In this section, we will discuss the range of opinions regarding the halachic propriety of cosmetic surgery, reviewing four classic responsa on this topic from four great, late twentieth-century poskim – Rav Moshe Feinstein, Rav Yaakov Breisch, Rav Eliezer Waldenberg, and Rav Yitzchak Yaakov Weisz.
Rav Moshe Feinstein
Rav Moshe Feinstein (Teshuvot Igrot Moshe C.M. 2:66) was asked whether it is permissible for a young woman to undergo cosmetic surgery to improve her chances of finding a suitable marriage partner. Rav Moshe approved the surgery based on the Rambam’s (Hilchot Chovel Umazik 5:1) definition of the prohibition of chavalah (wounding). In general, the Torah prohibits both wounding another person (see Devarim 25:3) and, as the Gemara (Bava Kama 91b) adds, even wounding oneself. The Rambam specifies that wounding is forbidden when it is performed “in a degrading manner,” (derech bizayon) or, according to an alternative text, “in a belligerent manner” (derech nitzayon). Thus, although the Rambam rules in accordance with the Tannaitic view (ibid.) that an individual is forbidden to wound himself, Rav Moshe infers from the Rambam’s proviso that if the wounding (whether of others or of oneself) is done in a beneficial manner, the prohibition of chavalah does not apply.1For further discussion and a summary of the authorities who either agree or disagree with Rav Moshe interpretation of the Rambam, see Rav Daniel Feldman, The Right and the Good pp. 159-161.
Rav Moshe cites four Talmudic sources for the Rambam’s ruling. First, the Gemara (ibid.) 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, unlike the clothes, the skin would heal itself. It appears that Rav Chisda was permitted to wound himself because it was not done in a degrading or belligerent manner.
Another proof is that the Tanach (Melachim I 20:35-36) and Gemara (Sanhedrin 89a-b) condemn the individual who refused to follow the prophet Michayhu’s divinely-received order that the individual wound him. It was necessary for the prophet to appear wounded in order to emphasize what King Achav should have done to the enemy king, ben Haddad of Aram. Once again, we see that wounding for a positive purpose (in this case, fulfillment of the divine command) is permissible when not done in a degrading or belligerent manner. One could question this proof, however, since an explicit divine command would supersede the prohibition in any case.
Third, the Gemara (Sanhedrin 84b) permits one to perform a bloodletting on his father,2We explain later that generally speaking, one may not perform a medical procedure on a parent when another health care professional is available (Rama Y.D. 241:3). For a summary of the sources on this topic, see Nishmat Avraham (2:148-151). citing as a source the celebrated pasuk, “V’ahavta l’rei’acha kamocha,” “Love thy neighbor as thyself.” Rashi (s.v. V’ahavta) elaborates, “We are forbidden only to do to others that which we would not want done to ourselves.” Rav Moshe explains that beneficial wounding, which bloodletting was considered, is something that all (prudent) people want done to them if necessary. Hence, this Gemara would permit wounding for any purpose that most prudent people would want, which Rav Moshe believes the case in question to be.
Finally, the Mishnah (Bechorot 7:6) discusses a bechor (firstborn) who had an extra finger and removed it, but the Mishnah does not comment on his right to do so. In contrast, earlier Mishnayot (Bechorot 1:1 and 2:1), discussing one who sells his cow to a nochri (gentile), do indeed criticize the sale, adding, “even though one does not enjoy the right to do so.” Since the Mishnah does not condemn removing an extra finger, we may infer that it permits doing so.
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. 3For a discussion of the applicability of the prohibition to injure another person to a situation in which the latter gave consent, see Rav Shlomo Yosef Zevin, L’or Hahalachah pp. 318-328. As it is not done in a degrading or belligerent manner, Rav Moshe asserts that cosmetic surgery does not violate the prohibition of chavalah.4Rav Hershel Schachter told me that Rav Yosef Dov Soloveitchik also permitted cosmetic surgery because it is not done in a belligerent or degrading manner.
Interpreting and Applying Rav Moshe’s Teshuvah
It is difficult to determine how far Rav Moshe would extend his permissive ruling. Does this teshuvah constitute a sweeping endorsement of the propriety of cosmetic surgery provided that it benefits the patient and has his or her consent? Or does Rav Moshe’s lenient ruling apply only in a situation in which the surgery is of great need, such as in the specific case that he adjudicated? Would Rav Moshe permit one to undergo eye surgery, for instance, to avoid the inconvenience of wearing eyeglasses or contact lenses? Rav Hershel Schachter told me that he believes that Rav Moshe’s permission applies only in a case of need, such as in the case that Rav Moshe adjudicated, where the girl wanted the surgery for purposes of finding an appropriate marriage partner.
