Eat or to fast? • All laws of choileh on Yom Kippur

Rabbi Naftali Halpern from halacha committee organization, Hatzalah, presents B'Chadrei Charedim a detailed document for patients and those who must eat on Yom Kippur.

- Preparations before Yom Kippur -

A Choleh who suspects that fasting may endanger him, must discuss his situation with his doctor (preferably a religious doctor) who is well acquainted with his particular situation. The following points need to be clarified:

1. Is it permissible to fast?

2. Is there a need to eat and drink or will one of the two suffice?

3. Is there an option of consuming less than a “shiur” (see later)?

4. How much food or liquid is required over the 24 hour period?

5. Is it essential that any currently prescribed medicine be taken on Yom Kippur?

As well as additional conditions that might have ramifications on his situation.

After consulting the doctor the facts should be presented to a competent Halachic authority who can advise him how to proceed. Under no circumstances should one rely on rulings received in previous years, but must let the Rav re-evaluate the situation anew every year.

Similarly, since no two conditions are identical, and in each situation the personal condition and state of the choleh is an individual case, therefore it is vital that his physician be consulted beforehand.

When drinking is required on Yom Kippur, one should measure his “melo lugmov” in a small cup beforehand, as will be explained later.

Eating on Erev Yom Kippur

It is a Mitzvah to eat on Erev Yom Kippur, even if one cannot fast due to his medical situation. If it is difficult for him to eat, he may rely on the opinions that he is not required doing so.

Customary Immersion in a Mikveh

A choleh who cannot immerse in a Mikvah, as is customary on Erev Yom Kippur, should have 9 “kav” of water - 23 liters - poured over him. (Leniency will allow 16 liters). The water should be flow consistently over the head of the choleh, and down his body, while his hands are held loosely over his chest. Some hold that a 4 minute shower with a standard water flow suffices.

Preparation of food on Erev Yom Kippur

It is permissible to leave prepared foods warming, for the consumption of those who are not fasting on Yom Kippur.

Eating only as is required

A choleh that is not limited as to the amount of food or drink that he may consume, may eat only to supply his dietary requirements. He must not eat anything solely for pleasure, if it is not required for his nutrition.

Eating less than a “shiur” to prevent eating more than a”shiur”

A choleh, who, in the doctor’s opinion, fasting for a few hours will cause him to require, eating regularly, later on, should begin eating “shiurim” from the beginning of the fast.

Eating regularly or via an IV

The prohibition to eat on Yom Kippur is only when the food intake is via the mouth and throat1. Nutrition introduced intravenously or via a nasogastric tube etc. is, strictly speaking, not prohibited. Nevertheless, a healthy person should not use it.

Having said this, a choleh who does need to eat on Yom Kippur is not required to receive his food via an IV in order to negate the necessity to eat regularly; rather he may eat in a normal fashion.

There are opinions that state that a choleh, who is not currently in danger and is eating only to prevent potential danger, should begin receiving nutrition via an IV from before the onset of Yom Kippur.

Staying indoors

Pregnant women or anyone else who feels weak, and there is a possibility that going to Shul might weaken them to such an extent that they will need to eat (even if only “shiurim”), must stay at home in order to avoid this situation.

This is the true even if staying indoors will only assist in no more than withholding food just once; it is nevertheless preferable to stay at home and not to come to Shul at all.

Uncertainty if a situation is life threatening

L’chatchila (=preferably) a choleh should clarify before Yom Kippur whether he must fast or eat, and if he does need to eat, how much and how often. However, if these facts were not clarified beforehand, or if the situation worsened on Yom Kippur, or reason for doubt arises on Yom Kippur itself, then we rely on a doctor, a medical professional, or even the choleh himself. In situations of suspected mortal danger we follow the rule that when suspected danger to life is involved, one must act leniently. The classifications are as follows:

1: If there is a Jewish doctor or EMT2, or any other Jew who is reasonably well versed in medicine3, or even a non-Jewish doctor, who says that the patient must eat to avoid risk of danger, even if the choleh himself feels that he does not need to eat, he must do so nevertheless.

2: If one doctor says that he needs to eat and another says he doesn’t, he must eat4. This is so, even if it is the non-Jewish doctor, as long as he is professional, or a woman, who is saying that he should eat5. The same applies if two doctors say he should eat and two say he doesn’t need to eat, he must eat.

