Most families in America have read about the dangers of exposing our children to (too much) television -- the bad values, the passivity, the obesity.

There seem to be fewer articles discussing the damage television watching can do to a marriage -- the bad values, the passivity, the obesity...

Television provides a distraction -- a distraction from work-related aggravation, a distraction from struggles with our children, a distraction from unfulfilled dreams, a distraction from our spouses. Instead of discussion over the dinner table, we turn on the TV. Instead of an after-dinner walk and catch-up, we turn on the TV. Instead of sharing quiet time and important thoughts, we turn on the TV. And instead of late night intimacy, we also turn on the TV. Clicking the remote is both a literal and figurative expression.

This isn't about the confusing messages or values (or lack thereof) of the medium. The noise, the fantasy, the distraction alone tears us apart.

Sure it's easier to turn on the television than to engage with a spouse. But television is cold comfort when your wife decides she's had enough. Even ESPN won't do it then. It's limited company when your husband throws in the towel. And nothing they do on "Days of Our Lives" can compensate.

Yes, there are educational shows. Yes, there are powerful moments. There may even be programs that couples can watch together and connect through the shared experience.

But those are the rarer moments. Television is meant to be an escape. But when escape takes up more of our time and energy than reality, we're in trouble. When watching other people's marriages takes precedence over living our own, something is lost. Let's turn the TV off before it's too late to get it back.

We are entering the Hebrew month of Sivan. The central event to take place in this month (and arguably in all recorded history) is God giving the Torah to the Jews at Mount Sinai.

Sivan is the third month of the Hebrew calendar if we begin our count from Nissan, the month of our liberation from Egypt, which is the way months are counted in the Torah. Three is a portentous number in Judaism. Moses was the third child in his family. The Israelites began the three-day process of preparing themselves to receive the Torah on the third of Sivan. God divided the Jews into three groups with different roles: the Kohanim, the Leviites, and the rest of the Jews, Yisrael.

Before we explore the mystical connotation of the number three, we have to understand what "truth" really is. Truth means a lot more than mere verbal accuracy. The mystical name for truth is Tiferet, which literally means "harmony" – not exactly the association most of us have with truth. What's the connection?

The Maharal, the famous renaissance-era Kabbalist, defines truth as: the entire picture. It includes past, present and future; it includes internal reality and its external counterpoint. It is a synthesis of the whole – harmony. If something is true at all, it must be true spiritually, physically, mathematically, and philosophically. If an idea "works" on one level, but doesn't on any of the other levels, it is not truth in the purest sense of the word.

We humans are mortal, which pretty well cuts us off from any foolproof vision of the future. Our access to anything that took place before we were born is colored by other people's interpretations of the past. Add a healthy scoop of emotional subjectivity even to our observations of the present, and it seems that our search for truth is doomed.

Transcendent truth, by definition, comes from a place above time and space. The Maharal regards transcendent truth as the only real truth. The only time we had access to it was at Mount Sinai, when we heard the voice of God.

ABOVE AND BEYOND

From this perspective, we can begin to examine the significance of the number three. The Maharal tells us to imagine a link chain. When you hold it up, the first link touches the second one. The second one touches both the first link and the third one. The third one touches the second one and not the first. Thus the third link is the first in the series that doesn't have any connection to the first link. The number three thus symbolizes something new, but not disconnected.

The Maharal refers to this quality (new, but not disconnected) as "nivdal", which means in Hebrew separate or transcendent; it is part of a process, but also beyond it. Thus, for example, Moses, the third child in his family, was connected to the heritage of monotheism that Abraham initiated, but he took it a step further, giving his people a sense of nationhood based on the Torah.

The month of Sivan is connected historically to Nissan, the month of liberation. In Sivan, however, the Jews went a step beyond physical freedom and became spiritually autonomous, defined only by the Torah, God's word. Nivdal. Connected but new. Part of the process, but also beyond it.

ON THE TRAIN PLATFORM

What does it mean to live with transcendence? I recently had an experience that gave me new insight into seeing how deeply this seemingly abstract concept affects me in my day-to-day thinking.

I was in New Jersey, heading to Sequacus at the Metrotrack station. It was about 2:00pm and the platform was almost empty. The only fellow travelers in sight were two women and a man. Suddenly, one of the women, standing quite close to me, lost her balance and fell backwards. I immediately bent over to help her get up. Although her eyes were open, she made no response. She was unconscious.

The second woman on the platform approached. She asked me if I knew first aid. I replied that I didn't, and she claimed that she also didn't know first aid, but she bent down and took the prostrate woman's pulse. When she saw that there was no pulse, she immediately began administering C.P.R. Clearly, she knew what she was doing.

In the meantime I called 911. Five minutes passed. The woman looked at me, exhausted. Copying what I had seen her do, I relieved her. Soon, a policeman appeared. I was appalled. We needed a medic, not a policeman! He began to administer mouth-to-mouth resuscitation, clearly the only first aid response he knew.

The platform suddenly shook with the vibrations of an arriving train. The woman who began the C.P.R, the one person who really knew what to do, muttered something about intubations and boarded the train. I looked on in horror. A person was dying, and she found it necessary to catch her train!

