When Doctors Disagree Whether Surgery Is Necessary

.. You write about the differing opinions among the doctors as to the correct course of treating your wife tichye, [with some of them suggesting surgery, while others do not]:

It is known that when there are doubts as to the wisdom of having surgery performed, then it is better not to have it performed.

May G‑d, “Healer of all flesh and Performer of wonders,” heal her and strengthen her in the proper manner and fulfill your hearts’ requests for the good.

(Igros Kodesh, Vol. XX, p. 88)

When Beginning to Feel Better Surgery May Be Unnecessary

.. I cannot definitively answer whether you should have surgery since your letter is not clear about what exactly ails you.

However, since you write in your letter that you are seeing an improvement in your health, hopefully you will get even better and surgery will be entirely unnecessary.

It would be advisable for you to ask the doctor who is treating you whether it would be worthwhile for you to go on a rice diet.

(Likkutei Sichos, Vol. XXXVI, p. 3011 )

New and Complex Surgery

The surgical procedure about which you write is: 1) very complex; 2) still in the developmental stages; [and] 3) few of these surgeries (in comparison to others at least) have been performed.

As a result, currently the effects of this form of surgery are not all that clear. Moreover — and this is of great import — the changes brought about by the surgery cannot be reversed.

Thus, if the situation is stable (i.e., it has not become any worse, G‑d forbid) you should hold off on this surgery until much more is known than what is known about it [now].

(Likkutei Sichos, Vol. XXXVI, p. 3012 )

Timing of Surgery

If another doctor concurs [that surgery is necessary], you should have it done in a good and auspicious time. Understandably — it is better [to have it done] in the month of Elul than in [the month of] Menachem Av.

In any event, the surgery should not be performed on Friday, but close to the beginning of the week.

(Likkutei Sichos, Vol. XXXVI, p. 3013 )

With the Agreement of At Least Two Doctors

With regard to the medical procedure:

Act according to the concurring opinion of (at least) two specialists. (In any event, do not have [the procedure] performed during the Three Weeks, [i.e., between the Seventeenth of Tammuz and the Ninth of Av].)

(Likkutei Sichos, Vol. XXXVI, p. 3014 )

Elective Surgery and Medical Procedures Prior to Shabbos

There are many medical procedures, particularly surgical operations, which, because of post-procedural recuperation and tests, require that a patient stay in the hospital after the actual procedure is completed.

It is customary in many countries, especially in the United States, to schedule such operations for Friday, and consequently, the recuperative period extends into Shabbos.

There are, however, several halachic considerations which cast serious doubt on the permissibility of such a procedure. We are not referring to emergency operations, for in cases of pikuach nefesh, when one’s life is in danger, Shabbos assumes secondary status. We are referring to those operations and procedures that are scheduled well in advance.

The following are some of the reasons why operations, or other procedures warranting a stay in hospital, should not be scheduled for the second half of the week.

The Shulchan Aruch, the Jewish Code of Law, states (Hilchos Shabbos 248:1): “One should not [set] sail on a ship within three full days preceding Shabbos; that is, from Wednesday on, inclusive of Wednesday itself ... for on the first three days (of ocean travel) people are afflicted with pain and disturbances ... and they do not return to their original state until after three full days. Hence, if a person sails within three days preceding Shabbos, he will not enjoy Shabbos.”

From this law it is clear that anything which creates disturbance and pain, or can mar one’s enjoyment of Shabbos in general, must be avoided during the three days preceding Shabbos.

The disturbances one feels when entering a hospital, with its attendant changes in routine (in eating, sleeping, waking hours, even special clothes), and especially the pain and trauma that follows an operation, are much greater than those caused by sailing on a ship.

Moreover, unlike a sea voyage, the havoc wreaked on the enjoyment of Shabbos caused by a hospital stay affects one’s family as well. Thus one should not enter a hospital from Wednesday on.

