Permission to Heal

The Gemora (Bava Kamma 85) states that from the verse, “v’rapo yerapei” teaches us that a doctor is given permission to heal a sick person.

Rashi explains that if not for that verse, I might have thought that the doctor would be forbidden from healing him, for Heaven has decreed that he should be ill; it would be contrary to his destiny. The Torah teaches us that he may be cured.

The Rishonim ask from the Gemora above (81b) which cites a braisa: How do we know that one must return another lost person? The verse says, “And you will return it to him.” Is it not obvious then that a doctor is Biblically obligated to save a person from dying?

The Moishav Zekeinim answers that the Torah is teaching us that the doctor is allowed to charge for his services, for otherwise, I would have thought that since it is a mitzvah, he must do it for free.

Tosfos HaRosh answers that without the extra verse, I would have thought that a doctor may only heal a person when the sickness was man-induced. However, an illness that emanated from Heaven, it would be forbidden for the doctor to heal him, for it might be as if he is nullifying the word of God. The Torah teaches us that all sicknesses may be cured.

Tosfos Rabbi Yehudahh Hachasid explains why the Torah wrote v’rapo yerapei” twice: The Torah is teaching us that a second doctor may heal an ill person even after a first doctor was unsuccessful, for we might have thought that by the fact that the first doctor was unable to cure him, this is a proof that Hashem does not want him healed and it is forbidden for the second doctor to attempt to heal him. The Torah teaches us that even the second doctor is permitted to cure him.

The Hadar Zkeinim answers that if not for the extra verse, we would think that only a person who is drowning, where he is dying at that moment, is it permitted to save him. However, if one is sick and is dying slowly, perhaps it is forbidden to heal him. The Torah teaches us that even this is allowed.

The Ramban adds that this verse is necessary to teach the doctor that he should not say, “Why should I get involved? Perhaps I will err and cause the person to die.” The Torah is telling him that he need not be concerned for this.

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Tov in the Luchos

By: Rabbi Avi Lebovitz

Rabbi Chanina ben Agil asked Rabbi Chiya bar Abba: Why do the first Commandments not have the word “good” in it, and the second Commandments do have the word “good” in it?

He replied: Before asking me why it says “good,” ask me if it says “good,” as I don’t know whether it says this or not. Go ask Rabbi Tanchum bar Chanilai, who used to learn from Rabbi Yehoshua ben Levi, who was an expert in Aggadic teachings.

When he went to Rabbi Tanchum, Rabbi Tanchum said: I did not hear anything from Rabbi Yehoshua ben Levi about this matter. However, Shmuel bar Nachum, the uncle of Rabbi Acha bar Rabbi Chanina, and some say the maternal grandfather of Rabbi Acha bar Rabbi Chanina, said: Being that the first ones were going to be broken (by Moshe, they did not contain the word “good”).

The Gemora asks: Why is this a reason that they should not contain the word “good”?

Rav Ashi said: Heaven forbid, this would mean that goodness would stop for the Jewish people.

Rashi explains that the Gemora is making reference to the term “tov” in the mitzvah of honoring one’s father and mother.

The Maharatz Chayus is bothered by the very difficult question: How is it that the Tannaim were not familiar with the text of the Ten Commandments, until it was confirmed by Rabbi Tanchum? Although Tosfos in Bava Basra writes that there were some who were not fluent in the Scriptural verses, it seems strange to say that they didn't know the Aseres Hadibros!?

The Maharatz Chayus suggests that the discussion was whether the Aseres Hadibros that are recorded in Parshas Yisro was the text on the first set of luchos, and the Aseres Hadibros in V’eshchanan are the second set of luchos. Rabbi Tanchum had a tradition that it was in fact the case, to which the Gemora finally explains that it now makes sense that the luchos which were to be broken didn't contain the term “tov.”

The Torah Temima (Devorim 5:16) offers another approach. The Gemora is making reference to a Medrash where Hashem says to Moshe that He is going to give a second set of luchos, to which Moshe reacts with joy by saying “Tov li toras pichah me’alfei zahav v’chasef” – Torah is more precious to me that thousands of gold and silver.

Why did he only express this happiness by the second luchos, and not the first? On that the Gemora explains that since they would be broken, it would be inappropriate to say that about the first set of luchos.

