This week, we will begin to our discussion of the range of opinions regarding the Halachic propriety of cosmetic surgery. We will review four classic responsa on this topic from four great late twentieth-century Poskim - Rav Moshe Feinstein, Rav Yaakov Breisch, Rav Eliezer Waldenburg, and Rav Yaakov Weisz. These four Rabbanim rank in the first tier of late twentieth-century Poskim and we will carefully examine their rulings on this topic. I am indebted to my cousin Yehuda Brandriss, with whom I studied this topic, for the insights he provided.

Rav Moshe Feinstein

Rav Moshe Feinstein was asked in 1964 whether it is permissible for a young woman to undergo plastic surgery in order to improve her chances of finding a suitable marriage partner (Teshuvot Igrot Moshe Choshen Mishpat 2:66). Rav Moshe permitted the surgery based on the Rambam’s (Hilchot Chovel Umazik 5:1) definition of the prohibition of Chavalah (wounding). In general, the Torah prohibits wounding another person (see Devarim 25:3) and the Gemara (Bava Kama 91a) states that this prohibition applies even to wounding oneself. The Rambam writes that this prohibition applies when it is performed “in a degrading manner.” An alternative text reads “in a belligerent manner” (Poskim regard both texts as viable). This is highly significant as the Rambam rules in accordance with the Tannaitic view that an individual is forbidden to wound himself. Rav Moshe infers from the Rambam that if the wounding is done in a beneficial manner the prohibition of Chavalah (to others or oneself) does not apply. An individual may wound himself if it is done for his benefit.

Rav Moshe cites four Talmudic sources for the Rambam’s ruling. First, the Gemara (Bava Kama 91b) records that when Rav Chisda walked among thorns he would roll up his pants so that his skin would be scratched instead of his clothes. He explained that the skin heals itself and the clothes do not. We see that the prohibition to wound oneself does not apply if it is not done in a degrading or belligerent manner.

Second, the Tanach (Melachim 1:20:35-36) and Gemara (Sanhedrin 89) condemn the individual who refused to follow the Navi Michah’s order (communicated from Hashem) to the individual to wound the Navi. It was necessary for Michah to appear wounded in order to emphasize a certain point in an exhortation he would deliver to King Achav. We see that wounding for a positive purpose (in this case fulfillment of the Divine command) is permissible since it is not done in a degrading or belligerent manner. One could question this proof, however, since a Divine command would seem to suspend a prohibition.

Third, the Gemara (Sanhedrin 84b) states that one is permitted to perform bloodletting on his father. The Gemara cites the celebrated Pasuk “Viahavta Lireiacha Kamocha” (love thy neighbor as thyself) as the source for this ruling. Rashi (s.v. Viahavta) explains, “We are only forbidden to do to others that which we would not want done to ourselves.” Rav Moshe explains that beneficial wounding such as bloodletting is something that all [prudent] people want done to themselves if necessary and therefore it is not included in the prohibition of wounding others. We see that wounding for a beneficial purpose is permissible.

Fourth, the Mishnah (Bechorot 45a) discusses someone who had an extra finger and removed it. This Mishnah does not add the words “even though one does not enjoy the right to do this.” In contrast, earlier Mishnayot in Bechorot (2a and 13a) mention one who sells his cow to a Nochri and indeed comment “even though that one does not enjoy the right to do so.” Thus, we may infer that the Mishnah permits removing an extra finger, since it does not condemn one who does this.

In light of this considerable evidence, Rav Moshe rules that the girl is permitted to undergo cosmetic surgery since it is done for her benefit and with her consent. Plastic surgery does not violate the prohibition of Chavalah since it is not done in a degrading or belligerent manner.

Interpreting and Applying Rav Moshe’s Teshuvah

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.

Rav Moshe’s ruling (Igrot Moshe Orach Chaim 3:90) regarding the permissibility of attaching an IV to a very sick individual to avoid the necessity for him to eat on Yom Kippur, might be relevant to this question. Among the reasons that Rav Moshe presents for forbidding attaching an IV for this purpose is concern that the Divine license to heal does not apply to such a circumstance. Some background information is necessary to understand this issue.

The Gemara (Bava Kama 85a) infers from the fact that the Torah (Shemot 21:1) obligates an individual who injures someone to pay the latter’s medical bills that “the Torah permits a physician to heal.” Absent such permission, we would have thought, explain Tosafot (ad. loc. s.v.Shenitnah), that we are forbidden to heal because we “appear to be contradicting the King’s decree.” The Torah teaches, though, that we are not contradicting the Divine Will, because the King who issued the decree for the individual to become ill or injured, also permitted physicians to heal.