A further problem is that many of the post-operative procedures involve work that is forbidden on Shabbos. Although some of them may fall within the category of pikuach nefesh, necessary for the patient’s essential welfare, one should not deliberately place himself in the position of having to desecrate the Shabbos.

In other words, one should not enter a hospital within three days of Shabbos knowing it will entail desecration of Shabbos.

This principle applies even if the forbidden tasks are performed by a non-Jew. The gravity of this situation is further compounded in cities where many of the hospital personnel may be Jewish (e.g., New York, Boston, etc.), and when the tests need the assistance of the patient.

Furthermore, even in many post-operative cases, the tests are not in the category of pikuach nefesh and must be deferred until after Shabbos.

A Jewish patient must then insist on having such tests performed after Shabbos; but immediately following an operation a patient does not usually have the requisite strength to refuse his doctors and insist on deferring the tests.

Moreover, many of these procedures are mandatory, not easily refused. And if one’s attending physician is Jewish, the patient who enters the hospital on Friday is causing another Jew, the doctor, to desecrate the Shabbos.

All these factors lead to the conclusion that it is completely prohibited to arrange for a hospital procedure on Friday, or even Thursday or Wednesday. It is possible, and has been demonstrated so in the past, for one to arrange to enter a hospital at the beginning of the week.

A further point: Hospital shifts are so arranged that over the weekend (Saturday and Sunday) it is mainly interns who staff hospitals, and not the more experienced physicians.

Should some emergency arise, it is the more inexperienced doctor who will attend to it. Then, even from a purely medical view, it would be wise not to schedule surgery for Friday.

One more important point: If a person becomes sick, G‑d forbid, Torah instructs us to seek the best medical assistance possible. Simultaneously however, a man must know that he is constantly being weighed on the Divine scale of good and bad.

An ill person would do well to consider that when his life or health is in danger, it is time to improve his conduct. His deeds must be beyond reproach, particularly in the very area of healing. In other words, the steps taken to become well (surgery, etc.) should be according to G‑d’s directives given to us in the Torah; then we may be sure that these steps will be successful.

Then G‑d, the “Healer of all flesh and Performer of wonders,” will bless each and every Jew with complete physical and spiritual health.

(Likkutei Sichos, Vol. XVI, p. 518ff.5 )

Elective Surgery and Medical Procedures on Fridays

.. After asking your great forgiveness, I must however make you aware that a complex medical procedure or surgery should not take place on erev Shabbos — for any number of reasons:

As can be deduced from [the issues] of departing on a ship [on the second half of the week],6 hospital procedures require that many tests be taken the day after the surgery, that matters be recorded and written down, etc. — some of them having no relationship at all to healing the individual, but merely for statistics and the like. In a city such as ... and similar cities, much of this is done by Jews, and many of them require the patients’ assistance, and so on.

Moreover, and this too is of great importance: The present situation is that on Shabbos (and Sunday) it is mainly beginning interns who staff hospitals, and not the more experienced physicians, and there is quite a difference in the degree of expertise and competency between these two categories of physicians.

(Likkutei Sichos, Vol. XVI, p. 5217 )

Use of the Word “Treatment” With Regard to Surgery

.. You ask me why I used the word “treatment” [with regard to your upcoming surgery]:

The reason is quite simple: I am referring to all the details in the treatment and healing process — that which transpires before surgery, that which transpires during surgery, and that which transpires during the recovery process following surgery. The purpose and intent of all these individual aspects is that they all lead to a speedy and full recovery. ...

(Igros Kodesh, Vol. XVIII, p. 267)

Begin With the Most Benign Form of Treatment

In reply to your letter of the 7th of Cheshvan where you write about the various suggestions offered by the doctors regarding assorted forms of treatment [in order for you to be able to bear children]:

Understandably, in such situations, [i.e., where there are a variety of options,] one is to begin with the easiest and most uncomplicated [form of treatment,] i.e., merely soaking in the baths in Tiberius.

