Monday, May 14, 2007

Who needs Doctors? Malpractice,Amulets and Faith.

In last week’s Parsha on the verse
יא וְנָתַתִּי מִשְׁכָּנִי, בְּתוֹכְכֶם; וְלֹא-תִגְעַל נַפְשִׁי, אֶתְכֶם.
11 And I will set My tabernacle among you, and My soul shall not abhor you.
[1]Ramban in a long comment discusses the meaning of these promised blessings. Basing it on his general understanding of Providence where everything is the result of hidden miracles[2]. He then goes on to say that doctors are not needed for the righteous.

רמב"ן ויקרא פרק כו פסוק יא

והכלל כי בהיות ישראל שלמים והם רבים, לא יתנהג ענינם בטבע כלל, לא בגופם, ולא בארצם, לא בכללם, ולא ביחיד מהם, כי יברך השם לחמם ומימם, ויסיר מחלה מקרבם, עד שלא יצטרכו לרופא ולהשתמר בדרך מדרכי הרפואות כלל, כמו שאמר (שמות טו כו) כי אני ה' רופאך. וכן היו הצדיקים עושים בזמן הנבואה, גם כי יקרם עון שיחלו לא ידרשו ברופאים רק בנביאים…
אבל הדורש השם בנביא לא ידרוש ברופאים. ומה חלק לרופאים בבית עושי רצון השם, אחר שהבטיח וברך את לחמך ואת מימיך והסירותי מחלה מקרבך…:
וזו היא כונתם באמרם (שם) ורפא ירפא מכאן שנתנה רשות לרופא לרפאות, לא אמרו שנתנה רשות לחולה להתרפאות, אלא כיון שחלה החולה ובא להתרפאות כי נהג ברפואות והוא לא היה מעדת השם שחלקם בחיים, אין לרופא לאסור עצמו מרפואתו, לא מפני חשש שמא ימות בידו, אחרי שהוא בקי במלאכה ההיא, ולא בעבור שיאמר כי השם לבדו הוא רופא כל בשר, שכבר נהגו. .... אבל ברצות השם דרכי איש אין לו עסק ברופאים:

My usual Paraphrase/translation/comments.

When the majority of Israel is perfect, they are not controlled by nature. That is so with their bodies, their land, as a group or as individuals, for God will bless their food and water and remove illness from among them so that they will not need doctors. They will also not need to follow medical practices as God Himself is their doctor. The righteous did thus at the time of prophecy, when, due to a sin, they did get sick, they did not turn to doctors but the prophets…
Someone who can ask God through a prophet will not turn to doctors. What place do doctors have in the house of those who do God’s will who promised that “He will bless your bread and water and remove sickness from among you”?...When the Rabbis say “Heal he shall” from here we see that a doctor may [is permitted to] heal, they do not say that the sick person may heal himself, rather they say the if one chooses to go to doctors, because he is not among the righteous, a doctor should not refuse to treat him. The doctor does not have to worry about possible malpractice liabilities because he is an expert. He also should not refuse because God heals all flesh, as it is customary to go to doctors!
[These last words are fascinating – the only reason to go to a doctor is because it is a minhag!]… But when God approves of a person’s deeds he has no use for doctors.

Ramban is saying that sin is the cause of sickness. Repentance alone and getting close to God negates the need for doctors. Every time I read this I am amazed as Ramban made a living as a doctor. Apparently with the medicine of his time in Christian Spain a sick person was better off ignoring doctors and relying on natural healing! I remember reading that wealthy people during the renaissance had a shorter life span than the poor. The rich could afford doctors who killed them while the poor could not.

The Mishna in Pessachim says that Chizkyahu hid the Sefer Harefuot.


