Monday, April 15, 2013

Ramban's (Nahmanides') View of Medical Care (Mystical View)

I think we should start with the Ramban's opinion about medical care since it is probably the most widely held stance in Orthodox Jewish circles (Either consciously or subconsciously). The first source that we can delve into is what he says in Parshas Bechukosai (Vayikra 26:11). In the middle of his commentary on this verse, the Ramban goes on to explain his Views of medical care. I will translate his words and then discuss them.

והכלל כי בהיות ישראל שלמים והם רבים, לא יתנהג עניינם בטבע כלל, לא בגופם, ולא בארצם, לא בכללם, ולא ביחיד מהם, כי יברך השם לחמם ומימם, ויסיר מחלה מקרבם, עד שלא יצטרכו לרופא ולהשתמר בדרך מדרכי הרפואות כלל, כמו שאמר (שמות טו כו): כי אני ה' רופאך. וכן היו הצדיקים עושים בזמן הנבואה, גם כי יקרם עוון שיחלו לא ידרשו ברופאים רק בנביאים, כעניין חזקיהו בחלותו (מ"ב כ ב ג). ואמר הכתוב (דהי"ב טז יב): גם בחליו לא דרש את ה' כי ברופאים, ואילו היה דבר הרופאים נהוג בהם, מה טעם שיזכיר הרופאים, אין האשם רק בעבור שלא דרש השם. אבל הוא כאשר יאמר אדם, לא אכל פלוני מצה בחג המצוות כי אם חמץ.

The General rule is that when the children of Israel are complete and numerous then nature does not effect them at all. Not their bodies, not their land, not as a nation and not as individuals because G-D blesses their bread and their water. He removes sickness from their midst to the point that they don't need a doctor and they are guarded in their path (of life) from (even needing to follow) the ways of medicine. For example, it says (Shemos 15:26) "Because I am G-D your healer." So too, that is what the righteous people did in the days of prophecy. When the important people would sin and become ill they would not seek out doctors, but only prophets like the story of Hezekiah (Chizkiyahu) when he became sick (Kings 2 20:2,3) Also, the verse says (Chronicles 2 16:12) "Also in his sickness he did not seek out G-D, only doctors" and if going to doctors was the path to follow what was the reason [the verse] mentions physicians (the verse should just say he did not seek out G-D)? The only sin here should be that he (King Asa) did not seek out G-D (to heal him and there should be no mention of doctors). However, (this was a case where) a man (the doctor) says so and so should not eat Matza (unleavened bread) on Pesach (passover) only Chametz (leavened bread) (and that apparently was the sin or increased the sin).      

אבל הדורש השם בנביא לא ידרוש ברופאים. ומה חלק לרופאים בבית עושי רצון השם, אחר שהבטיח וברך את לחמך ואת מימיך והסירותי מחלה מקרבך, והרופאים אין מעשיהם רק על המאכל והמשקה להזהיר ממנו ולצוות עליו.

However, the one who seeks out G-D through a prophet does not inquire of doctors. What is the purpose (lit. portion) of a doctor in a house that does the will of G-D? After we are assured (by G-D) that He will bless our bread, our water, and remove sickness from our midst (what is the point of a doctor?!?!). By doctors, their actions only involve warning us which food and drink we should stay away from and they make demands of us. 

וכך אמרו (ברכות סד א :

כל עשרין ותרתין שנין דמלך רבה רב יוסף אפילו אומנא לביתיה לא קרא, והמשל להם (במדב"ר ט ג): תרעא דלא פתיח למצותא פתיח לאסיא.
והוא מאמרם (ברכות ס א): שאין דרכם של בני אדם ברפואות אלא שנהגו, אילו לא היה דרכם ברפואות יחלה האדם כפי אשר יהיה עליו עונש חטאו ויתרפא ברצון ה', אבל הם נהגו ברפואות והשם הניחם למקרי הטבעים.

So it says [in the Gemara] (Tractate Brachos 64a):
During the entire 22 years that Rabbah reigned (as Rosh Yeshiva), Rav Yosef did not even call upon a cupper (some form of doctor) to come to his house (Showing that righteous people do not need doctors). Also, there is a parable for this [idea that a righteous person does not need doctors and a sinner does] (Bamidbar Rabba 9:3): A door that doesn't open for mitzvos (Jastrow translates as charity) opens for the physician (meaning you will be punished with sickness for not performing the mitzvos).   
This is a saying [in the Gemara] (Brachos 60a): It is not the [intended] path of man to deal with medicine, rather it is what they are accustom to doing. If it was not man's custom to deal with medicine then a man would become sick when he did a misdeed. (Meaning), he would sin and be healed by the will of G-D. However, they (man) are accustomed to deal with medicine so G-D leaves them to the occurrences of nature.

