On Mi Yodeyah, DonielF quotes the last mishnah in Qiddushin. The mishnah first lists a set of professions that one shouldn’t teach one’s son, because it’s hard to make money in them while avoiding theft. After a couple of debates about specific jobs belonging on the list, the mishnah says:

טוב שברופאים לגיהנם, והכשר שבטבחים שותפו של עמלק

The best of doctors is to Gehenna, and the fittest of butchers is a partner of Amalek.

The quote is perplexing, particularly the first part. Doctors are among the good guys — why is the mishnah saying that (even?) the best are headed for gehennom?

Doniel F. quotes the Maharasha’s treatment of this question:

יש לפרש טוב שברופאים דהיינו שמחזיק עצמו לטוב ולמומחה שברופאים שאין כמוהו וסומך ביותר על המחאתו מתוך גאוותו ולפעמים הוא טועה בטבע זה החולה וממית את החולה ברפואותיו בדבר שמזיק לחולה זה אבל יש לו לישא וליתן עם שאר הרופאים כיון שהוא סכנת נפשות:

There is to explain that “the best of doctors” refers to those who hold themselves in such high regard and expertise of the doctors that there are none like him, and he relies too much on his own experience because of his arrogance. Sometimes he will make a mistake in the natural way of things and will kill a sick person by trying to heal him with something bad for him. Rather, he should consult with other doctors regarding things that could lead to death.

Then he asks:

This seems a little strange to me: At best, the doctor can only be faulted for accidentally killing a person. It’s not like he intended to kill the patient. Why should that outweigh all the (presumably) many more lives that he’s saved?

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Here was my answer:

I am reminded of an insight I heard from R’ Aharon Lichtenstein zt”l.

Shaul was assigned the job of killing all of the tribe of Amaleiq. He led a war that almost did it; but he left one person — Agag, their king — alive. Shemuel told him that as punishment, Shaul would lose the throne; he would be a one-king “dynasty”.

Rav Lichtenstein taught that it was not saving Agag that was the great sin that carried such a punishment. Rather, by not killing Agag, Shaul demonstrated that killing every other Amaleiqi wasn’t to fulfill the mitzvah. If he wasn’t following G-d’s command to kill EVERYONE, then killing the rest of Amaleiq was simply genocide.

I read this Maharsha similarly.

The Maharsha mentions two things: arrogance, and the inevitable mistake. If a doctor acted purely to help others, then he wouldn’t be considered guilty for any mistakes. (But if they were capable of motives that pure, the doctor wouldn’t be human!) To the extent that a doctor acts for the sake of their own ego, the actions in which they erred also had that element of for their own ego. And they are guilty to whatever extent they harmed someone else out of a pursuit of self aggrandizement. Even if it’s also along with other, purer, motives, that element of petty motive leading to harm to someone else needs purging in gehennom.