Within a few minutes the ambulance crew finally arrived. Later, when recounting the episode, I was bothered by how the woman who was, by default, supervising the rescue effort could have simply left to catch her train. How important could a business meeting or a shopping date or even a chemo session be when compared to saving a life?

The answer illustrates the opposite of nivdal. If I had asked her that question the day before, she would certainly have answered, "Saving a life is more important." She certainly knows the transcendent truth. The problem is that when the train actually roared into the station, she was caught up with the reality of here and now. Physical reality is so vivid and immediate, that it eclipses transcendent reality.

And what would nivdal look like? Imagine that the woman who knew CPR had an appointment for a job interview for her dream job. Imagine that the train to that place came only once every three hours. Imagine that she had been unemployed for six months, and really needed that job. And now imagine that it was so clear to her that saving a life is more important than any of the above, that, when her train came, she chose to stay with the woman until the medics arrived, and she knew, without hesitation or regret, that that was the right choice. That's nivdal. It is living connected to the higher truth that the mere external reality conveys.

Receiving Torah is the ultimate nivdal. It is a commitment to go beyond the immediate, the vivid, and the seemingly real, and to get to the transcendent, inclusive picture that is the essence of truth.

MAZAL OF THE MONTH -- GEMINI

Moses was not the only one who brought the Jewish people to a place where they could hear the truth. His brother Aaron acted as his spokesperson from the early days in Egypt, when he arrived at Pharaoh's palace with the outrageous demand that he free the Jews. Each one of them played a role in expanding our consciousness in a specific and unique way. Moses was the ultimate lawgiver. He transmitted the commandments that teach us where the lines have to be drawn if we are to rise above pseudo truth and enter the realm of absolute transcendental truth. His brother Aaron approached each Jew with love, and brought forth the hidden yearning to live a life higher and more encompassing than the every day. Justice and love were intertwined; it is no coincidence that this month's sign is Gemini, the twins.

THE BOOK OF RUTH

Each of the three pilgrim festivals (Pesach Shavuot and Sukkot, which were celebrated in ancient times by a nationwide trek to Jerusalem) has a specific focus. On each, a different Megillah is read, narrating a particular aspect of the story of our relationship with God.

On Shavuot, we read the story of Ruth, the Moabite princess who abandoned everything safe and familiar to follow her mother-in-law Naomi to Israel, to a life of physical rigor and spiritual truth. Her story is the story of all of us this month, as we try to move beyond our limited grasp of truth and move closer to the whole picture we saw at Sinai.

For the weekly Torah portion in Israel, please click here: http://www.aish.com/torahportion/kolyaako v/Permission_to_Protect.asp" title="http://www.aish.com/torahportion/kolyaako v/Permission_to_Protect.asp" target="_blank"http://www.aish.com/torahport...

Passover has its Seder. Purim has its Megillah Reading. Chanukah has its Menorah. Sukkot has its Sukkah.

Shavuot, however, seems to be quite a barren holiday in terms of mitzvot, rituals, and commandments. True, many have a custom to remain awake the entire night studying Torah on Shavuot, but this is a custom that developed and not an obligatory law. The Torah does not prescribe any particular directive to be performed on Shavuot. This unique aspect of Shavuot in contrast to the other Festivals is extremely surprising.

Shavuot is certainly a more significant, more inspirational Festival than any of the others. The others derive their validity, both legal and spiritual, from the Giving of the Torah which occurred on Shavuot. Why then must we struggle to find meaning and growth from Shavuot? Beyond the special sacrifices brought on the Festival, why shouldn't the Torah assist us, as it characteristically does, by requiring an observance of some kind that would call to mind the Giving of the Torah? Why isn't there an obligation to recount the story of Sinai on Shavuot similar to the commandment on Passover to tell of the Exodus?

More questions:

The name Shavuot means 'Festival of Weeks.' We refer to it as such in the 'Shemoneh Esrai' prayers of the holiday. It is derived from verses in various places in the Torah. In Shemot 34:22, it is called the holiday of 'Shavuot,' and in Devarim 16:9-10, the Torah states: "Seven weeks shall you count; from when the sickle is first used on the standing crops, you should begin counting seven weeks. Then you should observe the Holiday of Weeks."

We see clearly that the name 'Weeks' is a descriptive culmination of the 49 days/7 weeks count which began on Passover.

Strange. Wouldn't it have made more sense for the holiday to be called 'Festival of Torah'? Even if for whatever reason that name would be rejected, the name 'Weeks' seems quite dry and incidental. True, we just completed a count of seven weeks, but why is it important to call the Festival 'Weeks'? Are we celebrating the weeks counted or the Day of the Giving of the Torah?

In addition, the Torah never refers to Shavuot by a particular calendar date as it does with all other holidays. Passover is described as the 15th of Nissan; Sukkot the 15th of Tishrei, etc. Yet, Shavuot is 'Seven weeks or 49 days after Passover.' The Torah implies that if theoretically no one would count the seven weeks, Shavuot would not take place that year. Shavuot can only exist when and if the counting preparations have occurred. Why does Shavuot have this unique aspect?

