Thursday, August 02, 2007

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.


Anonymous said...

I noticed that you enjoy controversy...

Torah said...

HMMMMM, I will talk to my husband about your post - It will be an interesting discussion.

Akiva said...

Good points! Two technical corrections...

"Cupping" or baankes (in Yiddish?) is NOT blood letting. The practice involved applying vacuum pressure to specific body points by taking a cup, somewhat larger than a shot glass, placing it upside down (open side down) on the body pressure point associated with the disease, inserting a small amount of kerosene thereby filling it with fumes, lighting it carefully, the burn uses up part of the air creating negative pressure and very tightly sealing the now heated remaining air and cup against the body. More here.

Blood letting is literally reducing blood in the body by inserting an open IV and letting a pint of blood drain out.

Leeches are and ancient and now again modern method of applying a blood-drinking creature, the leech, to a part of the body that either has a problem with blood flow or an infection. Because the leech applies a natural anesthetic and a natural anti-coagulant, it's been found to be extremely effective at draining blood painlessly, and has recently returned to modern medicine as more effective than all other modern techniques.

joshwaxman said...

I got "cupping" from Soncino. I suppose he was using the alternate definition -- "wet cupping/blood cupping" at the bottom of that Wikipedia link.

the chocolate doctor מרת שאקאלאד said...

Cupping ( שטעלן באנקעס shteln bankes "to set cups" in Yiddish)is actually coming back into fashion in some alternative medicine circles. An impressive comeback for a procedure immortalized as the epitome of ineffectiveness in the expression "עס העפֿלט װי אַ טױטן באנקעס" (es helft vi a toytn bankes--It helps like cupping helps a corpse), that is, the only thing that could be more futile than cupping is cupping a corpse.

Anonymous said...

Please see the article in 5 Towns Jewish Times by Rabbi Hoffman on the cards. It's on pages 66 and 67 here:

-Friend of Chaim's

Steg (dos iz nit der šteg) said...

interesting... i've been saying barukh rofei’ hholim for years when taking medicine, but only because i felt weird not saying anything.

(please correct me if i'm wrong about medicine not needing a berakha shehakol or whatnot)

joshwaxman said...

you are certainly correct about not needing a shehakol, since it is not taken to satisfy thirst or hunger.

and it certainly is not problematic to say the tefillah if you have the inclination to do so. i'm worried more about the reinvigoration and systemization of this custom.

Anonymous said...

FYI, the printing and dissemination of the refuah card in memory of my father, Harav Asher Haham Abittan, zt”l, was done at the urging, and with the approval of, Rebbeim of note, namely the author of the Nishmat Avraham, Rabbi Abraham S. Abraham, M.D. and Rabbi Paysach Krohn. They in turn received encouragement for the project from their Rebbeim. For example, the recitation of the Yehi Ratzon was presented to Rav Yehoshua Neuwirth, Shlita (author of Shemirat Shabbat K’Hilchata). Rabbi Neuwirth stated that one should say the Yehi Ratzon even when putting a bandage on a child’s skinned knee (See soon to be published updated Nishmat Avraham).

Chaim S. Abittan

joshwaxman said...

may it be a merit for his memory.

did both of them urge and both of them approve? and while they are Rebbeim of note, Rabbi Krohn, while a noted mohel and lecturer -- is he a posek of note?

I still disagree with the practice, for the aforementioned reasons.

Anonymous said...

Not only did they both urge and approve, but they were actively involved in producing the verbage of the card.

Rabbi Krohn showed and reviewed the card with Rav Dovid Cohen prior to us producing them and he approved of them. In addition, Rabbi Krohn has distributed over 10,000 cards over the past few months.

joshwaxman said...

Thanks. I'll add that to the post as an update, that it has this Rabbinic backing.

What I meant by the query was: Who was the first to come up with the idea of cards? Was it yours, and after consultation as a result, both urged you to proceed? Or did Rav Cohen start by saying "this is something neglected that should be resolved. Is someone in the community willing to step up?"

If asked whether the Yehi Ratzon is appropriate for a wounded knee, *I too* would say, to someone who asked and was interested in saying it, "Sure." The question I would like to pose to someone like Rav Neuwirth is whether it really is a crucial concern of the Jewish people at this juncture that we revive a forgotten and neglected extension of a blessing, which even when proposed was a subject of dispute, and which therefore when said is said without Shem and Malchus. And further, whether a Jew who neglects saying this safek blessing without Shem and Malchut is thereby doing something wrong, by ignoring what is a halachic requirement. It is a different question, from a different perspective.

And my concerns mentioned in the post remain. I mean, there are plenty other neglected practices that have fallen into disfavor. For example, not drinking Zugot. Or, as I hope to cover in a forthcoming post, not eating eggs while a sleepover guest. Any others, but I am talking off the top of my head.

Also of concern to me is the "personal experiences" section of the website, seeking inspirational stories. Therein lies a path to granting it segulah status.

Anonymous said...

Who is the רד"א?

Anonymous said...

I am trying to find the view that you quote from the רד"א? Where can I find it?

joshwaxman said...

Beer Heitiv on the page.

I posted a scan, now up as the top post (but who knows for how long...)

See it here:

If you click on the image, it will zoom in so you can read it better.

Anonymous said...

Wow- talk about over- thinking a beautiful thing..... imagine a world where the biggest issues are that people are thanking and recognizing Hashem in every minute aspect of life, even as trivial and putting on a bandaid. And what better chinuch to a young child than to show him/her the yad Hashem in every action. I vehemently disagree with the author of this article and his attack on this clear cut halacha. this is the equivalent of saying Baruch Hashem- this is a beautiful concept with halachik and rabinic backing.

Anonymous said...

Beautiful thing to do! Every time you say the pasuk you are acknowledging Hashem as the Healer of all healers! It's got a solid source, the Shulchan Aruch, unlike some of the wacky stuff you hear of people doing in the name of "Segula". I personally started doing it and I love that every time before I pop a pill, I stop and think, the pill won't make me feel better, Hashem will and does.

tiferes said...

I agree. I love this. I help my patients say it every time before I do cranial sacral treatments on them. Chazal say that a person has a specific time, healer and type of healing that they are meant to be healed by. This destiny can be changed by giving Tzedka and teshuva/tefilah. So I facilitate thier giving Tzedka and help them say the bracha. My question is halachically is one allowed to use Shem and malchus and where does one draw the line of when to say it. I also use essential oils which are very powerful in healing in most cases more then conventional medicine. Would i say it every time I apply?


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