Tag: surgery

Ascetics, Aesthetics, and Cosmetics

My halachah column for this past year’s פרשת נשא:

In Parashas Naso (6:11), a Nazarite is commanded to bring a sin-offering. As we have noted in previous years, the Talmud (Bava Kama 91b) cites an explanation that this is to atone for the sin of having (unnecessarily) deprived himself of the enjoyment of wine. Elsewhere (Nedarim 10a), the Talmud derives from this that one who engages in (discretionary) fasting is called a sinner.

But in yet another discussion of the topic, the Talmud (Taanis 11a-b) again begins by citing the opinion that the Nazarite and the faster are considered sinners, but then proceeds to cite two other opinions: one that considers them both ‘holy’, and one that invokes the term ‘pious’ (although Rashi and Tosafos actually disagree whether it is the faster, or the one who refrains from fasting, who is termed pious).

The Tosafos complicate matters even further, noting that the same sage (Shmuel) who maintains that the faster is considered a sinner, elsewhere maintains that fasting is permitted, and even a mitzvah! They explain that although fasting is inherently sinful, the mitzvah involved outweighs the sin. This is obviously difficult to understand.

R. An-Shlomo Astruc in his Midrashei Ha’Torah adopts a similar position, elaborating that the ‘sin’ requiring ‘atonement’ is not the Nazarite’s abstemiousness itself, but the underlying fact that his urges have become so powerful that he is compelled to become a Nazarite and renounce wine “which cheereth G-d and man” (Shoftim 9:13) in order to subdue his base nature and evil characteristics and eliminate his carnal lusts. He explains that just as some substances are good for the physically healthy but harmful to the ill, so, too, is wine good for the morally healthy but abstention therefrom a tonic for the morally deranged (cf. Gilyonot Nechama year 5710).

The Ramban in his commentary to our parashah sides with the view that Nazarism is praiseworthy. He explains that a Nazarite ideally ought to maintain his elevated status permanently – “he should remain all his days a Nazarite and holy to his G-d” – and that by declining to do so, he commits a grave sin, “and he requires atonement as he returns to becoming defiled by the lusts of the world”.

My parashah lecture, on the same topic, along with accompanying handout, is available at the Internet Archive. [See also our previous posts here and here about the permissibility of cosmetic surgery.]

First, Do No Harm

I recently recorded a lecture, and published an article, on the Halachah of malpractice; as usual, both are available, along with my lecture notes, at the Internet Archive. The former covers both general malpractice as well as medical malpractice in particular, while the latter is limited to the latter; both focus primarily on the native Halachah, touching only briefly on the important question of the Halachah’s recognition of secular malpractice law, for reasons such as דינא דמלכותא דינא and מנהג.

Update: Another lecture, covering both general and medical malpractice, at the Internet Archive.

Improving God's Handiwork, With Scalpel and Ether

Tzofia Hirschfeld reports for Ynet (h/t: Hirhurim):

Yes, today’s woman of valor wants grace and beauty, and during the International Plastics and Aesthetics Surgery Conference held in Jerusalem, the halacha’s different approaches towards plastic surgery were discussed, as well as the growing demand for such surgeries amongst the ultra-Orthodox sector.

“Man was created in the image of God, and Judaism puts great emphasis on respecting one’s body. This raises the question whether man is allowed to meddle with it,” explains Dr. Moshe Fried, one of the only religious plastic surgeons in Israel. “There is a consensus when it comes to health issues that the physician has the authority to heal according to the halacha. Anything having to do with illnesses, traumas, and birth defects – that’s not even a question.

“The problem starts when a healthy person sees a doctor and asks him to alter his body for aesthetic reasons. Is a doctor allowed to alter a creature made by God? And is a man permitted to risk his life, go under general anesthesia and then get surgery in order to improve his looks? When we hear the reaction from our patients today, we understand things we didn’t understand before – sometimes a person feels he’s ugly on the outside, even though others don’t see it. He feels he is flawed, and a physical alteration affects his metal status.”

“Surgery has developed a lot around the world. The levels of sophistication and capabilities have grown; surgeries are becoming less and less dangerous. Rabbi Eliezer Yehuda Waldenberg and Rabbi Moshe Feinstein viewed these surgeries as a danger to the patient, and since the Torah forbids man from putting himself at risk for no reason – they prohibited those who didn’t need such surgeries from having them. However, there are some rabbis, including Rabbi Ovadia Yosef, who took the fact that medicine is advancing all the time under consideration into account. They also understood that an aesthetic flaw is no less important than any other physical flaw, like a scar from an accident. Today, one can no longer ignore the fact that how a person feels about himself is very significant, because it affects him deeply.”

