EXOD567 Needless to say, the normative Jewish view today is that a Jew turns to a doctor to heal every illness, even though Jewish thought still believes that all healing ultimately comes from God. … Rabbi Moses Feinstein of the 20th century clearly states the normative Jewish viewpoint explained above regarding how doctors work in tandem with God: God is fully aware of man's most modern capabilities to heal when He brings the sickness to an individual, and God wants man to use the full range of cutting-edge medical knowledge in order to heal each sickness as quickly as possible. Responsa Igrot Oshe, Orach Chaim 3:90

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EXOD568 One of the 613 Torah commandments incumbent upon every Jew is to be healthy and protect oneself from harm. That Torah tells us to guard ourselves from sickness and anything that may bring harm to the body, and the Talmud equates sustaining even a single human life with the infinite value of an entire world. Deuteronomy 4:15, Sanhedrin 27a Therefore, every Jew has a special obligation to do whatever it takes to remain healthy. This appears to include taking any medications that would bring someone back to health as well as protect the body from becoming ill in the first place. The Talmud understands this principle to be the logical way to live one's life and even asks why a verse is necessary. Bava Kama 46b. When a person is sick, he or she should call a doctor, says the Talmud. The Torah specifically tells us that a sick person should be healed by a doctor (this verse). Maimonides seems to indicate that just as a doctor has an obligation to heal a patient, so too, a patient has an obligation to try to protect his or her health and prevent sickness. Maimonides commentary on Mishna Nedarim 4:4. In a different context, Maimonides emphasizes a Jew's obligation you strive to be healthy, explaining that someone who is not healthy cannot fulfill his mission on earth to serve God properly. Maimonides, Hilchot De'ot 3:3, 4:23. Furthermore, in building a Jewish community, there are certain rudimentary elements that must be present, even in the case of the smallest Jewish population living together. In addition to a synagogue and a teacher, every Jewish community must have at least one doctor.

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EXOD569 See [[EXOD233]] Exodus 15:26 healer AMJV 98

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EXOD571 The official view of Judaism on medicine is summarized in the Tur Yore Deah, §336: "The School of R. Ishmael derived from the words Verappe yerappe ('and the offender shall cause the victim to be thoroughly healed,' [this verse]) that permission is granted the physician to heal. The physician may not say 'Why borrow trouble? I may err and appear like one who killed a person unwittingly.' He shall indeed be exceedingly careful in exercising his art even as a judge must be careful in deciding criminal cases. In like manner, the physician may not say: 'God smites, and shall I heal?' This is not the way of men with regard to healing, as we find Asa and his sickness consulting not God, but physicians. Hence Scripture came to teach us that the physician is permitted to heal. He who is zealous in the work of healing is praiseworthy; and he who refuses to heal is a shedder of blood." Repeated in the Shulchan Aruch, this represents the law of traditional Judaism. The Kitzur Shulchan Aruch places the responsibility upon the patient. In time of sickness it becomes a religious duty to consult a physician. The neglect of calling for medical aid constitutes an active presumption on the part of the sufferer, for he seems to presume such righteousness as to merit the direct miraculous help of God. [Nahmanides, Torat Haadam, Shaar Hasakanah, and p. 16f. and Comment. on Leviticus 26:11]. It is instructive that medical means for checking pestilence were not regarded by the masters of Judaism as interference with the will of God. While teaching man to submit to the inevitable, they urged him to resist the things that blight life and to promote human health and welfare.

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EXOD570 See [[LEV1119]] Leviticus 26:16 wreak OXFORD 313-4

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EXOD566 Does Jewish law require doctors to do all within their power to prolong the life of a patient in chronic pain and suffering from a terminal illness? In a seminal ruling specifically addressed to physicians, Rabbi Moshe Feinstein wrote: "If a patient is terminally ill and in intractable pain, so that there is no hope of surviving in a condition free of pain, but it is possible, through medical or technological methods, to prolong his life, then it is improper to do so. Rather, the patient should be made as comfortable as possible and left without any further intervention" Igrot Moshe, Choshen Mishpat 2:73. [In the context of this response, Rabbi Feinstein goes on to make the statement previously cited that actively hastening the patient's death by even a moment is "murder"] On the other hand, if medicines can be found to make the patient comfortable, "so that he will not be in pain, [then] efforts should be made to prevent the patient from dying." Thus, for Rabbi Feinstein, the key concern regarding terminal patients, particularly those who can live for only a few more months, is the absence of "intractable pain." ... Dr. Kenneth Prager, an observant Jew, argues that even in instances in which pain can be contained, there are still reasons why it might be wrong to prolong a terminal patient's life. He feels, therefore, that Rabbi Feinstein's ruling "does not address the ever-increasing number of patients in Intensive Care Units on life support with no hope of leaving the hospital alive or are being kept alive by ventilators, dialysis machines, pressors (potent medications to maintain their failing blood pressure), potent antibiotics, and even artificial pumps that assist a failing heart. These patients are nearly always prevented from feeling pain by the administration of narcotics that render them unconscious. They cannot communicate with their families. Patients may be kept in this condition for literally weeks or even months during which time they developed horribly large and deep ulcers of their skin, disfiguring bloating of their entire body, and undergo repeated skin punctures for IVs and catheters. My experience with the Orthodox rabbinate is that they have been loath to allow withdrawal of life support in these situations even though the intensive care is clearly prolonging the misery of the dying process. These treatments, in my view, also violate the dignity of patients because of this disfigurement and breakdown of their bodies, sometimes with actual putrefaction of their tissues. I have even had rabbis who were loath to withhold attempts at recitation in these patients, thereby subjecting these poor people to the degradation of chest compression, rib fractures, and electric shocks in attempts to prolong the dying process for an even longer period. I believe that such efforts are in direct contradiction to those posekim (decisors of Jewish law) who have declared that if the physician cannot help a patient, but can only cause prolonged suffering, these physicians do not have permission to treat the patient. Verapo yerapeh ("And heal shall he heal") the biblical expression from which the Talmud derives reshut (permission) for doctors to practice medicine [this verse and Bava Kamma 85a) only pertains when the physician can help the patient. However, 'permission' to be a doctor ceases once a doctor can no longer help the patient. For too many rabbis, the sanctity of life has become an end in itself and they feel that efforts should be made to prolong the lives of patients at all cost, as long as the patients are not suffering, regardless of the breakdown of their bodies." [in Prager's view," the ancient notion of a goses (a legal term referring to a patient so sick that it is presumed he will be dead within 72 hours) is a very useful one. But unfortunately the definition of this term has been muddled in the halachic mind because of the sophisticated technology that can keep virtually everyone, no matter how sick, alive for a while, without, however, healing the patient. We need a new invigorated definition of the term goses by the rabbinate to accommodate the realities of changing medical technology."

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EXOD572 According to the Talmud, the last words of the following passage gave us permission to attempt to heal: “When men quarrel and one strikes the other with stone or fist, and he does not die but has to take to his bed, if he then gets up and walks outdoors on his staff, the assailant shall go unpunished, except that he must pay for his idleness [time lost] and he must surely heal him (ve-rapo yerapeh) Exodus 21:18-19. “And he must surely heal him”: From this verse we derive the permission [of human beings] to heal (Babylonian Talmud, Bava Kamma 85a). On the basis of “love your neighbor as yourself” (Leviticus 19:18), the Rabbis (Sanhedrin 84b and Rashi there, s.v. ve’ahavta) conclude that this permission even extends to treatments that require inflicting a wound, for they presume that we would all prefer to suffer from a temporary wound to get well and must therefore have permission to treat other people likewise. This, incidentally, also sets up the basis for judging therapies in terms of the balance of their risks and benefits, for in each case--and especially if the patient is unconscious or mentally incompetent--we must think of what we would want done and do the same out of love of our neighbor. On the basis of an extra letter in the Hebrew text of Deuteronomy 22:2 [והשבתו-AJL] the Talmud (Bava Kamma 81b) declares that the Torah imposes an obligation to restore another person’s body as well as his or her property and hence to come to the aid of someone in a life-threatening situation. That duty also stems from Leviticus 19:16, which the Talmud (Sanhedrin 73a) uses to ground our obligation to do what we personally can to save lives and also to hire those who are more qualified to heal others. “If you see your fellow’s ox or sheep gone astray, do not ignore it; you must take it back to your fellow. If your fellow does not live near you or you do not know who he is, you shall bring it home and it shall remain with you until your fellow claims it; then you shall give it back to him (ve-hashevato lo). Deuteronomy 22:1-2. On what biblical basis can it be derived that it is obligatory to restore the body of a fellow human being [when ill or in danger, just as it is obligatory to restore his or her property]? Because the Torah says: “And you shall restore it to him” (Deuteronomy 22:2). [“To him] is superfluous, for to whom else would you return it? The Rabbis, assuming that nothing in the Torah is superfluous, therefore use that extra letter in the Hebrew word indicating [to him” to assert that] the Torah imposes a duty on us to restore lost property to its owner and a person's body to him or her (avedat gufo, the loss of one's body) when it is lost through illness or danger [see Rashi on the Sanhedrin passage, s.v. talmud lomar ve’hashevato lo.] Babylonian Talmud, Sanhedrin 73a; see also Bava Kamma 81b.

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EXOD573 It was taught in the school of R. Yishmael: "and heal shall he heal" -- From here is derived the doctor's license to heal (Bava Kamma 85a)

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EXOD574 [Regarding health and illness] A person should place his trust in the Creator, while seeking continued health through natural means. He should fight illness in the customary way—as the Creator, May He be exalted, has commanded: “And he shall cause him to be thoroughly healed” (Shemos 21:19)--yet have no faith in the power of the [natural] causes of health and illness to help or harm except with God's permission. When a person trusts in God, He will cure him of his illness by [natural] means or without such means, as it says: “He sends His word and heals them” (Tehillim 107:20). He may even heal him by means of something very harmful, as you know from the account of Elisha and the bad water, when he cured its unwholesomeness with salt Melachim II, 2:19-22). So it also says, “And God showed him a tree, and he threw it into the water [and the waters became sweet]” (Shemos 15:25); the Early Ones say that this was wood of the bitter oleander (Midrash Tanchuma, ad loc.) Similarly, it says, “Let them take a cake of figs and spread it on the boil, and he will recover” (Yeshayahu 38:21). You also know what happened to Assa when, upon becoming ill, he relied on the physicians instead of trusting in God-- how he was disciplined and reproved for this. Scripture also says, “He hurts, but He soothes; He wounds, but His hand also heals” (Iyov 5:18).

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EXOD575 Dispensation to intervene in the natural order is derived from [this verse]; but once such license is given, medical therapy is not simply elective but acquires the status of a positive obligation. Sanhedrin 73a, this obligation mandates not only the rendering of personal assistance as is the case with regard to the restoration of lost property, but, by virtue of the negative commandant, "You shall not stand idly by the blood of your neighbor"(Leviticus 19:16), the obligation is expanded to encompass expenditure of financial resources for the sake of preserving the life of one's fellowman.

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