However, if the choleh himself agrees with the doctor who says he does not need to eat6, he should not eat. Also, if there are two doctors who agree that he does not have to eat and only one who says he does, and the choleh has no opinion on the matter, he should not eat, unless the doctor who says he needs to eat, is a bigger specialist than the other two. But if the professional says he does not need to eat and the other two say he does, the majority opinion is taken into consideration and he is given to eat7.

3. If the choleh himself says he feels he needs to eat8, even if a hundred doctors disagree, and even if they are of the opinion that food might cause him harm9, he is allowed to eat. This is so, not only when the patient says so on his own, but even if they asked him whether he feels he needs to eat or not, and only then he expresses his desire to eat, he may still eat10. However before he partakes of food one should remind him, in a soft and calm manner that today is Yom Kippur11.

The same applies if the choleh says he feels that it would be dangerous for him not to eat, that he is given food, after being reminded that it is Yom Kippur.

4. When there is some doubt whether the patient is in danger and no doctor is available to be asked, the rule is that with any a life threatening situation one is lenient, and the choleh should eat as is necessary.

5. When a doctor says that the patient can fast, but during the day his condition worsened to the extent that he feels extremely weak, and there is no doctor available, he must break his fast.

Praying before Eating

It is virtuous for a choleh to make the following declaration before he eats12:

“הנני מוכן ומזומן לקיים מצוות אכילה ושתייה ביום הכיפורים, כמו שכתבת בתורתך, ושמרתם את חוקותי ואת משפטי אשר יעשה אותם האדם וחי בהם אני ה’, ובזכות קיום מצוה זו, תחתום אותי ואת כל חולי עמך ישראל לרפואה שלימה, ואזכה ביום הכיפורים הבא לקיים שוב ועניתם את נפשותיכם, כן יהי רצון, אמן”.

“Behold, I am prepared to fulfill the commandment to eat and drink on Yom Kippur, as You have written in Your Torah ‘And you shall guard My statutes and My laws that one perform them and live by them, for I am God’. And in merit of fulfilling this commandment, seal me, and all other sick people of your folk of Israel, for a complete recovery, and next Yom Kippur I should merit fulfilling the directive to afflict our souls. May it be Your will so. Amen.”

A Choleh who does not want to eat

A choleh who needs to eat on Yom Kippur but refuses to do so, thinking that with such he is being more stringent, about such a person the verse tells us “But the blood of your souls will I demand offense from you”. Not only is he not being pious, but he is committing a serious offense. If there is reason to suspect that he will not want to eat, it is a Mitzvah for a Torah scholar to be present to ensure that he eats13.

Atonement for eating

A patient, who ate on Yom Kippur according to Halachah, needs no atonement, for he did so compulsory, not willingly14.

- “Shiurim” -

The amount forbidden to be eaten

It is Biblically forbidden to eat or drink even a small amount on Yom Kippur. One who wantonly eats food in a quantity equivalent to a large date or drinks a “melo lugmov” is punishable by the divine punishment of kares (which can include losing his share in the hereafter). If he did so in error, during the times of the Beis Hamikdash a sin offering would be brought.

This quantity, referred to as “the shiur” (lit: the amount) for food, is the same for everyone, whether he is a big build or petite15.

Sometimes, a choleh who is required to eat on Yom Kippur is given less than this “shiur” and should wait between each time he eats, the length of time required to eat half a loaf of bread (known as “achilas pras”). If this is not enough, he should eat the same amount and just wait less time. If even this is not enough, he should eat normally¹⁶ as will be discussed shortly.

It should be noted that eating even less than the aforementioned amount, is still prohibited by the Torah, and is not allowed unless there is a (risk of) mortal danger involved.

Less than the “shiur”

The amount of liquid required in order to be punishable by kares, or warrant a sin offering, is “melo lugmov”, as mentioned. This terminology is the amount that can be contained in one’s cheek full. Therefore, one who, for health reasons, needs to drink on Yom Kippur he should drink less than this amount, which for an average person is considered as approximately 40cc.

By drinking less than the aforementioned amount, the fast has not been entirely interrupted.

