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Association of Orthodox Doctors1

B”H. Second day of Rosh Chodesh Tammuz, 5715.

Brooklyn, NY

To the Committee of Orthodox Doctors’ Convention in New York,

Peace and blessing!

I was pleased to receive notice about your convention, the purpose of which is to organize an association of religious doctors.

If associations of those who are careful to fulfill the word of G-d were always important, how much more so are they in our generation, a generation of much confusion in light of the terrible events, which led many to complete disappointment in their various false opinions and ideologies, and aroused them to embark on a serious search for the truth.

An association of religious doctors can have a great effect on this movement of minds by issuing a clear declaration about some of the issues that many err or are confused about:

* Declare that the conclusions of true science — whose purpose is the truth, and only the truth — can never be in contradiction to our Torah, the Torah of truth. On the contrary: the more research that is done, the more we recognize the truth of the fundamentals, and even the details, of our religion, the religion of Israel.

* As doctors especially, you must completely negate the path of materialism, especially when paying attention to how greatly bodily health is dependent upon spiritual health. If in the past there was a medical saying “a healthy soul in a healthy body,” in our times how much more so have we come to recognize how the smallest spiritual problem leads to serious bodily problems. And the healthier the soul is, the greater is its control over the body and its ability to correct the body’s failings. Even many purely physical treatments have a far enhanced effect and success rate when the patient has a strong determination and spiritual fortitude.

This principle — of form (quality) over matter (quantity) — is highlighted also in the fact that even in bodily matters there is a steadily growing recognition that life force and vitality are not necessarily dependent on quantity; pills, hormones, and vitamins, are administered in minute quantities.

Note: The Verse states2 “From my flesh I see G-d” — from the recognition of how the soul rules the body (the microcosmic world) it is only a small step to recognizing G-d’s command of the world (the macrocosmic man). As our Sages put it:3 “Just as the soul fills the body, puts up with it, and sees but is not seen, so too G-d fills the world, puts up with it, and sees but is not seen.”

All of the above were general points. There are also many questions directly related to the medical profession, many of them being questions of practical Halacha. For instance:

* Publicizing the great benefit achieved by:

* Keeping the laws of family purity

* Keeping the laws of Kosher food

* Circumcision

* The reproductive system:

* Avoiding treatments or procedures that leave the person sterile, and substituting other methods of treatment. This is particularly important in surgeries on the prostate.4

* Medicines:

* Many of them can be prepared so that they are Kosher. It is only out of a lack of interest and awareness that they are done differently.

* Autopsies and other desecrations of dead bodies:

* For studying anatomy, they should use models or synthetics.

* For determining the cause of death: In most instances, this knowledge is not vital at all.

In a situation where it is necessary to save another life on the spot (such as exonerating someone who is accused of poisoning by doing an autopsy, etc.) — they should make incisions only where absolutely required, and bury all of the body parts afterwards.

There are many other, similar issues.

It should be superfluous to emphasize that my intention — when talking about the benefit people receive through fulfilling Mitzvot — was not to offer those benefits as the reasons behind the commandments. We must fulfill the Mitzvot because they are G-d’s expressed command and will. The reward for the Mitzvah is the Mitzvah itself, for this is the entire purpose of man — to connect and unite with his Creator, through fulfilling His commandments.

My intent was for those people who are unfortunately spiritually ill, and refuse to be brought closer to fulfillment of Mitzvot in any other way. Everything possible must be done to bring them to practical observance, even if it is through highlighting the material benefits involved.

I conclude with my wishes that the Verse be fulfilled amongst you: “Then those who fear G-d will speak, a man to his friend.”5 May G-d’s desire be successful through your hands, to bring about tangible results, as the verse concludes, “And it will be written in a memorial book before him,” as a memorial before G-d to bring merit to the public, since the merit of the many is dependent upon you.

The Role of the Doctor6

Regarding the verse7 “and healing shall he heal,” our Sages state8: “From here we see that permission was given to doctors to heal.”

