Parashas Beshalach includes the promise given by Hashem to the Children of Israel that they will not suffer the ailments of Egypt: “If you will give earnest heed to the voice of Hashem, your God, and do what is right in His eyes, and listen to His commandments, and keep all His statutes, I will put none of the diseases on you which I have put on Egypt; for I, Hashem, am your healer” (Shemos 15:26).
The words “I am Hashem, your healer” imply that it is Hashem, and not a human agent, who heals the Jewish people. Later, we find a similar promise. Hashem states that He will “remove illness from your midst” (Shemos 23:25). Nevertheless, it is common practice to go to doctors or healers in search of a remedy for a physical ailment. Indeed, as we will see below, care is a mitzvah of the doctor.
The status of healing as a mitzvah raises numerous questions concerning the obligation of a doctor. To what degree is a doctor exempt from other mitzvos on account of his healing duties? Are doctors obligated to daven? Must they find another doctor to take care of a patient while they perform the relevant mitzvah? We will discuss these questions, among others, below.
The Doctor’s Authority
The Gemara (Berachos 60a) notes a dispute concerning the authority of doctors to heal. According to Rabbi Acha, men should not in principle be involved with medicine which is the exclusive domain of Hashem. Although people practice healing, this is accepted ex post facto, and not by Divine recommendation.
Abbaye argues with Rabbi Acha, basing his position on Rabbi Yishmael’s interpretation of the verse in Devarim, “and he must surely heal him” (Shemos 21:19), to imply that a physician is authorized to heal. Abbaye thus maintains that the Torah grants full permission to the physician to heal the sick. By contrast with Rabbi Acha, it is not preferable to rely exclusively on pleas for Divine mercy.
Moreover, the Mishnah appears to say that healing is a full mitzvah for the doctor. The Mishnah teaches: “A person who is under vow not to benefit from his fellow… may receive healing from him” (Nedarim 4:4). The Rambam explains (in his commentary to the Mishnah) that this is permitted because the physician is obligated by Torah law to heal the sick since restoring one’s health is similar to returning his lost object. For this reason, it is not considered to be a benefit to the sick person from the physician, for the healing is the fulfillment of a Heavenly obligation.
The Rambam likewise cites this ruling in his Mishnah Torah (Nedarim 6:8).
A Mitzvah to Heal
In this context, it is important to note the distinction between the sick person, and the doctor.
A number of Rishonim discuss visiting a doctor. In a famous passage, the Ramban writes (based on the verse mentioned at the outset) that illness will not come upon the Jewish people under ordinary circumstances, and explains, “such was the situation for the righteous during the age of prophecy… Were it not that people became accustomed to practice medicine, an individual would become ill [only] as decreed in Heaven on account of sins, and would be healed in accordance with God’s will and His decree. When God favors a person’s ways, he has no need for remedies. Healing at God’s agency is also thorough and complete, by contrast with the limited healing of physicians” (Commentary to Vayikra 26:11).
Concerning great Talmudic sages, the Ramban writes as obvious that a physician never crossed the threshold of their houses.
However, concerning the practitioner’s duty, the Ramban (Toras HaAdam) is very clear, writing that a physician is not only permitted to heal the sick, but that it is a full obligation to do so, and can involve the mitzvah of saving a life.
He adds that it was necessary for the Torah to give permission to the physician to heal, for without this permission he might ask of himself: “If Hashem has brought illness to the sick, how can I heal him?” He writes that a physician might also decline to heal for fear of making a mistake and causing the patient graver damage. The Torah therefore grants permission to heal, provided the physician is sufficiently skilled and careful, and declaring him not culpable in the event of injury.
Once permission is granted, it is a mitzvah to heal. This is echoed by the Shulchan Aruch, again based on the Ramban (Yoreh De’ah 336:1): “The Torah gave permission to a doctor to heal; this a mitzvah, and falls under the category of pikuach nefesh (saving a life). If one refrains from it, he is considered a murderer. This is true even if there are other doctors available to heal the patient, since a person is not privileged to be healed through everyone” (see also Perisha).