It would appear, evidently, that we are indeed rejoicing in 'Weeks.' The purpose of the Counting period is to enable us to prepare for receiving the Torah. (See "Of Sefira Beards and Beacons Gone Bad" ) We cannot expect to accept the Torah without adequate preparation. In receiving the Torah we are entering into a marriage with God. Any good marriage consists of a man and woman who have grown spiritually and emotionally throughout their lives as individuals, thus preparing themselves through self-growth for bonding with another person. Without proper preparation, a marriage begins on shaky ground.

Similarly, we must prepare ourselves for God's giving of the Torah. If we would not prepare for receiving the Torah, it would be impossible for the Torah's goals, directives and instructions to stick to us and make an impact. We must first become people worthy of hearing the Torah's sophisticated message. We must work on our character and only then can we utilize and apply the Torah. This idea is expressed in Pirkei Avot (3:21): "If there is no character(derech eretz), there is no Torah."

So God established a holiday in which we rejoice in the weeks spent in preparation for Shavuot. We revel in the beautiful and refined people that we have become as a result of the previous seven weeks, knowing that it is only due to this tremendous self-improvement that we merit receiving a Torah, carrying out God's plans for the world through His Instructions for Living

Celebrating the counting and preparations also brings to life the concept of the application of Torah being primary and not just intellectual study, even if one studies with sincere and holy intentions. The goal of study is to impact upon all of our actions and thoughts in fulfilling the entirety of Torah's 613 laws. On Shavuot we accept and re-commit ourselves to the wholeness of Torah.

This clarifies a common misconception regarding Shavuot and returns us to our opening question as to why Shavuot has no specific mitzvah or observance prescribed.

Generally, it is understood that the focus of Shavuot is Talmud Torah, the commandment to study Torah. While this may be true if measured by a standard of time -- we do spend the entire Shavuot night studying Torah -- nevertheless it is inaccurate.

The focus of Shavuot should be a re-establishment of our connection to the entire Torah, with all of its laws, because it is on this day that we received the Torah. Whenever we experience a festival, we are not simply commemorating an event but we are re-living it. Every festival is an opportunity for growth because the festival is infused with spiritual forces that were unleashed due to some historical event (see Rav Eliyahu Dessler's Michtav Me'Eliyahu, Volume 2, page 21 for an elaboration on this concept).

On Shavuot the Jewish People received and accepted the Torah. Thus, every year we accept the Torah anew and we must find ways in our personal service of God to strengthen our commitment to Torah.

Perhaps, it is for this reason that the Torah does not prescribe a specific ritual observance for Shavuot. On other holidays, the Torah gives specific directions both in the letter and the spirit of the laws. At times, one can "get lost" in the performance of the ritual and fail to achieve significant general growth due to a lack of focus on the meaning of the festival. The Torah accounts for this, but for most holidays, allows the fulfillment of an observance to suffice.

On Shavuot, however, the Torah does not want us to become "distracted" by the performance of any specific commandment. The Giving of the Torah is far too powerful and all encompassing to enable any expression of specific ritual through physical action to be meaningful. The Torah includes all commandments. A mitzvah ritual obligation would actually detract, not enhance the general goal of a re-commitment to the entire Torah on Shavuot.

We learn all night and as much as possible on Shavuot to show how precious the Torah is to us and to express our great desire to know all of God's Torah. It is only through knowledge of the Torah that we can begin to allow it to impact upon us as people. Only through the knowledge of Torah will our character improve. And only through the knowledge of Torah can we hope to re-commit ourselves to it and its laws.

Learn hard on Shavuot but remember to re-accept the entire Torah, all 613 commandments, as well.

For the next few weeks, the Torah portion read in Israel will be different than the Torah portion read in the rest of the world.

For the weekly Torah portion that will be read in Israel, click here: http://www.aish.com/torahportion/moray/Di vine_Abundance.asp" title="http://www.aish.com/torahportion/moray/Di vine_Abundance.asp" target="_blank"http://www.aish.com/torahport...

Shavuot is a somewhat elusive holiday. While the Torah clearly states the historical events commemorated on Pesach¹ and Sukkot² , no such connection is clearly drawn between Shavuot and any historical event. Rather, the Torah's description of Shavuot is agricultural: The nation is commanded to bring their first fruits to Jerusalem.

The only description of Shavuot is as the holiday of first fruits; no historical explanation is offered. On the other hand, Pesach and Sukkot, aside from their own agricultural identity, are described in the Torah as the holidays that commemorate the Exodus from Egypt and the sojourn in the desert, respectively. Apparently, the Torah weaves the agricultural date into an historical holiday in order to provide deeper meaning and to heighten the farmers' religious experience: The three yearly pilgrimages were tied into the agricultural cycle, in addition to the historical/ theological significance of each holiday, creating a merger of the physical and spiritual realms, and heightened historical consciousness.³

Of the three major celebrations, only Shavuot is left without a clear "historical" connection, a fact made all the more striking by the monumental nature of the event which transpired at the same time of year (beginning of the third month) in the desert that first year after leaving Egypt: the Giving of the Torah.

In the third month, when the People of Israel went forth out of the land of Egypt, the same day came they into the wilderness of Sinai...And the Lord said to Moshe, 'Go to the people, and sanctify them today and tomorrow, and let them wash their clothes, And be ready by the third day; for the third day the Lord will come down in the sight of all the people upon Mount Sinai. [Shmot 1,10]

Fairly simple mathematics places the giving of the Torah more or less at the same time as the holiday of Shavuot⁴, though arguably not on the exact day:

Our Rabbis taught: On the sixth day of the month [Sivan] were the Ten Commandments given to Israel. R. Yose maintained: On the seventh thereof. [Shabbat 86b]

While this may seem strange we must keep in mind that in the days when the months were consecrated by the courts after witnesses testified that they saw the new moon, it was possible for the holiday of Shavuot to fall on the fifth, sixth or seventh day of Sivan⁵ and still coincide with the Giving of the Torah.

Nonetheless, a problem remains: According to the chronology recorded in the Talmud, the Jews left Egypt on a Thursday and the Torah was given on Shabbat, which would be fifty-one days --and not fifty-- after Pesach.

The Magen Avraham (Orach Chaim section 494) insists that the law is actually decided in accordance with the opinion of Rabbi Yossi cited above: the Torah was given on the fifty-first day after Pesach, the seventh day of Sivan. While the Magen Avraham therefore questioned the appropriateness of calling Shavuot "the day the Torah was given," we should note that the liturgy actually calls Shavuot "Zman Matan Toratenu", the time of the giving of the Torah, not necessarily implying the precise day.

Rav Shimshon Rafael Hirsch (commentary to Vayikra 23:21) suggested that the essence of Shavuot is not the giving of the Torah but the preparedness of man to accept the Torah. Just as the Jews in the desert prepared themselves to accept the Torah, so must we. This would alleviate the difficulty of assigning the date of the holiday to the sixth day of the month, which is not necessarily the day the Torah was given, but was, in fact, the day the People of Israel prepared themselves to receive it. This understanding is borne out by the choice of Torah reading for Shavuot, Chapter 19 of Shmot, which begins with the preparations made to receive the Torah.

The Torah itself remains silent regarding the relationship of the Giving of the Torah to the bringing of the first fruits. We are not told the date of the holiday – either of Shavuot or the giving of the Torah. Shavuot is fifty days after the Exodus, and the Giving of the Torah is in the beginning of the third month. While the connection between Shavuot and the Revelation is obscured in the Torah, the association was maintained by tradition.⁶

One expression of this tradition may be found in the Torah reading, the Sages' means of capturing and transmitting the spirit of the day. This is true for both the "primary" Torah reading as well as the "secondary" Haftorah reading. Regarding Shavuot we are told the following:

The difference between the two choices of Torah reading is telling: the section in Devraim describes the "Festival of Weeks"--Shavuot. This holiday is mentioned in various sections of the Torah. It describes an agricultural holiday, celebrated by bringing the first fruits to Jerusalem. The section in Shmot describes the Revelation, which links Shavuot with Matan Torah. According to the Mishna and the first opinion expressed in the Talmud, the reading for the first day is about Shavuot – the agricultural holiday, and the second day is about the Giving of the Torah. The conclusion of the Gemara is that on the first day of Shavuot we read the 19th chapter in Shmot, which describes the giving of the Torah, the Revelation and Decalogue, while on the second day (in the Diaspora) we read the description of the Holiday of Shavuot in Devarim (16:9). The irony is that it is possible that the Torah was actually given on what would eventually become the "s econd day" of Shavuot – hence the reading on the second day reflected the giving of the Torah, while the first day reflected the holiday of Shavuot.

The haftarah reading for the "first day" is the description of the Divine Chariot, and for the "second day" the section of Habakuk which mentions the giving of the Torah⁷ (and provides an overview of the years in the desert, and the conquest of the Land of Israel). Notably, both choices of the haftarah are related to the giving of the Torah and ignore the agricultural motif. The Rabbis always knew of the relationship between Shavuot and the giving of the Torah; perhaps, taking their cue from the Torah's silence, they too were reticent about openly declaring the relationship.

The final choice for the first day is the Prophesy of Yechezkel, known as the Chariot of Yehezkel. This section seems the most appropriate match for the section in Shmot that describes the Revelation; by choosing this as the haftarah, Chaz"al instruct us as to the nature of Shavuot while teaching us an important lesson about the Revelation. There are two distinct aspects of the Revelation to consider: first, the content of the Revelation and second, the fact that there was a Revelation at all– namely, that the Creator and Sustainer of the universe "descended" upon a mountain and made Himself "known". Upon reflection, we realize that the fact of Revelation is of primary importance: The content would have no significance had it not been for the fact that God Himself said these things. On the other hand, even had the Revelation been devoid of content, it would still have been of incredible religious significance, in and of itself, as a ren dezvous between man and God. It is this theme of revelation per se which is highlighted by the choice of the haftarah of Yechezkel.

