by Rabbi J. David Bleich
Judaism views the seeking of medical attention as a moral imperative. Moreover, man is obligated to exercise prudence in preserving health. Thus the Talmud (Sanhedrin 17b) states that a Torah scholar should not establish residence in a community which cannot boast of the presence of a physician.
Despite the obligation on the part of the patient to seek medical care, the concomitant obligation on the part of the physician is somewhat limited. There is no absolute, mandatory obligation which requires any specific individual to study medicine, no matter how talented one may be. (l) Similarly, no person is obligated to engage in any specific research designed to advance medical knowledge. By the same token, even after having received extensive medical training and having been licensed to practice medicine, no individual is obligated to enter into the practice of medicine as a vocation or to seek out patients in need of his professional skill and expertise.
However, if a physician is requested to render medical assistance or if the physician becomes aware of the needs of an individual requiring medical assistance, the situation is quite different. The [American] legal system is firmly rooted in Anglo-Saxon common law. Under that legal system the relationship between a physician and his patient is a contractual one. Therefore, legally, a doctor has the absolute right to refuse to treat a patient who is not yet under his care. In effect, he may refuse to enter into a contract with the would-be patient. This attitude is reflected in the Code of Ethics of the American Medical Association, which declares, "A physician may choose whom he will serve."
Judaism, to the contrary, regards the physician not simply as acting on behalf of the patient but as acting in the service of God. He is, in effect, God's messenger and dares not shirk the responsibility thrust upon him. This, quite apart from a general aversion to oath-taking, serves to explain why there is absent in the Jewish tradition any parallel to the Hippocratic Oath. Judaism has no knowledge of "ceremonial" oaths. No official swears an oath to discharge his duties faithfully. Witnesses are not "sworn in" in Jewish courts of law.
Rather, Jews are considered to be "forsworn from Sinai" to observe all the tenets of Judaism. (The fact that all Jews stood at Mount Sinai over 3,000 years ago and embraced Judaism created an eternal commitment for all Jewry to uphold its principles.) For one who has sworn at Sinai to observe the tenets of Judaism in their entirety, a subsequent oath to fulfill any specific religious obligation would be superfluous.
Accordingly, the doctor is under Jewish obligation to render medical care, not only in emergency, life-threatening situations, but even when such care is required simply for alleviation of pain or preservation of physical well-being. Man intuitively perceives a social morality which leads to the recognition that man is his brother's keeper. Men feel themselves to be reciprocally obligated to preserve the life, safety, and well-being of fellow members of the human community.
Human society has long recognized that unique obligations devolve upon certain of its members by virtue of their talents, training, and/or unique responsibilities. A swimmer who blithely ignores the plight of a drowning person acts in a morally reprehensible manner. "Nor shall you stand idly by the blood of your fellow" (Leviticus 19:16) is the scriptural formulation of the ethical imperative which mandates life-saving intervention. Not all men share equally in this responsibility. Obviously, a non-swimmer cannot be required to plunge into dangerous waters; his efforts would be futile at best. But, in a life-threatening situation, surely a skilled swimmer is morally bound to place himself at the disposal of his fellow-man. Enhancement of skills brings in its wake a commensurate increase in moral responsibility.
It is instructive to compare the obligations of the physician with those of the Torah scholar who is requested to impart information or to serve as an arbiter or judge in civil disputes. One of the foremost 19th-century rabbinic authorities, Rabbi Moses Sofer, (Teshuvos - Choshen Mishpat, no. 164) indicates that, as a matter of strict obligation, the scholar need not seek out persons in need of his services, nor must he make himself available during such times as he is engaged in earning a livelihood. But, when engaged in study, or in his free time, he must answer questions put to him and render decisions "for with regard to this, that which concerns his fellow-man takes precedence."
The physician, in situations in which the life of his fellow-man may be threatened, labors under an even greater obligation. When able to do so, he must act in order to preserve human life.
An individual physician might, indeed, sidestep his responsibilities by removing himself from situations in which his aid might be sought. While such conduct, to be sure, would not merit approbation, the physician who acts in this manner would not incur the guilt of a technical Jewish legal infraction.
Society, however, has wider responsibilities which are accompanied by broad-ranging authority. Within autonomous Jewish communities, society's responsibility for promotion of communal well-being is discharged through the rabbinical court. Thus, the rabbinical court is empowered to compel the physician to make himself available and to function in his professional capacity. Furthermore, it is the responsibility of the rabbinical court to assure that the burden of providing medical care is shared equitably by all physicians qualified to render such care. (2)
These statements reflect the view that diverse obligations devolve upon the individual and upon society. The obligations of society are not only greater but are qualitatively different. An individual must respond to an immediate danger. While every individual aware of the danger and capable of alleviating that danger is obligated to respond, such individuals, no matter how large their number may be, respond as individuals rather than as members of a society. Yet no person is obligated to prepare himself to respond to an as yet non-existent danger. The individual's responsibility to act is limited to a danger which is clear and imminent.
Moral responsibility is readily perceived in the context of direct, proximate, causal relationships. Obligations in less proximate situations are not at all obvious. For example, is a person obligated to develop life-saving skills so that he can succor others in time of need? Certainly, acquisition of such skills should be encouraged and is surely deserving of approbation. But is it incumbent upon any given individual to acquire such skills?