There are other views that state that since G-d is the one who made the person ill, the only proper response is to return to G-d and ask for His mercy, rather than attempting to correct the physical ailments — a tactic that would seem to be fighting against G-d’s will. It is in order to clearly negate this view that the Torah rules: Doctors have G-d’s permission to heal.

There are, however, various opinions regarding how far this permission extends:

The Ramban feels9 that doctors may not attempt to heal internal ailments. In his opinion, the only medical intervention that is permitted is for external wounds or afflictions, i.e. injuries that are similar to those being discussed in the verse at hand. Rabbi Avraham Ibn-Ezra, too, writes10 that doctors may only tackle external wounds. “Any internal ailment or wound, however, is in G-d’s hands to be healed, as the verse states11: “For He hurts and also heals.” Similarly, Assa King of Yehudah was rebuked12, “For even in his illness he did not seek G-d, but only doctors.” Obviously, his turning to doctors was considered a sin.

The Ramban also cites as proof for his view the fact that King Chizkiyahu “hid the book of cures, and the Sages agreed with his actions.”13 This demonstrates that we should limit our involvement with doctors and cures, in the words of our Sages, “And what room is there for doctors in the home of one who serves G-d?”

On the other hand, the Rambam rules14 that doctors are permitted to intervene even concerning internal ailments. In his view, the book of cures that Chizkiyahu hid was one that described the forms of various constellations and stars for the sake of astrological healing. This could easily have led the people to get involved in idol worship, etc. Medicinal and natural cures, on the other hand, are completely permitted. If a person is hungry and eats bread to satisfy his hunger, is that acting against his faith in G-d who made him hungry?! On the contrary! It will cause him to thank G-d who provided him with food. The same is true for medicine: He will thank G-d for providing him with the means to be healed. The problem with King Assa’s having turned to the doctors was either that he ignored G-d altogether and relied only on medical help, or that the doctors relied on astrological cures.

The founder of Chabad Chassidut, Rabbi Shneur Zalman of Liadi, offers the following resolution of the conflicting opinions:

In the Temple era, the Jewish people lived on a much higher spiritual plane. At that time, a Jew’s body received its sustenance directly as a result of his spiritual connection via his G-dly soul. Therefore, there was a direct correlation between the 248 positive commandments of the Torah, and the physical health and well-being of the 248 limbs of the body, as well as between the 365 negative commandments and the physical well-being of the 365 sinews in the human body. During that period, one could clearly see the fulfillment of the verse’s promise15: “If you hearken to the voice of the L_rd your G-d and do that which is correct in His eyes, then all of the illnesses that I placed upon the Egyptians I will not place upon you, for I am the L-rd, your Healer” and “you shall serve the L-rd, your G-d, and I will remove illness from within you.16

During that period, if someone was not fulfilling G-d’s commandments properly, natural cures would not help, since his physical limbs were dependent solely upon his spiritual ones. Assa is criticized for turning to doctors rather than to G-d, i.e. rather than concentrating on correcting his spiritual health. Similarly, Chizkiyahu hid the book of cures, since in his times it was superfluous.

Once the Temple was destroyed, the exile began. Through our actions, not only were we exiled from our land, but the Divine Presence was “exiled” as well. We no longer receive the Divine energy that gives us life directly from its true spiritual source, but rather through a “lower” level, one similar to the source of sustenance of the animal and vegetable kingdoms. Today, even if a Jew has not attained spiritual health, his physical body can be sustained much as an animal’s is, and he can be fully healthy and strong even if his spiritual limbs are desperately lacking. Nowadays, therefore, natural medicine can help us17, and we are enjoined to utilize it.

Where Life is at Risk, Who Decides?18

Regarding any medical issues (may none of our brethren ever need it), there is a clear Halachic ruling enjoining the patient to go to a doctor and behave as the doctor instructs. It is a straightforward law, which has implications with regard to the laws of Shabbat and Yom Kippur (Shulchan Aruch, Orach Chaim, 328. 618.) Based on a doctor’s recommendation one is permitted to desecrate the Shabbat, even if there is just a slight possibility of life-threatening danger. Jewish law even differentiates between an expert doctor and a novice, placing more trust in the expert.