May G‑d will it that the treatment meet with complete success, and may G‑d very shortly fulfill your desire to have children.

(Igros Kodesh, Vol. XVIII, p. 50)

Avoid Radical Treatment Whenever Possible

This is to acknowledge receipt of your letter of the 7th of Adar in which you write about the proposed surgery for Mrs. ... . I will remember her in prayer that whatever the final decision, it should meet with success.

Since you also ask my advice in this matter, I can only say that, in general, I am not in favor of radical treatment if there is any possibility in treating a patient in some other way.

I must also add that it is customary among Jews that when there is a difference of opinion among doctors as to the urgency of an operation, or whether or not to operate, it should be treated as any other question in Jewish law requiring consultation with a competent practicing Rav. The various aspects and details of the case should be explained to him, at which time he can state his opinion in accordance with the Shulchan Aruch.

I trust there is no need to emphasize at length that one always requires the blessings of the “Healer of all flesh and Performer of wonders.” The channel to receive His blessings is through living one’s everyday life in accordance with His Divine will, namely, in accordance with the Torah and mitzvos. When a special Divine blessing is needed, [then] an additional effort in this direction is called for.

(From a letter of the Rebbe, dated the 9th of Adar, 5739)

Undergoing Tests to Determine The Cause of Feeling Weak

[This is] in reply to your letter, in which you inform me of the state of your health — that you are feeling weak and the doctor wants you to go for tests. You ask my opinion whether you should do so.

[My reply]: You may accede to his request and take the tests.

With regard to your feeling weak: Make sure that you eat in the morning, and that from time to time you learn something, whether in Nigleh or in Chassidus, from which you will derive clear-cut and actual physical pleasure. ...

(Igros Kodesh, Vol. XXI, p. 120)

Avoid Tests That Will Be of No Value
Even if They Are Relatively Benign

I received your special delivery letter in which you describe your daughter tichye’s visit to the doctor and that the doctor suggested a variety of tests in order to ascertain which category she belongs to, and you also describe the various categories.

From the tenor of your writing, it would seem that the doctor caused you to be heavyhearted and you ask my opinion about [your daughter] having these tests:

In my opinion I don’t see how the test results — whatever they will show — will in any way affect your daughter’s development. Since they will be of no value, then no matter how benign these tests may be, still, since these tests are performed through the use of electricity near the head and the like, it is difficult to predict whether these tests will in some way prove harmful.

Such tests are to be taken only when absolutely necessary, particularly since these tests are not yet of proven benefit as it is only a few years since these tests have been developed and doctors are still half in the dark about them.

You should also take into consideration that you yourself observed that the doctors’ diagnosis about your daughter was flawed, and a greater degree of improvement has taken place than they originally thought possible. Surely this degree of improvement will continue in the future as well.

I therefore see no reason why you should lose money and put any undue strain on yourself with regard to tests that will provide no benefit, and that will, at best, cause no harm. ...

(Igros Kodesh, Vol. VI, p. 115)

Additional Dangerous Medical Tests

.. I am not pleased by the suggestion that your son ... sheyichye be subjected to additional medical tests that are extremely dangerous.

May G‑d grant that even without these [additional] tests the doctors be able to establish a proper course of treatment and healing for him. May there be fulfilled through [the doctors] the saying of our Sages, of blessed memory: “Permission was granted — which also means that they were empowered — to the healer to heal.”

Although [in general] one should follow the instructions of doctors, [they should] not [be followed] in this case where the tests are extremely dangerous.

(Likkutei Sichos, Vol. XXXVI, p. 3028 )

Treatments and Procedures to Achieve Pregnancy
Should Begin With the Most Uncomplicated and Benign

In reply to your letter of the 16th of Menachem Av [5710] in which you describe the state of your wife tichye’s health:

It is hard to understand that which you write concerning the reasons why your wife cannot conceive, when in the beginning of the letter you write that in Elul, 5709 she did become pregnant. [If she could conceive then,] surely she should be able to conceive now as well.

