Culture, Politics, Religion

Jewish Sources on the Provision of Health Care

by Rabbi Gail Labovitz
These remarks were part of the invited opening to a recent phone call on health care with President Obama for American rabbis.
When one starts from a worldview in which God is active in the workings of the world, it is quite possible to understand illness and physical weaknesses as God’s judgment on the ailing person, so that any intervention is a challenge to the workings of God’s will. This viewpoint has been voiced by some Jewish thinkers, from the sages of the classical rabbinic tradition, through the great bible commentators of the medieval period, and beyond. In other contexts, and in numerous sources, however, saving a life is considered to be one of the highest commandments in Judaism, so much so that almost every other commandment can be violated to further this end. This quite different perspective – one that validates medical expertise and makes the practice of healing a religious obligation – has also been present in Jewish tradition from its earliest expressions.
Two verses in particular from the Torah serve as the core foundation for what has become the normative Jewish view on healing and access to healthcare. Exodus 21:19 discusses a case in which one person has injured another in an altercation. The Torah rules that the assailant must see to it that the victim receives necessary medical attention: ”he shall certainly heal him.” In context, the obvious meaning is that the assailant must pay the victim’s medical costs, but the rabbis derive additional meaning from the doubling of the verb in Hebrew.
Thus we read in the Talmud, Berakhot 60a and Bava Kama 85a: “It was taught in the school of Rabbi Ishmael: ‘he shall certainly heal him’ – from this source, the healer is given permission to heal.” As Nachmanides noted in his 13th century work, Torat ha-Adam, “this is to say that it is not forbidden because of the concern that the doctor might inadvertently err; also, people should not say ‘the Holy One has struck (the ill person) and is the One to heal.’” Nachmanides continues, “it is a commandment to heal, and is in the category of saving a life.”

That healing is not only permissible, but can be considered a required act for those with the necessary knowledge and training, emerges all the more strongly from a second verse, Deuteronomy 22:2. In its basic, contextual meaning, the verse tells us that one who finds lost property is obliged to return it to the original owner: “you shall return it to him.”
Since the Hebrew suffix meaning “it” can also mean “him,” the rabbis reread the phrase, in Bava Kama 81b and Sanhedrin 73a: “From where do we know the requirement to return a person’s body?” – that is, save a person’s life? “The Torah says, ‘return him to himself.’” Maimonides, in his commentary on the Mishnah (Nedarim 4:4), makes explicit that this includes providing medical care: “the doctor is obligated by law to heal…and this is included in the explication of the verse, that ‘return it to him’ means to include (the ‘return’ of) his body…” Joseph Karo thus brings together these traditions to write in the Shulhan Arukh (Yoreh De’ah 336:1): “Torah gives the healer permission to heal. And it is a commandment, and is a matter of saving life. And if one withholds oneself, this person spills blood.”
We now come, then, to the question much on our minds at this moment – how is healthcare to be provided to those who need, and whose responsibility is it to see that health care is provided? Both the Palestinian and Babylonian Talmuds state that a person, or at least a scholar, should not live in a town that does not have a doctor (P.T. Kiddushin 4:12 [66b]; B.T. Sanhedrin 17b). At a time when all family finances were supposed to flow through the male head of household, the rabbinic tradition ruled that husbands were expected to pay for their wives’ needed medical treatment, and this was considered an obligation as basic as providing for her daily sustenance (Mishnah Ketubot 4:9; B.T. Ketubot 52b). Clearly, individuals and families have the first responsibility to seek out the healthcare they need and to pay for it as they are able.
Nor is a medical provider allowed to overcharge for treatments or for medicines in a case of dire need, a rule codified in the Shulhan Arukh (Yoreh De’ah 336:3): “One who has medications, and another person is sick and needs them, it is forbidden to raise their prices beyond what is appropriate.” Yet because receiving needed medical care can be a matter of life and death, and saving life is a religious and moral obligation, numerous sources suggest that doctors have an obligation to provide medical care in all cases, even to those unable to afford it on their own. The Talmud, in Ta’anit, praises the model of Abba the blood-letter: “He had a spot outside (of his workspace) to put coins; those who had put some in, but those who did not have could come in and sit without being ashamed.” But this approach is an ideal. Certainly, it could leave physicians in an untenable position, obligating them to care for all in need, but not yet insuring that their own needs to make a reasonable living will be met.
I turn, then, to a much more recent source, a modern responsum by Rabbi Eliezer Waldenberg, published in 1985 (Ramat Rachel, no. 24; published in vol. 5 of Rabbi Waldenberg’s collected responsa, Tzitz Eliezer). He begins by writing that the provision of needed medical care is of such significance that a bet din may, in fact, compel a doctor to provide free medical care to a patient unable to pay, and that it is not the responsibility of the court or the community to reimburse the doctor. However, he then modifies this ruling in a very important way, applying it only when there is just a single doctor in the locale. Where there are multiple doctors, no one doctor can be compelled to provide services not demanded of the others. Rabbi Waldenberg thus suggests several means by which a community might provide for its members, including paying for the medical care from communal charity funds, or creating a system whereby doctors equitably share the case load on a pro bono basis. His preferred system, where the community has the means, is to provide a monthly fee for doctors in exchange for seeing any patients in need. What is most significant about Rabbi Waldenberg’s responsa, then, is not that he provides the Jewish answer for the way in which a community should provide medical care for all. What he does tell us, though, is that providing such care, in the final analysis, is most certainly the responsibility of the community as a whole. It is thus not surprising that Jewish rabbinic and lay organizations across the denominational spectrum have agreed that we must seek the goal of an equitable system of access to healthcare in America.
Finally, I would like to conclude with the words of Maimonides, himself a physician in addition to his many other achievements. In Hilkhot De’ot (4:1), what we might call the Laws of Personal Development, he writes: “Health and wholeness of the body are among the ways of God, for it is impossible that one can understand or know anything of the knowledge of the Creator when one is ill. Therefore one must distance oneself from things that harm the body, and conduct oneself in ways that create health and wellness.” A failure to promote health when we have the ability to do so impedes our chances of achieving our full spiritual and personal potential. And as for the individual, so for the community made up of those individuals. May we be worthy to create a society in which no one is denied the opportunity to seek personal health and its benefits.
Rabbi Gail Labovitz is Associate Professor of Rabbinics at the Ziegler School of Rabbinic Studies at the American Jewish University in Los Angeles