Rav Moshe suggests that perhaps the Divine license to heal applies only to remedy a malady or injury but not to enable a sick individual to fast on Yom Kippur. Perhaps Rav Moshe also believes that Hashem permits us to perform cosmetic surgery only when it is done in case of great need but not when it is done merely for convenience. I find it difficult to determine what Rav Moshe’s opinion is on these matters from his published Teshuvot.

Rav Yaakov Breisch

Rav Yaakov Breisch (who lived in Switzerland and died in 1970) was also asked whether it is permissible for a young woman to undergo plastic surgery in order to straighten and reduce the size of her nose, in order to facilitate her finding a suitable marriage partner (Teshuvot Chelkat Yaakov 3:11 and Choshen Mishpat 31 in the new editions of this work). Parenthetically, it seems that Rav Moshe and Rav Breisch were addressing the same case and that the Rav who submitted the question to Rav Moshe also submitted it to Rav Breisch for adjudication (this is conjecture, as Rav Breisch’s responsum is not dated and the Igrot Moshe does not identify the questioner).

Rav Breisch attacks the question differently than Rav Moshe. Instead of defining the prohibition of Chavalah, he searches for precedents in earlier works for wounding for cosmetic purposes. Rav Hershel Schachter once mentioned (in a talk at Yeshiva University) that the Litvish (Jews from Lithuania) style of resolving Halachic issues is to define the parameters of the prohibition or Mitzvah that is addressed, while the style of Poskim from Galicia is to search for precedents that are comparable to the issue they address.

Rav Breisch cites the ruling of the Shulchan Aruch (Yoreh Deah 241:3) forbidding one to remove a thorn, or perform bloodletting, or cut a limb of one’s father even though he intends to heal him. The Rama (ad. loc.) adds that this is forbidden only if there is no one else available to perform this task. However, if no one else is available and the father is in pain, it is permissible for the son to perform bloodletting or to cut a limb, to the extent that the father consents. Rav Breisch infers from the Rama that a doctor is permitted to cut a limb merely to alleviate pain. Rav Breisch assumes that the Rama addresses even a patient whose life is not in danger.

Moreover, the Gemara (Shabbat 50b) states that a man is permitted to remove scabs from his body to eliminate pain but not for beautification purposes. Rashi explains that removing scabs for beautification purposes is forbidden for a male because it is regarded as feminine behavior. Tosafot (ad. loc. s.v. Bishvil) write, “If the only pain that he suffers is that he is embarrassed to walk among people then it is permissible, because there is no greater pain than this.”

Rav Breisch observes that Tosafot expand the definition of pain to include psychological distress. Accordingly, Rav Breisch permits the young woman to undergo plastic surgery since it is done for the purpose of finding a suitable mate. The inability to find an appropriate marriage partner is certainly most distressing and the prohibition to wound does not apply to cosmetic surgery that is performed to resolve this problem.

In addition, Rav Breisch addresses an issue that is not discussed in Rav Moshe’s responsum, the prohibition to place oneself in danger (see Shulchan Aruch Y.D. 116 and C.M. 427). The questioner cited a responsum of the Avnei Neizer (Y.D. 321; the Avnei Neizer lived in the early twentieth century) forbidding a child to undergo surgery to straighten his crooked leg, because of the danger involved.

Rav Breisch, in turn, notes that the Gemara in numerous places (such as Yevamot 72a) permits certain activities that involve some danger if people commonly engage in such behavior. The Gemara teaches that if society deems an activity to constitute a tolerable risk, one is permitted to engage in such activity. Accordingly, Rav Breisch writes, we are permitted to travel in an automobile and airplane despite the risks. Similarly, Rav Breisch explains that the risks associated with surgery have lowered dramatically since the times of the Avnei Nezer. He notes that today society regards surgery as an tolerable risk and thus is permissible in our times.

Rav Breisch’s explicit permission to undergo plastic surgery applies only to a situation where there is a great need for it. The precedents cited by Rav Breisch sanction Chavalah only when the individual is suffering physically or psychologically. Indeed, this is the position that Rav J. David Bleich (Judaism and Healing pp.126-129) adopts as normative. However, Rav Breisch also does not explicitly forbid cosmetic surgery done for reasons of convenience. He simply does not address this issue.

Conclusion

Next week, IY”H and Bli Neder, we will present the opinions of Rav Eliezer Waldenburg and Dayan Yitzchak Weisz and conclude our discussion of cosmetic surgery.