The Merkava (Chariot) deals with the Revelation witnessed by Yechezkel:

And it came to pass in the thirtieth year, in the fourth month, in the fifth day of the month, as I was among the exiles by the Kevar River, that the heavens were opened, and I saw visions of God. [Yehezkel 1:1]

The ensuing chapter provides an elaborate description of Divinity. The images are stark yet mysterious; the symbols are illusive yet tantalizing. More than any another scriptural prophesy, this section became associated with mystical knowledge and exploration.⁸

There may be another message being communicated by this choice. The Prophesy of the Chariot is actually an unlikely candidate for haftarah reading at any time. The Rabbis teach in the Mishna that there are those who believe that the Chariot may never be read in public as a haftarah:

The portion of the chariot is not read as a haftarah, but R. Judah permits this. [Megilah 25a]

Why were the Rabbis hesitant to publicly read about the Chariot? The Mishna taught that this section may not be taught in public – not even to a small group of initiates:

The [subject of] forbidden relations may not be expounded in the presence of three, nor the Work of Creation in the presence of two, nor [the Work of] the Chariot in the presence of one, unless he is a sage and understands of his own knowledge. [Chagigah 11b]

So intense and mystical is the teaching of the Chariot that it was not to be taught or even read publicly. Too much would be revealed.

It is the glory of God to conceal a thing [Mishlei 25:2]

The choice of this section for this day speaks volumes: Though on other occasions it would be more prudent to conceal, on this day we may reveal a bit, for on this day Revelation took place. Even post- Revelation man must realize that there is so much about God that we cannot know and indeed will never know. On this day of Revelation, perhaps we should even conceal that something was revealed, yet we boldly read about the Revelation and follow with the description of the Chariot. We know that something - perhaps better concealed - was revealed. By choosing the haftarah of the Merkava, the rabbis were expressing their ambivalence in identifying Revelation as the key aspect of the day, and subtly telling us to be careful with our conclusions. The challenge of revelation is to avoid hubris; man may become overconfident, deluded into thinking he understands what may actually elude him. To avoid this pitfall, revelation must be obscured and protected. Ultimatel y if man wishes to understand God and His ways, the only way to reveal this secret is to learn His Torah and perform His commandments. This is the gift of Revelation with which we are entrusted throughout the year; the content of the Revelation at Sinai is the key to unlocking the secrets of the Revelation itself.

Accessing Revelation is not something that is limited to one day on the calendar; we are enjoined to see every day as if the Torah was given anew on that day.⁹ Receiving the Torah is not limited to one day a year.

COMMAND YOU THIS DAY. This suggests that they should ever be to you as new commandments, as though you had heard them for the first time on that day (Siphre on v 32)[Rashi Dvarim 11:19]

The Torah writes at the conclusion of the first fruit ceremony:

This day the Lord your God has commanded you to do these statutes and judgments; you shall therefore keep and do them with all your heart, and with all your soul. [Dvarim 26:16]

Rashi comments are instructive:

THIS DAY THE LORD YOUR GOD HAS COMMANDED YOU: This suggests - each day they (God's commandments) should be to you as something new (not antiquated and something of which you have become tired), as though you had received the commands that very day for the first time. [Rashi, Dvarim 26:16]

How interesting that specifically on the holiday of Shavuot, at the celebration of the first fruits, we are commanded to think and act as if the Torah was given on that very day! We now know that, in fact, it was.

Our attitude toward Torah should be as if it were given on each and every day. Perhaps this frame of mind takes us back to the first fruits: The man who has worked so hard during the entire year now has the fruits of his labor in his hands. He experiences a sense of renewal and completion. The first fruits were a living example of what man's orientation to Torah should be – a sense of newness and freshness coupled with resolve to continue, a recognition of hard work coupled with an appreciation of its rewards. Remarkably, the ceremony which accompanied the First Fruit Offering included a revelation – a Bat Kol calling on man to continue onward:

THOU SHALT THEREFORE KEEP AND DO THEM. A heavenly voice ("Bat kol") pronounces by these words a blessing upon him (the worshipper) - "Thou hast brought the first fruits to-day - thou wilt be privileged to do so next year, too!" [Rashi Dvarim 26:16]

The themes of Revelation and first fruits are inseparably intertwined in the holiday of Shavuot. The window between the revealed and the concealed is opened for us on this singular holiday, and the content and purpose of the Revelation at Sinai, the Torah and its commandments, is wrapped around the more familiar and accessible agricultural aspects of the day. As we offer the first fruits of our physical labor before God, the physical bounty with which we have been blessed serves as a reminder of the personal and national destiny we accepted at Sinai. In the final analysis, the holiday of the First Fruits was about receiving the Torah all along, about the medium and the message of Revelation.

The first successful face transplant was recently performed in France. A woman had lost her nose, lips, and chin after being mauled by her dog. The injuries left her grotesquely deformed, making it virtually impossible for her interact normally with others. Muscles, blood vessels, nerves, and other tissues were transplanted from a "brain dead" donor in order to fashion a "hybrid" face that neither resembled the donor nor the recipient's original face.

This surgery marked a new milestone in transplantation, raising new questions to the usual list of ethical issues involved in transplantation. Unlike, kidney, liver, lung, or other vital organ transplants, which are life-saving procedures, the recent historic surgery brings transplantation into the realm of plastic surgery.

From a Jewish perspective, the face transplant raises two sets of questions. There are the technical questions regarding transplant and a more fundamental set regarding the approach of Judaism to vanity and plastic surgery.