It therefore seems to me that she should not take — to quote you — “extreme measures.” Rather she should again inquire of a specialist what she should do; surely he will find more benign methods of treatment.

Through “this specific doctor and this particular medication,” everything will surely turn out well, and the blessing of my father-in-law, the Rebbe, הכ"מ — that G‑d should cause your hearts to rejoice with viable and healthy children — will be fulfilled.

(Igros Kodesh, Vol. III, p. 386)

Follow Advice of Specialists Who Recommend Surgery

In reply to your letter ... in which you cite the opinion of the specialists whom you have recently visited regarding how you should be treated for your ailment [and their recommendation of surgery]:

Our Torah, the Torah of Life, grants permission for physicians to heal, and this empowers them to be instruments of healing as well, [for which reason you should follow their recommendation].

May G‑d will it that your surgery lead to a rapid healing and a complete recovery. ...

(Igros Kodesh, Vol. XIX, p. 3)

Consult With At Least Two — Better Yet Three —
Specialists Prior to Surgery

In reply to your letter of the first day of Chanukah in which you write about surgery for removal of a gland, etc.:

As in all matters of surgery, i.e., an act that cannot be undone, you should ask the opinion of experts in the field; at least two, and even better three.

I am sure that your father-in-law sheyichye will not oppose this, for even according to the directives of our Torah, the Torah of Life, the opinion of two or three individuals carries with it much more force than does the opinion of a solitary individual.

Rational human thought concurs with this as well, for any one individual, no matter who he is, is a created and inherently limited being. When there is a consultation among two or three individuals together, the result is that in “Salvation lies in much counsel.”9

(Igros Kodesh, Vol. XVI, p. 183)

Radiation or Surgery

In reply to your letter of the 19th of Cheshvan, [where you write] about your health situation and the [different] opinions of the doctors [as to whether you should have surgery or radiation]:

Generally speaking, from the two alternatives you mention, surgery or radiation, you should lean towards the former — understandably after having received the consent of a Rabbi who regularly rules on matters of Jewish law.

[The reason for my opinion is] that one can never predict the outcome of the radiation with certainty, i.e., whether one has accomplished what one is seeking to accomplish, [that is to say, whether the tumor has been wholly and successfully irradiated].

As is customary in such matters, you should have a concurring opinion of two specialists in the field, in addition to the agreement of the Rabbi, as previously mentioned.

May G‑d lead you in the pathway that is best for you in all aspects.

You observe no doubt the “good custom” of Jewish women to always give tzedakah prior to lighting candles erev Shabbos and erev Yom Tov.

(Igros Kodesh, Vol. XXII, p. 354)

Receive Two Concurring Opinions Before Undergoing a Procedure

[This is] in reply to your letter of the 17th of Teves ... in which you write about your health and the opinion of the doctor [that you should have a procedure done]:

In response to your question in this matter: You should act in accordance with the concurring opinion of two doctors.

Additionally — and of greatest import — place your bitachon in G‑d, “Healer of all flesh and Performer of wonders,”10 that the procedure be successful.

May you have a speedy healing.

(Igros Kodesh, Vol. XXIV, p. 50)

After Five Years of Regular Treatment, Why Suddenly Operate?

In reply to your question [whether your wife should immediately have surgery]:

Since your wife tichye has already been undergoing treatment for more than five years, why suddenly operate? In any event, [you should] consult and follow the unanimous advice of three specialists.

It would be proper for you to check your tefillin and mezuzos to assure that they are kosher according to Jewish law.

Most importantly, strengthen your daily conduct so that it be in keeping with the directives of our Torah, the Torah of Life, and the performance of its commandments concerning which it is stated,11 “You shall live by them.”

In addition to the main point that [one should do so because] G‑d has so commanded, this is also the path through which one receives G‑d’s blessings regarding all those things that a person needs.

