing one to seek medical aid in the instance of a man- afflicted blow, whereas in the case of a Divinely afflicted illness, it would be forbidden to seek medical help. Surely in the latter case we might think that we were tampering with a Heaven-sent decree, in a punishment sent specifically upon a person for an unknown reason. But the Torah clearly says "No": one is permitted to seek healing even in a Heavenly afflicted disease.

Why couldn't we learn the sanction for the practice of medicine from the obligation to restore lost property?

The Rishonim are hard put to understand why we require a special authorization to allow medical ministration, and we do not suffice with the command of the Torah: "You shall not stand aside when mischief befalls your neighbor" (Vayikra 19:16). Chazal derive from here that whoever sees a fellow man drowning in a river or being molested by a wild animal or attacked by brigands is required to come to his aid. We can infer as well that one who sees his neighbor writhing in pain and about to die is equally obligated to save him, both from the negative aspect of not standing idly by and from the positive injunction of taking action to succor him. If so, why do we need this phrase sanctioning the right to seek healing through medicine?

Rabbenu Yaakov of Orleans settles the question by stating that the permission allowed the physician is not merely to heal, for this is an obligation derived from the above verses, but includes the possibility of taking a fee for his ministrations.

The Rosh (in Tosafos Brochos 60a) brings the above responsa and writes that it seems to him that the question can be resolved differently. The phrase "And he shall verily heal" comes to teach us Heavenly sanction for a doctor to treat Heaven-inflicted afflictions. We derive the obligation of saving a person who is being attacked by a third party, wild animals or the forces of nature from the Torah obligation to return lost objects. But when a person falls prey to an illness through an act of Hashem and not as a result of a fight, one might think that the bystander or friend is not required to intervene and offer help since this is tampering with a Heavenly decree. If it were permissible to heal in this instance, it stands to reason that it would be a definite obligation, like restoring lost property. How are we to know that we are permitted to intervene and that this is not considered tampering with a Divine decree?

This we derive from the words, "And he shall verily heal." After we have learned that it is permissible, and that it is not considered defying a Heavenly edict, it stands to reason that it is an absolute obligation, whether from the aspect of the duty to return lost property, which also includes the property of one's self, that is, to restore to a person his health and vitality, or from the aspect of the prohibition of not standing inertly by when a person is endangered.

The gemora teaches that a malicious blow of an enemy is also Heaven-sent

We must infer that the practice of medicine, per se, requires a special license, so to speak, or Heavenly authorization, for without this permission it would be forbidden to seek any help since the measure of suffering allotted to the given person was a punishment or trial specifically meted to him. And not only is a disease that suddenly appears, like an internal cancerous growth, G-d forbid, a direct measure from Heaven, but likewise pain inflicted upon a person by a fellow man! For we find this license particularly in that place where the Torah discusses a man-inflicted blow requiring healing! "And if men struggle and one man hits his neighbor with a stone or a fist and he shall not die but take to his sickbed, if he rises from it and walks abroad upon his staff, then the striker shall be acquitted; only he shall pay for the loss of his time and shall assure him to be thoroughly healed."

We might think that such a blow should not be treated since "Hashem strikes and Hashem shall heal." But we see that the Torah did allow for medical treatment. But from the very fact that we are dealing with an explicit permission to heal, we can deduce that this selfsame pain which was inflicted by an enemy, is also Heaven- sent.

Any and every amount of pain, without exception, is sent by Divine Providence through the Creator. When Reuven strikes Shimon and inflicts injury, this is because it has been already decreed that Shimon be smitten and suffer to a specified degree. Nevertheless, this does not absolve Reuven, who inflicted the blow from his own free will, from bearing the consequences of his willful act. Heaven did not ordain that he be the bad guy, even though the pain was decreed upon Shimon. Still, the rule is that Heaven employs the righteous to bring about good while it employs the wicked to mete out punishment.

This applies to physical blows as well as to every form of pain and suffering. Even when Reuven curses Shimon, one must regard this as a measure of emotional pain decreed against Shimon. When Shimi ben Geira cursed Dovid Hamelech, and even threw stones at him, Dovid's reaction was, "What do I and you hold against him, sons of Tzruya, that he curses? Hashem told him to curse Dovid, so who shall say: `Why did you do this?' " (Shmuel II 16:10).

No person as much as lifts a finger on earth below without it having been decreed from Above. A person's suffering is for his own benefit, for his troubles have been sent purposely, through personal Providence. And if so, it is clear that his tribulations have some purpose (Chofetz Chaim on the Torah).

