By Rabbi Yair Hoffman for 5tjt.com
A lawyer once told of a surgeon who lined up his surgeries back-to -back – to back in order to maximize his income. He would have an assistant close up the stitching as he would move on to the next patient. The problem was that sometimes problems develop during the immediate post-surgery recovery and since he is in another surgery, a quick and effective response – doesn’t always happen. On the other hand, there are surgeons who time things in such a manner where the patient’s care is the top priority, and they ensure that they can monitor and respond efficiently to any post-surgery glitch.
Does a doctor who looks at patients only as cash cows – also get a Mitzvah of healing patients? What about other health professionals – if their intent is solely to make a living? What about pharmacists, or those who electronically fill prescriptions with no manual labor on their part whose only intent is for making a living? Parenthetically, and actually, most primary, we must always express our appreciation and admiration for our health professionals who give their heart, soul, time and life to help heal others. But this question is fascinating, nonetheless.
A STORY FROM THE CHOFETZ CHAIM
A story is told of the Chofetz Chaim who entered into the local pharmacy in Radin and told the pharmacist: “I am quite jealous of all of the multiple Mitzvos that you get each and every day!” The pharmacist responded, “Rebbe, the truth of the matter is that I am in it strictly for the money. I don’t intend for any Mitzvah of healing others. To me, it’s a living.”
The Chofetz Chaim then remarked, “If that is the case, then I have some very worthwhile advice to give you. Whenever you prepare a medicine thinking that you are doing it to make a living – add to the thought. Also think about the fact that you are trying to heal this customer or the one it is intended for. And that you are performing a Mitzvah. Doing so will earn you remarkable merit and reward.” It is said that the pharmacist ended up becoming very close to the Chofetz Chaim and became one of the most righteous and leading citizens of the area.
Although we generally do not pasken halacha from stories, the general implication of this story is that, had the pharmacists not focused on the Mitzvah aspect of his career – he would not have received merit for it.
ON A TORAH MITZVAH
Generally speaking, we rule that when a person fulfills a Torah Mitzvah, Kavana is required in order for it to count (See Shulchan Aruch OC SIman 60 Mishna Brurah 60:10). Kavana means that a person must have in mind that he is fulfilling the Mitzvah of Hashem as found in the Torah. This would seem to be the case in regard to Chessed as well (See Ahavas Chessed 2:23), and would also seem to be the Chofetz Chaim’s view as seen from the aforementioned story.
ON A RABBINIC MITZVAH
It is also interesting to note that many Poskim distinguishe between a Torah Mitzvah in this regard and a Rabbinic Mitzvah. For a Rabbinic Mitzvah, if one performed it without intent or by rote – then post facto it still counts and one does not need to repeat it (Mogain Avrohom citing the view of the Radbaz). The Mishna Brurah 60:10 cites the view of the Vilna Gaon who makes no distinction between Torah Mitzvos and Rabbini Mitzvos in regard to this concept (with the exception of reciting a blessing the second time). Healing, of course, is a Torah Mitzvah.
THE CHAZON ISH’S VIEW
The Chazon Ish, however, believed that this concept of not receiving credit for a Mitzvah when one does it by rote without intent does not apply in regard to Mitzvos that are between man and man (Toraso yehge, Miluim #10). This author’s reading of the Chazon Ish’s view is that “rote intent” still has the underlying realization, if one were to ask him, that he is doing something beneficial for another.
RAV ZILBERSTEIN’S VIEW
Rav Yitzchok Zilberstein has a view that is slightly different than that of the Chofetz Chaim. He (Shiurei Torah LaRofim Vol. I p.55) rules that if one has intent for money – he receives no merit and compares it to a case of a paid messenger who is travelling on Sukkos. We know that a messenger for a Mitzvah who is travelling is exempt from the Mitzvah of Sukkah. The paid messenger, however, is obligated in sleeping in a Sukkah. However, Rav Zilberstein distinguishes between intent at the very beginning and intent while healing. He explains that while the doctor is involved in the action of healing – he intends to heal and is “not in it for the money” at that time. He therefore rules that the doctor does get a Mitzvah. The story from the Chofetz Chaim seems to indicate that he would not have agreed with this analysis.
THE TORAS KOHANIM
There is also a fascinating Toras Kohanim (12:13) that is cited by Rav Yitzchok Zilberstein which states that if a wealthy person inadvertently dropped money from his cloak and a poor person picked it up and benefited from it – the Holy One establishes blessing for the former. This means that there still is at least minimal merit even if there is no such realization. It could be, however, that this Toras Kohanim is only referring to a case where the rich person would have responded – “Well, I didn’t know that I dropped it, but given the choice between having the coin be lost forever or for someone poor to benefit – I would prefer that someone benefit from it.” But a true misanthrope would not receive credit. Also, presumably, the Chofetz Chaim would not reject this Toras Kohanim as authoritative, so he would probably assume that it refers to a lower level of credit and bracha.
RAV SHTERNBUCH’S VIEW
In a fascinating response to Rav Zilberstein’s conclusion (ibid p. 573), Rav Moshe Shternbuch differentiates between action-oriented Mitzvos and result-oriented Mitzvos. He writes that healing a result-oriented Mitzvah and that Kavannah – intent is thus not required for its fulfillment. Rav Shternbuch thus explains that if a doctor performs the minimal requirements to treat the patient – then he would receive reward for a Mitzvah – even if his intent is just to make a living. He writes, however, that if he rushes his patients, as is often the case – he notes, then he receives no Mitzvah at all.
So it seems that we have a number of different opinions.
- The Chofetz Chaim holds that Kavanah – intent to perform a Mitzvah is required in order to receive higher level merit (above that of what is referenced in the Toras Kohanim).
- The Chazon Ish holds that when dealing with Mitzvos between man and man – intent is not required in order to receive credit.
- Rav Zilberstein holds that the doctor does receive credit during the actual healing action because he does not intend for money when he actually heals.
- Rav Shternbuch holds that the doctor does receive credit because it is a result oriented Mitzvah – but only when there is an actual action that is medicinal – rather than keyboard action. He writes that if there is any rushing or otherwise -substandard behavior – he gets no Mitzvah.
Regardless, everyone would agree that the greater the intent to perform Hashem’s Mitzvah of healing the better off everyone is. And, once again, we must always feel and express our deep hakaras hatov and appreciation for our hard-working doctors and other healthcare professionals.
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