Community Magazine May 2013

apply thereto are well-grounded in the Torah and discussed at length in our codes of Jewish law. “The Torah gives permission to the physician to heal; moreover, this is a mitzvah.” The complexity of the philosophical tension between Gd’s control of health and the role of the human healer is encapsulated by the enigmatic words with which the Shulhan Aruch , the authoritative code of Jewish law, opens its discussion of the laws applying to physicians: “The Torah gives permission to the physician to heal; moreover, this is a mitzvah and it is included in the mitzvah of saving a life; and, if he withholds his services, he is considered a shedder of blood.” This sentence is rather puzzling. We do not find the Shulhan Aruch informing us that the Torah gives permission to keep kosher, observe Shabbat, or perform any of the other mitzvot presented in the Torah. Why is permission specifically granted here? The answer is that only with regard to this mitzvah might we have thought that the action should be forbidden. Left to our own logic, we would have no choice but to assume that Gd makes people sick and Gd alone heals. However, once the Torah clearly stated that healing is permitted, it immediately becomes a mitzvah – a religious obligation – like all other mitzvo t. Therefore, the Shulhan Aruch quite appropriately states that “the Torah gives permission to the physician to heal; moreover, this is a mitzvah.” THE JEWISH VIEW OF THE PHYSICIAN What is the Jewish approach to the physician? The Tanach tells a fascinating account of Asa, King of the Judean Kingdom, who, when he fell ill, “ did not seek out Gd, but only doctors ” (Divre Hayamim II 16:12), for which he was criticized. If healing and guarding health are mitzvot, what did King Asa do wrong? His error was that he only sought out the doctors. Healing is a partnership between Gd and man. While Gd is the ultimate healer, He delegates part of His role to mankind and asks the physician to practice medicine. Gd makes a person ill, and He then finds him the right doctor to heal him. We might say that part of the “punishment” of illness is the fear that one will not find the right physician capable of healing him. This is why the Shulhan Aruch states: “if he withholds his services, he is considered a shedder of blood. And even if there is someone else (available) capable of healing, not every physician is destined to heal every patient.” Medicine is an art, and therefore one must pray that he finds the right doctor who is destined to cure him. Similarly, no physician may excuse himself from a case merely because there is another physician present, for he may be the one destined to cure this patient; he may be the one who will make the right diagnosis and prescribe appropriate treatment, when all others are baffled or incorrect. This approach must obviously exist within the reality of the physical limitations of each physician and the special divine inspiration necessary to make correct decisions. The Jewish approach to illness and medicine requires us to recognize the preeminent role of Gd in healing, while seeking appropriate medical care. Asa’s sin was turning exclusively to doctors, without the recognition of Gd as the ultimate healer. THE PHYSICIAN’S RESPONSIBILITY The Talmud, in a baffling passage, states: “ Tov sh’brofim l’gehenom ,” which literally means, “The best of the doctors are bound for gehinom ” How do we reconcile this astonishing statement with the positive view Judaism promulgates regarding physicians? One traditional explanation is that the physician must recognize the awesome responsibility that he holds in treating illness, as even a small error could possibly cause a patient’s death. Constant vigilance is required to avoid making a preventable error that would be bordering on criminal negligence. A second understanding of this mysterious passage focuses on one of the great risks of medical practice – arrogance. The statement can be understood to mean that specifically those doctors who consider themselves the best are bound for gehinom. The humble physician will recognize his limitations and consult with colleagues to ensure his patients are receiving the best possible care. One who considers himself the “best” doctor will see no need to consult with those less qualified than himself, eventually causing unnecessary harm to a patient for which he will be culpable. Like the patient, the physician, too, must recognize his role as an intermediary in healing, not its source. When the physician begins seeing himself as the source of healing, he is destined for gehinom. LIMITS TO MEDICAL PRACTICE On this basis, we can easily understand why, despite the normative Jewish attitude that considers healing to be a mitzvah, even in the most expansive Jewish approach to medicine there are limits to the authorization to heal. Physicians are granted a mandate to heal . However, it is unequivocally clear from halacha that permission is granted to a physician to treat a patient only when he can offer that patient therapy that can be reasonably expected to be efficacious. This, at times, may include even experimental treatments that could potentially be beneficial. But when a physician cannot offer effective therapy, cannot alleviate pain, and cannot cure the patient, he or she ceases to function as a physician. In such a case, he or she has no more of a license than anyone else to cause harm to another person. Judaismbelieves that physicians are given both a great opportunity and an awesome responsibility. The mandate to heal is, essentially, a command to rise to the challenge and do Gd’s work effectively, honestly, and responsibly. Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia, PA and an Assistant Professor of Diagnostic Imaging at Thomas Jefferson University School of Medicine. Dr. Eisenberg writes extensively on topics of Judaism and medicine and lectures internationally on topics in Jewish medical ethics. King Asa - King Asa reigned as king for 41 years. He was a great king as he made a clean sweep of idiolatry. However, the Torah records that when he became ill he erred. King Asa's sin, we are told, was not that he consulted physicians but that he placed his reliance entirely upon them, forgetting that the physician is Gd's agent in the treatment of disease and that the patient must pray for healing as well as go see the physician. 72 Community magazine