Acts vs Outcomes: The Rambam and Ramban on the Mitzvah of Refuah
As healthcare professionals, we strive to heal, yet the final decree rests in God's hands. Even when modern medicine and interventions are applied to their fullest, the end of life is determined by His will. In general, treating and healing a person constitutes the mitzvah of refuah. The Rambam and Ramban argue about the primary source of this mitzvah. One consequence of this debate is whether one still fulfills the mitzvah of refuah when a patient passes away.
The Rambam sources the mitzvah of refuah from the pasuk of “VaHashevoso Lo – And you shall return it to him” (Devarim 22:2). However, the Ramban cites many areas in the Torah that show there is a mitzvah but contends that the primary source is“v’Rapo Y’rapei.” (Shemos 21:19) The Rambam doesn't use v’Rapo Y’rapei as his primary source because then there would be no need to derive it from VaHashevoso Lo.
The crux of their discussion is constituting what the mitzvah of refuah is. The Rambam’s source of VaHashevoso Lo is written regarding the mitzvah of Hashavas Aveidah (returning a lost object). It is also derived to teach that the mitzvah of refuah is restoring a person’s health. However, just as one is obligated to return a lost item, but if the item becomes ruined or damaged, they do not fulfill the mitzvah of Hashavas Aveidah, the same logic would seemingly apply: a physician who fails to restore their patient’s health has not fulfilled the mitzvah, despite their best efforts. However, Ramban’s primary source is the pasuk of “v’Rapo Y’rapei.” Meaning it's the act of healing itself that constitutes the mitzvah. Therefore, even if a physician errs or the outcome is not as hoped, one still fulfills the mitzvah or refuah.
Adapted from medicalhalacha.org