OU Press

Human Initiative and the Divine Hand

February 10, 2010

“He shall certainly cure” (Shemot 21:19) — The School of R. Ishmael taught: “He shall certainly cure” From here it is derived that permission was granted to the doctor to heal. (Bava Kama 85a)

The Rabbis taught: “King Hizkiyahu initiated six actions, three of which the sages endorsed and three they did not endorse. He dragged his father’s bones on a bier of ropes, and they endorsed him; he pulverized the Copper Snake, and they endorsed him; he hid away the Book of Cures and they endorsed him. He cut off the doors to the Sanctuary and sent them to the Assyrian king, and they did not endorse him; he sealed up the waters of the Upper Gihon, and they did not endorse him; he made a leap year during Nissan, and they did not endorse him.” (Pesahim 56a)

What was the Book of Cures, and why was hiding it praiseworthy? Rashi explains that this book enabled people to cure any ailment instantaneously. Such a book needed to be hidden because sickness has its place in the divine scheme of things – ill health reminds us of our human frailty and turns our attention back to Hashem. Therefore, when the ability to instantly restore good health counteracted the religious benefits of sickness, Hizkiyahu removed the Book of Cures.

In his commentary on the Mishna (Pesahim 4:9), Rambam offers two other interpretations. Perhaps the book described healing based on pagan practices, which would violate a biblical prohibition. The Jews had such a book because one is allowed to study this type of material in a purely theoretical way; once some of them began to actually use the practices in the book to treat illnesses, it needed to be taken away. Alternatively, Rambam suggests, the book may have been an encyclopedia of poisons and antidotes, and the problem was that people began to make extensive use of the sections describing poisons. According to both of Rambam’s views, the problem has nothing to do with human medicinal success getting in the way of the divine plan.

Indeed, the Rambam cites such an idea only to vociferously denounce it. He draws a powerful analogy to human attempts to combat hunger. Just as turning wheat into bread does not violate any religious ideal, so too curing the sick is in no way religiously problematic. Not only does the human initiative not contradict a sense of dependence on the divine, it enhances it. Rambam points out that just as we thank God when we eat food, we can thank God for creating the cure developed by human hands.

Interestingly, although the six actions of Hizkiyahu are found in our contemporary editions of the Mishna, they are not part of the mishnaic text in the Gemara (both Talmud Bavli and Yerushalmi), and Rambam seems to follow the Gemara. The fact that the Rambam comments on a non-mishnaic text in a commentary on the Mishna reveals how strongly he felt about this idea. He begins his comment with the words: “This halakha is a tosefta, but I saw fit to explain it as well because it is beneficial.” The Rambam only rarely uses his commentary on the Mishna to discuss texts other than a given mishna. He apparently felt that endorsing human initiative in the world of medicine was so important that he departed from his usual procedure in order to highlight this point.

Hazon Ish (Emuna uBitahon 5:5) refutes the Rambam’s analogy between procuring food and searching for cures, arguing that seeking food is the norm of human existence, while sickness is a deviation from the norm. Unlike hunger, illness reflects divine punishment. Therefore, only illness constitutes a divine message to repent. We respond to hunger by harvesting wheat, but ideally we should respond to illness with prayer and repentance.

My sympathy in this debate lies fully with Rambam, but I should mention a solid argument advanced by Hazon Ish. He points out that the gemara (Bava Kama 85a) needs the scriptural phrase Ve’rapo yerapei (“He shall certainly cure,” Shemot 21:19) to allow the doctor to cure. No parallel gemara requires a source to allow the hungry person to take steps to alleviate his hunger. Apparently, Hazon Ish argues, healing involves more religious questions than preparing food. Of course, the Rambam might counter that it was only a theoretical possibility that healing might be problematic; once we have the derivation, we discover that seeking remedies does not truly differ from seeking food. On a theological plane, Rambam clearly sees no distinction between hunger and sickness; illness may be less frequent than hunger, but it is very much a part of the natural order. God set up that order for us to function within as we utilize the best of our human resources.

These two approaches reflect broad differences in religious understanding. I shall paint the two perspectives in broad strokes that will admittedly leave out some nuances. One approach denies or minimizes the natural order, tending to see all difficulties as divine punishments and playing down the significance of human initiative within the natural order; the other approach maximizes the natural order, viewing many difficulties as the normal functioning of nature and granting great value to human naturalistic efforts to alleviate those difficulties. (See David Shatz’s fine article in the Torah u’Madda Journal, vol. 3, for a discussion of these issues.)

Rav Yosef Dov Soloveitchik firmly identifies with Rambam on this issue. He sees human scientific efforts in general, and the realm of medicine in particular, as the fulfillment of a religious duty:

To live, and to defy death, is a sublime moral achievement. That is why Judaism has displayed so much sympathy for scientific medicine and commanded the sick person to seek medical help. Curing, healing the sick is a divine attribute reflecting an activity (rofe holim) in which man ought to engage.” (“Majesty and Humility,” p. 34)

R. Yisrael Lipshutz also strongly endorses human science and medicine. In his commentary on the Mishna (Tiferet Yisrael ), he discusses, in the eighth chapter of Yoma, how to treat both scurvy and rabid dog bites. The same attitude is reflected in his commentary on the source about Hizkiyahu (Pesahim 4:10). R. Lifshitz assumes an interpretation similar to the Rambam’s first explanation. He suggests that the Book of Cures discussed amulets with images and constellations, but he does not think that using such a book, in and of itself, constitutes idolatry. Therefore, when people were led to idolatry by the book, Hizkiyahu hid it but did not destroy it (as he destroyed the Copper Snake). This enabled people to use the Book of Cures in times of real danger. Apparently, even a work that might lead to idolatry must be preserved if it can heal serious human illness.

We see that religious people who believe in the stability of the natural order and endorse human initiative within that order must be careful not to set up a theology that removes God’s providence from the world. We must achieve a certain balance between the human and the divine. Religious ideals should not inhibit human efforts to alleviate human suffering; on the contrary, they should inspire such efforts. Still, at the same time, that effort must be seen as part of the scheme of divine providence.

Adapted from Fresh Fruit & Vintage Wine: The Ethics and Wisdom of the Aggadah by Rabbi Yitzchak Blau.

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