Rav Waldenberg does, indeed, forbid plastic surgery for cosmetic reasons (“לשם יופי”)‎,1 but the reference to Rav Moshe seems erroneous; on the contrary, Rav Moshe’s published responsum on the topic explicitly permits such surgery:

אם נערה מותרת ליפות עצמה על ידי נתוח שהוא חבלה בגופה

כ’ אדר תשכד,

נשאלתי בנערה שרוצה ליפות עצמה כדי שיקפצו עליה לקדשה על ידי מה שהמציאו עתה הרופאים על ידי נתוח שהוא חבלה בגופה אם מותרת מצד האיסור לחבול בעצמה.

והנה בתוספות בבא קמא דף צא: ד”ה אלא איתא דאסור לחבול בעצמו אפילו לצורך כהא דאשה שטפחה על ראשה להרויח כאיסר שמן. ואם כן אף שכאן הוא צורך גדול הא יש לכאורה לאסור דדוחק לחלק בין צורך קטן לצורך גדול כל זמן שלא מצינו בפירוש. …

אבל הרמב”ם הא כתב בריש פרק ה’ מחובל באיסור הכאה לאדם כשר מישראל שהוא במכה דרך נציון ולחד גירסא דרך בזיון עיי”ש, ואם כן בעובדא זו שהחבלה היא ליפותה הרי אינו דרך נציון ובזיון שלא שייך האיסור ואם במכה חברו הוא רק דרך נציון ובזיון גם במכה בעצמו אין לאסור כשהוא ליפות שאינו דרך נציון ובזיון. …

[ועיין שם שהאריך להוכיח כדעת הרמב”ם, והעלה:] ולכן נראה מזה שיש להתיר להנערה ליפות עצמה אף שהוא על ידי חבלה כיון שאינו דרך נציון ובזיון אלא אדרבה לטובתה. …

[ועיין שם שהאריך עוד בזה, וחידש שאף להחולקים על הרמב”ם ואוסרים בכל אופן, מכל מקום היינו דוקא כשהוא נגד רצון חבירו, ולכן העלה:] אבל ברצון חברו לכולי עלמא מותר … אף אם לא נסבור כהרמב”ם ונאסור חובל בכל אופן כיון שהוא לטובתו וברצונו … ואם כן בנערה ליפות עצמה שהוא לטובתה וברצונה יש להתיר בפשיטות אף אם לא נסבור כהרמב”ם בחדושו דבעינן שיהיה דרך נציון ובזיון.

וקצת ראיה יש עוד להביא מבכורות מה. שתנן היתה בה יתרת וחתכה, ואם היה אסור לחותכה הו”ל למיתני אף על פי שאינו רשאי, … אלא צריך לומר דכיון שהוא לנוי שלכן הוא לטובתו שרוצה בזה ליכא איסור דחובל והוי מזה ראיה ממש לעובדא דידן שכל שכן בנערה שהיפוי יותר צורך וטובה לה מלאיש דהא איתא בכתובות נט: תני ר”ח אין אשה אלא ליופי שודאי יש להחשיב שהוא לטובתה ומותרת לחבול בשביל להתיפות.

משה פיינשטיין2

Although Rav Moshe was asked about a girl whose marriage prospects would be improved by the surgery, it seems that he would have ruled leniently regardless of this consideration, as per the arguments that he adduces, and given that he explicitly rejects the distinction between a “great need” and a “small need”, as we have seen.

R. Chaim Jachter, however, is unsure about this:

An important question, though, emerges from this Teshuvah of Rav Moshe. Does this Teshuvah constitute a sweeping endorsement of the propriety of cosmetic surgery provided that it benefits the patient and is performed with his/her consent? Or perhaps Rav Moshe’s permissible ruling applies only in a situation where the surgery is of great need, such as in the specific case that Rav Moshe adjudicated? Would Rav Moshe permit one to undergo LASIK eye surgery in order to avoid the inconvenience of wearing eyeglasses or contact lenses? I am unsure how to resolve this question.

For other sources on the general topic of cosmetic surgery, see the rest of R. Jachter’s typically lucid and useful discussion: Part I: Rav Moshe and Rav Breisch, Part II: Rav Waldenberg and Rav Weisz, and see the various sources cited in the ספר המפתח הגדול3.

  1. שו”ת ציץ אליעזר חלק י”א סימן מ”א מאות ח’ והלאה, ועיין חלק י”ב סימן י”ח [↩]
  2. שו”ת אגרות משה חו”מ חלק ב’ סימן ס”ו – קשר [↩]
  3. חלק ב’, ערך ניתוח פלסטי, עמוד א’לו [↩]