Why I Oppose the Refuah Card

So I saw the following on Mystical Paths (picture at the right) -- a card with a Yehi Ratzon to say before and after taking any medication or undergoing any medical procedure. And it establishes it as an halachic requirement, both on the card by citing those sources (Shulchan Aruch and Mishnah Brurah) and on the website by describing it as such.

I oppose this, for reasons I'll eventually get to. Let us begin by tracing the development of this practice.

We see in Berachot 60a, cited lehalacha by the Rif, the following:

{Brachot 60a}
On entering a bath-house one should say: 'May it be Thy will O Lord, my God, to let me enter peacefully, and leave peacefully, and deliver me from this and from the like of this in the time to come.

And when he leaves, what does he bless?
Rav Acha said: Blessed be he who delivered me from the fire.

On going in to be cupped {let blood} one should say: May it be Thy will, O Lord, my God, that this operation {/endeavor} may be a cure for me, for You are a free healer.

And when he leaves, what does he bless?
Rava said: Blessed is the free healer. {rofeh chinam}

The context was only that of going to be cupped -- that is, to have his blood let. And that is how the Rif cites it, without extending it.

I would note a slight difference in girsa. This follows the girsa of our gemara, and Rif and Rosh. But the Rambam, Smag and Tur have "Baruch Rofeih Cholim," rather than "chinam." (So says the Divrei Chamudos on the Rosh.)

There are two other girsological differences - Rava vs. Rav Acha, and ki kai -- when he gets up -- rather that ki nafik -- when he leaves.

But throughout, this is said specifically when having blood let. And though the card cites the Shulchan Aruch, the Shulchan Aruch only says the same -- when having blood let. However, a commentary on the Shulchan Aruch, namely the Magen Avraham, says that the same should also apply to any matter of refuah.

This is a new extension of the old din, and if this were so, I would have expected someone earlier to say this. One can argue in favor of it, but it is just one commentator's opinion on the matter. The other major commentator on the Shulchan Aruch there, the Taz, does not put forth this extension. And, the רד"א takes exception to the extension. He says that this is said only in cases where there is sakana, danger to life. And we know from other gemaras that blood-letting has aspects of sakana to it. But that this is not meant to extend to e.g. changing a band-aid or taking a Tylenol.

Indeed, given the context of the statement -- going into a heated bathhouse, which we see from commentators that there is an aspect of sakana, and the thing to say before and after entering a city -- that it should be for peace -- the idea seems to be here that this was a tefillah instituted specifically for bloodletting, that this procedure should be for good and for healing, and not, chas veshalom, for death or illness. (Thus, I would disagree with the Magen Avraham and agree with רד"א.)

Meanwhile, the Taz says (and other girsaot have it) that the blessing upon leaving has Shem and Malchus -- that is, it should be "Baruch Ata Hashem Elokeinu Melech HaOlam Rofei Chinam (or Cholim)."

Now we have an issue of Bracha Levatala, a blessing said in vain, if we extend it to cases where it should not extend. No problem -- only say it with Shem and Malchus where there is actually bloodletting, but otherwise say it without, so as not to entire into the dispute between רד"א and Magen Avraham.

And so rules the Mishnah Berurah. And so rules the Aruch haShulchan.

For what is the harm? Like this, you are saying extra praise and prayer to Hashem, and reminding yourself that whatever physical medical procedures you undergo, it all is ultimately in the hands of Hashem. Beautiful.

My first opposition to it, though, is on the grounds of feature creep. This is part of a long process, by which every aspect of Judaism is extended and extended and extended. See my posts on eating meat during the Nine Days for another example. And here, it is fairly clear that רד"א is correct and Magen Avraham not so much. But, rather than assessing the validity of the two positions, and choosing between them -- rather, since there is no harm in ruling "lechumra" and saying it, we might as well satisfy that position. But taking that approach over and over will lead to clutter of halacha, as anything anyone says which can be satisfied will be added to the ball of tar. And it will not just be cluttered, it will also get more and more chamur, stringent.