(From a letter of the Rebbe, dated the 19th of Sivan, 5730)

Diet and Tranquility Preferable to Surgery

In reply to your letter ... in which you describe your health status and the opinion of the doctor:

Since the doctor says that if you continue your diet you can forgo surgery for at least a year or two, then it is understandable that there is no room for thinking about undergoing surgery, particularly since from time to time new methods are discovered to treat a situation such as yours. Thus it is quite possible that you will not require surgery at all.

The matter depends on your self-control — not to become upset and angry, to more or less stick to your diet, and in general to follow the instructions of your specialist. ...

(Igros Kodesh, Vol. XIV, p. 151)

Follow Advice of Specialists Who Recommend Surgery

In reply to your letter ... in which you cite the opinion of the specialists whom you have recently visited regarding how you should be treated for your ailment [and their recommendation of surgery]:

Our Torah, the Torah of Life, grants permission for physicians to heal, and this empowers them to be agents of healing as well, [for which reason you should follow their recommendation].

May G‑d will it that your surgery lead to a rapid healing and a complete recovery. ...

(Igros Kodesh, Vol. XIX, p. 3)

Try to Refrain From Employing Measures That Cannot Be Undone

In light of the rapid advances in medical research during the past few years, every new day carries the possibility of bringing with it new medical knowledge and revelations.

A person should therefore seek to refrain from employing measures that cannot be undone when the new medical techniques and knowledge will have discovered that the original measures should not have been taken. ...

(Igros Kodesh, Vol. XIX, p. 134)

Inquire of a Rabbi Who Regularly Issues Halachic Rulings
Prior to Having Halachically Questionable Surgery

With regard to the question in your letter about having the procedure done (the operation, etc.) [for purposes of fertility]:

Before anything else, you must ascertain from a practicing Rav whether this operation is permissible according to the Torah, the Torah of Life.

(Igros Kodesh, Vol. XXIV, p. 208)

Avoid the Procedure During the “Three Weeks”

With regard to your medical treatment: ... In any event do not undergo the procedure during the “Three Weeks,” [i.e., between the Seventeenth of Tammuz and the Ninth of Av].

(Igros Kodesh, Vol. XXIV, p. 357)

Surgery During the Nine Days And Close to Shabbos

..Your desire to do the above, [i.e., to have your operation] in the “Nine Days” [between Rosh Chodesh Menachem Av and Tishah BeAv,] and close to Shabbos,is not at all understandable.

It would be advisable to push off the surgery to [a day at] the beginning of the week, and after Tishah BeAv.

(From a letter of the Rebbe, dated Rosh Chodesh Menachem Av, 5731)

Delay Surgery Until After Tishah BeAv

In reply to your question transmitted to me by ... with regard to your health status and the opinion of the doctor:

In general, one should act in accordance with the instructions of two specialists in the field, [and] since you write that both of them are in agreement, you should therefore undergo the procedure.

With regard to the timing:

If at all possible, try to push it off until after the ninth day [of Av, i.e., Tishah BeAv,] and if the doctor insists that the procedure be performed at an earlier date, then do it prior to Shabbos Chazon.

May G‑d, “Healer of all flesh and Performer of wonders,”12 send His “healing words” and heal you through [the medium of] “this specific doctor and this particular medication.” And may you be able to convey glad tidings of openly revealed goodness.

(Igros Kodesh, Vol. XIX, p. 376)

Follow Doctor’s Advice of Diet, Rather Than Surgery

.. With regard to your friend [who faces the possibility of surgery]:

Since one of the doctors says that surgery is unnecessary and he need only be careful about his diet, he should follow that doctor’s advice.

Your friend should also strengthen his bitachon in G‑d, the “Healer of all flesh and Performer of wonders,” [particularly since] peace of mind is one of the most potent cures for ailments such as your friend is suffering.

(Igros Kodesh, Vol. IX, p. 235)