וזו היא כוונתם באמרם(שם:

ורפא ירפא מכאן שנתנה רשות לרופא לרפאות.
לא אמרו שנתנה רשות לחולה להתרפאות, אלא כיון שחלה החולה ובא להתרפאות כי נהג ברפואות והוא לא היה מעדת השם שחלקם בחיים, אין לרופא לאסור עצמו מרפואתו, לא מפני חשש שמא ימות בידו, אחרי שהוא בקי במלאכה ההיא, ולא בעבור שיאמר כי השם לבדו הוא רופא כל בשר, שכבר נהגו. ועל כן האנשים הנצים שהכו זה את זה באבן או באגרוף (שמות כא יח): יש על המכה תשלומי הרפואה, כי התורה לא תסמוך דיניה על הנסים, כאשר אמרה (דברים טו יא): כי לא יחדל אביון מקרב הארץ, מדעתו שכן יהיה. אבל ברצות השם דרכי איש אין לו עסק ברופאים.

This is the intention of the saying [in the Gemara] (Berachos 60a):
(It says in Shemos 21:19) "He shall cause him to be healed," from here [we see] that [G-D] gave permission to physicians to heal.
It does not say that [G-D] gave permission to the sick person to seek out healing. However, since the sick person became ill and [instead of seeking out G-D] came to be healed, for [the sick person] is accustomed to use medicine. Furthermore, [this man] is not from the congregation of G-D that their portion is while living (and G-D will cure this man Himself). Therefore, the physician should not inhibit himself from his healing. Not because he is worried that perhaps [the patient] may die by his hands, because he is an expert in his work. Also, [the physician should not be worried] because [of the idea that] is said that G-D alone is the healer of all flesh, because it is already the custom [of people to seek out a physician.] Therefore,  by the men who are fighting and hit each other with a stone or fist (Shemos 21:18) there is a payment needed for the healing of the wound, because the Torah (Bible) does not rely its laws on miracles. When the [Torah] says (Devarim 15:11) "For the poor shall not cease from in the midst of the land (this is in reference to the commandment of charity),"  this was because He knew [and wanted] it to be this way. However, [this is opposite to healing] because G-D wanted the path of man to be that he [or she] should not deal with medicine or physicians.  

I want to sum up the Ramban's view and then I will discuss it in more detail. The Ramban goes through great length to explain that, simply put, a sick person seeking out a doctor or medicine is a Bidieved (not optimal) situation. The way the world is supposed to work is man sins, he is afflicted with sickness, he prays to G-D and is healed. However, because man has perverted the original path of the world and has accustom himself with seeking medicine and doctors, now those avenues are the natural way to be healed.

This opinion really fits well with the Ramban's whole philosophy of life. This philosophy can be found most clearly and succinctly in the Ramban's commentary on Shemos 13:16 in the last paragraph.
 From the great open miracles man will admit to the hidden miracles that are the foundation of the entire Torah. For a man does not have a portion in the Torah of Moshe, our teacher, until he believes that all our dealings and occurrences are miracles that are not nature or the custom of the world whether it be on a general or on an individual scale. [One must believe] if he does the mitzvos (commandments) our success is his reward. However, if he transgresses [the mitzvos] our destruction is his punishment. Everything is according to heavenly decree, as I have mentioned already. (Breishis 17:1, Shemos 6:2)
The Ramban believes that there is no such thing as nature, at least by the Jewish people. Everything that happens to us, rain or shine, is directly from G-D. This philosophy obviates the need for the Ramban to explain why medicine appears to be the healer and not prayer to G-D. According to the Ramban, G-D really does directly heal. In fact, back in the good old days, that was the only way to be healed, pray and be healed. However, somehow man became reliant on medicine, because that became the custom. This led to G-D changing the healing process from an open miracle (pray and thou shalt be healed) to a hidden miracle (you must go to doctors). Still, it is not the medicine that heals the person, but G-D (through a hidden miracle that APPEARS to be nature).

My explanation of the Ramban comes down to a few details. The Ramban believes that nature (at least with regards to Jews) is an illusion. Everything is directly from G-D either in the form of an open miracle (10 plagues of Egypt) or a hidden miracle ("natural" occurrences). This leads the Ramban to explain that a patient should NOT seek out a doctor, because prayer to G-D SHOULD help in and of itself. In fact, the Ramban points out that this used to be the only way to be cured from illness. However, once man became accustom to seeking medicine and medical care that was ALLOWED to be given by a doctor. There was no obligation created to give medical care, because people should NOT be seeking medical care.

That is how I will end my opening explanation and thoughts on the mystical view of medical care as seen through the Ramban's eyes. Really, medical care is part of the illusion of "nature" according to this view.   

No comments: