R’ Dr. Yehudah Mordechai Gardin
Teaneck, New Jersey

Permission to Heal

The Mishnah (Kiddushin, 82a) admonishes: “The best of physicians deserves Hell…” This is generally interpreted to mean that physicians who are arrogant and feel that they are infallible—i.e., they “play G-d” as it were—or refuse to treat the needy free of charge, deserve an untoward end. So, how do we know that under Jewish Law, the physician has the right to hang out a shingle and practice medicine? This is not a trivial question since there are many references to G-d being the Supreme Healer in the Torah and in our prayers. As an example, in Shemos Parashas Beshalach, 15:26, it states: “I am G-d your healer.” In our morning prayers, we refer to Pokeach Ivrim (“He who opens the eyes of the blind”). In the Amidah (Shemoneh Esrei), we say, Somech noflim v’rofeh cholim, (“He who lifts up the fallen and heals the sick”) and after we go to the restroom, we say, as part of the Asher yotzar prayer, Rofeh kol basar umafli la’asos (“Who heals all flesh and acts wondrously”).

This actually is the subject of a machlokes between the Ramban (Rabbi Moshe ben Nachman, born 1194, died 1270) and the Rambam (Rabbi Moshe ben Maimon, born 1135, died 1204). Specifically, the Ramban posits that it demonstrates a defect in our emunah (faith) to rely on earthly healers—i.e., physicians—even though the Ramban himself is a physician-scholar. The Rambam, a physician-diplomat-scholar, argued that physicians were empowered by the Torah to heal their fellows. Sources for the physician’s empowerment to help the Supreme Healer include the double lashon, rapo y’rapeh—“You shall surely heal”—in the context of two men quarreling, in which the aggressor strikes the other with a stone or his fist (Devarim, Parashas Mishpatim, 21:19, as explained by Tanna debai Rebbe Yishmael [Bava Kama, 85a]); and vahasheivoso lo (“You should return [a lost object] to him”, Devarim, Parashas Ki Seitzei, 22:2). The Talmudic explanation (lomdus) is that just as the one is obligated to return a lost object to another, so too, he is obligated to return his lost health to him. We are also instructed that we must make efforts to protect ourselves and not rely on a miracle to save us (Ein somech al hanes). The Torah also admonishes us that we should “take heed to thyself and take care of thy life” (Devarim, Parashas Va ‘Eschanan, 4:9) and “take very good care of your lives” (V’nishmartem me’od le’ nafshosechem [Devarim 4:15]).

The Magnitude of the Problem

Various examples could be cited in which people endanger their health by their own actions—including the use of excessive alcohol and illicit drugs; smoking; significant overeating; and a lack of appropriate exercise. In this particular discussion, I will focus on the threats to health related to smoking. Smoking is well-known to be associated with an increased incidence of cancer, emphysema, heart and vascular disease, as well as other ailments. The negative effects affect not only the smoker, but also others who are exposed to smoke (“passive smoking”). It was estimated that in the beginning of the 1990s, about 1.1 billion people worldwide were smokers. This represented about one-third of the world’s population above the age of 15. The annual global death rate at that time was estimated to be 3 million smokers (Chapman, Brit Med J 1996;313:97). Although in the Western world, there has been a decline in the number of adult smokers over the past 20 years (1998 to 2009), from 24.1% to 20.6%, the American Heart Association estimates that from 2000 to 2004, the number of deaths each year from smoking was approximately 270,000 among males and 174,000 among females (Roger, et al. Heart Disease and Stroke Update Statistics 2011 Update. Circulation. 2011;123;e18-e209.).

Key Modern-Day Responsa

Faced with the evidence of the detrimental effects of smoking, some key poskim (Rabbinic authorities) have ruled that it is Biblically forbidden to smoke. These include HaRav Eliezer Waldenberg, a major modern-day Israeli posek (Tzitz Eliezer, Part 15, # 39 and Part 17, # 21-22; see also Steinberg A. Encyclopedia of Jewish Medical Ethics, vol 3. Feldhelm Pub. 2003:971-977.). In the United States, the Gadol Hador of the last generation, HaRav Moshe Feinstein, z”tz”l, felt there was not a Biblical halachic basis for prohibiting smoking. Reasons cited by HaRav Feinstein for not declaring that smoking was forbidden (assur)—despite the fact that it should be discouraged and prevented if possible—were the following:

• Many holy people in previous generations smoked and they certainly did not violate Torah law; furthermore, it is forbidden for the Rabbis to enact a law that will be trampled by the masses (shedashu ba rabim);
• Since some argue that smoking harms only a minority of smokers (a conjecture now subject to serious question), one cannot include it among the prohibitions related to the precepts related to Shomer es nafshosechem; and
• Any act which the masses accept the risk of performing—i.e., driving in a car, flying in a plane, etc.—cannot be forbidden since the masses are protected under the umbrella of Shomer pesaim HaShem (“The Lord watches out over fools [or simpletons]”). (Iggros Moshe, Yoreh Deah, Part 2, # 49 and Choshen Mishpat, Part 2, # 76)

It should be noted that more recently, there have been some stronger rabbinic calls to forbid smoking, including from HaRav Ovadyah Yosef.

Activism of the Gedolim (Torah Sages) in Cases of Dinei Mamonos

Recent examples of important Rabbinic authorities issuing bans related to excessive monetary expenditures include a ban that was promulgated by the Moetzes Gedolei HaTorah (Council of Torah Sages of the Agudath Israel), and publicized in The Jewish Observer, related to excessive expenditures for Jewish weddings. In particular, the Rabbis put a cap, in most instances, on the number of courses permitted as part of the wedding meal, the number of attendees at the wedding, the number of musicians in the band, etc. The idea was to avoid the squandering of large sums of cash—particularly by individuals who could ill afford to do so and who put their families in financial distress for many years in order to “keep up with the Goldbergs.” In a similar vein, a number of years ago, HaRav Moshe Heinemann of the Star-K in Baltimore set a ceiling on the sales price for esrogim for use on Succos.

Call to Action

It is our opinion that in order to improve the health of the community and demonstrate that protecting one’s life and health is as important as protecting one’s money, the Torah Sages of our age—and other poskim who have not already done so—should consider issuing proclamations, and publicize them widely, that include the following points:

• It is their strong advice (eitzah tovah) that men and women stop smoking, or not start;
• It is imperative that Rebbeim (Rabbis) not smoke in class or in other public venues; and
• Yeshivos and seminaries must encourage, and provide time in their curriculum for, regular exercise and menus featuring healthful food.

In our view, Rebbeim should issue a “call to health” from their pulpits and shtenders for boys and girls and men and women to not only “guard your tongue” (mishmeres lashon) but also to “take care of your body” (mishmeres guf).

Quotes on Health

Mishmeres Guf

American College of Cardiology Press Release

Dr. Gardin's Biosketch