As earlier noted, the “shiur” for eating is identical for everyone17. This is not the case with regards to the “shiur” for drinking which changes from one person to another, depending on their build. To this end, it would be advisable that prior to Yom Kippur one should fill one side of his mouth until one of his cheeks projects, and spew the liquid out into some sort of measuring cup. This way they can be sure what is his “shiur” of “melo lugmov”.18 On Yom Kippur they should drink less than that amount at preset intervals as will be discussed shortly.

With regards to food, less than the “shiur” is the volume of food that is equivalent to 30 ml of water. Some are more stringent that wherever possible he should not eat more than 25 ml (this amount will be altered when eating sponge like foods such as sponge cake that have volume but very little weight).

Between each intake of food, and between one drink and the next one should wait – l’chatchila -9 minutes.

These “shiurim” are measured in volume; therefore the choleh should prepare small cups (shot glasses) with the exact measurements before Yom Kippur. The cups should be used in administrating the required amount of food and drink, to be consumed as required. One should not rely on an assessment, since he can easily err.

A choleh who, according to the doctor’s diagnosis “shiurim” will not suffice, should decrease the period of time between one food or drink intake and the next according to his requirements by waiting 8 minutes instead of 9. If he needs more he can wait 7 minutes and so on up until 2 minutes. If even this is not enough, he should try and wait at least the amount of time it takes to drink a revi’is. If even this does not suffice, he can drink regularly, as long as everything in accordance with the ruling of a Rav and in consultation with a doctor.

The same applies to food. If according to the doctor, the aforementioned “shiurim” will not suffice, he may add up until 38cc. If this too is not enough he can lessen the waiting period between each food intake, and when even this will not be of avail, he can eat normally, as long as everything in accordance with the ruling of a Rav and in consultation of a doctor.

Permission to eat or drink less than the “shiur” is only within the overall amounts that the doctor and Rav endorsed him to do so. One must not eat any more than the amount that he has been prescribed even if it is still less than the “shiur”. {Although often the doctor himself is not exactly sure of the exact amount of liquid or solids the patient needs}.

A choleh needs to be given explicit permission for food and explicit permission for drink, since often one suffices without the other.

In a case that a choleh is given to eat due to his own insistence, after the food is placed before him he is reminded that it is Yom Kippur today and is also told that if he thinks that there might be danger involved by not eating it all at one time, he should eat freely. But if not, he should limit himself to eating “shiurim”19.

Combining food and drink

All types of food combine when measuring the “shiur” for solids, and all sorts of drinks combine to form the “shiur” for consumption of liquids. Solids and liquid do not conglomerate together as one20. Therefore one is allowed to eat less than a “shiur” and at the same time drink less than a “shiur” (although care should be taken that the solids and liquids should not be in his mouth together, lest the liquids cause the solid to expand to more than a “shiur”).

Solids and Liquids

Any solid or firm substance, such as butter, cheese or the likes, is considered food. Any sort of liquid is called a drink. There are many food items that their status is unclear whether they are considered food or drink, and one should discuss their Halachic standing with a Rav.

Food marinated in liquid

One who soaks bread or cake or other foods into a liquid, all the fluid therein is considered as food and combines for the quantity of 30 cc. Similarly, any spreads used with bread, even if, were they to be used on their own they would be considered as a liquid, since they are on the bread they are counted as food and connect to form the 30 cc “shiur”.

Measuring on Yom Kippur

It is permissible to measure and weigh these amounts on Yom Kippur itself, although it is preferable to do so beforehand. The “shiur” of liquid, which, as mentioned earlier,is measured by taking drink into his mouth until one cheek projects and then spewing it out, must be measured before Yom Kippur.

Distraction - A Berachah

One who takes a break between eating or drinking one “shiur” and the next, is not required to make a new Berachah before eating or drinking subsequent “shiurim”21. Eating less than a “shiur” does not require an after-Berachah.

- Laws of the meal -

Eating without Kiddush

A Choleh who eats on Yom Kippur does not make Kiddush beforehand, even when Yom Kippur coincides with Shabbos²².

Washing hand before the meal

A choleh who eats bread on Yom Kippur, washes his hands as he does the whole year - until his wrist. This is permitted since his intention is to fulfill the Mitzvah and not for enjoyment. He may also wash “mayim achronim” if he normally does so.

