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The Foreseeable Future: May We Try to Find Out What Lies Ahead?
Adapted from the writings of Dayan Yitzhak Grossman
August 1, 2024
The AP reports:
What if there was a way to peer into your body and spot early signs of cancer and other life-threatening ailments before they became serious?
That’s the pitch from a new cluster of companies selling high-tech scans to healthy people interested in learning more about their wellness.
These whole-body MRI scans aren’t cheap. Startup companies like Prenuvo charge between $1,000 to $2,500 for various scanning options, none of which are currently covered by insurance…
But many medical experts say the companies are selling expensive, unproven technology that may cause extra worries and unnecessary treatment, while driving up costs for the U.S. health system…
Companies like Prenuvo say their scans can help identify more than 500 medical conditions that can go undetected at a typical doctor’s visit.
The company charges $999 to scan the torso, $1,799 for the head and torso or $2,499 for the entire body. Several other companies offer similar services and pricing…
Many radiologists say the likelihood of finding a serious problem, such as a cancerous tumor or brain aneurysm, in someone with no symptoms is very low. Instead, scans are likely to flag growths that are usually harmless. Definitively ruling out a problem could require additional tests, appointments and even surgeries…
The American College of Radiology does not recommend MRI screening in people without symptoms, stating that there is “no documented evidence” the technique is “cost-efficient or effective in prolonging life.”[1]
In this article and a follow-up, we consider some halachic perspectives on such “preventive” scans.
The Torah commands: “Tamim tihyeh im Hashem Elokecha.”[2] ArtScroll translates this as “You shall be wholehearted with Hashem, your G-d,” but the truth is that the sense of this mitzvah is not entirely clear, and the mefarshim offer a variety of interpretations.[3] One that appears in a number of classic sources is that Hashem is admonishing us against attempting to discern the future through improper means. The Gemara says:
From where do we derive that one should not consult astrologers (Kaldi’im)? For it says: You shall be wholehearted with Hashem, your G-d.[4]
Tosfos cites a similar passage from the Sifri, with “lotteries (goralos)” in place of “Kaldi’im.”[5] These prohibitions of the Gemara and the Sifri are codified by the Shulchan Aruch.[6] (For various explanations of why the sorts of lotteries that are commonly performed or endorsed by halachic authorities do not violate this prohibition, see the sources cited in the notes.[7])
Rashi explains the pasuk similarly:
Walk with him with wholeheartedness. Look ahead to him, and do not delve into the future. Rather, whatever comes upon you, accept with wholeheartedness, and then you will be with Him and His portion.
The problem here is articulating precisely which means of delving into the future are forbidden: Are weather, financial, and political forecasting prohibited? The late R’ Yisrael Elya Weintraub, a leading ba’al machshavah, apparently maintained that political punditry, or at least the acceptance of its conclusions as certainties, may indeed potentially violate tamim tihyeh:
A man reads a newspaper, and he sees, for example, an assessment of General So-and-So that he will succeed in vanquishing the threats of the enemy, with the addition of “interpretation” involving lessons and intricate analysis of the consequences for the future according to his words. [The reader] has faith in this, he lives by this, and he is calmed from his terror…One must know that there is a concern here of violating a mitzvas asei (i.e., tamim tihyeh), which is absolutely among the foundations of emunah…The astrologers (chovrei shamayim) of our times are the newspaper pundits, that see, based on the details of the context, the future consequences, and they speak with assurance of “the situation afterward”…[8]
But this does not seem to be the generally accepted perspective.[9]
One brief but important attempt at a delineation of the contours of the injunction of tamim tihyeh is by R’ Moshe Feinstein, in the context of the propriety of screening for the gene that causes Tay-Sachs:
Even though only a small minority of children are born with this condition, and it is possible to apply to this the pasuk of Tamim tihyeh im Hashem Elokecha, according to Rashi’s explanation…nevertheless, since now it has become easy to check, we may consider whether one who does not check himself is like closing his eyes to avoid seeing what is visible, and since if, chas veshalom, something like this happens, it will engender extremely great pain to the parents of the child, it is appropriate for one who needs to marry a woman to check himself.[10]
Indeed, almost all halachic authorities approved of Tay-Sachs screening,[11] with the notable exception of R’ Menashe Klein, who did indeed invoke tamim tihyeh in the course of inveighing against the “novel and strange” custom of “investigating future things, matters that are beyond our grasp, hidden, and covered…via laboratory testing, and they do not rely upon that which is explained in the Torah, the Nevi’im, and the Ksuvim that the decree that a specific woman is destined to be married to a specific man is from Hashem,[12] and tamim tihyeh im Hashem Elokecha…”[13]
R’ Moshe apparently assumes that on the one hand, the applicability of tamim tihyeh to a particular attempt to predict and avoid some future harm hinges on the likelihood of that harm occurring, and if it will occur in “only a small minority” of cases, attempting to predict and avoid it may violate tamim tihyeh. On the other hand, if predicting such harm is an “easy” process, doing so no longer falls under tamim tihyeh but is tantamount to “closing his eyes to avoid seeing what is visible.” According to these criteria, it is quite possible that the preventive MRIs discussed above would indeed violate tamim tihyeh, insofar as “the likelihood of finding a serious problem…in someone with no symptoms is very low” and the scan itself is quite expensive, which would seem to make it not “easy” to perform.
