Alternatives in Jewish Bioethics

1. Religious Naturalism: Human Responsibility and Divine Decree

1 Religious Naturalism: Human Responsibility and Divine Decree I. Intervention and Providence Modern medicine is often at the forefront of technological advance. a triumph of applied empirical science. Still. the goal of modern physicians is the same as that of their less successful predecessors: overcoming injury and illness. From a theistic perspective. this goal carries a potential for tension with the demands of piety. Attempts by human agents to heal the sick may appear to constitute interference with divine plans. The Jewish theistic tradition would seem especially susceptible to such tension. for it combines a strong emphasis on the duty to rescue any threatened human being with a pervasive faith in divine providence. Amongst the various sources of human suffering. illness-insofar as it is not produced by human agency-is particularly prone to be perceived as constituting divine chastisement, as will be seen below. An initial recognition of potential tension between human responsibility and divine determination seems to underlie a well-known talmudic statement about the "permission to heal." This "permission" is derived from a law in Exodus 21:19. which stipulates that an assailant must (among other liabilities) pay for his victim's healing: "and he shall cause him to be thoroughly healed"this implies that a physician is granted permission to heal. (BT. bava qama 85a). 20 Alternatives in Jewish Bioethics The logic of this inference is simple: if the Torah-God's law-requires hiring a phYSiCian, then the physician's work cannot be illegitimate! D. Hartman sees in this text an endorsement of "[taking h]uman responsibility for the conditions of life." Medical practice represents human action in general: "The permission granted to the physician to heal signifies the legitimacy and importance of acting to alleviate human suffering." (Hartman 1985, 229-30). Such permission is needed because the existing state of affairs, along with the suffering it entails, is thought to be determined by God. l Why, then, is the physician's intervention appropriate ? The Talmud simply pronounces it so, without offering any theological account. The theological problem is openly confronted in an early medieval rabbinic discourse which draws an analogy between medical practice and other forms of human actionin the face of conditions produced by God. In the following text, two great rabbis are depicted both as physicians and as explicators ofwhat might be termed "medical theology": R. Ishmael and R. Akiva were strolling in the streets of Jerusalem accompanied by another person. They were met by a sick person. He said to them, "My masters, tell me by what means I may be Healed." They told him, "Do thus and so and be healed." He asked them, "And who afflicted me?" They replied, "The Holy One, blessed be He." [The sick person] responded, "You intrude in a realm which is not yours; He has afflicted and you heal! Are you not transgreSSing His will?" They asked him, "What is your occupation?" He answered, "I am a tiller of the soil and here is the sickle in my hand." They asked him "Who created the orchard?" He answered, ..the Holy One, blessed be He." Said they, "You too intrude in a realm which is not yours. [God] created it and you cut away its fruit!." He said to them, "Do you not see the sickle in my hand? If I did not plow, sow, fertilize and weed it nothing would grow." They said to him, "Oh you fool! Does Religious Naturalism 21 your occupation not teach you this, as Scripture says -as for man, his days are as grass: as grass of the field, so he flourishes' (Psalms 103: 15). Just as a tree, without weeding, fertilizing and plowing will not grow; and even if it grows, then without irrigation and fertilizing it will not live but will surely die-so it is with regard to the body. Drugs and medical procedures are the fertilizer, and the physician is the tiller of the soil."2 But are plants which require cultivation a proper analogue to sick people in need of medical aid? With respect to agricultural activity, it can perhaps be supposed that God initially created the botanical realm intending for humans to realize its potential. In order to yield bountiful fruit, plants naturally require tending. But people's natural condition is, arguably, good health; they were not created needing medical treatment. If they fall from good health, is this not a...