Abstain from Zimun

Where a few cholim are eating together they should be sure not to obligate themselves with zimun. This can be done be for example by eating in different venues or at different times, or by having in mind that they do not intend to join together for a zimun23.

Yaaleh Veyavo

A Choleh or a child who eats on Yom Kippur enough to require him to say Birkas Hamazon, adds “Yaaleh Veyavo – B’yom Hakippurim hazeh”. If it is also Shabbos, Retzeih should be recited as well24.

If Yaaleh Veyavo was omitted and he realized only after having conlcuding the Berachah “Bonei Yeruhshalaim” he should continue the blessing of Hatov U’Meitiv. Birkas Hamazon is not repeated25, and no separate Berachah of its own is recited either26.

The same applies with the Berachah of Al Hamichya (known as Meaiyn Shalosh). Yom Kippur is mentioned by adding the words “זכרנו לטובה ביום הכיפורים הזה”, but if omitted, it is not repeated. If it also Shabbos, the words “רצה והחליצנו ביום השבת הזה” should be added.

Eating in Public

There is no prohibition for a choleh to eat in public.

- Prayer -

Standing for the confession

Viduy (confession) on Erev Yom Kippur should be recited standing. In case of need, the choleh may lean while confessing.

A choleh or an elderly person may be lenient to lean during the viduy in the repetition of the Chazan. Some are of the opinion that the sick and elderly may lean on something even while reciting the viduy of the quiet Shemonei Esrei.

Teffilah Zakoh

A choleh who has been informed that he must eat less than a shiur, may still say the words “הריני מקבל עלי מעתה איסור מלאכה וחמישה עינויים איסור אכילה ושתיה וכו’” (Behold I take upon myself, from this moment the five afflictions of this day, the prohibition to eat or drink etc) in Teffilah Zakoh at the onset of Yom Kippur. But he should omit the words “הריני מקבל עלי לענות גופי ונפשי” (Behold I accept upon myself to afflict my body and soul)²⁷.

If he is required to eat more that the shiur, or even if this is only a possibility, he should say “הריני מקבל עלי מעתה איסור מלאכה” (Behold I accept upon myself the injunction of not doing Melachah) or “הריני מקבל עלי לענות נפשי ולא לאכול יותר מהצריך לי לסלק מעלי את הסכנה” (I herewith take upon myself to afflict my soul and not to eat more than is required to ensure that I am in no danger)²⁸.

A Choleh who finds it difficult to pray

A choleh who has difficulty in praying a long supplication, should try at least and say the viduy found in the machzor “אבל אנחנו חטאנו”, (But we have sinned) and continue “אשמנו בגדנו” as well as “על חטא”, since confession and repentance are the main focal points of the day. One, who finds even this strenuous, can omit the Al Chet. “Ashamnu” should be said.

Eating During Shemonei Esrei

A Choleh who feels weak during Shemonei Esrei and needs to eat, should not make a Berachah on the food but just think the words of the blessing in his heart29.

Aliyah to the Torah

A Choleh who is required to eat on Yom Kippur, may nevertheless receive an Aliyah to the Torah during Shachris, however it is correct that he does not receive Shishi (the sixth Aliyah) or Maftir unless Yom Kippur coincides with Shabbos, when he may receive that Aliyah.

{During Teffillas Minchah of Yom Kippur that coincides with Shabbos, Kohen and Levi may receive an Aliyah, however there is some doubt about Shlishi, since that includes Maftir³⁰.}

If less than a “shiur” was eaten, he may receive an Aliyah during the Torah reading of either Shachris or Minchah.

Taking Medication

It is forbidden to taste anything on Yom Kippur even if it is spat out and not swallowed31. Having said this, one, for whom the Rabbinical prohibition to take medication on Shabbos and Yom Tov is not applicable in his case32 may wash his mouth with a bitter medicine and spit it out, if such is required for his welfare33. There is room for leniency, even to swallow such a medication as we shall see shortly.

Syrup or a Succulent Medication

A Choleh in mortal danger that necessitates taking medication on Yom Kippur, should be instructed to embitter the liquid with salt (or another ingredient if he cannot take salt). In this way, the drink is prohibited only as a Rabbinical ordination34 since it is not fit for normal consumption.

Tasteless pills for a Choleh that it not in danger

Tasteless pills may be taken by a Choleh even if he is not in mortal danger35.