However, based on the conventional understanding of the Gemora, it certainly seems to indicate that the Aseres Hadibros of Yisro were the first luchos, and V’eschanan the second. Based on this, we can make another observation. In the second luchos, by Shabbos and honoring one’s father and mother, it says “like Hashem your God commanded you,” which Rashi interprets as a reference back to Marah where the water was bitter. Why is this reference specifically in the second luchos and not the first?

The Chasam Sofer in Parshas Beshalach explains that Hashem taught us in Marah that he is our personal doctor – “ki ani Hashem rof’echah.” Unlike a physician who just heals the sick, Hashem is our "family doctor" who is just as interested in providing us with preventive medicine as He is with remedies for illness. In the second luchos, Hashem wanted to remind Klal Yisroel that committing transgressions (such as the golden calf) forces Him to bring upon us illnesses, and then He demonstrates to us that He has the power to heal. He much prefers avoiding illness in the first place by our commitment to His Torah.

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Destined to Give an Account

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The Mishna in Pirkei Avos (4:29) states: Against your will you were created; against your will you were born; against your will you live; against your will you die; and against your will you are destined to give an account before the King who rules over kings, the Holy One, Blessed be He.

The question is obvious: If a person is living against his will, why is he forced to give an account of his actions?

The Vilna Gaon explains this based upon the Mishna: If someone (owned fields surrounding the field of his friend and) put up fences around three sides (separating their fields), we do not make the owner of the inner field pay (for the cost of building the fence, for it does not really help him, since his field is left opened on one side). Rabbi Yosi says: If the one being surrounded makes the fourth wall, he is obligated to pay his share in all of the walls (for he has demonstrated that he approves of the building of the other three sides). If the owner of the outer property surrounds the inner owner on three sides, the inner owner is not obligated to defray the cost of the building because he has not benefitted, for the fourth side is completely opened. He also can claim that he did not request this at all. However, if the inner owner builds the fourth wall, he has revealed that he approves of the building of the three walls, and he therefore is obligated to contribute to the cost of all four sides of the fence.

So too, explains the Gaon, Hashem fences a person on three sides: A person is created; he is born; and he is living against his will. Accordingly, he is not obligated to pay for it (to give an account of his deeds). But when a person becomes ill and is close to dying, he makes every effort available to him in order to stay alive. He will spend any amount of money for doctors, medicines and cures. He will cry out with all his might that he wants to live. This is as if he is fencing the fourth wall. He is demonstrating that although he was created and born against his will, he now approves and is willingly living. He therefore is destined to give an account of his actions.

The Netziv recounted that one time the students of the Gaon were sitting around the Gaon’s table when he said over this explanation. The Dubno Maggid was there as well, and upon hearing the interpretation, offered the following parable: A man had two daughters; one of them was extremely ugly and the other one had a very bad temperament. No man wanted to marry them until the following marriage was suggested: A blind man should marry the ugly one, and a deaf one should marry the one with the dire disposition, for he will not hear her yelling. The father of the girls accepted and his daughters were married off. Many years passed and the couples prospered. They became wealthy and built a beautiful family. One day an expert doctor arrived in the city and told them that he is capable of healing both the blind man and the deaf one. They agreed on a price and the procedures were successful. However, to the dismay of the couples, strife and arguments between the men and their spouses immediately flared up. The ex-blind man saw the hideous appearance of his wife and the ex-deaf man heard his wife’s constant nagging and yelling.

When the doctor approached them with his bill, they refused to pay him, claiming that he made it worse for them, not better. The case was brought to court and the judge inquired of the doctor if it was possible for him to undo that which was done. He replied that this would no problem at all for him to do. The judge ruled that since these men were better off before the doctor’s involvement in their life, he must make them blind and deaf again. When the men heard the ruling, they proclaimed that they would rather keep their sight and their hearing. Upon hearing this, the judge reversed his ruling and said that they now have revealed that they are happy with the improvement, and they are obligated to pay the doctor for his services.

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Best of Physicians to Gehinom

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The Mishna (Kiddushin 82a) had stated: Abba Guryon of Sidon says in the name of Abba Gurya: A man should not teach his son to be a donkey driver, a camel driver, a wagon driver, a sailor, a shepherd, or a shopkeeper, for their craft is the craft of robbers. Rabbi Yehudah says in his name, Most of the donkey drivers are evil men, and most of the camel drivers are righteous. Most of the sailors are pious. The best of the physicians are destined to Gehinom, and the most righteous of the butchers is the partner of Amalek.