פירוש המשנה לרמב"ם מסכת פסחים פרק ד משנה י

הלכה זו היא תוספתא, אבל ראיתי לפרשה ג"כ לפי שיש בה תועליות. ספר רפואות, היה ספר שהיה בו סדר רפואות במה שאין מן הדין להתרפות בו, כגון מה שמדמין בעלי "הטלסמאת" שאם עושין "טלסם" בסדר מסוים מועיל לחולי פלוני וכיוצא בזה מדברים האסורים, ומחברו לא חברו אלא על דרך הלימוד בטבעי המציאות לא כדי להשתמש במשהו ממה שנכלל בו, וזה מותר כמו שיתבאר לך שדברים שהזהיר ה' מלעשותם מותר ללמדם ולדעת אותם, כי ה' אמר לא תלמד לעשות ובא בקבלה אבל אתה למד להבין ולהורות. וכאשר קלקלו בני אדם ונתרפאו בו גנזו. ואפשר שהיה ספר שיש בו הרכבת סמים המזיקין כגון סם פלוני מרכיבין אותו כך, ומשקין אותו כך, וגורם למחלה זו וזו, ורפואתו בכך וכך, שכשיראה הרופא אותם המחלות ידע שסם פלוני השקוהו ונותן לו דברים נגדיים שיצילוהו, וכאשר קלקלו בני אדם והיו הורגין בו גנזו. ולא הארכתי לדבר בענין זה אלא מפני ששמעתי וגם פירשו לי ששלמה חבר ספר רפואות שאם חלה אדם באיזו מחלה שהיא פנה אליו ועשה כמו שהוא אומר ומתרפא, וראה חזקיה שלא היו בני אדם בוטחים בה' במחלותיהם אלא על ספר הרפואות, עמד וגנזו. ומלבד אפסות דבר זה ומה שיש בו מן ההזיות, הנה ייחסו לחזקיה ולסיעתו שהודו לו סכלות שאין ליחס דוגמתה אלא לגרועים שבהמון. ולפי דמיונם המשובש והמטופש אם רעב אדם ופנה אל הלחם ואכלו שמתרפא מאותו הצער הגדול בלי ספק, האם נאמר שהסיר בטחונו מה', והוי שוטים יאמר להם, כי כמו שאני מודה לה' בעת האוכל שהמציא לי דבר להסיר רעבוני ולהחיותני ולקיימני, כך נודה לו על שהמציא רפואה המרפאה את מחלתי כשאשתמש בה. ולא הייתי צריך לסתור פירוש זה הגרוע לולי פרסומו.

Rough Paraphrase:

Rambam proposes two possibilities for why this book of medicines was hidden. Either it was a book of talismans which someone had written as a report of what people did. Although it is forbidden to use the talismans one may learn about them so that one may rule about what is permissible and not. [I understand that he is referring to the need of members of Sanhedrin to know all about Avodah Zara so they can recognize it when a case comes to them]. As people started using it Chizkyahu decided to hide it away.

The other possibility is that it contained a list of poisons and their antidote. It was useful for doctors to know how to treat patients who developed symptoms that suggested they had ingested those poisons. As people started using it to kill others he decided to hide it.

Rambam then continues that the reason he is talking about this at length is that he has seen wrong interpretations of this Mishna. Some understood that this book was written by Shlomo and it contained very efficient medicines. As people relied on this rather than God Chizkyahu decided to hide it. Besides the nonsense and imaginings that go into this opinion they also attribute to Chizkyahu and his followers stupidity that only the lowest of the masses could be expected to be so stupid. Furthermore how can the Rabbis praise such stupidity?! According to this ignorant and idiotic [Rambam’s words not mine] thinking, a hungry person who turns to bread and eats it has lost his faith in God? O idiots shall they be called! For just like I thank God for the food he gave me so do I thank Him for providing me with medicines to heal me from my sickness! I had to debunk this wrong understanding because of how widely it is accepted!

I am not sure that Ramban would not agree with Rambam that Chizkyahu would not hide a good medicine book, but Rambam certainly does not agree with Ramban that a righteous man does not turn to natural healing methods. On the contrary, he takes the medicines and thanks God for having provided them. That is Avodat Hashem!