The nature of doctors nowadays19 is to think: “My own power and the strength of my hand has accomplished for me all this.20” If the doctor happens to be an observant Jew, he might mention that G-d helped him. Otherwise, all he talks about are his own skills.

An expert doctor possesses a sharp mind, a skilled hand, and a wealth of experience. He may even be successful at healing even patients that other doctors have given up on. However, the more successful he is, the more likely is to announce that this is due to his own skills. After all, “This doctor didn’t know what to do. The other doctor made things worse. And still, I managed to save him! Now the patient is walking on his own two feet, completely healthy.”

He can even prove that his self-esteem is not exaggerated for after all, his fee is twice or three times the norm, and yet it is he who is constantly consulted because of his expertise. He may even realize that nature dictates that a regular doctor is only slightly haughty, while a great doctor is extremely haughty. Nevertheless he loudly proclaims: “It is my own might and power!”

The haughtiness of a physician who places absolute credit in his own skill and who is not G-d fearing (i.e. does not believe that he is merely an emissary, while the true cure comes from G-d) is further strengthened when an observant Jew visits him. When the observant Jew pays him twice as much as he would pay a doctor who, though G-d-fearing, is not quite so expert, this strengthens the doctor’s absolute faith in his own talents. After all, even the observant Jew consults with him rather than with the observant doctor.

Some Jews ask me for advice about which doctor to consult. I assume that just as they ask me, they also ask other Rabbis, or personal friends. This is a practical question, and the Rabbi is obviously responsible for the advice he gives. The Rabbi faces a choice: Does he rely solely on G-d’s mercy, or does he send him to a doctor?

Even if sending him to a doctor, there are two options:

(1) To consult with a doctor who may not be the greatest expert, but who dons Tefillin and prays three times a day, and declares that G-d is the “Healer of all flesh.” (After all, it is explained in Kabbalistic and Chassidic works that G-d’s mercy is needed for a doctor to successfully heal the patient. Returning to G-d in repentance is required, for “suffering does not come without the presence of sin.21”) The theory behind this approach is clear: It is impossible that the “Healer of all flesh” will send His help through an expert doctor, even one who has exhibited great success, if he claims that it is all as a result of his own skills. Accordingly, there is no point in consulting with such a doctor. On the contrary, it may be completely forbidden.

(2) To consult with an expert doctor, without bothering to ascertain if he is G-d-fearing and Torah observant. Or even to consult with an expert doctor whom we know to be non-observant, even if we are certain that this consultation will further fuel his ego and sense of self-sufficiency.

Since this is a question that involves life and death one cannot say that the Rabbi will be extra stringent or lenient, since either approach may be endangering the patient’s life! Even one who refuses to answer is taking a great responsibility — the very life of the patient who may, as a result, not consult with the appropriate doctor.

Anybody who argues that G-d will not send a cure at the hands of a non-observant Jew must know that they are accepting upon themselves the responsibility for those people who will not be cured because they will not consult with expert medical help as a result.22

The Brisker Rav’s Ruling

After having publicized the above views, I received a note from Jerusalem, from a Rabbi who has been a recognized Halachic authority for decades. I don’t want to mention his name, but he is someone who is very exact whenever discussing something that will relate to a practical Halachic ruling.

He writes that someone once asked Rabbi Yitzchak Dov Soloveitchik, the Brisker Rav of blessed memory, which of two doctors to consult. They were both equally expert, but there was a possibility that one was more G-d-fearing than the other. The Rav angrily replied that one should not even consider the doctor’s “fear of G-d” when discussing medical abilities. The entire subject should make no difference in one’s decision whatsoever.

