Doctor’s Efforts Versus God’s Control

The Aish Rabbi Replies

Thank you for your profound question. You are right that there seems to be a fundamental contradiction between man’s efforts and God’s control. On the one hand, we are obligated to make reasonable efforts in most areas of life – we must earn a living, care for our health, maintain law and order in society, etc. On the other hand, the outcome of our actions is entirely up to God. Whether or not we will be rich or poor, healthy or unhealthy, ultimately depends on God’s will. If so, what is the purpose of our efforts? Why even bother with them?

This is a big topic and there are actually many different approaches among Jewish philosophers. What I will do below is present a few general thoughts and approaches.

First of all, regarding the topic you raised – medical care – the Talmud teaches us explicitly that we are obligated to practice medicine and preserve our health. The Torah, when discussing the laws of damages, writes explicitly that if one person injures another, “he shall surely heal [the victim]” (Exodus 21:19). The Sages understand this phrase to mean that the perpetrator must pay the victim’s medical expenses. Based on this, the Talmud derives: “From here [we may infer] that permission was granted to the doctor to heal” (Bava Kama 85a). In other words, the perpetrator must pay for the victim’s medical care since that is surely a legitimate expense. We do not say that God determines our health and there is no point even going to doctors. Rather, God placed the responsibility in our own hands to care for our health. (See similarly Talmud Brachos 32b which figuratively derives from the Torah’s phrase “and you shall be very careful with your souls” (Deut. 4:15) that we must never endanger our lives.)

The same is true when it comes to earning a living. Except for exceedingly pious individuals, we must make some kind of effort to support ourselves and our families (see Pirkei Avos 2:2, 3:21; Talmud Brachos 35b). Exactly how much and how hard we must work depends on our spiritual level and our trust in God. But ever since the curse of Adam that “through the sweat of your brow shall you eat bread” (Genesis 3:19), virtually every person must at least make some effort to make ends meet.

Thus, to begin with, we do not live life with an attitude that God will take care of us regardless of what we do. Rather, we must make our own reasonable and responsible efforts – realizing, of course, that ultimately the results are up to God.

But let’s say we do not? If a person sits back and does no work, claiming that God determines his bottom line, will he receive the same income regardless? And if he neglects his health, will he live just as long and healthily since it’s anyway all up to God?

The answer is no. Although the Talmud (Beitzah 16a) teaches that our income for the coming year is determined every year on Rosh Hashanah, that is clearly contingent upon a person’s efforts. God may determine how much we can earn in the coming year – and working extra hard will in no way increase that, but we can certainly not realize our earning potential if we are lazy and do not put in the requisite effort.

The same is true regarding our health – and even lifespan. If we neglect our health – eat poorly, fail to exercise, do not do regular screenings, etc. – we may well fail to realize our potential lifespan – and certainly not live as well for the years that we are here. Not only medical statistics, but Judaism teaches us this as well. As several Jewish thinkers explain, although God decrees all, it is dependent upon our doing our share – living responsibly and taking good care of ourselves. In fact, as some add, the very fact that we were reckless with our health is in itself sinful – and can result in our receiving less Divine protection. (Some also explain that only such matters as life and death are determined by God every year. Our quality of life – such as how good our health will be – is somewhat more in our hands to control.)

(To be honest, even with the above said, this raises further important theological questions. Say a person does not screen for a dangerous illness, common for his age group, or say he recklessly drinks and drives. He certainly may harm himself or even end his life early. But even so, it is God who determines the outcome of his recklessness – whether he actually will contract a dangerous disease or get into a car accident. One way of looking at this is that God grants every person his allotted lifespan – contingent upon his adequately caring for himself. If he does not, God may protect him from his recklessness despite that – but He may not. Once a person forfeits his Divine protection and endangers his life unnecessarily, the assumption that he will live out his full lifespan is no longer a given. God might not have especially caused the person’s untimely death had he been more careful. But now that he has not been, will God protect him from dangers he wantonly exposed himself to? Very possibly not.)

There is a further angle to this which we must address. If God is the one who makes a person sick, who are we to defy God’s decree and heal him? Although we did learn above that the Torah permits doctors to practice, how is this justified theologically? God made the person sick! If He determines that the time has come for the patient to recover, He can just as easily heal him. If we seemingly heal him sooner, aren’t we going against God’s will?

The very simple answer to this is that we do not worry about such matters. Our mission is to heal the sick – as well as support the poor, feed the hungry, rescue the endangered, cheer the lonely, etc. It is not ours to question God’s ways why He made the person sick or impoverished in the first place. (I once heard that story that a disciple asked his Rebbe that if we can learn from everything in the world, what can we possibly learn from an atheist? The Rebbe answered that we learn from him how to act when the poor ask us for help. We do not say, “God obviously wants you to be poor, so helping you is against His will.” On the contrary! We forget about God and run to help him – leaving the theological questions in Heaven where they belong.)

Apart from that, there are several theological approaches to understanding God’s ways in such situations. For example, perhaps God made the person sick in the first place to give others an opportunity to help him. Or perhaps God only intended for the person to suffer temporarily – knowing that the doctors would heal him in short order. (In fact, God is the one who placed the means of healing many diseases in the world – and God is the one who aided modern man in his discovery of their cures. Indeed, had God not wanted the patient to recover at all, He would have afflicted him with an incurable ailment.) Finally, the fact that another person performed the good deed of treating the patient brought more merit into the world and helped grant him healing.

The bottom line is that we do not have to worry about how our actions accord with God’s will. As the Talmud puts it, “With the pathways of Heaven why are they [of concern] to you?” (Brachos 10a). We must fulfill our obligation to heal the sick – and if our actions do not conform with God’s will, He will see to it that the sick remain sick regardless.

Of course, we must realize that although we make our own efforts at helping others, so to speak forgetting about God, it is ultimately God who decides the results. A doctor therefore must always see himself as merely God’s messenger – trying his best yet realizing that he is not there to change God’s will – only to help the patient recover if so God wills it. And likewise, there is a prayer which the Talmud obligates a sick person to say before taking medicine or undergoing treatment. (See here for the details.)

There is a further fascinating consideration, which I heard from R’ Yitzchak Berkowits. Imagine you are a surgeon, operating on a patient suffering from a life-threatening condition. Is the patient’s life actually in your hands to preserve or does God determine the outcome of the surgery? Surely, it is God who determines all outcomes in this world. Yet the Torah still teaches us that the doctor must heal. We must make our best efforts – although the actual results are God’s doing. And this leaves us with an interesting dichotomy. If the surgeon tries his best to save the patient – but God determines that he should die, that so to speak was not the surgeon’s doing. He tried his best – and Heaven will judge him as one who saved a life. Conversely, if the surgeon is negligent – yet God determines that the patient should live regardless, Heaven may well judge him a murderer – even though God for His own reasons preserved the life of the patient regardless. For God judges us based on our efforts much more than on the results – which are truly in His hands and not ours.

In any event, it is clear that practicing medicine is a wonderful merit, and an opportunity to help the many. Even if philosophically it may be argued that the results of our efforts are decided by God, a person who chooses such a profession has at the very least volunteered to make himself God’s messenger of healing to mankind, and that will certainly earn him much eternal merit. Much success in your chosen field!