The Mitzvah of Pru U’ Revu Requires Effort
Every birth of a child is a great mitzvah and partnership with Hashem in the creation of the world * Our Sages determined it is impracticable to rely only on the birth of two children since we do not know what their future will be, and thus one must try to have at least four children * In the past, artificial methods of giving birth were considered unnatural intercession, however, today, when methods of treatment have proven to be effective, it is a mitzvah to make use them * Just as one does not rely on prayer to earn a living but works for his sustenance, thus, prayers alone should not be relied upon – and when necessary, turning to treatment is obligatory
The Mitzvah of Pru U’ Revu
Q: Are a couple who find it difficult to fulfill the mitzvah of pru u’ revu obligated to consult a doctor?
A: It is a mitzvah from the Torah to procreate and multiply (pru u’ revu in Hebrew), and with every child born to a husband and wife, they fulfill a great mitzvah, are privileged to partner with Hashem in the birth of a human being, and thus, maintain an entire world (Niddah 31a, Mishna Sanhedrin 4: 5). This is the fundamental goal of creation, for Hashem desired the world to be inhabited, as our Sages said: “Indeed the world was created only for procreation”(Mishnah Gittin 4: 2), as it is said: “He created it not a waste, He formed it to be inhabited (Isaiah 45:18).
Since the fulfillment of this great mitzvah depends on many factors, without a binding definition – despite people’s good intentions – many will not succeed in fulfilling it. Thus, halakha determines it is a mitzvah to marry by the age of twenty, and when necessary, as in our times, marriage can be postponed until the age of twenty-four (Peninei Halakha: Simchat Ha’Bayit U’Birchato 5:7-11).
Two Steps in the Mitzvah
From the Torah, the obligatory mitzvah is to give birth to a son and daughter, and our Sages additionally determined as an obligatory mitzvah that a person beget more children. There are two reasons for this: 1) because of the great significance of partnering with Hashem in the birth of life into the world, “for one who adds a soul in Israel, it is as if he built a world”, and 2) because even if a person merited giving birth to a son and a daughter, he cannot be certain he has fulfilled the mitzvah. Perhaps one of his children will die, or is sterile, or remains single all his life. Apropos to this, Rabbi Yehoshua said (Yevamot 62b): “If a man married in his youth, he should marry again in his old age; if he had children in his youth, he should also have children in his old age; for it said, ‘In the morning sow your seed and in the evening let your hand not be idle, for you do not know which will succeed, whether this or that, or whether both will do equally well’ (Kohelet 11:6).
Seemingly, one could say that the obligation determined by our Sages is unlimited and that one must strive with all his might to have as many children as possible. However, it seems more likely that there are two steps in the mitzvah determined by our Sages. The first step is suitable for everyone – namely, to have about four or five children. The second step is a hiddur mitzvah (an enhancement of the mitzvah) – i.e., having more children – each couple according to their ability and discretion (Peninei Halakha ibid 5: 5-6).
The Obligation to Use Medical Treatment
Q: In the event of difficulty in getting pregnant, must a couple turn to doctors, perform tests, and use medical treatments to fulfill the mitzvah?
A: A couple who has found through reliable tests that the chances of having a child naturally are very low must do everything acceptable according to medical practice in order to fulfill the mitzvah of pru u’revu. This includes in-vitro fertilization, which is performed by taking eggs from a woman and sperm from a man and combining them in a test tube where they mix and begin developing into a fetus which is then inserted into the uterus.
Indeed, in the past, the poskim ruled that a person did not have to take unnatural steps in order to fulfill the mitzvah, and as ‘Divrei Malchiel’ wrote about a hundred years ago in his Responsa: “We were commanded to fulfill the mitzvah of pru u’ revu naturally, and not by such deception, which is closer to the issur (prohibition) and the michshol (obstacle)”. The “michshol” is hotza’at zera levatalah (the wasting of seed), and the fear that a woman may have been impregnated by the sperm of another man.
However, this was at a time when no reliable methods of solving the problems were found, and even doctors differed; consequently, the majority of people were not used to using methods developed by some doctors, and thus trying them was considered unnatural. However, today when medical methods have developed successfully, to the point where the majority of problems of infertility are resolved by them, everything common within the framework of medicine is considered obligatory in the mitzvah. And clearly, the obligation includes all treatments that health funds are required to provide to their policyholders. In addition, it seems that even treatments that are not included in the regular health insurance, if most people who want to have children use them, they must be done even if they are expensive, in order to fulfill the mitzvah of pru u’revu (Peninei Halakha ibid 6: 1, footnote 1).
A Woman’s Obligation is the same as a Man’s
Q: Since only the man is obligated in the mitzvah of pru u’revu and a woman is exempt, is she obligated to undergo fertility treatments, which involve physical and mental difficulties, for her husband?
A: Firstly, in the general mitzvah, a woman has no less of a part than a man, and only in the context of the individual requirement is a man obligated and a woman exempt (see Peninei Halakha ibid, 5: 2 footnote 2). Second, after Rabbeinu Gershom’s decree was accepted, according to which it is forbidden for a husband to marry two women or to divorce his wife against her will, at the time of her wedding a woman agrees to participate with her husband in the obligation of the mitzvah (Chatam Sofer, E H. 20; ibid 5:14).