The fool thinks that it is sufficient to cut off the current . . .

All is ordained from Heaven. Sometimes, verbal abuse and curses come to atone and purify a person, and thus to reduce his punishment and judgment after death. Alternately, illness can be visited upon a person for the purpose of making him repent. It makes him reflect upon his ways and rouses him to return wholeheartedly to his Creator.

However his very preoccupation with healing himself is liable to make him forget the true purpose behind any illness brought upon a person. Instead of his examining his spiritual status, a condition which can always use improvement and upgrading, he focuses on the doctor, the medicine and the professional aspect of physical healing and resolving his condition as soon as possible so that he can get on with his normal routine.

To what can this be compared?

Every car has an oil gauge showing how much oil the motor has. When the oil is about to be depleted, a red bulb lights up. If this happens, the driver knows he must go to the nearest garage and renew his oil supply. If he ignores the warning signal, his car will continue to go until the last drop of oil has been used but then the motor will burn itself up and the car will stop going. If this happens on a lonely road, then the driver is in for trouble.

A fool was once driving along. Like other drivers, he knew enough to look at the dashboard, but when he saw the red oil light flashing, he decided to act in a novel way: He went to the nearest garage and asked the mechanic to disconnect the flashing light. The mechanic saw he was dealing with an obstinate fool and tried to convince him to fill up on oil instead, but our friend insisted. He figured differently: from now on he wouldn't have to fill up on oil because the red light wouldn't flash; this would solve his problem forever.

No amount of explanation helped. The mechanic cut a wire or two and the driver was thrilled. But not for long. It took only a few moments of travel before the motor stalled. The engine had burned itself out.

Why did Chizkiyohu hide the Book of Medicines

Preoccupation with the disease itself while ignoring the fact that it serves as a red light to warn and preserve the supply of `oil' in the person's body -- his spiritual stature -- is similar to the fool's severing of the warning light.

Nothing is more important to a person than what happens to him after 120. Each person will reside under his canopy and be singed by the fire of his neighbor's canopy. A person's sins can ultimately damage his canopy and detract from his eternal reward, but this can be avoided by taking to heart the message of an illness, which is like a warning light.

That illness is supposed to jostle a person awake from a spiritual freeze and steer him back onto the right path. He must stop driving and fill up on oil. He must, in other words, examine his deeds and repent wholeheartedly.

This is what the wise man does; he acts upon the warning. The fool who is visited by illness will ask for a doctor's appointment and will obey him to the letter. The wise man will do likewise, but he will also examine why he ever came to such a plight -- and this will lead him to teshuva. The fool will suffice with medical treatment.

It was for this reason that King Chizkiyohu saw fit to hide the Book of Healing (Pesochim 4:9). Rabbenu Ovadia of Bartenura quotes the wording of Rashi's commentary to this act of Chizkiyohu:

"Because their hearts were not subdued by their illnesses but they cured themselves immediately."

In other words, the illness lost its very purpose; therefore it was necessary to conceal this book.

In his commentary to the mishna, the Rambam attacks this explanation in acerbic language. After offering his own commentary, which we will present later, he adds the following words:

"I am expanding upon this topic because I heard, and it was explained to me, that Shlomo authored the "Book of Medicines." Whenever a person fell ill or was privy to any kind of disease, he consulted that book; he did whatever it said and was healed. When Chizkiyohu saw that people were no longer relying upon Hashem or turning to Him, he took away and hid the book.

"And now, heed this: in attributing to Chizkiyohu this act as if it were foolish and mad we are doing him an injustice which the most base and demented people do not deserve. For if a man is starving and he eats bread, he will undoubtedly be cured of his terrible pangs, the illness of starvation. Therefore he has no hope and will not rely on Hashem?!?! We will say to such as argue that way: Fools! Just as I thank Hashem while I eat the food He has provided me with and which has sated me, and [thank Him] for having removed my hunger and that I can thus be sustained and live, so, in the same measure, will I thank Him for having created the medicine that heals my illness when I am thus healed. And I would not have had to question this terrible interpretation were it not so widespread."

Even Being Healed by Medicine in a Natural Way is Accompanied by Suffering which Tempers a person towards Repentance

What, then, was the reason for Chizkiyohu's having hidden away this Book, according to the Rambam?