5 thoughts on “Jewish Sources on the Provision of Health Care

  1. >>“What he does tell us, though, is that providing such care, in the final analysis, is most certainly the responsibility of the community as a whole.”
    What he does not tell us is that the medical system should be taken over by the government, whose politicians will then decide who gets which treatment and who doesn’t.
    >>“It is thus not surprising that Jewish rabbinic and lay organizations across the denominational spectrum have agreed that we must seek the goal of an equitable system of access to healthcare in America.”
    Considering that all Americans already have access to healthcare, that goal seems to have been reached.
    >>“May we be worthy to create a society in which no one is denied the opportunity to seek personal health and its benefits.”
    Is anybody in America being “denied the opportunity to seek” personal health and its benefits?
    Meanwhile, pregnant British women are surely in love with their “equitable” government healthcare system…
    (BTW if you’re in favor of “reform” have you bothered to read the bill yet?)

  2. eric – As a person that could not afford healthcare in the U.S. and therefore had no access to it, i do find it a bit rude of you to go about saying we all have access. IF i had the money, THEN i could go to a doctor/hospital. but since i didn’t, i couldn’t. i could go to the emergency room and they would bill me later and i still wouldn’t have the money and then they would send my bill to the bill collectors but that hardly seems like access.
    i’ve read parts of the bill (intro, title I sub c, title II sub b, ect) and i’ve yet to find anything i absolutely hate…but i assure you, i’ll keep looking! really it just reminded me about how much my life sucked in the U.S. and why i had to move to south korea for a year. so uhh thanks?
    here in south korea, i have national healthcare and i really love it. i pay 53,000 won a month (about 42 bucks) and i can go see doctors for things i really need checking up on (my asthma, allergies, teeth, pinched nerve…) things i’ve neglected in over 5 years because i couldn’t afford it (it’s like 250 bucks to go see an asthma doctor, plus scripts). granted south korea is MUCH smaller than the U.S. and therefore healthcare is fairly simple in comparison. and i’m sure it made making laws like this a easier to hash out. but that doesn’t mean that i don’t think i deserve the same care i get here, when i’m in my home country.

