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Rosh HaShanah Morning 5768 Rabbi Benjamin Sharff, Temple Emanu-El of Tucson, AZ
As many of you know, just as basketball is a driving passion for Tucsonans, football is more than a hobby or a sport; it really is a way of life for Texans. Almost every boy who grows up in Texas grows up playing back yard football. Oftentimes a driveway is one end zone while the curb is the other. The most common play call is, “go deep.” And the football can either made of synthetic leather or that strange spongy substance known as ‘nerf.’ This was the environment I grew up in. Lazy afternoons spent beating the schmutz out of each other all with the goal of achieving glory, at least among the neighborhood kids. Despite at least two concussions (which explains a lot), I still enjoyed playing football so much that I wanted to be on my middle school football team. This was my life’s ambition. When I happened to mention my desire to my mother, her response caught me off guard. She not say, “no.” Or now that I think about it, did she say, “yes” either. Instead she took me to visit our orthopedic surgeon, who also happened to be one of the machers of our congregation. When I walked into his office Dr. Kant gestured towards all of the patient rooms, nurses, x-ray machines, and as well as the beautiful building, which contained them. He said to me, “See all of this … football paid for all of this.”
Needless to say, that was the end of my football career, but ever since that point I have been fascinated by the practice of medicine. Almost immediately I became determined to become a doctor. In high school, I returned to Dr. Kant’s office as part of a mentor program for gifted and talented students. I have a feeling I was chosen for this program not because of any particular gifts or talents, but to instead to get me out of the building. But that is a sermon for another day. As part of this mentor program, I followed Dr. Kant around on calls, on rounds, and I even got to watch several surgeries. It was neat scrubbing in, though much to my chagrin, they did not let me make any actual incisions. They only let me suture afterwards. Oh well. (For any malpractice attorneys out there, I am just kidding). After finishing high school, I headed off to college. The first of my several majors was pre-med. Though you might be wondering to yourself, how did this nice Jewish boy end up in rabbinic school rather than medical school? Which reminds me of a old classic Jewish joke like those heard on Too Jewish with Rabbi Sam Cohon and Friends, which can be heard every Sunday at 9am on KVOI 690am But to answer your question as to why I never went to medical school the answer is found in these two simple words: organic chemistry. So even though my medical career ended before it began, I have always been interested in the practice of medicine, which of course only grew when I met and married a soon-to-be doctor. It was in rabbinic school where I learned how medicine was more than merely a personal fascination, but also a significant component of Jewish life as well. The rabbis actually spend countless pages and hours discussing medicine as if the actual practice of medicine is a holy act in and of itself. In order to understand how they came to this conclusion we need to go to the very beginning of our people’s ancient narrative. We have to travel all the way back to the story of Adam and Eve. It is in this story we learn the central concept of how each of us are all created b’tzelem elohim, in the divine image. This concept of b’tzelem elohim is used to demonstrate how there is something unique in each and everyone of us, an element of the Holy that establishes a sense of divine worth. As we are taught, because we are all created in the image of God, we are all creatures worthy of being treated with respect and dignity. But there is another element at work in the creation story as well. As we learn from Genesis, when God created Adam, God breathed life into him thus creating a creature both of spirit and body. So even though we are created from dust, we also have the Divine breath within each us. Thus the rabbis argue that though we are made up of two separate elements, nefesh (the spirit) and the goof (the body), nonetheless they make up one integrated whole. As the rabbis argue, we cannot possibly exist without both our bodies and our souls working together in a symbiotic ballet of physical needs and spiritual desires. According to this understanding, we are obligated to take care of our physical well-being. This is based on the Jewish notion that what we have ultimately is a gift from God. To take it a step further, this gift is to be treasured and not decimated, hence we find prohibitions against acts like tattooing and extreme body piercing. Yet as the rabbis also argue, there is another element at play as well. If our bodies and our souls make up the complete whole, then how our bodies bring our soul’s manifestations to life represent who we truly are. For how we use our bodies and our souls together demonstrates our personal fulfillment of the brit, the covenant, established at Sinai. Thus there is an imperative in our tradition, an obligation, in the words of Eliot Dorff in his book Matters of Life and Death, “to maintain our health not only to care for God’s property but also so that we can accomplish our purpose in life, namely, to live a life of holiness.” Yet there is a still a large chasm to cross between the notion of taking care of ones’ physical self and healing others. So much so that upon initial reading of our sacred literature, one might even come to the conclusion that the job of healing others cannot possibly even rest in human hands. The Torah argues in multiple places that illness is a punishment for sin. This is notion is painted quite vividly with the story Miriam, who in the book of Bemidbar spoke out against Moses, and was struck down with an illness often translated as leprosy. In this passage our text appears to be arguing that God is the source of illness. But we also find in our tradition the notion of God as healer. Upon witnessing the affliction his sister is struck down with, Moses pleads with God, “el nah, refah nah lah,” “God of healing, please heal her” (Num. 12:13). At which point Miriam was sent from the camp to be healed from her physical pain. Hence one might come to the conclusion that just as God is the only source of illness, God too is the only source for healing. It is this interpretation that has led some faith traditions that use our sacred texts to argue against any form of human intervention when it comes to the issues of illness and healing. Though acutely aware of this line of reasoning, the rabbis, nonetheless argue it is incumbent upon humanity to heal. In order to come to this conclusion, they too also cite passages from the Torah as well. They look to statements like the mitzvah of how an assailant as part of his obligation, must insure that his victim is thoroughly healed (Exodus 21:19-20). Another passage often cited to support the practice of medicine is, “do not stand idly by the blood of your neighbor” (Lev. 19:16). From these as well as other textual citations we learn how it is incumbent upon each of us to come to the aid of a person in distress, which often times is through the use of medicine. By the time of the compilation of the Talmud