Taking water with the treatment

Someone who needs pills, even if he is no danger, but cannot swallow the pill without water, may take a little water that has been made bitter so that the palate does not receive any enjoyment.

Birkas Shehakol on the water taken with a pill

Water taken in order to enable one to swallow a pill does not require a Berachah36.

Washing and wearing shoes for the Choleh

Washing for medical reasons

A choleh, even if he is not dangerously sick can be bathed, if the medical staff feel that there it is needed for his health37, as long as he is in such a position that there would be no issur to wash him on Shabbos (occurs often with a lady after childbirth)38.

If, on Yom Kippur one is suffering from an attack of unbearable headache (such as migraine), so much so that he is in terrible pain and weakened by it, or needs to lie down, he may wash his head in cold water in order to ease the pain.

Wearing Shoes

A choleh, even if not dangerously sick, who has an injury to his foot and is sensitive to cold air and he cannot be without his leather shoes, may wear leather shoes. If he can find comfortable shoes that are without leather, he should wear them.

A choleh that is allowed to wear leather shoes may do so even if his sickness is not noticeable. However, he should try not to walk anywhere he doesn’t actually have to.

Leather shoes should not be touched directly rather via a cloth, otherwise he will need to wash the part of his hands that touched the shoe39.

- Laws of Pregnancy, Postpartum and Nursing -

A woman who is pregnant or nursing, needs to fast the whole day of Yom Kippur40.

Pregnant

Women who are pregnant, or after a birth, should prepare themselves well for the fast in advance, by increasing their liquid intake. On the fast day itself they should remain at rest in an (air condition) cool area, since dehydration can induce premature births. Furthermore she must consciously take note that the fetal motions are regular.

A woman enduring a high risk pregnancy or with any other medical complications should discuss her condition with the Rav and gynecologist.

A Pregnant Woman who Smelled Food

A lady who is pregnant and smelled food, and craves for it to the extent that symptoms of such are visible in her facial features41, or even of that wasn’t the case but she expresses explicit need for that food, one should whisper into her ear that today is Yom Kippur. If that calms her desire, all is well and good, and if not she should be given to eat until the desire wanes. With regards to this Halachah, there is no difference as to which stage of pregnancy she is42.

When the aforementioned lady is given to eat she should be given in the following order:

Initially she should be given only a few drops of the sauce or gravy from the food she desires in anticipation that maybe that will suffice to calm her cravings43. If that proves to be insufficient, she should be allowed to taste the gravy in amounts that are less than a “shiur”. If this too is inadequate, she can be given from the food itself less than a “shiur”. If there is still no improvement, she can eat like normal until her yearning abates44.

If her eye sight dims or becomes impaired due to the fast, she is given to eat immediately until her sight is restored45. If she becomes extremely weak and those around her feel that she is in danger, she is given to eat instantaneously.

After Birth

A Lady within seventy two hours of birth46 must not fast at all47, she should eat regularly and not in small less-than-”shiur” amounts (although some are stringent she has not expressed the need to eat that she should be given less than the “shiur”). Even if she says that she doesn’t need, food is placed in front of her and she is told to eat it48. In this case however, she should be given less than a “shiur”.

If Yom Kippur occurs between the fourth and seventh day after birth, if she declares that she feels a need to eat, she may eat49.

If she feels that she needs to eat but the doctors disagree, she should be given to eat in portions less than a “shiur”50.

If she isn’t sure if she needs to eat or not, or she does not express desire for anything in particular, and nobody says that she doesn’t need to eat, she should be given less than a “shiur”51.

If she feels she does not need but the doctors say she does need52, or they are not sure53, she may eat regularly.

If she says she doesn’t need to eat and there is no-one contradicting her, she should fast

Once seven days from the birth have passed, she is considered like everyone else and no longer in any danger because of the birth. Therefore, even if she feels that she needs to eat as a result of the birth, she is not allowed to do so. But, if she feels a need to eat since her sickness is becoming overwhelming, she may eat like any other choleh who feels a need to eat54.

Miscarriage

A mother who lost the child she was carrying, the laws that are applicable to her, are identical to those of a woman after child birth. If the fetus died within forty days of conception, a competent Halachic authority should be consulted55.