However, we are lucky! This practice has fallen into disuse. Quite probably this is because nowadays almost no one has their blood let. (Though recently, some doctors have applied it -- with leeches -- to positive effect.) But for whatever reason, kelal yisrael has not kept this extension of the original statement in the gemara, this extension of what the Rishonim say. Still, it survives as a relic in our halachic texts. But, mimetic tradition -- what people actually practice, is not in according with doing this. Rather, it is in according with רד"א, and what appears to be pashut peshat according to everyone up to that point. So, while their website says:

Prior to taking medication, or undergoing any medical procedure, Halacha requires one to pray to Hashem for the success of the procedure or medication, thereby recognizing that Hashem alone is the true healer. Over time, this halacha has been neglected and has fallen into disuse.

, it may well be that halacha does not require one to pray like this -- though it certainly is a good thing to do. I don't like how selective citations on cards and handouts in shul claim things are halachic obligations, such that those who don't are doing wrong. "Neglected" also has the same connotation. I would say, rather, that likely for hundreds of years, this has been the practice to only say it for bloodletting, then at a specific span of time, based on some opinions (there was dispute) it was extended to other medical procedures as well, and eventually the custom changed, such that people are no longer practicing the extension.

Many things in Shulchan Aruch, Mishnah Berurah, and Aruch haShulchan are not actually practiced today. We often conduct ourselves differently. One example off the top of my head -- the Aruch haShulchan paskens that really one should not talk at all during a meal, even between courses. In terms of talking between aliyot, many do not follow the Mishnah Berurah. That is not because they are doing wrong, but rather because these are compendiums of Jewish law, with a pesak halacha, but it is not really binding on everyone. Pesak halacha takes place outside the realm of these seforim as well.

If you want to change existed established Jewish practice, go to a Gadol haDor, put it forth to him, and ask him to publicize that people should do this. (It is also cited in Nishmas Avraham.) Maybe he will agree, maybe not.

Instead, anyone can start putting out cards, leIlluy Nishmat X, advocating a specific practice which is written in source X and Y (even where source A and B disagree), and encouraging people to accept this practice which they are not accustomed to, as a positive chumra or as a required halacha. I don't favor this approach.

{Update: The following Rabbis are involved in the project:
Rabbi Pesach Krohn, noted lecturer, storyteller, and mohel -- indeed, the mohel for both me and my son.
Rabbi Abraham S. Abraham, M.D., author of Nishmat Avraham, cited above.
In turn, Rabbi Krohn consulted with Rav Dovid Cohen for approval on the card. And Rabbi Neuwirth said, in response to being presented with the card, that one should say it even on putting a bandage on a child's skinned knee.
See the comment section for more on this, from the source.

I still have strong reservations about the card and its appropriateness in shaping modern Jewish practice, for all the reasons discussed in this post.
}

Finally, I have to wonder why. Why try to reestablish specifically this practice? Yes, I don't only question motivations of people involved in Women's Tefillah Groups. I also question motivations in newly adopted Tu BeShvat Seders, and I question motivations here.

Is it really because it is halacha and it is really troublesome that people are neglecting it? Or is it part of a larger trend of printing up zuggach on cards, to say incantations in all areas in life? (E.g. the popularization of the Rabbi Meir Baal HaNes cards for lost items.) I suspect the latter, and it doesn't help its case that I see it on Mystical Paths. If so, we might have issues of lochesh on hamakkah, whispering incantations over a wound, which is frowned upon. (The gemara restricts it in various ways, but the spirit of the superstitious practice is still present, if that is how it will be cast by various people.) That is the second reason I am opposed to it.

One final "problem" with the cards -- they left out the dagesh chazak in the yud of sheyehei. But there should be a dagesh there, and thus also a sheva na under the yud. {Update: Yes, I know that often enough, yud sheva or mem sheva causes loss of the dagesh, though not always. I have doubts it happens here for various phonological reasons I won't get into in this post.}

Of course, in any matter of halacha, consult your local Orthodox rabbi.