In this analysis, we understand R’ Moshe’s second criterion to be the ease with which a particular prediction of the future can be made. R’ Chaim Jachter, however, apparently understands R’ Moshe somewhat differently:
Interestingly, Rav Moshe Feinstein (Teshuvos Igros Moshe Even Ha’ezer 4:10) was asked if Rashi’s approach applies to genetic testing to determine if one is a carrier for a congenital disease before finding a shidduch. Rav Feinstein responded that it does not apply, because genetic testing does not predict the future; it reveals what already exists.[14]
According to this understanding of R’ Moshe, preventive MRIs would presumably not violate tamim tihyeh, because they, too, do not predict the future, but rather reveal what already exists. While this does not seem to be the straightforward understanding of R’ Moshe’s intent, we shall iy”H see in the follow-up article that some do indeed posit such a distinction with respect to the applicability of the mitzvah of tamim tihyeh.
[1]Matthew Perrone. Celebrities are getting $2,000 MRI scans to learn about their health. Should you? AP News. https://apnews.com/article/mri-medical-scans-prenuvo-kardashian-cancer-29ffe65e1f2fc26cb6384e4ca2fef592.
[3]See Rashi, Rashbam, Ibn Ezra, Bechor Shor, Ramban, and Ralbag ibid.; Hosafos HaRamban LeSefer Hamitzvos mitzvas asei 8; Ha’ameik Davar ibid. 18:13-14. Cf. R’ Chaim Jachter, Tamim Tihyeh Im Hashem Elokecha, Kol Torah Vol. 32.
[5]Tosfos Shabbos 156b s.v. Kalda’i. (This passage is not present in our text of the Sifri, as noted in Sefer Hametzareif cited below).
[6]Shulchan Aruch and Hagahos HaRama Y.D. 179:1. Cf. Trumas Hadeshen psakim uchsavim siman 96.
[7]Shu”t Ha’elef Lecha Shlomo O.C. siman 62; Sefer Hametzareif siman 69 (cited in Taharas Hamayim ma’arechess hagimmel os 16, cited in Sdei Chemed cheilek 2 klalim ma’arechess hagimmel Pe’as Hasadeh siman 14); Shu”t Sheivet Halevi cheilek 7 (O.C.) end of siman 16 os 6; R’ Chaim David Halevi, Shanah Beshanah (5750) pp. 176-77; Shu”t Yabia Omer cheilek 6 C.M. siman 4 end of os 6.
[8]Nafsho Gechalim Telaheit, Gilyon 293 Chayei Sarah 5781.
[9]For detailed discussions of the parameters of tamim tihyeh, see R’ Yaakov Hillel’s Tamim Tihyeh; R’ Nosson Gestetner’s Shu”t Lehoros Nasan cheilek 6 simanim 78-83 (a response to the previous work); and R’ Esi Halevi ibn Yuli’s Shu”t Nachalas Levi cheilek 3 Y.D. siman 1.
[10]Shu”t Igros Moshe E.H. cheilek 4 siman 10. Cf. R’ Moshe’s follow-up letter available here.
[11]See the sources collected here.
[13]Shu”t Mishneh Halachos cheilek 12 siman 265. Cf. here.
[14]Rav Jachter ibid.
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