Medical Science

In the Jewish ethical tradition, medical interventions to promote health and healing are an unmitigated good. The high esteem for scientific knowledge and inquiry that one finds in Jewish sources contradicts the notion that there is an inherent conflict between religion and science. The embrace of medical science is an expression of the high value placed on life and health in Jewish teachings.

Jewish ethical teachings establish limits so that science and medicine are pursued and applied in ways that promote good and not harm. In the not so distant past, terrible cruelty was inflicted in the name of science in Nazi "experiments" on Jewish victims and in the Tuskegee syphilis study in the United States. The field of bioethics is dedicated to ensuring that medical research and treatment are pursued in ways that are ethical.

How can Jewish teachings from the past help us apply current scientific knowledge to the urgent problems we face today?

The Value of Expertise

(ה) עֻבָּרָה שֶׁהֵרִיחָה, מַאֲכִילִין אוֹתָהּ עַד שֶׁתָּשִׁיב נַפְשָׁהּ. חוֹלֶה מַאֲכִילִין אוֹתוֹ עַל פִּי בְקִיאִין. וְאִם אֵין שָׁם בְּקִיאִין, מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ, עַד שֶׁיֹּאמַר דָּי:

(ו) מִי שֶׁאֲחָזוֹ בֻלְמוּס, מַאֲכִילִין אוֹתוֹ אֲפִלּוּ דְבָרִים טְמֵאִים, עַד שֶׁיֵּאוֹרוּ עֵינָיו. מִי שֶׁנְּשָׁכוֹ כֶלֶב שׁוֹטֶה, אֵין מַאֲכִילִין אוֹתוֹ מֵחֲצַר כָּבֵד שֶׁלוֹ, וְרַבִּי מַתְיָא בֶן חָרָשׁ מַתִּיר. וְעוֹד אָמַר רַבִּי מַתְיָא בֶן חָרָשׁ, הַחוֹשֵׁשׁ בִּגְרוֹנוֹ, מַטִּילִין לוֹ סַם בְּתוֹךְ פִּיו בְּשַׁבָּת, מִפְּנֵי שֶׁהוּא סְפֵק נְפָשׁוֹת, וְכָל סְפֵק נְפָשׁוֹת דּוֹחֶה אֶת הַשַּׁבָּת:

(5) If a pregnant woman smelled [food on Yom Kippur], they feed her until she feels restored.

A sick person is fed at the word of experts. And if no experts are there, they feed him upon his own request until he says: enough.

(6) If one is seized by a ravenous hunger, they feed him even unclean things until his eyes light up.

If one was bit by a mad dog, they do not feed him the lobe of its liver. But Rabbi Matia ben Harash permits it. Moreover Rabbi Matia ben Harash said: if one has pain in his throat, they may drop medicine into his mouth on Shabbat, because it is a possibility of danger to human life and every potential danger to human life overrides Shabbat.

This passage of the Mishnah enumerates diverse cases in which concerns of life and health override religious laws because of the imperative of Pikuakh Nefesh, to safeguard life. But who decides what qualifies?

  • What are the various situations in which religious laws are suspended? What do these various case have in common? How are they different from each other?
  • When are experts called and when is their expertise most valuable? Can you account for why these particular circumstances are identified? When is outside expertise most important?
  • Who do you think these experts are and what do they know? What are the different kinds of expertise that Mishnah values?
  • How does the presence of experts influence decision-making in the Mishnah?
  • As we confront the pandemic today, what kind of expertise is valuable? In what ways is the knowledge of diverse experts providing help and guidance as you face difficult decisions? What kind of expertise would help you make better decisions?

