inflicting pain in surgery & Brit Mila

Hi,

I am Jay Reidler (Harvard College '09; currently studying Refuah V'Halacha in Yeshivat Hakotel for the year; I've enjoyed coming to the Schlesinger lectures very much over the year).

I read Dr. Steinberg's recent article in JME IV(1) on Anesthesia and Circumcision and it prompted some important questions:

1a) Let's take the theoretical example of a patient with a malignant tumor on their skin. A doctor has a chiyuv (V'Hashevota Lo, etc) to remove that tumor, and is permitted to cut off/around the tumor, since the issur of chabala (hurting someone) is overridden/waived. Now let's say the doctor cuts off the tumor without any anesthesia, and in so doing causes unnecessary pain to the patient (there's was no medical justification for not using anesthesia) — has he violated any issur (e.g. chabala)???. My impression is that the doctor had permission to do a certain amount of chabala (i.e., cutting off/around the tumor), but did not have permission to cause unnecessary pain and so he does violate an issur.

1b) If the doctor does violate an issur in question 1a for causing unnecessary pain, would a patient be permitted to accept such a treatment without anesthesia, if doing so has no medical benefits? If my understanding of chabala in question 1a is correct, this would not be allowed either because it would be tantamount to self-inflicted chabala, which is also an issur?

This question is very relevant to medicine in general, because it examines whether a doctor has a chiyuv to minimize pain even when he is doing a necessary/permitted treatment, and asks if an issur is overridden if he doesn't (other example – a doctor who can give a local anesthetic before giving a shot, but doesn't because "the child won't remember" or "it's too much of a hassle for a small shot and not worth it…").

I believe R' Moshe Feinstein took the idea of causing unnecessary pain into account when determining whether to prolong the life of the terminally ill patient – but I don't recall him employing the concept of chabala.

2) The relevance of the above question to Dr. Steinberg's article is as follows: Dr. Steinberg seems to conclude that, while according to some poskim one may not use anesthesia for an infant/adult, according to many it is permitted (mutar) to use anesthesia on an infant. Now, if we hold according to the latter poskim that it is mutar, shouldn't it be a chiyuv to use anesthesia! The mitzvah of circumcision gives us right, perhaps by the concept of aseh docheh lo ta'aseh, to cause a certain degree of chabala to the child (e.g. removing the arlah), but does it give us permission to cause unnecessary pain while doing this?? In the time before anesthesia, the mitzva of brit milah may have allowed us to inflict pain while doing circumcision because there was no alternative, but now that we have anesthesia, do we still have permission to cause this unnecessary pain?

(I am writing an article on this topic which I might submit to "B'Iyyun," a new Intercollegiate Undergraduate Journal for Orthodox Judaic Thought. I'd appreciate if you'd let me know if I can quote/paraphrase your response. I won't be insulted if you don't give me permission).

Thank you very much

Jay Reidler

(You have my permission to publish/paraphrase this question in a future JME edition, if you'd like)