Rabbenu Ovadia of Bartenura sums it up succinctly:

"The Rambam explains the `Book of Medicine' as being a work dealing with astrology and talismans, that certain heavenly astrological configurations at certain specified times have the power to heal specified illnesses. And this study was very conducive to drawing people to idolatry and the worship of the celestial bodies, which is why he cached the book away."

In Moreh Nevuchim, the Rambam explains that this was verily a book of idol worship. After he writes at length some of the commandments of the Torah designed to distance us from false notions and pagan rituals in the area of medicine, agriculture and other things, he concludes: "The most famous of all those mentioned is what is said in the beginning of the work on Nabatean worship on grafting, concerning grafting the olive with the citron. And I maintain that the `Book of Medicine' that Chizkiyohu hid away undoubtedly is from this cult" (Vol. III, chap. 37).

Even the ministrations of normal medicine can be accompanied by fear of Heaven and can thus draw a person closer to Hashem and cause him to repent. For doctors and medicines do not provide instant restoration of health but are accompanied by acute pain and difficult treatment, exhausting visits, considerable expense and the tension that accompanies the diagnosis period until the ultimate cure. All of these are appendices to the ailment and even if the doctor is able to help and the patient recovers, the latter cannot avoid these stages. Thus, in any event, the process of recovery is necessarily coupled with pain and accompanying nuisance and bother. And if he pays attention to them, a person will surely arrive at submission before Hashem, will mend his ways and repent with all his heart.

With this understanding, we can possibly reconcile the attack of the Rambam to the first explanation. There is a vast difference between the nostrums listed in the Book and those which one gets from a doctor. Yaavetz dwells upon them in his work on Mishna, Lechem Shomayim. He explains there that we must differentiate between common medicines to which a person will resort immediately and will forthwith be cured, in which case he will likely ignore the message intended and required of him -- and the medicine prescribed by a doctor which is not always clear, is accompanied by doubts and is conducive for a person to, indeed, become subdued and harbor thoughts of teshuva.

Regarding the comparison of a starving person who assuages his hunger and a sick person who takes medicine, Yaavetz writes:

"It seems that it is not necessary to deny the first explanation because of the Rambam's opposition. For the pangs of hunger are normal; this is how Hashem created man [to be hungry when he lacks food]. Whereas sickness is not normal but is [a message] directly sent by Hashem to rouse a person regarding his deeds, to chastise him so that he pays attention and rectifies his sins, prays to Hashem and tries to appease Him. This is the very purpose of pain and suffering that are brought upon a person, as explained in the Torah and in Kabboloh."

"Your Rod and Your Staff, They shall Comfort Me"

One thing we must know for certain: "Whatever the Merciful One does is for the good." A sickness visited upon a person is for his benefit! It can be a blow, a hard and painful one, but when all is said and done, it is a blow from one's Father.

Maran the Rosh Yeshiva zt'l used to repeat what he had heard from his uncle, Maran HaRav Isser Zalman Meltzer zt'l:

Dovid Hamelech says in Tehillim: ""Your rod and Your staff, they shall comfort me." This raises an obvious question: One can understand that Hashem's staff and supportive help serve to encourage and comfort a person. But what comfort could Dovid Hamelech possibly find in feeling the blow from Hashem's rod? It is a painful thing! R' Isser Zalman used to explain this with a parable:

A son was once walking through a thick forest together with his father. Throughout the way, he held on tightly to his father's hand so as not to get lost. Suddenly, he separated himself and ran off on a side path. The father shouted at him to come back but the child was quickly gone from sight and out of earshot.

The boy wandered about happily at his leisure and it took some time before he realized that he was alone and lost. The sun set and darkness enveloped the entire forest. Tears gathered in his eyes and sobbing choked his throat. Every so often, he would cry out, "Abba!" but only a dull echo answered his cry. The child sank into despair as he tried one path after another in search of his father, but became all the more entangled in the forest. Would he ever see his father again?

Meanwhile, the father was searching for his son even more energetically. His son was his very life! He did not relax his efforts for a moment but searched high and low, looking for clues where his son could have gone. Finally, his eyes lit up: he saw the child up ahead, shivering with cold and dissolved in tears. He hurried forward until he was a step behind him. Then he raised his hand and struck the boy smartly on his cheek.

R' Isser Zalman would pause here and rhetorically ask his audience, "What, in your opinion, was the child's reaction?"

After a pause, he would reply himself:

The blow did not hurt the boy in the least. At that time, there was nothing sweeter in the world than that slap, and a shout of joy burst forth from the child's lips, "Abba!"

