Friday, February 19, 2010

A Great Person Sees A Doctor.

In a recent post on the excellent blog Bein Din Ledin there was a discussion about the two opposing positions of Rambam and Ramban on whether it is appropriate to seek help from a doctor, when one is ill. I discussed this several years ago here where I showed that each of these great Rishonim followed their own understanding of how the world operates as a result of HKBH’s will. What I found disturbing is the quote from Rav Dessler who suggests that Rambam and Ramban do not disagree but rather are talking about two different people at different levels of perfection. Ramban is talking about the truly perfect human being who relies completely on HKBH who should not use doctors but rely on God’s intervention to heal him when sick. Rambam is talking about a regular person who of course cannot rely on a miracle to save him. Such a person and these people are the majority of the population, should go to doctors and doctors are for them. I find this kind of “synthesis” very disturbing and counterproductive. Rav Dessler’s interpretation suggests that there are no binding natural laws, that a perfected person can transcend these laws and live according to a different reality. Once a person truly relies on God, he no longer is bound by nature. BTW, this is the general consensus in the Yeshiva world that real religiosity is total reliance on HKBH and any slack in that belief is at the root of all the evil that befalls Klal Israel. (I believe that this belief, in the sense it is presented, is at the root of all the bad things we currently witness in our community.) RD implies that Rambam would agree with that statement. In my opinion, he is trivializing a great thinker and does not even give justice to Ramban’s approach. In this post, I will analyze Rambam’s position and show why RD is wrong. In a following one, I will present Ramban’s position.
Rambam in his Pirush on the Mishna clearly states that anyone who suggests that King Chizkyahu hid the Sefer Refuot because he did not want people to avail themselves of it, when sick, instead of praying to God, is a fool impugning evil deeds to great people.

ואתה שמע הפסד זה המאמר ומה שיש בו מן השגיונות ואיך יחסו לחזקיהו מן האולת מה שאין
ראוי ליחס כמותו לרעועי ההמון וכמו כן לסיעתו שהודו לו

You must understand how faulty this idea is, how much nonsense it contains. How could they attribute such evil to Chizkyahu, when it does not befit the lowest of the populace to do such a thing? How much more to [attribute such evildoing] to his retinue [of sages] who supposedly agreed with him.

Rambam is unequivocal in stating that this idea is not only nonsense but also evil. Rambam’s world is the reality of material existence that we live in and human beings, with their unique ability, must study it, understand it and by doing that decipher God’s will at creation and act in accordance with that will. It is axiomatic in Rambam’s world that “good” is not necessarily that which makes a particular person happy and “bad” is not that which makes him unhappy. “Good” is continuity and existence and “bad” or “evil” is destruction and any action that might lead to it. We are not talking just about the existence or destruction of the individual, but rather that of his current family and future descendants, the community present and future, all of humanity present and future and even our world and its future. When man was created with his special ability of freedom of thought and choice, the creation of the world was completed. It now had a component that could alter and make changes and adjustments to it as needed. It now had the tools for its long-term survival as a planet for human habitation. We believe that this happened as a result of God’s will, a will whose ultimate purpose and goal we cannot and should not try to understand. It would be a futile quest. However, we do know that God wants it to exist forever and that He has given humankind the responsibility to see to it that it does.

כח וַיְבָרֶךְ אֹתָם, אֱלֹהִים, וַיֹּאמֶר לָהֶם אֱלֹהִים פְּרוּ וּרְבוּ וּמִלְאוּ אֶת-הָאָרֶץ, וְכִבְשֻׁהָ; וּרְדוּ בִּדְגַת הַיָּם, וּבְעוֹף הַשָּׁמַיִם, וּבְכָל-חַיָּה, הָרֹמֶשֶׂת עַל-הָאָרֶץ. 28

And God blessed them; and God said unto them, 'Be fruitful, and multiply, and replenish the earth, and subdue it; and have dominion over the fish of the sea, and over the fowl of the air, and over every living thing that creep upon the earth.'

This verse reads as a command to initiate an ongoing process without any timeline or end point. It is a constant responsibility that goes on forever. Man must multiply so that he can subdue and dominate his surroundings. Part of that dominion and subjugation is to understand the world we live in, its physics, chemistry, biology and all sciences that pertain to it. It is in this process of thinking that man discovers God, His will and ways, and learns how to emulate them.

