58 Mark Washofsky
Iyun Yaakov commentary to the Ein Yaakov, B. Avodah Zarah 18a: it is possible that during times of religious persecution one is indeed permitted to commit suicide in order to escape physical torture that would otherwise lead one to commit heinous sins.(He cites Tosafot, Gitin 57b, s.v.kafizu kulan; see also Tosafot, Avodah Zarah 18a, s.v. veal yechavel beatzmo.) R. Chaninah’s refusal to open his mouth to the flames is therefore an expression of his special piety(midat chasidut) and not a decision that he was obligated to make. If so, says Waldenberg(Resp, Tzitz Eliezer 18:48), the implications of the case of R. Chaninah are restricted to situations of persecution, and his example should not be analogized to a medical context.
76. Jakobovits, Jewish Medical Ethics(New York: Bloch, 1959) is to my knowledge the first monograph published in English on the subject. It was subsequently translated into Hebrew as Harefuah vehayahadut(Jerusalem : Mosad HaRav Kook, 1966).
77. R. Immanuel Jakobovits,“Badin im mutar lekarev mitato shel choleh no’ash hasovel yisurim kashi,” HaPardes 31:3(1956), pp. 16-19.
78. The first part of Jakobovits’s article appears in HaPardes 31:1(1956), pp. 283
79. See Turey Zahav, Yoreh Deah 339, no. 2 and Nekudot Hakesef ad loc.
80. Shiltey Giborim to Alfasi Moed Katan, ch. 3, folio 16a(siman 1237). The answer is“anticipated” because the Shiltey Giborim dates prior to the commentators cited in the preceding note.
81. See Beit Lechem Yehudah, Yoreh Deah ad loc., s.v. mikoach she'omrim.
82. Nachmanides writes(Torat Haadam, Shaar Hasakanah, ed. Chavel, pp. 41-42) that the source of this mitzvah is Exodus 21:19, which establishes medicine as a permitted activity(reshut; see B. Bava Kama 85b). Nachmanides infers that this “permission” is in fact an obligation, inasmuch as we learn from a number of sources that medicine is a sub-species of pikuach nefesh, the commandment to preserve human life. His argument is summarized in Tur, Yoreh Deah 336, and see Beit Yosef ad loc. Rambam (Maimonides ; Commentary to M. Nedarim 4:4) locates the source of the mitzvah in Deuteronomy 22:2(a midrash on the word vehasheivoto; B. Bava Kama 81b and B. Sanhedrin 73a). Jakobovits implies that each of these sources applies to its own specific medical situation. The Rambam source covers obligatory treatment(medicine that offers a successful or tolerable