Rav Mordechai Willig noted (in a personal conversation) that Rav Moshe does not at all address the question of safety. Rav Willig infers that Rav Moshe’s permission applies only when there is no safety concern involved in the surgery. The greater the danger, the greater the need must be in order to permit the surgery.
Rav Yaakov Breisch
Rav Yaakov Breisch (Teshuvot Chelkat Yaakov 3:11) was also asked whether a young woman, seeking to facilitate her finding a suitable marriage partner, could undergo cosmetic surgery to straighten her nose and reduce its size. Rav Breisch cites the ruling of the Shulchan Aruch (Y.D. 241:3) that forbids removing a thorn, performing a bloodletting, or amputating a limb for one’s father even though he intends to heal him. The Rama (ad. loc.) adds that this is forbidden only if there are others available to perform this task. However, if no one else is available and the father is in pain, the son may perform the bloodletting or amputate the limb so long as the father consents. Rav Breisch, assuming that the Rama addresses even a patient whose life is not in danger, infers that he would permit a doctor to cut a limb merely to alleviate pain.
Rav Breisch then expands the definition of pain for which a doctor may injure. His source is the Gemara’s (Shabbat 50b) permission for a man to remove scabs from his body to eliminate pain, but not merely to beautify himself. Rashi (ad. loc. s.v. Mishum L’yafot) explains that removing scabs for beautification purposes is forbidden for a male because it is regarded as feminine behavior.5Halachah forbids both men and women from imitating the behaviors of the opposite gender; see Devarim 22:5 and Shulchan Aruch (Y.D. 182). Tosafot, however, (ad. loc. s.v. Bishvil) qualify the Gemara’s statement: “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.” Thus, Tosafot extend the definition of pain to include psychological distress. Accordingly, since the inability to find an appropriate spouse is certainly most distressing and the prohibition to wound does not apply when attempting to alleviate pain, Rav Breisch permits the young woman to undergo cosmetic surgery.
In addition, Rav Breisch’s teshuvah addresses an issue that Rav Moshe leaves untouched – 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 (Teshuvot Avnei Neizer Y.D. 321) 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.6This principle is discussed at length in our chapter about smoking. The Gemara teaches that if society deems an activity to constitute a tolerable risk, the activity is entirely permissible. Accordingly, Rav Breisch writes, we are permitted to travel in an automobile or an airplane despite the risks. Similarly, the risks associated with surgery have decreased dramatically since the times of the Avnei Neizer, and hence society today regards surgery as a tolerable risk, rendering it permissible.
Rav Breisch’s explicit permission to undergo cosmetic surgery obviously applies only to a situation of great need, as the precedents he cites sanction chavalah only when the individual is suffering physically or psychologically. Indeed, Rav J. David Bleich (Judaism and Healing pp. 126-129) adopts this position as normative. However, Rav Breisch also does not explicitly forbid cosmetic surgery performed for reasons of convenience; he simply does not address the issue.
Rav Eliezer Waldenberg
Rav Eliezer Waldenberg (Teshuvot Tzitz Eliezer 11:41) presents a radically different approach from Rav Moshe’s and Rav Breisch’s. He categorically prohibits all cosmetic surgeries, forbidding both a doctor to perform cosmetic surgery and patients to undergo it.
Some background information is necessary in order to understand Rav Waldenberg’s concerns. The Gemara (Bava Kama 85a) infers from the obligation that the Torah (Shemot 21:1) imposes upon an injurer to pay his victim’s medical bills that “The Torah permits a physician to heal.” Absent such permission, explain Tosafot (Bava Kamma 85a s.v. Shenitnah), we would have thought that we are forbidden to heal because we “appear to be contradicting the King’s decree.” By authorizing medical attention, however, the Torah teaches that we are not contradicting Hashem’s will, because the King who issued the decree for the illness or injury also permitted physicians to heal.
Rav Waldenberg forcefully argues that the divine license to heal applies only to curing an illness, not to altering one’s appearance. It is certainly forbidden, he adds, to risk one’s life to undergo cosmetic surgery, even if the risk is not great.