He knew for sure that his father was again at his side.

A blow hurts, for sure, but it signifies that Father is nearby.

"Many are the Sorrows of the Wicked, but One Who Trusts in Hashem is Surrounded by Kindness"

Studies have proven that a religious person finds it easier to bear his illness than one who does not believe or practice Torah. The atheist sees himself a victim of blind circumstances, a person who has lost out on the pleasures of life by a quirk of fate. While the believer knows that his illness has a purpose and design. He knows that Hashem has decided that it is for his benefit and there is reward for his suffering. He regards his illness as a sign from Heaven, a warning signal that he repent. And if he repents and continues to suffer, he attributes it to a kindness from Hashem in enabling atonement for past sins.

Either way, he is able to bear his suffering with greater aplomb than one who only sees it as hard luck with no reason for it.

This line of thinking is employed by commentators in interpreting the verse, "Many are the sorrows of the wicked, but one who trusts in Hashem is surrounded by kindness." In the past, when a person fell ill and had to take medicine, he despised the bitter nostrums and would gag as the bitter brew went down his throat. But he had no choice, knowing that this was his only resort.

Today there are ways of circumventing the revulsion. The bitter powder is put into a capsule which the patient swallows whole without tasting the medicine. Some pills are even sugar-coated, which makes the medicine go down much more easily.

Diseases that come upon a person are often difficult and painful, sometimes even unbearable. But a tzaddik is able to bear the suffering. His sense of trust and faith in the purpose of the sickness greatly mitigates the pain and sweetens its bitterness, just like the capsule or sugar that coats the despised bitter powder.

"Many are the sorrows of the wicked," while one who trusts in Hashem is surrounded and enveloped by a sense of comfort and reassurance that his suffering is Heaven- sent and this serves as a sugar-coating that mitigates his suffering.

"All the Disease that I Put on Egypt I Shall not Put on You"

Now we can better understand the meaning of the promise, "And He said: If you verily listen to the voice of Hashem your G-d and do what is righteous in His eyes, and you give ear to all of His commandments and you guard all of His statutes, then all the disease that I gave in Egypt I shall not put on you for I am Hashem your Healer" (Shemos 15:26).

Many questions were posed upon this verse. The first, upon which many of the commentators dwelled, is: What is the meaning of the words "For I am Hashem your Healer"? Who needs sickness to begin with? If Jewry is impervious to illness, why should they need a doctor?

Rashi explains that the verse refers to preventive medicine and proper nutrition. "According to the simple meaning, `I am Hashem your Healer,' implies that Hashem teaches us Torah and gives us commandments which are designed to keep us well. They are preventive medicine, so to speak, like a doctor who tells his patient, `Avoid foods that are detrimental to your health.' The mitzvos regulate a person, as King Shlomo said, "It shall be health . . . " (Mishlei 3:8).

There is another question that begs to be asked: The Torah promises that the Jews will be spared the plagues afflicted upon the Egyptians. What about those that were not afflicted upon them? Will these be visited upon them?

Someone interpreted the verse in the following manner:

The purpose of illness is to arouse, to draw a person closer to Hashem, to cause him to repent. An illness that descends upon a person without any ultimate purpose is very difficult and painful for it is an arbitrary blow for the sake of the blow.

These were the plagues inflicted upon Egypt. They were empty, pseudo plagues in the aspect of their not being for the sake of accomplishing anything by the Egyptians. The Egyptians were determined to persevere and this was the reason Hashem hardened their hearts -- so that they could bear more plagues even after suffering through the previous ones. This punishing rod was all pain, without any dimension of comfort. Plagues of this kind will not be inflicted upon Jews, who, in the course of time, will fall ill like others do, but their suffering will be designed to arouse them spiritually and cause them to repent.

These latter diseases will be for their benefit.

This is what the Torah says, "All the disease that I put on Egypt . . . " [They will not suffer] from disease purely for the sake of disease which is not for the purpose of causing them to reflect and mend their deeds. Such disease, "I will not place upon you" but disease of another sort altogether I will inflict you with. And when I do, it will be for your own good, so that you wake up and abandon wicked ways. And when those diseases have served their purpose, I will remove them, "For I am Hashem your Healer."

Let us bear this in mind for every trouble that comes our way, G-d forbid. Let us remember that suffering is sent to rouse us, to make us repent and return to our Father.

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