The imperative to heal

The imperative to heal

I am no relation to Prof. Noah Feldman, so I can speak my mind about his provocative article in the New York Times Magazine. And since not long ago I published a book which addresses a dominant issue in that article, I feel impelled to speak.

The issue is the matter of the halachic and social question of a Jewish doctor treating a non-Jewish patient on the Sabbath, a question with far more significance — and even glory — than may appear at first glance. As I point out in my book, "Where There’s Life There’s Life" (Yashar Books, Brooklyn, N.Y.), the development of the entire concept is remarkable.

The principle of pikuach nefesh in the Mishnah teaches that Shabbat and Yom Tov must be set aside where a life can be saved. Since we are, however, not instant diagnosticians, we are taught that even safek, even the possibility, without sure knowledge of the seriousness of the condition, or the identity of patient or victim, means that the life-saving steps must be taken, and without hesitation.

What’s more remarkable is that the doctor, being made aware of the needs of a patient, does not have the luxury of sending another physician, one geographically closer. What, after all, does enable and require the doctor to travel on Shabbat from his home in the suburbs to answer the call of a patient in, say, Manhattan? Why do we not ask the patient to avail himself of the services of the many doctors already in Manhattan? The answer is that effective therapy is helped by the relationship of trust built up between this doctor and this patient, more even than any skill he may have.

The halachic system, so apprehensive about any violation of the Sabbath, is surprisingly ready to yield to the intangible — and unproven — greater ability of this doctor to hasten recovery for this patient. It’s a striking lesson in the overriding imperative of doing whatever may save a life.

But there’s more, and it’s more remarkable. Now that the emergency is over, the doctor can further "set aside" Shabbat or Yom Tov and travel back to his home. But why? Rav Moshe Feinstein gives the reason: He may travel home on Shabbat so that when the call comes another time, he will not hesitate to go — telling himself, for example, that he is not really needed. Such rationalization causes the forbidden hesitation. The imperative to heal without delay is thus made possible in advance for next time.

It at first seemed counterintuitive that so liberal a set of concessions should apply as well to care of a non-Jewish patient. It did not seem to follow from the enabling principle, "Violate for him this Sabbath so that he be here to keep many Sabbaths." Yet, the desire and the instinct to do so were clearly felt, and two considerations were invoked to allow it.

One was "mi-shum eivah," that the Sabbath be set aside to offer such treatment, in order to "prevent enmity," to promote good public relations. The other consideration was "b’tselem Elokim," that all mankind is created "in the image of God," and the duty to break Shabbat and save life knows no ethnic boundaries.

It is told of the late talmudic giant Prof. Saul Lieberman that he figured in a public challenge as to which of these two considerations is the essential one. A newspaper reporter had heard of the dialectic, and asked Prof. Lieberman what is the real reason Jewish doctors do treat gentiles on the Sabbath. He offered the "image of God" reason. When the reporter left, satisfied, a student demanded: "But does not the Talmud first present the other reason, ‘to prevent enmity’?" Rabbi Lieberman answered "That’s what my response accomplished. It prevented enmity."

It must be said that Prof. Noah Feldman’s intent must have been the opposite: to create enmity. How else account for his linking of this remarkable and humane teaching to the aberration of Dr. Baruch Goldstein and the tragic manslaughter he perpetrated? He claims that "at least one" Israeli newspaper reported that Dr. Goldstein had earlier refused to treat Arab patients. Prof. Feldman chooses to ignore what the other newspapers said, namely that he would regularly treat Arabs in need — until one night their shouts of "death to the Jews" simply unnerved and unhinged him. But where is fairness? A desperate act against the declared enemy on a weekday is linked to our halachic and social struggle with Sabbath restrictions? Where is fairness, if the noble but expected policy and record of Israeli hospitals are totally omitted from the article — the policy of giving Jew and Arab, terrorist and victim, the same high-quality and dedicated medical treatment? And, if Sabbath is the issue, does Prof. Feldman not owe it to his readers to learn, and tell us, that even the pre-eminent Orthodox hospital, Shaarei Tzedek in Jerusalem, allows no hesitation in its emergency room services in saving any human life any time?