When I read this I was truly amazed at the novelty. After all, the question was about a case where they are both equally capable; why then should one’s observance not then be taken into account? Yet, the Brisker Rav rejected such an approach, and insisted that the doctor’s observance not even be mentioned at all! When I considered this carefully — since I know, by reputation, how careful the Brisker Rav was with his words, especially with regard to Halachic rulings, and even more so in medical areas where lives hang in the balance — I realized that it is a clear law in the Torah!

Whenever lives are at stake, we consider a possible danger to life as being the same as a certain danger — even if there are several layers of doubt.23 There is also a law24 stating that when lives are endangered, “it is a mitzvah for the greatest amongst the group” to personally desecrate the Shabbat, etc. “One who shows alacrity is praiseworthy, one who stops to ask is a murderer, and one who is asked is worthy of disgust.”25 The reason for the last case is that if someone knows a law pertaining to mortal danger, and he lives in a place or time where some people may not know about it or be in doubt about its importance, he is obligated to publicize it.

Questions have been raised: Why is it a mitzvah for the greatest of the group specifically? Why not send a simpleton to desecrate the Shabbat? Similarly, the law states26 that in cases of danger to life, one should not worry about minimizing the desecration of the Shabbat at all, but rather do everything that might be necessary without hesitation. Why not attempt to minimize the amount of work needed, and minimize the desecration?

The answer is simple: If we ever see hesitation when there is a need to desecrate the Shabbat in order to save a life, such as if the greatest among the group does not break Shabbat himself but rather sends someone else, or if people attempt to minimize the desecration as much as possible, etc. — even if in this particular situation the life will still be saved, since it is indeed enough to do less — this will have a negative effect on the future. Whenever there is again a situation where lives are endangered, people will hesitate and wonder whether to go, how, etc. Especially unlearned or ignorant people may not be able to differentiate, and may not recognize the subtleties involved. Thus, hesitation can eventually lead to actual risk to life.

Because of the confusion that can possibly result, both certain and dubious risks to life are considered mortal dangers. That is why it is a mitzvah for the greatest among the group to act, and to avoid even the slightest hesitation; it is in order to avoid creating any doubt or uncertainty in the public’s approach to saving lives.

(This is similar to the fact27 that it was permitted to desecrate the Shabbat in order to testify about the New Moon, even if an earlier group of witnesses had already testified, in order to avoid weakening their enthusiasm in similar circumstances in the future.)

According to this reasoning it is understandable that the Brisker Rav refused to allow (to the point of getting upset with the person mentioning it) the issue of a doctor’s fear of G-d to be discussed altogether, even when both doctors are equally expert:

If it will become public knowledge that a Jewish sage showed an interest in the degree of a doctor’s observance — even when both doctors posses comparable skills — this may eventually lead to a catastrophe. When a second or third person will hear the story, he will not hear all of the details. He will just be told that the degree to which the doctor was G-d fearing was taken into account. They may then choose a doctor who is more G-d-fearing over one who is more expert. In other words, even allowing the issue to be considered could ultimately lead to a situation where lives are placed at risk. This is why the Brisker Rav did not allow it to be considered, and publicly announced that it makes no difference whatsoever. (It is, after all, a fact that even now, years later, the exact words he used are remembered.)

The reason for this zealousness is that in any situation where lives are or can be at risk, it is forbidden to remain silent. Since the Brisker Rav recognized that even his students did not realize that this is an issue that could endanger lives, he announced that the issue should not even be mentioned at all. In this way he strengthened the approach — set forth in Jewish law — that with regards to medical activities, the doctor’s practical expertise is the only factor to be considered.

Although the doctor may boast about his skill and show no humility towards G-d, this is all irrelevant to his practical expertise — which is what he is being consulted for. The doctor’s level of observance may be a factor when dealing with his credibility in issues pertaining to Jewish law, but not with regard to medical healing itself. In such areas, he has full credibility, for an expert would never do anything that would damage his reputation.28

Heeding Doctor’s Orders29

My father-in-law (the Previous Lubavitcher Rebbe, Rabbi Yoseph Yitzchak) repeated several times the statement he had heard from his father, the Rebbe Rashab: “How dear is the body of a Jew, for which so much Torah and Mitzvot were dispensed.” After all, G-d’s Torah and His commandments were given specifically to physical human beings, rather than to angels.