Healing: Divine and Human

(כו) וַיֹּאמֶר֩ אִם־שָׁמ֨וֹעַ תִּשְׁמַ֜ע לְק֣וֹל ׀ יְהוָ֣ה אֱלֹהֶ֗יךָ וְהַיָּשָׁ֤ר בְּעֵינָיו֙ תַּעֲשֶׂ֔ה וְהַֽאֲזַנְתָּ֙ לְמִצְוֺתָ֔יו וְשָׁמַרְתָּ֖ כָּל־חֻקָּ֑יו כָּֽל־הַמַּֽחֲלָ֞ה אֲשֶׁר־שַׂ֤מְתִּי בְמִצְרַ֙יִם֙ לֹא־אָשִׂ֣ים עָלֶ֔יךָ כִּ֛י אֲנִ֥י יְהוָ֖ה רֹפְאֶֽךָ׃ (ס)
(26) He said, “If you will heed the LORD your God diligently, doing what is upright in His sight, giving ear to His commandments and keeping all His laws, then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the LORD am your healer.”
(יח) וְכִֽי־יְרִיבֻ֣ן אֲנָשִׁ֔ים וְהִכָּה־אִישׁ֙ אֶת־רֵעֵ֔הוּ בְּאֶ֖בֶן א֣וֹ בְאֶגְרֹ֑ף וְלֹ֥א יָמ֖וּת וְנָפַ֥ל לְמִשְׁכָּֽב׃ (יט) אִם־יָק֞וּם וְהִתְהַלֵּ֥ךְ בַּח֛וּץ עַל־מִשְׁעַנְתּ֖וֹ וְנִקָּ֣ה הַמַּכֶּ֑ה רַ֥ק שִׁבְתּ֛וֹ יִתֵּ֖ן וְרַפֹּ֥א יְרַפֵּֽא׃ (ס)

(18) When men quarrel and one strikes the other with stone or fist, and he does not die but has to take to his bed— (19) if he then gets up and walks outdoors upon his staff, the assailant shall go unpunished, except that he must pay for his idleness and to make him heal to healing.

The two biblical verses above both use the same Hebrew word--Rofe רופא --which means "healer" or "doctor." The translation of Exodus 21:19 is awkward, because it preserves the repetition of this word that appears twice in the Hebrew. A less literal and less awkward translation would be: "Let him heal completely."

  • What does "healing" mean in these biblical verses? Does it mean the same thing for each verse?
  • According to the Torah, who is responsible for healing?
  • How do these verses come into play in the rabbinic debate below, on Berakhot 60a of the Bablylonian Talmud?

דְּאָמַר רַב אַחָא: הַנִּכְנָס לְהַקִּיז דָּם, אוֹמֵר: ״יְהִי רָצוֹן מִלְּפָנֶיךָ ה׳ אֱלֹהַי שֶׁיְּהֵא עֵסֶק זֶה לִי לִרְפוּאָה, וּתְרַפְּאֵנִי. כִּי אֵל רוֹפֵא נֶאֱמָן אָתָּה וּרְפוּאָתְךָ אֱמֶת, לְפִי שֶׁאֵין דַּרְכָּן שֶׁל בְּנֵי אָדָם לְרַפּאוֹת אֶלָּא שֶׁנָּהֲגוּ״.

אָמַר אַבָּיֵי: לָא לֵימָא אִינָשׁ הָכִי, דְּתָנֵי דְּבֵי רַבִּי יִשְׁמָעֵאל: ״וְרַפֹּא יְרַפֵּא״ — מִכָּאן שֶׁנִּיתְּנָה רְשׁוּת לָרוֹפֵא לְרַפּאוֹת.

As Rav Aḥa said: One who comes to a bloodletter says this prayer:

May it be Your will, O Lord my God, that this enterprise be for healing and that You should heal me. For You are a faithful God of healing and Your healing is truth, because it is not the way of people to heal, but they have become accustomed.

Abaye responded and said: One should not say this, since it was taught in the school of Rabbi Yishmael that from the verse, “And to make him heal to healing” (Exodus 21:19), from here we derive that permission is granted to a doctor to heal.

This passage comes from an extended section in the Babylonian Talmud in which the Rabbis provide prayers for a variety of occasions and experiences. The Babylonian Talmud was likely edited in the seventh century CE, but the authorities in this passage come from an even earlier time. Abaye lived in Babylonia in the fourth century. It is unclear which Rav Aha is mentioned here. Rabbi Yishmael was a celebrated sage who lived in the Land of Israel in the second century. Throughout this time, bloodletting and other healing arts were widely practiced by Jews and by their non-Jewish neighbors. The Rabbis considered them effective.