I just find it fascinating contrasting the opinions of these two greats. Whose opinion won out into our times? I heard this anecdote about the Steipler that during the last few years of his life he refused to see a doctor repeating the Ramban statement - ומה חלק לרופאים בבית עושי רצון השם. I am not sure how true this story is but just the telling is indicative of the current state of mind of the community.

[1] Art scroll translates; וְלֹא-תִגְעַל נַפְשִׁי, אֶתְכֶם. My spirit will not reject you which agrees with Ramban reading of it. He explains the rejection that after death the soul will not require transmigration (Gilgul). That is a separate discussion. To Ramban it is central in his understanding of reward and punishment while it is anathema to Rav Sa’adyah Gaon, Rambam and many other Rishonim.

[2] Yes I know Rabbi Dr. David Berger’s article. Dr. Berger holds that when Ramban is talking about hidden miracles, it applies only to the righteous who have special status. The general population is controlled by Mikreh – chance. It is a discussion for another post.

8 comments:

  1. The biggest problem I have with this whole issue is that, as much as I agree with Rambam conceptually, when you look at the context of the mishna, it's pretty clear that Ramban and others are probably correct.

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  2. Greg, The Mishna seems quite neutral to me. Where do you see any indication that it was Ramban's reasoning? In fact what I find interesting is the Nechash Hanechoshet, where Rambam did not even find it necessary to comment upon!

    I believe that we come to these old sources with our own prejudice of what we felt the early Rabbis thought and believed in context of their time.

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  3. >>>According to this ignorant and idiotic [Rambam’s words not mine] thinking, a hungry person who turns to bread and eats it has lost his faith in God?

    The Chazon Ish asks a strong kashe on this analogy. It is not anamolous for an individual to be responsibile to seek his own bread and sustenance. It is anamolous for a person to get sick - we recognize it as an onesh of yad Hashem precisely because sickness is not the normal human condition. Just because we have a matir to engage in histadlus in the former case is not automatic license for hishtadlus in the latter case.

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  4. R. Chaim, the Kashye however is completely against Rambam's ruach. Sickness results from two possibilities, lack of self control and indulgence in unhealthy foods and pursuits or from birth defects (genetic in modern parlance) or environmental. The first is considered sin the other two are just minhago shel olam. Treatment for all three are done by the doctor who either makes the sick person aware of his transgressions or treats the ailment. See MN 3:12 and other places.

    Thank you for bringing this to my attention and I will BN expand on it in a post.

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  5. From the context of the other cases brought in and around that mishna.

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  6. Gilgul is also anathema to me. Unfortunately, my opinion doesn't carry much weight.

    And, needless to say, my fellow Sephardim are not especially tolerant of the Maimonidean take on this issue (l'daavonenu)...

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  7. >Gilgul is also anathema to me.

    Yes, but only to your current gilgul. :)

    Rabosai. Did anyone ever notice that medieval theology about the static nature of God's will existed in a time when the popular scientific conception of the world was mechanistic and static?

    Should not the new science of quantum mechanics and probabilities lend more support to a dynamic view of will similar to that which the mekubalim conceived of? I am thinking of Rav Kook's call to creative and dynamic spirituality in Orot HaKodesh I, p. 165, translated by Rav Naor here: http://www.orot.com/lights_holiness.html#Anchor-Holiness-27445

    Just throwing some bones and seeing if anyone will bite. :)

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  8. As you know, Chardal, I am not familiar enough with Rav Kook's torah though I have been reading up a little on it lately.

    But now that you throw this out, let me ask you back, can we go beyond what we learn from the Sifrei Nevuah when metaphysics is discussed? Don't you see the attribution to ruach Hakodesh, giluy Elyahu and other such "creativity" terms as dangerous? In fact risk being heretical? Is it not what the gemara means by Nitla nevuah min haneviim?

    I cannot accept any metaphysical theory unless it is anchored in the text or in a midrash chazal that is based on them being "Ma'atikei Hashemuah".(That term is not strictly correct as it applies to halacha only - but something in that vein).

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