Let us leave aside the issues of cadaveric transplantation and brain death involved in the recent face transplant case for another day and ask the more basic question of how far an individual may go to improve his/her appearance? Clearly the face transplant patient's surgery was not prompted by vanity, but we must still ask if even routine plastic/cosmetic surgery is permitted at all? What might the possible concerns be that arise for one contemplating plastic surgery?

Cosmetic versus Reconstructive Surgery

Plastic surgery may be divided into cosmetic and reconstructive surgery. The former is performed for enhancement of one's physical appearance (such as rhinoplasty, liposuction, or breast augmentation). The latter is performed to correct a defect, whether congenital (from birth) or acquired (for instance suffered in a car accident). These two indications for surgery may overlap and there is not necessarily a neat line that separates deformity from normal appearance. As has often been repeated, beauty is in the eye of the beholder.

Judaism treats the subjective sense of the individual very seriously when a person feels unattractive. What about a self-perceived cosmetic defect, one that is neither a true congenital defect nor the result of an injury? How much importance does Judaism place on self-esteem and self-consciousness?

The History of Plastic Surgery

The oldest descriptions of plastic surgery date back to 2600-year-old Sanskrit texts and ancient Egyptian papyri. These documents describe nose, ear, and lip reconstructions utilizing surgical flaps and skin grafts! Nevertheless, the term "plastic surgery" to describe reconstructive surgery was not introduced until 1818.¹

Despite the long history of plastic surgery, no responsa were written about surgery performed for cosmetic surgery until the latter half of the 20th century. This is hardly surprising, since prior to the mid 19th century, all surgery was limited by the inability to adequately ameliorate the pain of the surgery itself and the high morbidity and mortality of surgery in general.

This all changed due to important advances made in the second half of the 19th century. Building upon the work of Ignaz Philipp Semmelweis (who argued that handwashing would decrease hospital infections) and Louis Pasteur (who proved that bacteria cause infection), Joseph Lister introduced the concept of antiseptic surgery in the late 19th century, significantly decreasing the risk of surgical infection. Ether, the first form of general anesthesia, was publicly utilized for the first time on October 16, 1846, in an operating theater at the Massachusetts General Hospital, ushering in the age of modern anesthesia. ² With these two breakthroughs came rapid advances in surgical techniques, and advancements in both reconstructive and cosmetic surgery, particularly between the first and second world wars.

The Earliest Responsum

As plastic surgery developed and the options for cosmetic enhancement grew, formal halachic discussion began. In 1961, Rabbi Immanuel Jakobovits, considered by many to be the father of the discipline of Jewish medical ethics, ³ addressed the American Society of Facial Plastic Surgery at a symposium entitled "Religious Views on Cosmetic Surgery." ⁴ Rabbi Jakobovits, later Chief Rabbi of Great Britain, discussed the parameters of plastic surgery from a Jewish legal perspective.

After explaining that no responsa had yet been written on the topic, he dealt with the question of whether one may undergo plastic surgery for the purpose of improving one's physical appearance. As Rabbi Jakobovits eloquently described in his classic work, Jewish Medical Ethics: ⁵

The problem was considered under four headings: the theological implications of "improving" God's work or "flying in the face of Providence"; the possible risks to life involved in any operation; the Jewish objection to any mutilation of the body; and the ethical censure of human vanity, especially among males.

He concluded⁶ definitively that plastic surgery for aesthetic enhancement is a form of arrogance and vanity (particularly for men) and is forbidden unless the patient meets certain criteria. He later wrote as part of an overview of the Jewish approach to medicine:

In the sparse rabbinic writings on the subject, these reservations could be discounted, provided the danger is minimal; and especially 1) if the operation is medically indicated, e.g. following an accident, or for grave psychological reasons; 2) if the correction of the deformity is designed to facilitate or maintain a happy marriage; or 3) if it will enable a person to play a constructive role in Society and to earn a decent livelihood. ⁷

The four ethical concerns of Rabbi Jakobovits remained the pivotal issues in all future responsa and therefore bear further elucidation, as subsequent poskim have approached them in different ways.

Ethical Concerns

The first potential practical objection to plastic surgery is the Torah obligation to guard health (See: "Taking a Risk") which might limit the surgical risks that one may accept as part of plastic surgery. In addition to the hazards associated with the surgery itself, anesthesia, particularly general anesthesia, presents a very small but real risk of death or incapacitation.

Beyond the blanket obligation to guard health, there is the particular prohibition of self-mutilation. Just as one may not injure someone else, one may not cause injury to oneself. The prohibition of injuring someone else is called chavala and is derived directly from the Biblical verse⁸ that warns the court not to give a convicted criminal more lashes than legally mandated. The verse is interpreted to mean that if the court must not strike a criminal without justification, surely an ordinary individual may not strike or otherwise injure his neighbor.

The Talmud⁹ discusses whether this prohibition applies to harming oneself, concluding that "one who injures himself even though it is forbidden, pays no damages. But if someone else injures him, they pay damages." Injuring oneself without a valid reason is called chovel b'atzmo. This proscription has limitations however. We are only barred from causing unnecessary injury to ourselves. The key question is what is considered necessary.