Authorities discuss what the source of the mitzvah is and which mitzvah category healing falls under. The Rambam suggests that it falls under the obligation of returning lost property, which includes returning a person’s ailing body to good health. Others suggest vechai achicha imach (which refers to aiding a poor person), or to the general instruction to love another person as one’s self.
Though some medieval commentators distinguish between external wounds, for which there is a mitzvah to heal, and internal which one should refrain from doing so (see Ibn Ezra, Shemos 21:19), this is not the mainstream approach. According to normative halachah the mitzvah applies to all cases of healing.
Osek Be-Mitzvah Patur Min Ha-Mitzvah
The general halachic principle is that a person who is occupied with performing one mitzvah is exempt from performing other mitzvos.
This principle is taught by the Mishnah in the context of Sukkos: “Messengers on a mitzvah mission are exempt from the mitzvah of Sukkah; the sick and those caring for them are exempt from Sukkah” (Sukkah 25a). A person already involved in one mitzvah, is exempt from others. The Ritva writes that it is actually forbidden for him to abandon the mitzvah he is performing for another mitzvah.
Rashi explains that travelers on a mitzvah mission are exempt from the mitzvah of Sukkah even while they are encamped. Tosafos, however, finds difficulty with this position: “If they are able to fulfill both mitzvot why are they exempt? Is a man who has tzitzit on his clothing and tefillin on his head exempt thereby from other mitzvot?” The conclusion of Tosafos (possibly an understanding of Rashi) is that indeed, the exemption from mitzvos applies only to cases in which fulfilling the mitzvah of Sukkah at night prevents them from properly fulfilling the other mitzvah the next day.
The Ran differs, and explains why even somebody who is not actively involved in a mitzvah remains exempt. He writes. “Someone involved in a mitzvah is exempt from another mitzvah, even though he could fulfill both of them.… The Torah exempted anybody involved in God’s work from going to the trouble of fulfilling other mitzvos, even where it is possible to do both.”
The Ran concedes that if someone does not need to expend any special effort to fulfill both mitzvos he should do both—though this falls short of a full obligation.
The halachic ruling for this dispute is given by the Rema (Orach Chaim 38:8). The Shulchan Aruch rules the basic halachah of exemption: “Writers of tefillin and mezuzos, their wholesale and retail salesmen, and anyone involved in the Heavenly work are exempt from putting on tefillin all day except during the reading of the Shema and during prayer.” To this the Rema adds: “And if they absolutely must do their work (writing tefillin and mezuzos) during the reading of the Shema and prayer, then they are exempt from reading the Shema and prayer and tefillin. Anyone involved in doing a mitzvah is exempt from another mitzvah, provided that he must go to trouble to perform the other. If he is able to do both without any special exertion, he should do both.”
The Rema thus rules in accordance with the Ran, against Tosafot. He concludes (see also Biur Halachah, Orach Chaim 38, s.v. “Im Tzarich”) that a person does not have to perform an extra action in order to fulfill a second mitzvah while engaged in the first one. Only where a single action can do both mitzvos will he have to do both. The reason is that, “the Torah did not obligate somebody involved in doing God’s labor to go to the trouble of fulfilling other mitzvos, even if it is possible.”
Doctors’ Exemption from Mitzvos
Among those exempt from mitzvos, as mentioned by the above Shulchan Aruch, are merchants of Tefillin and the like. The Magen Avraham (38:8) distinguishes different types of intention: “It seems that who sells them for profit is not called `involved in a mitzvah.’ ”
The Mishnah Berurah (in Biur Halachah) raises the Gemara in Nedarim (33), where it seems that one who returns a lost object is called “involved in a mitzvah” even if he is paid for returning the item. Possible resolutions include that returning lost property is different, because he is only paid for time lost from work and not for the actual mitzvah act. Alternatively, the main intent of somebody returning lost property is to return the lost object, while merchants primarily intend to profit.
This raises the question of exemption from mitzvos for doctors. A doctor is usually paid for his work, and not merely for his lost time. On the other hand, his intention is often primarily to heal—though he doubtless wishes to make a living as well. Somebody selling Tefillin is thinking about the price but a doctor diagnosing a patient is not thinking of his compensation. Is he therefore exempt from mitzvos on account of his occupation with the mitzvah of healing?