  3. Eric– pregnant women in the UK have better health than those in the US, primarily because the standard of care there is midwifery and women giving birth are not over-treated as they are here. This is a statistical fact: they have more live births over there than here.
    And it seems extremely odd to say that all Americans have access to health care; it’s a bit like saying all Americans have access to buying an expensive house. Sure they do, if they have enough money, but if they don’t, then they don’t have access. Especially given that private insurers can and do exclude ill people from necessary care because of “pre-existing conditions,” even if said ill people pay their premiums, I have no notion how you can say that everyone has access to health care. (And, in case it’s not obvious, people need health care far more than they need an expensive house.)
    Also, from a societal point of view, the last thing you want is poor people waiting until they are sick enough to show up in an emergency room. That costs the health care system far more than providing preventive care to everyone. I also have no notion why these costs don’t matter to Republicans, who supposedly are trying to cut down on spending.
    Yes, politicians and national health care workers may decide, not who gets which treatment, but which treatments national health insurance will pay for. Private insurance companies decide this every day, purely based on profit motives, and often their decisions impact who will live and who will die. I don’t get to vote them out of office if I don’t like their decisions, and, if I am insured through work, I don’t get to change my insurance company either. How is this preferable?

  4. To say that the USA has the best medical system in the world and that everyone has unlimited access to care is total nonsense. The truth is that millions are denied health care because it is often unaffordable or inaccessible:
    Mexico’s health care is more affordable and accessible:
    And the Canadian health care system is vastly superior to ours:
    Far right Christians {sic} claim to be such devout do goody God fearing types who worship the Prince of Peace. That same Prince demands that His adherents refrain from telling lies. Therefore, if these professing Christians want redemption, they better wake up and speak the truth.

  5. The article below should be part of the discussion.
    >> Arieh Lebowitz, Communications Director, Jewish Labor Committee
    Why We Must Support Universal Health Care
    by Rabbi Elliot N. Dorff / Jewish Journal [L.A.] Aug 26, 2009
    Whether or not we are believers in the Obama plan, or any of the particular plans for universal health care currently winding their way through Congress, support for universal health care is an imperative in Jewish law. Although what is available in medicine and its cost have changed radically, particularly over the past century, the fundamental right to receive good care — and to be compensated for giving it — goes very far back in our heritage, though perhaps, ironically, not all the way to the Torah or even the Mishnah.
    When physicians could not do much to heal a sick patient, their services were easily attainable, relatively cheap, and, frankly, not much sought after. “The best of physicians should go to hell,” the Mishnah says, reflecting people’s frustration in the second century C.E. with doctors’ inability to cure.
    With the advent of antibiotics in 1938, as well as other new drug therapies, and, especially, new diagnostic and surgical techniques, however, there has been an immense increase in the demand for medical care, precisely as it has become much more expensive. This raises not only the “micro” questions of how physicians should treat a given person’s disease, but also the “macro” questions of how we, as a society, should arrange for medical care to be distributed. It is precisely this argument that is taking place in town halls and in the halls of Congress these days, sometimes in rational arguments but all too often in shouting matches that are clouding the real issues.
    Jewish tradition imposes a clear duty to try to heal, and this duty devolves upon both the physician and the society. Jewish sources on distributing and paying for health care are understandably sparse, however, because before the 20th century, medical care was largely ineffective and inexpensive. The classical sources that describe distribution of scarce resources and apportioning the financial burden for communal services deal instead with questions like providing for the needy or rescuing someone from captivity, from highway robbers or from drowning. Still, those discussions raise moral problems and suggest solutions that are often similar to those associated with scarcity and cost in modern medical care.
    One set of issues is this: Who should get what when medical interventions are scarce and/or expensive? The other set of questions is this: Who should pay for health care? I discuss at some length the answers that emerge from the Jewish tradition to both of these questions in Chapter 12 of my book, “Matters of Life and Death: A Jewish Approach to Modern Medical Ethics” (Jewish Publication Society, 1998). I will share here a general sense of how the Jewish tradition responds to these questions, which are at once so ancient and so contemporary. (For specific source references, visit this article at MORE …
    You can read the entire post here:

Leave a Reply

Your email address will not be published. Required fields are marked *

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

The reCAPTCHA verification period has expired. Please reload the page.

This site uses Akismet to reduce spam. Learn how your comment data is processed.