Risk and harming oneself are not the only issues. There are also philosophical considerations. Do we assert that God, as the ultimate craftsman and molder of human beings, makes each person exactly as they should be and that our "remodeling" of ourselves is an affront to His judgment? That is, does the divine mandate to heal and obligation to seek medical treatment extend to plastic surgery?

The fourth issue applies predominantly to men. The Torah commands that a man not wear the clothing of a woman and that a woman not wear the clothing of a man. This prohibition extends beyond mere clothing, but includes actions and activities that are characteristic of one of the sexes. For instance, in most situations a man may not dye his white hairs back to black for purposes of improving his appearance since this is considered to be a feminine activity. Is plastic surgery also considered a "feminine" activity?

A Variety of Approaches

In 1964, Rabbi Mordechai Yaakov Breish, Rabbi Menasheh Klein, and Rabbi Moshe Feinstein were each asked to rule on questions of cosmetic surgery for enhancement of appearance.

Rabbi Mordechai Yaakov Breish, author of the Chelkas Yaakov and a prominent posek [authority in Jewish law] in Switzerland, discussed the issues of risk and chavala (self-injury) when asked whether a woman may undergo cosmetic surgery to straighten and decrease the size of her nose in order to improve her chance of finding a suitable husband. ¹⁰

He used a previous ruling of Rabbi Abraham of Sochachev, the 19th century author of the Avnei Nezer, as a starting point for his discussion of why it is permitted to enter into surgery or other dangerous situations, even when not absolutely necessary. The Avnei Nezer¹¹ had forbidden a child to have surgery to straighten a crooked leg due to the risk of the operation. Rabbi Breish points out several objections to this ruling.

So long as a doctor practices in an acceptable way, it is a mitzvah for a physician to treat even non-life-threatening illnesses even though he may injure or kill patients inadvertently. ¹² That is the nature of the mandate to heal. Additionally, the Talmud allowed bloodletting as a preventative health mechanism, even though it was known to be somewhat dangerous. We also clearly see that one is not prohibited from entering into a dangerous situation voluntarily since we do not prohibit women from having babies, despite the risks associated with pregnancy and childbirth. ¹³

Rabbi Breish also points out that the general population undergoes surgery for non-life-threatening conditions with a very low complication rate. He therefore invokes the concept of Shomer Pasaim Hashem, ¹⁴ that God watches over the simple, to defend low risk surgeries. He rules that from the perspective of risk, one may pursue plastic surgery as one of the activities that the general population finds to be acceptably safe. To support his contention that one may injure oneself (independent of any associated risk) for treatment of a non-life-threatening malady, he brings two proofs. The Code of Jewish Law¹⁵ warns a child not to remove a thorn, bloodlet, or amputate a limb from a parent, even for medical reasons, lest he transgress the capital offense of (unnecessarily) injuring a parent. Rabbi Moshe Isserles, in his gloss to the Code of Jewish Law, states that the child should only refrain if there is someone else present who can help the parent, for otherwise, the child should even amputate the limb if the parent is in pain. It seems clear that the prohibition is only to injure one's parent, but the concept of bloodletting or amputation merely for pain, despite the trauma involved, does not appear to be problematic!

The second proof is fundamental to our discussion of plastic surgery, particularly cosmetic surgery. The Talmud¹⁶ states that a man may remove scabs from his body to alleviate pain, but not to improve his appearance. ¹⁷ At first glance, this may appear to exclude the possibility of plastic surgery. However, Tosofos, ¹⁸ commenting on this statement, promulgates a concept that demonstrates a very sensitive understanding of human nature and psychology. He writes: "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." Tosofos recognizes that there is no greater suffering than psychological pain and that it is very difficult to judge for someone else the degree of suffering they are experiencing as a result of a self-perceived defect.

Citing the psychological pain associated with the inability to find a spouse, Rabbi Breish ruled that the woman may have the cosmetic surgery.

The same year, Rabbi Moshe Feinstein (1895-1986) was asked the same question. His responsa first examines the parameters of the prohibition of chavala. He points out that in his Mishneh Torah, ¹⁹ Maimonides clearly describes chavala as injury with malice. Rabbi Feinstein brings several examples of injury without the intention to do harm that Jewish religious literature finds acceptable. ²⁰ His final ruling permits surgery when it is in the best interests of the patient, even if they are not sick and it does not treat an illness. As a result, he permitted the woman to have cosmetic surgery since it was to her advantage and not being done to harm her.

Also in 1964, Rabbi Menasheh Klein, author of Mishneh Halachos, dealt with the question of the permissibility of cosmetic surgery to correct various facial imperfections that mar a woman's appearance, such as a very long nose which makes it difficult for her to marry and which she feels makes her very unattractive. ²¹ Rabbi Klein utilizes an ingenious approach to evaluate the question. He points out that there is ample precedent for medical intervention to improve appearance in dating back to Talmudic times.

