The gemara raises the question whether a son can do bloodletting for a parent. Both Rav Masna and Rav Dimi cite sources that indicate it is permitted since it is beneficial for the parent. However, the gemara then quotes two stories, one with Rav and the other with Mar Brei D'ravina who didn't permit their children to remove a splinter and remove puss from a burn, out of concern that they would cause a wound which would be an inadvertent violation (of a chiyuv chenek). The ma'aseh with Rav and Mar Brei D'Ravina seem to contradict the previous gemara which permitted a son to do a surgical procedure for a parent since it is ultimately beneficial for them. There are 3 approached in the Rishonim (cited in Beis Yosef Y.D. 241) to explain this gemara:
1. Rambam makes a distinction whether or not there is someone else available to do it. Rav Masna and Rav Dimi are both speaking when there is no one else aside from the son to do it, so it is permitted. But Rav and Mar Brei D'ravina are speaking when there is someone else, so they didn't permit their sons to do it.
2. Rif and Rosh hold that there is a machlokes. We pasken like the ma'aseh with Rav and Mar Brei D'ravina. Therefore, it is assur for a son to remove a splinter of a parent, or even to let blood for a parent. Even if there is no one else available, so long as it isn't life threatening, it is forbidden.
3. Ramban explains that there is a fundamental difference between blood letting and the removal of a splinter (or letting puss out of a burn). By blood letting the actual wound is the refuah. A son is allowed to give the parent a wound when the actual wound is beneficial and for the sake of refuah. However, in the situation of the splinter and burn, the actual procedure should not result in any wound, but there is a concern that the son will cut more than necessary causing the parent to bleed. Since the wound is not the refuah, it is merely incidental and may result from the refuah, it is forbidden for a son to do it for a parent (unless there is no one else available to do it).
A major question on the entire sugya is whether a parent has the ability to be mochel. Although a parent can be mochel and forgo their kavod, it isn't clear whether mechila would help to allow their son to curse or wound them. The Minchas Chinuch (mizvah 48) assumes that mechila would help for this. He learns this from the Rambam (sanhedrin 26:6) who holds that once a person violated the prohibition of cursing, mechila will not rectify the situation. This implies that if one gave permission in advance for someone to curse, it will work. The minchas chinuch assumes that just as one can be mochel to allow someone to curse him, he and even a parent can also be mochel to allow someone to hit him.
The Turei Even (Megilla 28a) cites a Rivash (teshuva 220) who says that a Rebbi can be mochel on kavod, but cannot give permission to the talmid to degrade him (it is assur for the rebbi to be mochel and the mechila isn't effective). Based on this he assumes that the same would be true for a parent. Although a parent can be mochel on kavod, they cannot be mochel on degradation or to allow their child to hit them.
The Turei Even proves his point from our gemara. Why did Rav and Mar Brei D'ravina not allow their children to remove a splinter or take out puss, they should have been mochel to allow their children to do it? The Minchas Chinuch dealt with this proof by saying that since they weren't expecting an injury, they weren't mochel on it, therefore their children couldn't do it. But had they been fully mochel in the event that the son cuts the parent to cause bleeding while removing the splinter, it would be permitted.
Even the Turei Even cites a gemara in Kiddushin 32a which seems to understand that mechila would permit even a son to degrade a parent. The situation was where Rav Huna ripped silk in the presence of his son to test if he would get angry, but wasn't violating lifnei iver by causing the son to disrespect the parent, because Rav Huna was mochel. We see that mechila would help to allow a son to disrespect the parent, and it should follow that with mechila the son should even be able to hit the parent.
Based on all the above, if a child is a surgeon and receives permission from his parent to do the surgery, even if it isn't pikuach nefesh, when no other doctors is as proficient as the son, it is mutar. According to the Ramban so long as the actual procedure requires the drawing of blood (such as a surgery), we don't consider it to be a wound since the actual surgery is productive and beneficial. Even if it is considered a chabura and should be assur, the Rambam permits if there is no one else. It seems that if there is no one else who is as proficient in the surgery, it would qualify as no one else. Furthermore, even if it considered a chabura, the minchas chinuch holds that a parent has the right to be mochel, and the Turei Even seems to submit based on the gemara in kiddushin.
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