There are several explanations as to the meaning of the Mishna when it states that the best of the physicians are destined to Gehinom.

Rashi understands it to mean that doctors do not fear sicknesses for they eat healthily. They therefore are not humble before Hashem. There are times that they will cause someone to die. They also can refuse to heal the poor if they do not have money to pay for their services.

The Pardes Yosef writes that a doctor must visualize Gehinom opened up before him at all times, for his decisions can lead to someone’s death.

The meaning cannot be that all doctors are destined for Gehinom, for there are many examples of great Torah scholars who were also physicians. Shmuel, Rabbi Chanina, Abba Umna, the Rambam and many more were all doctors. Rather, there are two types of doctors. There are the righteous ones who know that that they can accomplish nothing without Hashem; they are merely Hashem’s agents to heal. There are others, unfortunately, who are not believers. They think that they have the power of healing in their hands. These physicians skip the blessing of “Refa’einu” in Shemoneh Esrei. Accordingly, they have only seventeen brochos in Shemoneh Esrei. This is what the Mishna means: “Tov she’b’rofim” – the numerical value of “tov” is seventeen. Those doctors that have only seventeen brochos in their Shemoneh Esrei are destined for Gehinom.

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Healing an Idolater

(Gittin 70) For a skin disease (moist outside and dry inside), he should take seven plump wheat stalks and roast them over a new hoe and smear himself with the oil that exudes from them. Rav Shimi bar Ashi used this remedy for a certain idolater for “something else” (leprosy), and it cured him.

Tosfos asks from the Gemora in Avodah Zarah (26b) which states that it is forbidden to heal an idolater. The Gemora rules that one may not assist an idolater woman giving birth, even for payment, for she will raise the child to serve idols!?

Tosfos answers that Rav Shimi was permitted to heal the idolater, for this would help him perfect his medical skills, and thus enable him to heal other Jews.

Tosfos in Avodah Zarah adds that Rav Shimi was not an expert practitioner at all, and he was training when he cured the idolater.

Furthermore, in cases where the idolater knows that the Jew has the ability to cure him, it would be permitted to heal him, for otherwise, it would propagate hatred from them to us.

Alternatively, there may be a distinction between a child being born, who will serve idols, and one who already worships idols.

The Geresh Yerachim asks: How was Elisha permitted to heal Naaman from his leprosy?

He answers that Elisha knew that Naaman would not serve idols any longer, and therefore, it was permitted.

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Which Surgeon should He Use?

The Gemora (Megillah 18) discusses whether one who knows the Torah by heart would be permitted to write a Scripture scroll without copying from a text. The Gemora states that Rabbi Meir was permitted to write a Megillah from memory because he knew the words fluently by heart.

Reb Elyashiv, cited by Chishukei Chemed ruled on the following inquiry and he derived his ruling from that Gemora. A person residing in Eretz Yisroel developed a heart issue and he was required to undergo a risky heart surgery. The local doctors said that they do not perform this type of surgery frequently, but they are ninety-five percent confident that the surgery will be a success. There is an expert surgeon outside of Eretz Yisroel who performs this surgery daily and he said that if he would perform the surgery, he would be successful ninety-five percent of the time.

Should this individual travel outside of Eretz Yisroel to have the surgery performed by the expert surgeon? Reb Elyashiv ruled that he should go because that doctor is more accustomed in performing this type of surgery.

The Gemora in Taanis 15a states regarding a communal fast: They would send a chazzan to lead the prayer who was an elder and fluent in the prayers. Rashi explains: One who is fluent in his prayers will not make a mistake.

The Gemora states that one who is fluent in the words of the Torah will not make a mistake when he is writing the Torah without copying from a text.

This is why it would be preferable to travel to the doctor outside of Eretz Yisroel even though the percentage of success is the same. Someone who is more accustomed to performing this type of surgery will not make a mistake.

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Food for Thought

*** Do we make a special kesuvah for Kohanim?

*** How do we evaluate the worth of a woman or anyone that is being held captive?

*** If a wife eats certain foods that are unhealthy and because of that she falls ill, is the husband required to pay for the doctor bills?