The Mishna²² discusses the case of a man who betroths a woman on the condition that she has no defect (mum) where a "mum" is defined as any defect that would bar a Cohen (Jewish priest) from serving in the Temple. Tosofos²³ states that if the woman had her blemish corrected by a physician before her engagement, the marriage is valid. Since many of the blemishes that would apply to a Cohen include cosmetic imperfections²⁴ of the face for which people today would desire elective plastic surgery and Tosofos permits these blemishes to be corrected by a physician, Rabbi Klein states that it appears that a man or woman may go to a doctor to correct a cosmetic defect merely for enhancement of their appearance. Rabbi Klein rejects the argument that plastic surgery entails any danger whatsoever based the information which he received from physicians.

In a second responsum, ²⁵ printed immediately following the previously discussed one, Rabbi Klein discusses plastic surgery and chemical peels in men with respect to the prohibition of a man performing female behaviors. He reiterates his previous ruling and adds that (minor) cosmetic procedures are forbidden to men if done strictly for aesthetic enhancement, but that the prohibition does not apply if the blemish causes the man enough embarrassment that he shuns social interaction. Rabbi Klein wisely points out that such a distinction requires a great deal of intellectual honesty.

In 1967, Rabbi Yitzchak Yaakov Weiss (1902-1989), head of the Eida Chareidis rabbinical court in Jerusalem and author of Minchas Yitzchak, dealt briefly with the issues of chavala and risk with respect to plastic surgery. ²⁶ He takes the same approach to self-injury as Rabbi Feinstein, arguing that the prohibition of chavala only applies when the wound is inflicted with the intention of causing harm or degradation. He feels that cosmetic surgery would be permitted if not for the risk of surgery, which he believes to be a serious concern. He refers to one of his earlier responsa²⁷ which was directed to his in-law, Rabbi Breish, in which he forbids surgery for non-life-threatening conditions. While admitting that the line of reasoning of Rabbi Breish has merit, he disagrees, arguing that the permission of the Code of Jewish law to allow amputation of a limb is only in a life-threatening situation. He also agrees with Rabbi Breish that people de siring plastic surgery may be ill, but states that they are not endangered, and therefore is hesitant to allow elective plastic surgery, ending his 1967 responsa by saying the question requires further study.

Despite the generally strong support among halachic experts for the permissibility of reconstructive surgery for congenital defects and traumatic injuries, one dissenting opinion stands out with regard to cosmetic surgery merely to enhance one's appearance.

I am the Lord Your Healer²⁸

There is an inherent tension in Judaism regarding the philosophical underpinnings of the mandate to heal. While the Torah clearly empowers the physician to treat illness, there is controversy regarding how far the permission extends (See "Mandate to Heal"). While most Biblical commentators and Jewish legal scholars interpret the Torah to grant a very broad license to heal, there is a consensus that the patient must be ill to allow the physician to treat the patient, particularly if the treatment is dangerous or requires injuring the patient in the process of healing.

This is one of the major concerns voiced by Rabbi Eliezer Yehuda Waldenberg, author of Tzitz Eliezer, a multivolume set of responsa, much of which deals with medical issues. First, Rabbi Waldenberg²⁹ objects to performing surgery on someone who is neither sick nor in pain. ³⁰ He argues that such activities are outside the boundaries of the physician's mandate to heal (since he questions whether cosmetic surgery is truly included in the category of healing). He further asserts that the patient has no right to ask the physician to wound him or her for the purposes of merely enhancing beauty. Rabbi Waldenberg then makes the theological argument that as the ultimate artisan, God creates each person in His image, exactly as he or she should be, with nothing extra nor anything lacking. He therefore posits that cosmetic surgery that is not for pain or true illness is an affront to God and is forbidden.

A Final Argument

The last major posek to voice an opinion is a fitting conclusion to our discussion of the various approaches of Jewish legal authorities to plastic surgery. Dr. Abraham Abraham reports³¹ the opinion of Rav Shlomo Zalman Aurbach (1910-1995), the great Israeli posek, on the question of a person whose arm or finger had been traumatically amputated.

In response to those who forbid plastic surgery, Rabbi Aurbach discussed the question of whether an amputated limb could be reattached by surgery requiring general anesthesia, even if the patient had already been treated so that he was no longer in danger his life. He ruled that the surgery would certainly be permitted on a weekday³² "since the surgery would not be considered an injury but a repair and treatment to save the limb. Why then should it be forbidden for someone to undergo plastic surgery in order to look normal?" In a published responsa, ³³ Rabbi Aurbach writes:

if the plastic surgery is done to prevent suffering and shame caused by a defect in his looks (for instance a nose which is very abnormal) this would be permitted based on the Tosafot and the Gemara, since the purpose is to remove a blemish. However if the only reason is for beauty, this is not permitted.

Rabbi Aurbach sums up the consensus of most legal experts in ruling that plastic surgery to allow someone to appear normal, and more importantly to view themselves as appearing normal is permitted. It is only when such surgery is performed merely for vanity that the rabbis have serious reservations. Clearly however, true reconstructive surgery and even surgery for an appearance that makes one feel embarrassed is not an issue of vanity. Such was clearly the case with the French face transplant recipient.

This leaves us with a very potent human message. We must always appreciate the self-constructed prisons in which some of our friends and acquaintances live. Whether it is the torture of feeling unattractive or the feeling of hopelessness of a single friend who is losing hope that he/she will ever have a wife/husband and family, we must always look for ways to ease their pain.

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