by R' Yerachmiel Kram
The Patient's Right to Avail Himself of Medical
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
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
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
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
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
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
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
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
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
"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
Even Being Healed by Medicine in a Natural Way is
Accompanied by Suffering which Tempers a person towards
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
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
"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
Maran the Rosh Yeshiva zt'l used to repeat what he had
heard from his uncle, Maran HaRav Isser Zalman Meltzer
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
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
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
"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
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
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
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
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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