*** Is one Biblically obligated to provide a dowry for his daughter?

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Ask the Doctors

The Gemora had inquired: May one cohabit with his virgin wife for the first time on Shabbos? The Gemora explains the inquiry: Is the blood (which is produced when the hymen is broken) in the womb stored up (and cohabitation would he permitted, since the blood flows out of its own accord, and not because of any wound), or is it the result of a wound (caused by the tearing of the vaginal walls when they separate from each other), and therefore be prohibited?

The Gemora’s inquiry is difficult to understand. This is not a question regarding a specific woman, but rather, it is relevant to all women in the world, including idolaters. This point of inquiry should be an established fact; let us inquire from the expert doctors in this field as to the facts?

Perhaps, one may counter and say that doctors are not believed regarding halachic issues. This is not the case. The Divrei Chaim (vol. II, 77) writes regarding a woman who bleeds every time that she has relations: Even if an idolater midwife will inform us that the woman has a wound in that area, she is believed because this is a fact that we can verify with another midwife. The Maharsham relied many times on two doctors, when we asked each of them separately. Certainly in our Gemora, where it is relevant to every woman in the world, why don’t we ask the doctors?

The Chasam Sofer sheds light on our Gemora by saying the following: The Gemora is not inquiring as to the facts. In truth, the blood is loosely stored in the womb similar to the manner which liquid is contained in a sponge. Our Gemora is uncertain regarding the amount of force necessary to release the blood.

The Rambam in Hilchos Shabbos writes that threshing, squeezing, wounding and milking are all liable on Shabbos, and are included in the same category of melachah. Accordingly, the Chasam Sofer asks: The husband should certainly be liable in this case because he is separating the blood from the womb?

He answers: If this would be performed by hand, similar to squeezing and milking, he would certainly be liable. However, the question of our Gemora is regarding the strength necessary to release this blood. If it requires minimal strength, it is considered as if the blood is coming out on its own accord, and he will not be liable. However, if a considerable amount of force is necessary, he then would be liable for such an act.

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DOCTORS AND THEIR ROLE IN HALACHIC RULINGS - Yevamos 92 - Daf Yomi

The Rogatchover Gaon was writing a letter (in a 1933 letter to Rabbi Shimon Schwab, deciphered by Rabbi Aryeh Carmell) regarding the issue of a father learning with his son other studies. He cites a Gemora in Sanhedrin (78) regarding a case where one man hit another with a stone or a fist, and caused injury to the other. The victim was initially assessed to be viable, and then died. The halacha is that the murderer is exempt from capital punishment. We say that either the victim's health worsened afterwards (not directly due to the striking), or that one cannot be found guilty of a murder after he had been previously acquitted of it. This, says the Rogatchover, is unlike the Gemora in Yevamos (92), which states that we would say that this was not a legitimate legal ruling, but rather, a blunder. If it would be regarded as an error on Beis Din’s part, they should have the ability of ruling again, and convicting the murderer. It emerges from here that the Torah assigns the authority to evaluate and to rule to the expert doctors.

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Daf Yomi - Megillah 18 - WHICH SURGEON SHOULD HE USE?

The Gemora discusses whether one who knows the Torah by heart would be permitted to write a Scripture scroll without copying from a text. The Gemora states that Rabbi Meir was permitted to write a Megillah from memory because he knew the words fluently by heart.

Reb Elyashiv, cited by Chishukei Chemed ruled on the following inquiry and he derived his ruling from our Gemora.

A person residing in Eretz Yisroel developed a heart issue and he was required to undergo a risky heart surgery. The local doctors said that they do not perform this type of surgery frequently, but they are ninety-five percent confident that the surgery will be a success. There is an expert surgeon outside of Eretz Yisroel who performs this surgery daily and he said that if he would perform the surgery, he would be successful ninety-five percent of the time.

Should this individual travel outside of Eretz Yisroel to have the surgery performed by the expert surgeon? Reb Elyashiv ruled that he should go because that doctor is more accustomed in performing this type of surgery.

The Gemora in Taanis 15a states regarding a communal fast: They would send a chazzan to lead the prayer who was an elder and fluent in the prayers. Rashi explains: One who is fluent in his prayers will not make a mistake.

Our Gemora states that one who is fluent in the words of the Torah will not make a mistake when he is writing the Torah without copying from a text.

This is why it would be preferable to travel to the doctor outside of Eretz Yisroel even though the percentage of success is the same. Someone who is more accustomed to performing this type of surgery will not make a mistake.

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