Is Medical Treatment a Mitzvah or Only a Last Resort for Those of Weak Faith?

Parashat Mishpatim
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Who is Authorized to Heal?
We are currently in a big quandary regarding doctors, medicine and healing. The world has suffered for close to a year from the devastating pandemic, which has killed more than two million people to date. There is a worldwide dispute regarding who is authorized to diagnose, cure and govern medical procedures, especially concerning the administration of vaccines. There is no lack of healing in our time. An overflowing amount of various healing and healers are available to us. There exits several spiritual energy types of healing, as well as the latest discoveries in modern orthodox medicine, and a vast multitude of different kinds of alternative healing, such as homeopathy, reflexology, acupuncture, herbology etc. In addition, we have been learning about spiritual healing according to the Torah. The healing powers of prayer, Torah learning, mitzvah observance and character development are also well known. It is not always easy to choose between the different modes of healing available to us. It is even more difficult to resolve the question of when to turn to medicine, and when to rely on spiritual healing. Some ‘Rebbe- Nachman-adherents’ may even refuse medical help altogether, even if a baby has meningitis, G-d forbid, לֹא עָלֵינוּ. Does this outlook belong to some crazy fanatics or does it have any foundation in Torah sources? How do we know that anyone except Hashem is authorized to practice any kind of healing at all? We learned in Parashat Beshalach that Hashem proclaimed Himself as our ultimate Healer, as it states, “I am Hashem your healer…” (Shemot 15:26). Why would Hashem need anyone’s help to heal? By looking into various Torah sources on ‘healing,’ we discover that from time immemorial, there has been a dispute among our Torah sages, whether to turn to medicine or rely solely on Hashem’s spiritual healing. 

The Underlying Purpose of Illness is Repentance
The Torah makes it clear that the purpose of illness is for us to repent:

Rabbi Levi said: Avraham invented old age, Yitzchak invented suffering, and Ya’acov illness. Chezkiyahu invented recoverable illness. He said, it isn’t good to keep a person standing until the day he dies. However, if he falls sick and then recovers, he will come to repent. G-d answered him, “By your life, this is a good idea. And I’ll start with you!” This is what is written, “The writing of Chezkiyahu, King of Yehuda, when he had been sick and recovered from his sickness” (Yesha’yahu 38:9); (Midrash Bereishit Rabbah 65:9). 

When Chezkiyahu fell mortally ill, and the prophet told him to set his affairs in order, because his end was near, Chezkiyahu turned his face to the wall, repented wholeheartedly, and prayed to Hashem with profuse weeping. Hashem heard his prayer, saw his tears, and promised to heal him and add 15 years to his life (II Kings 20:1-6). Chezkiyahu thus experienced that illness has a positive effect on a person – i.e., to examine his deeds, soul search and discover the true purpose of life and how to attain it. This is why Chezkiyahu concealed the Book of Remedies that King Salomon, the wisest of all people, had written. This book included the cure for any ailment that one would ever suffer. The remedies were too effective, and when using them, people would not develop true trust in Hashem. When they fell sick, they used to consult the Book of Remedies and become healed, without any need for repenting. As a result, rather than helping to humble people’s hearts before Heaven, healing became just a mechanical process. Chezkiyahu saw that reliance on the Book of Remedies prevented people from being truly healed. While its remedies may cure physical ailments, the very effectiveness of these cures allowed those who used them to avoid confronting their underlying spiritual flaws, for which purpose Hashem sent the illness. Concealing the Book of Remedies encouraged people to actualize their latent spiritual powers and play an active role in their own healing process.

Therefore, our Rabbis approved of King Chezkiyahu’s putting away of the Book of Remedies… (Babylonian Talmud, Berachot 10b).

Relying on Physicians and Medicine Instead of Relying on Hashem
Ten generations before Chezkiyahu, his ancestor, the saintly King Asa, fell sick with excruciating pain in his feet. The swelling spread upwards through his whole body. “Even as ill as he was, he still did not turn to Hashem, but to physicians” (II Chronicles 16:12). Asa sinned by relying on natural means, lacking perfect bitachon (trust in Hashem) (Malbim, ibid.). King Asa was reluctant to accept that his sickness was divine chastisement. He regarded his sickness as a natural phenomenon. Instead of repenting, he turned to the physicians – and consequently died. Asa was criticized, not so much for going to doctors, as for failing to seek out G-d in his time of distress. A man on his level was expected to understand that sickness is not a chance occurrence, but from Hashem. This is what King Chezkiyahu sought to correct when he put away the Book of Remedies. When illness strikes, and all is rush and panic, Chezkiyahu asks us to take a moment to turn our faces to the wall, cry out to Hashem and take a careful look at ourselves. Where is G-d? Where am I? The purpose of illness is to make us cry out to G-d and search for Him. “For I, G-d, am your Healer” (Shemot 15:26).