If our Creator values our bodies so much, it is obvious how careful we must be in guarding this precious article, which was given to us for safekeeping.

The Torah informs us30 that “permission was granted to doctors to heal.” In other words, a doctor acts with the permission and by the command of the Torah. There is no doubt that even if heeding the doctor’s orders will require one to temporarily abandon the fulfillment of some good custom, or some extra stringency, the Torah will not remain in debt. Through abandoning this good deed for a short time, the person will be able to increase his dedication to Torah and Mitzvot to a much greater degree, over many long and good years.

Halachic Issues in the Study of Medicine31

In response to your letter, in which you ask about your plan to study medicine, although there are several stumbling blocks, which you started to enumerate, etc.

In general, as with all questions that are relevant to the Code of Jewish Law, you should turn to a local Halachic authority, since an actual ruling involves knowledge of many specific details, which cannot always be easily put in writing. In this case, there is not even a need to attempt to do so, since there are local Rabbis in your neighborhood to whom you can turn, to clarify and discuss the issues face to face.

The main point is that something that is forbidden according to the Code of Jewish Law is absolutely forbidden. What benefit is to be had by fooling yourself, as if it is possible to come up with some type of leniency, when a Halachic authority who is expert in this field tells you clearly that this is not so? As our Sages said about a Mitzvah that is achieved through committing a transgression, “When the robber blesses, he has scorned the L_rd.”32

FOOTNOTES
1. Igrot Kodesh, vol. 11, p. 202.
2. Iyov, 19:26.
3. Midrash Tehillim, 103:5.
4. See Sefer HaMinhagim Chabad, p. 83. Sha’arei Halacha Uminhag, Even HaEzer, 16.
5. Malachi, 3:16.
6. Oral tradition in the name of the Alter Rebbe. Printed in Kovetz Yagdil Torah, Brooklyn, NY, vol. 36 (Sivan-Tammuz, 5740), p. 279.
7. Shemot, 21:19.
8. Berachot, 60a.
9. Commentary to Vayikra, 26:11. Cf. Taz on Yoreh Deah 366, and sources cited in Torah Sheleima, Mishpatim 376.
10. His commentary, ibid.
11. Iyov, 5:19.
12. Divrei Hayamim II, 16:12.
13. Pesachim, 56a.
14. His commentary to Mishna, Pesachim, ibid. cf. Tosafos Yom Tov ad loc.
15. Shemot, 15:26.
16. Shemot, 23:25.
17. Cf. Tanya, Igeret HaTeshuvah, ch. 6.
18. Based on: Sichat Yom Simchat Torah, 5737 (Sichat Kodesh5737, vol. 1, p. 169). Sichat Shabbat Parashat Vayishlach, Yud-Tet Kislev5737(ibid. p. 341).
19. In addition to the statement of the Mishna (end of Kiddushin): “The best of doctors….”
20. Devarim, 8:17.
21. Shabbat, 55a.
22. Obviously, we are not talking about those who think that healing is a purely natural dynamic. May G-d protect us from such a view, which maintains that the curing of a patient, and especially of a critically ill patient, is something that is completely governed by the laws of nature!
23. Yuma, 83a. Alter Rebbe’s Shulchan Aruch, Orach Chaim 329:6.
24. Yuma, 84b.
25. Yerushalmi, Yuma 8:5. Alter Rebbe’s Shulchan Aruch, Orach Chaim 328:2.
26. Alter Rebbe’s Shulchan Aruch, Orach Chaim 328:13, 16, 18.
27. Rosh Hashana, 21b.
28. Alter Rebbe’s Shulchan Aruch, Orach Chaim 618:6.
29. Igrot Kodesh, vol. 3, p. 297.
30. Berachot, 60a.
31. Igrot Kodesh, vol. 24, p. 176.
32. Bava Kama, 94a. Tehillim, 10:3.
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