המצווה השמינית
הציווי שנצטווינו להדמות לו ית' כפי יכלתנו, והוא אמרו:
"והלכת בדרכיו" (דברים כח, ט). וכבר כפל ציווי זה ואמר: "ללכת בכל-דרכיו" (שם יא, כב), ובא בפירוש עניין זה:
"מה הקב"ה נקרא רחום - אף אתה היה רחום;
הקב"ה נקרא חנון - אף אתה היה חנון;
הקב"ה נקרא צדיק - אף אתה היה צדיק;
הקב"ה נקרא חסיד - אף אתה היה חסיד" - זהו לשון ספרי.
וכבר כפל צווי זה בלשון אחר ואמר: "אחרי ה' אלקיכם תלכו" (שם יג, ה), וגם בפירושו בא, שעניינו להתדמות למעשים הטובים ולמידות הנכבדות שבהם מתואר יתעלה על דרך המשל - יתעלה על הכל עילוי רב.

This is the eighth Mitzvat Asseh. The first example of emulating of God is

"מה הקב"ה נקרא רחום - אף אתה היה רחום
Just as God is merciful, so you be merciful.

What exactly is merciful?

“We see, for example, how well He provides for the life of the embryo of living beings. How He endows with certain faculties both the embryo itself and those who have to rear it after its birth, in order that it may be protected from death and destruction, guarded against all harm, and assisted in the performance of all that is required [for its development]. Similar acts, when performed by us, are due to a certain emotion and tenderness called mercy and pity. God therefore, is said to be merciful.” (MN1:54)

Isn’t healing others and ourselves by developing and administering medicines that prolong life and existence, what emulating God in this context mean? Is it not what Rambam means when he says, “Similar acts, when performed by us, are due to a certain emotion and tenderness called mercy and pity”? It is a Mitzvat Asseh thus a-priori obligation that commands us to follow in God’s ways and give or take medicines when sick. Doing nothing and relying on God, according to this approach is not an option, it is sinful and wrong and probably even borders on apostasy.
So where does prayer come into play? What does the prophet mean when he criticizes King Assa for turning to doctors without praying?

דהי”ב טז יב
גם בחליו לא דרש את ה’ כי ברופאים

When we decide how to act based on our understanding of the healing sciences, we want to make sure that it is the correct decision long term, that it fits in with HKBH’s will for the continuity of the whole. We acknowledge the human limitations of not seeing beyond the immediate and in that humble moment, we turn to God to help us overcome our own failings that may influence our decision. It is only in this state of realism and humility than we can hope to make the correct decision and act properly. It is in this state of true self-analysis that we can hope for an answer to our prayer. King Assa was criticized for not acknowledging his humanity, his human limitations.

The greater the man the greater is his understanding of the human frailty and the greater his humility.

ג וְהָאִישׁ מֹשֶׁה, עָנָו מְאֹד--מִכֹּל, הָאָדָם, אֲשֶׁר, עַל-פְּנֵי הָאֲדָמָה. {ס} 3

Now the man Moses was very meek, above all the men that were upon the face of the earth.--

The paradigm of a perfect human being was the humblest. He too would have turned to medicine when sick after acknowledging his limitations and praying for guidance.
Shabbat Shalom.


  1. Similar acts, when performed by us, are due to a certain emotion and tenderness called mercy and pity. God therefore, is said to be merciful.”

    This "emotion" is mind and Deah insofar as it reflects a trained pattern of response or derech that presupposes judgment about the natural principle or tzelem of the animal.

  2. I like your analysis of all that is happening in the Orthodox world today. People don't feel responsible for their actions, since they claim they can not act contrary to what God wants anyway. If people really believed in free choice today, they would be more responsible.

  3. David Guttman,
    Will you please explain to me how the sefer refuos circulated in the the first place? If what Rambam says is accurate, what purpose would a Sefer filled with superstitious healing have?

  4. Yeshivish,

    I suggest you read the whole piece in Rambam's Pirush Hamishna on Pessachim 4:10 preferably in Rav Kapach translation. Rambma suggests two possibilities:

    1 - notes by someone on useless talismans - IOW medicine that does not work to know what is real medicine and what is a sham.

    2 - A compendium of poisons that can be used to kill people.

  5. See the chapter on bitachon in Rabbi Avraham's Sefer HaMaspik. He removes all doubt. If the cases RD is suggesting to avoid doctors falls under Rabbi Avraham's 2nd category then he is still wrong because he is going against the Rabbis' statement.

    Sorry for being vage but I want to make sure people read Rabbi Avraham's words and not assume they can understand complicated principles by reading a comment.