To Rely on Prayers Alone?
Those who claim it is enough to pray to Hashem, thinking, if Hashem wants, He will mercifully grant them special providence – are similar to a hungry person who doesn’t go to a store to buy bread, saying that if the Almighty wants, He will bring bread to his house. And as Rambam wrote (in his commentary on Mishnah Pesachim 4: 9) about the ‘Book of Remedies’ that Hezkiyahu hid, which should not be interpreted as the fools did, saying it contained true cures and Hezekiyahu hid it so that people would pray to Hashem. Anyone who interprets it in this way attributes to Hezekiyahu and his faction “foolishness that one should only associate with the lowliest of the masses. According to their erroneous and weak logic, if a person is starving, and then eats bread, he will undoubtedly be cured of his great pain — they would say that he removed his trust in God. One should tell them they are deranged. Just as when I eat, I thank God that He created something to remove my hunger and to keep me alive and well, we should also thank Him for creating a cure that cures my illness when I need it.” Rather, the ‘Book of Remedies’ he hid, contained false medicines or dangerous drugs.
Similarly, Rabbi Yehuda Ayash (1688-1759) of Algeria, in his book, ‘Shevat Yehuda’, wrote that a sick person and his relatives are obligated to seek out a doctor and medicine to be healed. Anyone who is lazy and negligent in this matter, and is not careful to be cured in medicine naturally, but relies on a miracle that Hashem will send His word and heal him free of charge, is nothing but “of the puzzled and ignorant”, “and is close to being a heretic himself, and destined to be judged.” Just as a person must guard himself against heat and cold, and anyone who does not, rationalizing “If Hashem doesn’t want me to be sick, nothing bad will happen to me” is a fool – so it is in medical matters, that Hashem created the world for us to behave according to nature – some medicines are naturally beneficial, and others in a supernatural way, as explained in the Talmud. Our Sages also said it is forbidden for a Torah scholar to live in a place where there is no doctor (Sanhedrin 17b). Indeed, there were tzadikim (righteous people) answered by prayer and had no need for medication, however, they did not rely on a miracle, but were answered beforehand. And if a person lingers in his illness and does not go to the doctor to be cured by natural means, he will die of that same disease, and not as previously decreed for him to live longer; he is similar to someone who enters a fire sure to burn him, and will die an untimely death. This is the essence of what he wrote.
Erroneous Claims in the Name of Faith
It is true that in the words of Ramban in his commentary on the Torah (Bechukotai 26:11), it follows that it is proper for the righteous not to turn to medicine. This is how the righteous acted in the time of prophecy – if they were sick, they would not seek out doctors, rather prophets: “What is the purpose of a doctor in a house that does the will of Hashem? After we are assured by Him that He will bless our bread, our water, and remove sickness from our midst. And regarding the Torah obligating a person who injured his friend to pay his medical fees – this refers to those who wish to follow the paths of nature, “because the Torah does not rely its laws on miracles… because Hashem wanted the path of man to be that he should not deal with medicine or physicians.”
However, the Ramban himself has already written that it is an obligatory mitzvah to draw on doctors and medicine, and it is even considered pikuach nefesh (preservation of life), just as a patient is fed on Yom Kippur, and Shabbat is desecrated for the preparation of medicine (Torat Ha’Adam, Shaar Ha’Mechush, on the issue of danger).
Some Torah scholars explained that the difference is between when prophecy rested in Israel – at that time the righteous relied on prophets – and when there is no prophecy and ruach ha’kodesh (Divine inspiration), at which time people are obligated to take advantage of doctors (Chida, 366:6; Divrei Yatziv, Likuteim 114).
Tested Medicine Must be Used
However, it appears that the main difference is in the type of medicine and drugs. All agree that a person whose life is in danger because of the fast of Yom Kippur is obligated to drink and eat and not to turn to God in prayer, because it is understood that drinking and eating will benefit him. Likewise, if a house collapsed upon a person, all agree that Shabbat must be desecrated by removing the rubble in order to save him. This is also the attitude towards any medical treatment proven and known to heal. On the other hand, there were drugs which in the opinion of doctors of that time were beneficial, but were far from certain, and concerning them, the Ramban, who was a doctor himself, wrote it would be better for the righteous to trust Hashem, and not to go to doctors.
However, when it comes to medical treatments that are proven to be beneficial in high percentages, Ramban would also agree that the righteous must go to doctors. Just as a person is required to eat and drink as needed in order to live, he is also obligated to take advantage of medical treatments known to be lifesaving. Similarly, a couple who cannot fulfill the mitzvah of pru u’revu naturally, are obligated to turn to fertility treatments, which in the last generation have proven to be very helpful.
In other words, after methods of scientific research have developed in recent generations, everything systematically tested and found to be very useful to a person’s health is considered part of the laws of nature, and must be used for curing. And what seems to be useful but its effectiveness is unclear and nevertheless doctors use it for lack of a better solution, falls into the general category of what Ramban wrote, namely, whoever wants to follow the ways of Hashem does not need medicine.
This article appears in the ‘Besheva’ newspaper and was translated from Hebrew.