Faith and Intervention

Here is an entry that I wrote last year for the WebYeshiva Blog:

We are all familiar with the famous philosophical conundrum of reconciling free will with divine omnipotence (and omniscience). The religious personality’s encounter with illness shares a certain tension with this eternal debate, though more poignant in its application to some of the most dramatic moments of our lives. Here too the inherent friction emerges between faith in Hashem’s involvement in our lives and man’s facility to be proactive in his own destiny.

In sickness man faces his own mortality, and intervention is a frank struggle directly with fate. Perhaps the object here is to seek divine intervention. After all, Hashem is the source of our troubles and ultimately determines our redemption. Inserting the middle man of the doctor might only serve to obscure this point and can easily be construed as rejecting divine providence.

This viewpoint seems to be supported by the Ramban in his commentary on the Torah (Vayikra 26:11) where he describes a perspective of the righteous in the age of prophecy to recognize the correlation between sin and sickness and seek out prophets instead of doctors when in need of healing. Despite this, at some stage in history man became accustomed to relying on medicine, at which point God acquiesced to the practice. Based on this flawed state to which we are now adjusted the medical practitioner is given permission by the Torah to practice his expertise. The level of Ramban’s disappointment in the patient who seeks medical intervention even in our current epoch is not clear.

To rely on medicine according to this point of view is a demonstration of weakened faith. In principle, we should seek personal resolution of our ills directly from Hashem. The Ramban concludes his thought with, “Though concerning the wishes of Hashem, man’s ways would have no business with doctors.”

This may not sit well with today’s faithful individual. We generally feel the need to stay healthy to serve Hashem and associate that with a responsibility to follow doctors’ orders. How then can this be a lack of faith? We see no contradiction between our reliance on Hashem for healing and our seeking the natural means by which He can clothe His will to provide that healing. Not to mention the horror stories we’ve heard about religious fundamentalists (mostly Christian, though not unheard of in the Jewish world) refusing medical care for their own children.

One critic of the Ramban’s viewpoint that we find among the gedolim of the modern age is that of Baruch Halevi Epstein, the Torah Temima. In his notes on Devarim 22:2 he writes about the Ramban, “I find his words uncomfortable for several reasons and I have found him no company in any of those statements and if I would propose to discuss this further the discussion would go very long and here is not the place to drag it out.”

R. Epstein points out that the Ramban is at odds with the perspective, not surprisingly, of Maimonides that medicine is actually a mitzvah. In his commentary on the mishna in Nedarim (4:4) the Rambam explains the reason that a person who swears off benefit from another person may still receive medical treatment from him because it is a mitzvah covered by the injunction to return lost objects. In this case one returns a man’s own body to him. The Torah Temima remarks that the Ramban must not have seen these words of the Rambam or he surely would have addressed them directly.

The Rambam’s grounding of the mitzvah of refuah in returning lost objects was not the only possible source. The gemara in Sanhedrin describes neglecting to save a person’s life if you see them drowning or in other dangerous situations as transgressing the mitzvah of “…do not stand upon the blood of your fellow…” (Vayikra 19:16). Why then skip over this obvious source for the obligation to heal and instead take the further leap of tying the mitzvah to returning lost objects?

Perhaps there is a reference here to a more hidden nature to healing practices. Often medicine is an enigma to the patient, who finds himself completely in the dark about how to return his own health. Here the doctor reveals the command over one’s own body that has been lost in obscurity. The danger might be very real and at the same time quite inexplicitly present. In the case of drowning, no secret is revealed. What must be done is obvious.

This touches upon the reason that medicine and faith are intertwined in the first place. Since the means of help are not explicit, the patient must trust, have faith, in the doctor. Thus the doctor begins to infringe upon the province, of the One and only deserving recipient of our faith. Now we begin to understand the Ramban’s antipathy towards that state of affairs.

But let’s think about a practice that might be considered medical, yet the means are much more explicit than we have imagined so far. A man who aids his fellow with an open wound by stemming the flow of blood might quite obviously be called not standing ‘by the blood of your neighbor’. What if the severity of the situation calls for applying a tourniquet even though this implies that you are applying more specialized training? What about washing the area and applying disinfectant, keeping common medical knowledge of germ theory in mind?

It appears that as certain medical practices become more evident as beneficial they approach the explicitness of the act of saving a man from drowning, even if the skill to apply them might require specialized training. Perhaps this is part of the historical development that the Ramban describes in our attainment of medical practice as a Torah condoned activity.

One can easily imagine then that the earliest stages of medical development would have been much less religiously appealing. Particularly since there must have been a much less discernible distinction between the limited faith in the mysterious, and perhaps ritualistic, healer and one’s true faith in Hashem. Later, as the cause and effect relationship between practices became more familiar, the medical response followed a progression towards greater acceptability. A doctor who simply initiates an almost perceptibly mechanical process of healing is no match for faith in the One who determines the outcome of all processes.

That is not to say that there is no more danger to the religious perspective. The dynamic is to some extent reproduced up to this day depending on the rarity of the malady and the novelty of the treatment. The cutting edge of medicine is quite incomprehensible. Doctors too, besides the profession’s notorious struggle with the ‘god complex’, are likely to redirect the patients’ faith back to them personally in certain situations by virtue of the phenomenon of specialization. The more that unique expertise in a particular problem is recognized to be in the hands of only a few, or only a single doctor, the more likely a person is to fixate on the doctor and cut out Hashem.

Despite this, R. Yosef Caro establishes in the Shulchan Aruch (Y.D. 336:1) the halachic status of medicine as permitted, and in fact a mitzvah that carries with it severe culpability if neglected. The most amazing detail about this halacha is that its formulation is a direct quote from the Ramban!

In his treatise on the laws of mourning, Toras Haadam, the Ramban does once again describe the compromise of man’s ideal state in the history of medicine, but he concentrates much more on the current reality of a true and important obligation to practice medicine. Going beyond a begrudging Torah permission to practice, he says “to restrain oneself is to spill blood.” Not only that, he too explains that vis-a-vis the patient, “his body is lost and the Torah says ‘return it to him.’” So now the Ramban provides the mitzva of medicine with the backing of several Torah sources, including that which the Rambam used.

So ultimately it is the belief of all the responsible authorities that medicine be deferred to and practiced. Yet the initial comments of the Ramban must still ring in our minds as a call to diligence in assessing our spiritual state.

A religious individual faced with the trials of sickness is likely to find the pull in one of these two directions very strong. To deal with the daily rigors of assessment and treatment in the hands of aloof, yet powerful personalities could be frightening, awe inspiring and literally distracting from remembering that “I am God your healer.” (Shemot 15:26) Or it might inspire complete rejection of the medical establishment in order to seek one’s greatest spiritual actualization in calling directly to Hashem. In fact, the challenge is to recognize the necessity of human intervention imposed by reality and yet maintain a supreme focus of the heart on Hashem as the true master of destinies.

That is, until we merit the state that the Ramban describes in those original comments in Vayikra where, “Israel being complete and great will not have their issues directed naturally at all, not in their bodies, not in their land, not in their assembly and not with an individual from them. For Hashem will bless their bread and their water and remove sickness from their presence until they have no need for a doctor or to guard any of the ways of medicine at all.” So should it be His will speedily in our days.