Society as a whole may well be obligated to train lifeguards and to post them at public beaches, but no individual need necessarily feel obligated to make this profession his life vocation. The training and deployment of policemen, firemen, lifeguards, etc., in anticipation of potential emergencies, is a societal rather than a personal obligation. But, subsequent to completion of training and acceptance of responsibility, the members of these professions do assume personal obligations.
A similar distinction may be employed in resolving dilemmas arising from conflicting moral duties. May a person on his way to a class in first-aid instruction ignore the plight of a dying man on the plea that he must perfect skills which may enable him to rescue a greater number of persons at some future time? Our instinctive response is a clear-cut negative. No person may plead that an activity designed to advance future societal benefits is justification for ignoring an immediate responsibility. Immediate needs create immediate obligations: Anticipated needs do not generate immediate, compelling obligations. The "here and now" test is a general rule of thumb which may be applied to most situations requiring an ordering of priorities.
Physicians possess skills which are not shared by other members of society. In opening a medical office or in accepting hospital appointments, they agree to make their skills available to those whom they serve. Hence, society has a unique claim upon their services, and they, in turn, bear a unique responsibility to society. The physician may not, for example, engage in strike action which compromises the health of his patients. He may not fail to attend his patient even if his motive is to effect improvement in health-care facilities or services rather than his own pecuniary self-interest. It is not legitimate for a doctor to shirk an imperative moral responsibility to patients requiring medical attention "here and now" on the plea that present nonfeasance will ultimately redound to better care for more patients at some future time. An immediate moral claim cannot be set aside in anticipation of future claims which do not as yet exist...
Despite the awesome responsibility placed upon the physician, or perhaps because of it, rabbinic writings convey a certain negativism with regard to the medical profession. "The best of physicians is destined to Hell," declares the Mishnah (Kiddushin 82a). This statement is simply a reflection of the fact that the Talmud recognizes that individual physicians are quite prone to be remiss or negligent, on occasion, in performing their duties. Such lapses, according to Jewish teaching, occasion the severest punishment.
The physician bears responsibility not only for the physical well-being of the patient, but for his spiritual well-being as well. Old-time Jerusalemites tell an interesting anecdote about the late Dr. Wallach, of blessed memory, the founder and first medical director of Sha'arei Zedek Hospital. It was his invariable practice to visit each newly-admitted patient shortly after admission and to inquire after his or her mother's Hebrew name. Sha'arei Zedek Hospital maintains a synagogue on its premises and has instituted the laudable practice of reciting Psalms on behalf of its patients; thereafter a prayer for the recovery of each of the patients is recited. Traditionally, the prayer for the sick includes the patient's Hebrew name as well as that of the patient's mother. Hence, Dr. Wallach solicited this information and transmitted it to the synagogue sexton.
Yet Sha'arei Zedek Hospital is an efficient institution. As in all medical institutions, patients, upon admission, are required to give many details of pertinent personal information. This is followed by the recording of a medical history. Surely, another line could have been added to the admission form requesting the additional item of information and a copy routinely transmitted to the sexton! Dr. Wallach obviously wished to convey a message to the patient: This information is solicited by the medical director himself because he is fully cognizant that all healing comes from God and wishes the patient to be aware of this as well.
The 12th century commentator Rashi, in his analysis of the earlier cited Mishnah, catalogues the failings of both commission and omission common to physicians. Among them are "He gives [the patient] the diet of healthy persons to eat and does not humble his heart before God." The latter phrase is conventionally understood as referring to the excessive pride which is, at times, evidenced by physicians who erroneously come to believe that life and death are in their hands rather than in the hands of God.
A more grammatically consistent interpretation, which takes cognizance of the concern manifest in Dr. Wallach's conduct, would render the translation "and does not cause him [i.e., the patient] to humble his heart before God." In failing to impress this awareness upon the patient, the physician is remiss in fulfilling the divine trust with which he is charged. In sensitizing the patient to the spiritual component inherent in the healing process, the physician bears testimony to the divine purpose underlying all natural phenomena.
1. See, for example R. Moshe Feinstein, No'am, VIII (5728), 9 as well as the responsum of Rabbi Feinstein which appears in the Tishri-Cheshvan 5735 issue of Mitteilungen, published by K'hal Adath Jeshurun of Washington Heights, New York City. Sefer Chasidim (Mekitzei Nirdamim edition, Berlin, 5651-53), no. 1469, declares that one who refrains from studying medicine for fear that he will later be inconvenienced by being called upon to treat a poor patient, or because he is fearful of committing an error, will be held culpable if a sick person dies as a result of the lack of a qualified physician. This statement should presumably be understood as expressing moral censure of unworthy motivation rather than as reflective of an absolute obligation to undertake the study of medicine.
2. See R. Eliezer Waldenberg, Ramat Rachel, no. 24, sec. 6; cf. Aurkh ha-Shulchan, Yoreh De'ah 261:6.
3. R. Eliezer Fleckles, Teshuvah me-Ahavah, III, Yoreh De'ah, no. 336; R. Shalom Schachneh, Mishmeret Shalom, II, 99; and R. David Katz, Bet David, II, Yoreh De'ah, no. 306.
Printed with permission from InnerNet.org