some 1600 years ago, the practice of medicine was iffy at best. Despite this fact, Talmud prohibits Jews from living in a community in which there are no physicians, as if to say, even though the help might not be the best, there still should be individuals practicing medicine where you choose to live. To take it one step further the Shulchan Aruch (the central code of Jewish law) states, “The Torah gave permission to the physician to heal; moreover, this is a religious precept and is included in the category of saving life, and if the physician withholds his services, it is considered as the shedding of blood.” From this we learn the duty for an individual physician to provide healthcare. If one is trained in the practice of medicine, one is obligated to use such knowledge to save a life also known as pikuah nefesh. The essence of Pikuah nefesh is so central to our core as human beings that the act of fulfilling this mitzvah can even override the laws of Shabbat and Yom Kippur. These laws just represent the actions of single individual medical professionals, so once again we are left asking yet another question. Does the greater community have any obligations towards providing healthcare? To begin to find our answer, we must once again return to the world of the Talmud. The Talmud states there are ten specific items a community must provide for its members, “It has been taught a scholar should not reside in a city where any of the following ten are missing: (1) a court of justice … (2) a charity fund … (3) a synagogue; (4) public baths; (5) toilet facilities; (6) a moyel; (7) a surgeon; (8) a notary; (9) a shochet (ritual slaughterer); (10) a schoolmaster” (BT Sanhedrin 127b). It is interesting to note how many of these have to do with public health and healthcare. In this passage communities are required to have proper facilities with public baths and toilets as well as proper medical personnel such as surgeons and moyels, yes moyels are considered proper medical personnel. Thus we learn from this passage: the state of communal healthcare can and should be a vital concern of the Jewish community. When we discuss Judaism and medicine we tend to focus on what Judaism has to say about specific issues. What does Judaism have to say about end of life care, fertility issues, abortion, and even cremation? When looking to our tradition we find a breadth and wealth of information to help guide us in our difficult and personal decisions many of us encounter in our lives. But it is also worth noting that our tradition has a lot to say about the broader scope of medical care including the distribution of such care, its costs, and issues relating to managed care. I would hope that we would all be in agreement that the healthcare system in our country is fundamentally flawed in many ways. It is outrageously expensive. Patients often have to wait long hours to receive treatment, and when they do, they are often charged ridiculous amounts for it. Doctors, who spent years in training, now have to see more patients than ever just to pay their bills, because they receive less and less remuneration for their skills. No other place in our society are individuals not paid for what they charge. While at the same time our society as a whole is becoming unhealthier in a lot of ways especially as a result of our expanding waist lines. Our healthcare system is sick. We are left wondering is our healthcare system in a terminal state? Or is there a cure? Right now, in the national debate, there appear to be only two solutions to this fundamental problem. The first is a nationalized system, which is often referred to as socialized medicine. Those in favor describe how a system maintained by the government will cure most of our ills. Those against describe a national healthcare system as being one step closer to communism at best or the French at worst. It is a system of complete government oversight, which opponents argue will prevent innovation, instead resulting in long waits for important medical procedures. However, at least in theory, this sort of system should help keep costs down because it spreads the impact on the entire population. More than that, it is also quite probable the amounts we pay in insurance premiums are still more than we would pay in taxes for such a system. A purely capitalist system on the other hand, is focused primarily on profits first and then treatment second. When a policy holder becomes unprofitable, either their procedures are denied, or they are dropped from the program due to that dreaded pre-existing condition. You are left asking such foolish questions as how many stitches constitute a case of urgent care versus a true medical emergency. If you guess wrong, your insurance is likely not to cover this procedure. This system does encourage innovation, but at what cost we often wonder. So which system, as Jews, should we be supporting? To find the answer I suggest we again turn back to tradition. There is a ruling in the Shulchan Aruch which states, “If someone is taken captive and he has property but does not want to redeem himself, we redeem him “with the money his property will bring” against his will. Even though this source is about redeeming the captive, for the rabbis the principle remains the same, we as individuals have a financial obligation to take care of ourselves. But at the same time our tradition also argues that each community is not only supposed to provide the proper medical personnel, but it also “must pay for the healthcare of those who cannot afford it as part of its provision for the poor” (Dorf 307). Thus our tradition proposes setting up a system with both communal and personal elements to it. Judaism argues it should be a system built both upon personal responsibility as well as communal obligation. We can talk about holding corporations more responsible for their actions, yearly caps on increases, tax deductions for the young and healthy, maximum times limits on determining pre-existing conditions, establishment of more urgent care facilities, proper payment for services, rewarding healthy behavior, rewarding doctors for encouraging healthy choices, regulations on the prescription drug industry, and the like. We can work to create a system that holds people accountable for personal choices, but does not punish them for their genetic heritage. But Judaism will tell us, in the end, it is essential to have medical care be accessible and affordable to all without draining too much the resources of the land in which we live. For being able to access medicine may not be a right of the individual to acquire, but it is certainly an obligation of the community to provide it. It will take people of great motivation and courage to bring such a vision to fruition. It may mean we have to change our fundamental understanding of what medicine is and how it should be provided. So on this Rosh Hashana we are encouraged to lend our voices to the national debate not just as individuals, but also as Jews. Our tradition provides us with the authority and the parameters to help guide the establishment of a healthcare system that provides fair and quality treatment for all members of society. For no matter the debate, we as Jews who come from a long tradition of uplifting all of those among us, not just those who can afford it.
Shana Tova!
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