Halakhah к Шмот 21:20

The obligation to render medical assistance flows from multiple scriptural sources and a person who renders such aid fulfills a number of diverse mizvot. Perhaps the most widely quoted source is the statement found in Baba Kamma 85a: " 'And he shall cause him to be thoroughly healed' (Exodus 21:20)—from here [it is derived] that the physician is granted permission to heal." Ramban, in his authoritative halakhic work, Torat ha-Adam, comments that the "permission" or "dispensation" of which the Gemara speaks in actuality constitutes a commandment or obligation ("Hai reshut, reshut de-mizvah hi"). Thus the medical practitioner is not merely permitted, but is required, to render aid.

Noteworthy is not only Maimonides' extension of this concept to cover medical matters but also his failure to allude at all to the verse "and he shall cause him to be thoroughly healed." It would appear that Maimonides is of the opinion that without the granting of specific permission one would not be permitted to tamper with physiological processes; obligations derived from Deuteronomy 22:2 would he limited to the prevention of accident or assault by man or beast. The dispensation to intervene in the natural order is derived from Exodus 21:20; but once such license is given, medical therapy is not simply elective but acquires the status of a positive obligation.³Cf. R. Baruch ha-Levi Epstein, Torah Temimah, Exod. 21:19 and Deut. 22:2. Cf., also, R. Abraham Danzig, Ḥokhmat Adam, 141:25. As indicated by Sanhedrin 73a, this obligation mandates not only the rendering of personal assistance, as is the case with regard to the restoration of lost property, but, by virtue of the negative commandment, "You shall not stand idly by the blood of your neighbor" (Lev. 19:16), the obligation is expanded to encompass expenditure of financial resources for the sake of preserving life of one's fellow man. This seems to have been the interpretation given to Maimonides' comments by R. Joseph Karo, who, in his code of Jewish law, combined both concepts in stating: "The Torah gave permission to the physician to heal; moreover, this is a religious precept and it is included in the category of saving life; and if the physician withholds his service it is considered as shedding blood."⁴Yoreh De‘ah 36:1. See R. Eliezer Waldenberg, Ramat Raḥel, no. 21, and idem, Ẓiẓ Eli‘ezer, X, no. 25, chap. 7.

R. Chaim Sofer, Teshuvot Maḥaneh Hayyim, Yoreh De'ah, II, no. 60, explains that availing oneself of the ministrations of a physician is permitted only because of specific dispensation granted by the verse "and he shall cause him to be thoroughly healed" (Exodus 21:20). Permission to utilize medical remedies entails an obligation to use them in the preservation of life and the obligation to preserve life, in turn, serves to obviate strictures of religious law. However, the obligation arising out of that verse, asserts Maḥaneh Hayyim, is limited to use of natural remedies; no similar obligation exists with regard to the use of non-natural, occult or metaphysical powers in effecting a cure. Infractions of Jewish law are permitted for purposes of preserving life only because such measures are demanded by Halakhah. Accordingly, Maḥaneh Hayyim maintains that, according to Rambam, even segulot of demonstrated efficacy may not be used despite danger to life if such use involves an infraction of a halakhic prohibition.