Nursing

A nursing mother whose child is sick or in danger and refuses food from any source other than from her, and fasting could be perilous for the child, must not fast. A doctor and Rav should decide if she should eat more or less than a “shiur” and if she can manage only with an intravenous.

1 מנ”ח שי”ג, שו”ת מהרש”ם ח”א סי’ קכ”ג, שו”ת אחיעזר ח”ג ס”ט.

2 שו”ע סי’ תרי”ח סעי’ א’.

3 משנ”ב סי’ תרי”ח סק”א.

4 שו”ע שם סעי’ ב’.

5 משנ”ב שם סק”ו.

6 שו”ע שם סעי’ ג’.

7 שו”ע שם.

8 משנ”ב שם סק”ד.

9 עיין ביה”ל סי’ תרי”ח סעי’ א’ ד”ה ואם החולה ודלא כהט”ז.

10  משנ”ב שם סק”ה.

11 הועתק ממחזור עתיק, עיין בס’ תורת היולדת פ’ נ”ב אות י’.

12 משנ”ב סי’ תרי”ח סק”ה.

13 משנ”ב שם.

14 שו”ע סי’ תרי”ב סעי’ א’ ה’.

15 שו”ע סי’ תרי”ח סעי ז’ ח’.

16 משנ”ב סי’ תרי”ח ס”ק כ”א.

17 משנ”ב שם.

18 משנ”ב סי’ תרי”ח ס”ק כ”ד.

19 סי’ תרי”ב סי’ ב’.

20 הליכות שלמה פרק ו’ ס”ק י”א.

21 משנ”ב סי’ תרי”ח ס”ק כ”ט.

22 שו”ע סי’ תרי”ח סעי’ י’, ועיין במשנ”ב שם ובשעה”צ אות כ”א, ובמשנ”ב סי’ קפ”ח ס”ק י”ט.

23 משנ”ב סי’ תרי”ח ס”ק כ”ט.

24 משנ”ב סי’ קפ”ח ס”ק י”ט ודלא כהמג”א.

25 עיין מנח”י ח”ו סי’ נ”ח

26 עיין ש”ש עמ’ קכ”ד.

27 אבנ”ז או”ח ל”ז ח’

28 עיין שו”ת רעק”א מה”ק תשו’ כ”ד, ועיין שו”ת מנחת אליעזר ח”ב סי’ ע”ב, ובשו”ת חת”ס או”ח תשו’ קנ”ז.

29 רמ”א סי’ תרי”ב סעי’ ו’.

30 שבה”ל ח”ד סי’ נ”ד ו’.

31 דאף אם יבלע אין בזה איסור דאורייתא, דהוה משקין שאינן ראויין.

32 כמבואר ברמ”א בסי’ תרי”ב סעי ט’ דפטור על משקין שאינם ראויין, ובמשנ”ב ס”ק ט”ו לגבי אכילת דברים שאינם ראויין דהוא איסור מדרבנן.

33 אגרות משה או”ח ח”ג צ”א, ישועות יעקב תרי”ב.

34 שבה”ל ח”י סו”ס פ”ג, דכל שלא רוצה להנות, לא יברך.

35 משנ”ב סי’ תרי”ג סק”י.

36 עיין משנ”ב שם.

37 משנ”ב סי’ תרי”ד ס”ק י”ד.

38 שו”ע סי’ תרי”ז סעי’ א’.

39 משנ”ב סי’ תרי”ז סק”ב.

40 משנ”ב שם סק”א.

41 משנ”ב שם ס”ק ד’.

42 תורת היולדת פרק נ’ אות ב’.

43 תורת היולדת שם אות ג’.

44 שו”ע שם סעי’ ד’.

45 משנ”ב שם סק”י.

46 שו”ע שם.

47 משנ”ב שם ס”ק י”א.

48 משנ”ב שם ובשעה”צ אות ט”ז.

49 שו”ע סי’ תרי”ח סעי’ ה’.

50 עיין משנ”ב סי’ תרי”ח ס”ק י”ג דמיירי שמכיר החולי אלא שמסופק אם יסתכן, דאל”ה הוי כאיניש דעלמא.

51 משנ”ב סי’ תרי”ז ס”ק י”ב.

'בחדרי' גם ברשתות החברתיות - הצטרפו!