Does the Torah Give Permission for the Doctor to Heal?
Yet in Parashat Mishpatim, the Torah gives permission to the physician to heal: 

ספר שמות פרק כא פסוק יט רַק שִׁבְתּוֹ יִתֵּן וְרַפֹּא יְרַפֵּא:                                                              

“He shall give only [payment] for his [enforced] invalidity and shall cause him to be thoroughly healed” (Shemot 21:19). 

Rav Acha said: Before being treated by bloodletting, one should say the following prayer, “May it be your will, Hashem, My G-d, that this treatment should be therapeutic for me and heal me. For You, G-d, are a mighty and dependable healer and Your healing is true. Whereas, it is not proper for people to rely on medicine, but they have become accustomed to doing it.” Abaye said: “One should not say that, for it has been taught in the school of Rabbi Yishmael: The Torah verse, “He shall cause him to be thoroughly healed” (Shemot 21:19), grants permission for the doctor to heal…” (Babylonian Talmud, Berachot 60a). 

To Heal or not to Heal
Rav Acha and Abaye disagree about how we should approach medical therapy. They both agree that when a person undergoes medical treatment, or is about to take a medicine, it is appropriate for him to turn his heart in prayer to Hashem, and request that He enable the success of the treatment. However, according to Abaye, receiving healing is a Torah commandment and not a bedieved (last resort) position that needs to be apologized for. The Torah already said, “He should cause him to be thoroughly healed,” which implies that Hashem gives permission for the doctor to heal. This is not only for those who have weak emunah (faith). Rather, the field of medicine is itself the fulfillment of Hashem’s Divine will. Rav Acha, however, regards the phrase, it is not proper for people to rely on medicine, but they have become accustomed to doing it,” as a crucial element of the prayer. Since a person who is wholly faithful and cleaving to the Blessed One, does not need to rely on manmade cures, he should rather search within his heart to find what spiritual failing may have caused him to become susceptible to illness. Then, after repenting, he must pray to Hashem to have mercy on him. This certainly seems in keeping with the Torah’s promise, “If you will listen carefully to the voice of Hashem, your G-d… I am Hashem, your healer” (Shemot 15:26). Yet, the ordinary person, whose faith is weak and feels himself too far from Hashem to rely on miracles, has no choice but to avail himself of the current therapeutic options. Therefore, according to Rav Acha, he must apologize to Hashem, for not being on the level of those who have perfect faith in G-d, but instead, seek cures from doctors, as is the way of the world. 

What is the Halacha Regarding Seeking Medical Intervention?
Ramban brings to our attention that, although, we learn from Shemot 21:19 that permission was given for the doctor to heal, there was not given permission for the sick to be healed… Thus, according to Hashem’s will, a person should avoid any dealings with doctors. (Ramban, Vayikra 26:11). His follower, Rabbeinu Bachaya, brings us a compromise, stating, “Permission for the doctor to heal,” only applies to an external injury, as described in the verse. However, regarding internal illnesses, one may not rely on a doctor of flesh and blood, but rather on the Healer of all flesh, in Whose hand is the soul of all the living (Rabbeinu Bachaya, Shemot 21:19). Yet, the halacha sides with Abaya, that it is a mitzvah to avail oneself of medical assistance, which obviously doesn’t preclude repentance as well. “The Torah gives permission to the doctor to heal. It is a mitzvah and included in the laws of פיקוח נפש/pikuach nefesh – ‘saving a life.’ Preventing oneself from healing is considered as spilling blood…” (Shulchan Aruch, Yoreh Deah, 366:1). Thus, the question of whether to seek medical intervention or not is very complex. It would be prohibited to ignore the halacha in Shulchan Aruch, which clearly states, that those who avoid going to the doctors are considered as if they spill blood. On one hand, perhaps, the highest level is to be so connected to Hashem that medicine becomes unnecessary. Yet, on the other hand, it is also not permitted to rely on miracles. 

Between Repentance and Human Healing
Hashem’s supervision pertains to each person according to his emunah. Therefore, the stronger our emunah, the less we need to rely on doctors and medicine. We must, therefore, have enough self-awareness to know our level of emunah, and accordingly determine what is our correct healing path. It seems as if the question of whether the highest value is to rely directly on Hashem for healing; or instead to reveal Hashem’s supervision through natural means of medicine and healing remains inconclusive. Perhaps, in the same way as conventional medicine is more suitable for some ailments, and alternative medicine more suitable for others, there are certain ailments that lend themselves to spiritual healing, whereas others are more conducive to revealing Hashem through medicine. The general principle should be: the more acute the illness, the more need for conventional medicine. Rabbeinu Bachaya made a very important distinction between external injuries and internal illness. If a person, G-d forbid, broke his leg in a car accident, it would be against halacha to rely only on repentance and prayer, while ignoring medical treatment. On the other hand, there are sicknesses that have no medical cure. Then a person has no choice but to rely on repentance and prayer. For the range of ailments in between these two extremes, we must use our judgment to decide between spiritual and physical healing and optimally a combination of both.