Rav Waldenberg even calls cosmetic surgery an insult to our Creator, because it implies that His work is inadequate. To prove this point, he cites a story in the Gemara (Ta’anit 20b) in which Rabi Elazar ben Shimon met an exceptionally homely individual and asked him whether all of the people in his town were as ugly as he. The man responded that Rabi Elazar had insulted Hashem by implying, “What an ugly vessel You have made!” Rabi Elazar sought his forgiveness, and though the man refused to extend it at first, the townspeople eventually convinced him to relent. Tosafot, citing Masechet Derech Eretz, comment that the ugly man was none other than Eliyahu Hanavi in disguise.
In another responsum (Teshuvot Tzitz Eliezer 12:43), Rav Waldenberg addresses the permissibility of undergoing elective surgery on a Thursday or a Friday. While the questioner was primarily concerned about the surgery interfering with Shabbat observance and enjoyment,7See Gray Matter 2 pp. 19-23. Rav Waldenberg simply responds that Halachah never condones elective surgery. If a surgery is not necessary, it may not be undertaken.8See the observations of Rav Immanuel Jacobowitz (Noam 6:273) and Dr. Abraham S. Abraham (Nishmat Avraham 2:49) for more regarding Rav Waldenberg’s opinion.
Rav Yitzchak Yaakov Weisz
In a very brief responsum (Teshuvot Minchat Yitzchak 6:105:2) concerning cosmetic surgery, Dayan Weisz focuses on two issues - chavalah and sakanah (the prohibition to enter into a dangerous situation). He adopts an identical stance to Rav Moshe’s regarding chavalah, namely, that it is not forbidden unless it is done in a belligerent or degrading manner. Thus, the prohibition of chavalah constitutes no impediment to undergoing cosmetic surgery. Unlike Rav Breisch, however, Dayan Weisz does believe that the danger involved in any surgery, small though it may be, is of major concern.
Dayan Weisz refers to an earlier responsum (Teshuvot Minchat Yitzchak 1:28:2) in which he forbids undergoing any surgery unless it is necessary to save the patient’s life. In this vein, he interprets the Rama’s aforementioned permission for a son to cut his father’s limb as referring only to a case of life-threatening danger.9This reading appears difficult, as had the Rama had intended this, he should have said so explicitly. According to Dayan Weisz, the Rama omits a vital condition from his ruling.
Accordingly, although Dayan Weisz concedes that some would-be cosmetic surgery patients are defined as cholim (as Rav Breisch argues), he hesitates to permit the surgery, since these people are not cholim sheyeish bahem sakanah (sick individuals whose lives are endangered). Dayan Weisz concludes that he is unsure of this matter, and remarks that with God’s help he might look into the matter further in the future. Though he does acknowledge that Rav Breisch’s argument is a “sevara gedolah” (cogent argument), he stops short of endorsing it.10Rav Shmuel Wosner (Teshuvot Sheivet Halevi (6:198) similarly forbids cosmetic surgery out of concern for the danger involved, small though it may be.
I find it illuminating that neither Rav Moshe nor Rav Breisch shares Rav Waldenberg’s fundamental theological concerns about cosmetic surgery. Arguably, cosmetic surgery does not insult the work of the “Craftsman” because He also revealed to mankind the knowledge and ability to perform cosmetic surgery. Perhaps Rav Moshe and Rav Breisch view such surgery as part of our role as “junior partners” with Hashem in the ongoing creation of the world (see Shabbat 10a and Ramban to Bereishit 1:28).11Rav Gidon Weitzman suggested to me that Rav Waldenberg might respond that we are considered partners with Hashem only when improving the world, such as when creating a child (see Niddah 31a) or when turning wheat into cake (see Tanchuma, Parashat Tazria, parashah 5). Rav Waldenberg could argue that because cosmetic surgery does not constitute a real “improvement” in the world, we are not considered partners with Hashem when performing such a procedure. As such, we are declaring Hashem’s work to be inferior when we attempt to alter it without any real improvement.
Conclusion
The four classic teshuvot on the topic of cosmetic surgery present significantly different approaches to the issue. Rav Moshe and Rav Breisch both permit such surgery, at least when it alleviates distress, while Rav Waldenberg and Dayan Weisz both prohibit it. Rav J. David Bleich (Judaism and Healing pp. 126-128) concludes that it is permissible in case of great need. However, there is no published ruling from a major halachic authority that explicitly permits cosmetic surgery for no reason other than convenience. One who is contemplating cosmetic surgery should consult his or her Rav for a ruling on its permissibility.