Rabbi Dr. Avraham Sofer addresses this question in his Nishmas Avraham (Orach Chaim 38:6), and writes (citing Rabbi Yitzchak Zilberstein): “Although doctors and nurses are paid for their work, they are still considered as returning lost objects—for there is surely no greater return of a lost object than healing! Therefore, since he does not think about profit while working, but is only involved in healing the patient, and his care or that of a nurse is the mitzvah itself, he has the status of one who is involved in a mitzvah.”
Dr. Sofer adds (93:1), citing Rabbi Yehoshua Neuwirth, that even when a doctor is not actively healing, but only performing related duties, he is exempt from mitzvos: “I have heard from my master R’ Yehoshua Neuwirth that a doctor is exempt from prayer not only when examining or treating a patient (even without danger to life), but even when he is writing the patient’s record, and even when he is writing release documents. All this is considered involvement in the mitzvah.”
This halachah emerges from a statement of the Mishnah Berurah concerning gravediggers. The Mishnah Berurah (Biur Halachah 38, s.v. “im“) explains that a person digging graves is exempt from mitzvos even while he rests for a short time. Even while resting he is considered “involved in a mitzvah,” for his rest allows him to regain strength for continued digging.
However, if a person involved in a mitzvah can perform another mitzvah without special exertion, such as reciting the first Pasuk of Keriyas Shema, then it is correct to do so. As the Rema rules (cited above), “…if he is able to do both without any special exertion, he should do both.” Thus, if a doctor is not actively healing and can recite Keriyas Shema (or at least the first Pasuk thereof) without being distracted from his work, he should do so.
The Mishnah Berurah makes this clear concerning people involved in communal work, writing, “If one can stop for Shema and return to complete communal needs without strain, he should do so” (70:18).
Life Threatening Situations
Although any doctor in the process of healing (and related work) is considered “occupied with a mitzvah,” there is a distinction between a doctor who is doing routine work and one who is dealing with a life-threatening situation.
In the latter, Poskim are more adamant that he should not stop his work, even momentarily, for the purpose of a mitzvah. For example, the Mishnah Berurah (640:10) writes concerning Sukkah that, “in caring for a dangerously ill patient, it appears that one should be lenient even when the patient does not need him.” Cases of Pikuach Nefesh, or cases that may develop into life threatening situations, are qualitatively different from routine medical procedures.
Note, however, that doctors today usually take breaks during their working day. In such breaks, of course, there will be an obligation to daven.
Rabbi Yosef Shalom Elyashiv zt”l addresses the question of whether a doctor is permitted to turn away patients in order to take a mid-day nap (which will allow him to function better during the rest of the day). He concludes that this is permitted, and that it does not transgress any prohibition. This strengthens the position that under ordinary circumstances, a doctor should be able to find the time to daven.
Conclusion
We have seen that healing is a mitzvah, and that therefore doctors who are occupied with healing are exempt from other mitzvos. They need not daven; they need not say Keriyas Shema; they need not wear Tefillin; and so on.
However, clearly where it is possible, a doctor must plan his day so that he will be able to perform these and all other mitzvos. A person may not intentionally place himself in a situation that exempts him from mitzvos. Though this might happen relatively often to doctors (in particular when working on emergency shifts and so on), it should be avoided wherever possible.
For instance, if an equally qualified doctor is available to take over for the duration of davening (for example), an arrangement should be made (see Mishnah Berurah 640:10).
In addition, we have seen that where a person is able to perform both mitzvos, he should strive to do so in spite of the basic exemption. When involved in non-life threatening work, it is thus proper for a doctor to perform mitzvos that he is able to perform without being distracted from his work.
The yoke of mitzvos is another factor in the challenging life of a doctor or other medical practitioner. We owe doctors, nurses, and all those involved in the field of medical practice a huge debt of gratitude for their dedicated work. May Hashem place His blessing upon their hands, that they should bring healing and well-being to their patients, and be faithful practitioners of their holy work.