  • How do you interpret Rav Aha's prayer? How would you characterize his attitude toward bloodletting? If he think humans should not be involved in healing, why does he provide this prayer for the practice?
  • Why does Abaye object to Rav Aha's prayer?
  • Abaye affirms that humans have God's permission to practice medicine. What evidence does he find in the Torah for that? How persuasive is Rabbi Yishmael's reading of Exodus 21:19?
  • Abaye and Rabbi Yishmael provide a foundation for Judaism's affirmation of medical science. Jews no longer question whether humans have a role to play in healing. What do you see as the appropriate role for prayer as human doctors, researchers and health workers pursue their work?

Preventive Medicine

כִּי נָפֵיק, אוֹמֵר: ״בָּרוּךְ. אֲשֶׁר יָצַר אֶת הָאָדָם בְּחׇכְמָה, וּבָרָא בּוֹ נְקָבִים נְקָבִים, חֲלָלִים חֲלָלִים, גָּלוּי וְיָדוּעַ לִפְנֵי כִּסֵּא כְּבוֹדֶךָ שֶׁאִם יִפָּתֵחַ אֶחָד מֵהֶם אוֹ אִם יִסָּתֵם אֶחָד מֵהֶם אִי אֶפְשָׁר לַעֲמוֹד לְפָנֶיךָ״.

מַאי חָתֵים?

אָמַר רַב: ״רוֹפֵא חוֹלִים״.

אָמַר שְׁמוּאֵל: קָא שַׁוִּינְהוּ אַבָּא לְכוּלֵּי עָלְמָא קְצִירֵי. אֶלָּא: ״רוֹפֵא כׇל בָּשָׂר״.

רַב שֵׁשֶׁת אָמַר: ״מַפְלִיא לַעֲשׂוֹת״.

אָמַר רַב פָּפָּא: הִלְכָּךְ נֵמְרִינְהוּ לְתַרְוַיְיהוּ — ״רוֹפֵא כׇל בָּשָׂר וּמַפְלִיא לַעֲשׂוֹת״.

Upon exiting (the bathroom) one says:
" Blessed (is God) Who formed the human in wisdom, creating within many orifices and cavities. It is revealed and known before the throne of Your glory that were one of them to be ruptured or blocked, it would be impossible to survive and stand before You."

What is the conclusion of the blessing?

Rav said: (conclude it with the words "Blessed are You) who heals the sick."

Shmuel said: Abba (another name for Rav) has rendered everyone sick. Rather, one should say: "who heals all flesh."

Rav Sheshet said: One should conclude: "Who performs wondrous deeds."

Rav Pappa said: Therefore, let us say them both: Who heals all flesh and performs wondrous deeds.

This passage is from the continuation of the long section of the Babylonian Talmud that provides blessings for human activities and occasions. Here, the Talmud provides a blessing to be recited upon exiting the bathroom, thanking God that the human body works effectively. The Talmud preserves a debate about how this blessing should be concluded. Rav and Shmuel were the leading Rabbis in Babylonia in the third century CE, and the Talmud transmits many of their debates.

  • Rav initially suggests that when we thank God for our ability to go to the bathroom, we should thank God for "healing the sick." In what sense is eliminating or excreting a matter of healing?
  • Why does Shmuel object to Rav's proposal? In what way does Rav's language "render everyone sick?"
  • When the Talmud makes a distinction between "healing the sick" and "healing all flesh," it suggests that healing is not just for the sick but for everyone. What does it mean to pursue healing in a time of the pandemic? What are some ways to pursue health and healing for those who are not sick?
  • In what ways can the pursuit of medical research be considered a "wondrous deed?"
  • How can Jewish teachings such as this passage contribute to the debate about how to allocate resources: Is it more important to pursue cures and therapies or to pursue a preventive vaccine?

The pandemic raises pressing questions for bioethicists: When medical supplies are scarce, how can they be distributed fairly? Under what circumstances is it appropriate to use experimental therapies whose effectiveness and risk have not yet been established? In the push to develop a vaccine for COVID-19 as quickly as possible, how will human subjects be protected?

In the context of the current pandemic, one thing is clear: A decision that does not take the considered opinions of scientific experts into account cannot be considered ethical. As you face difficult decisions for yourself and others, what structures are in place to ensure that you benefit from the best, most recent scientific knowledge? What kind of experts do you need for reliable guidance and information? How can you incorporate faith and prayer alongside medical science in your pursuit of healing?