A “regular” sick person, whose whole body is ill but whose life is not in danger, is obligated to fast but may take pills that have no taste * A gravely ill person is obligated to eat * Not all medical worries are considered life-threatening, therefore a religiously observant doctor should be asked * Eating in “measures” – only for the gravely ill * Diabetics – better to eat more than a “measure” and come to synagogue * Pregnant and nursing mothers must fast, and not drink in “measures” * Today, sick people and pregnant women are not considered weak like in the past, but are actually healthier * In the era of milk substitutes, shortage of milk cannot be considered a danger * Advice for nursing women before the fast
The Mitzvah to Fast
The most important aspect of atonement on Yom Kippur is dependent on fasting. By fasting, a person withdraws from all bodily actions, draws within his inner-self, his soul, and reveals his true, inner aspirations – to follow Torah and mitzvot, and thus participate in ‘tikun olam’ (repairing the world). By doing so, his sins become external, and ‘zedonot’ (willful transgressions) are transformed into ‘shegagot‘ (inadvertent errors). And if thanks to Yom Kippur a person merits to repent deeply and completely, to the point where he amends all of his sins, he will also merit having his ‘zedonot’ transformed into ‘zechuyot‘ (spiritual credits).
Therefore, the mitzvah of fasting is the only commandment intended for each and every Jew on Yom Kippur, as it is written: ” “[Each year] on the 10th day of the 7th month you must fast…this is because on this day you shall have all your sins atoned, so that you will be cleansed. Before God you will be cleansed of all your sins” (Leviticus 16:29-30).
A Sick Person Whose Life is Not in Danger is Obligated to Fast
Even one suffering pain from his illness – as long as his life is not in danger, it is forbidden for him to eat or drink anything. If necessary, he should lie in bed all day, rather than eat or drink anything.
This is the difference between Yom Kippur and other fasts – namely, on the fast of Yom Kippur, ill people must also fast because it is a Torah prohibition; on the fast of Tisha B’Av, ill people are exempt from fasting; and on the minor fasts, pregnant and nursing mothers are also exempt.
Nevertheless, a sick person who experiences discomfort from his ailment, or those who take medication every day, are permitted to swallow medicine on Yom Kippur, provided these pills do not taste good, and as such, are not considered food. One should take care to swallow them without water. Those who cannot swallow them without water can mix a drop of soap in water, thereby extremely impairing its taste, and swallow the pill with such water.
If the fast causes a person great pain, he is permitted to take pills to relieve the pain. Similarly, individuals suffering from intense headaches due to not drinking coffee are permitted to take pills containing caffeine, or pills to relieve headaches.
The Gravely Ill
Someone who is gravely ill and the fast is liable to result in his death, is commanded to drink and eat as necessary, because ‘pikuach nefesh’ (saving a life) overrides the mitzvah of fasting, as is the case for all other mitzvoth from the Torah (Yoma 85b). A person in a state of ‘safek sakana’ (questionable risk of death) and is ‘machmir‘ (stringent) with himself not to drink or eat – sins, for He who commanded us to fast, also commanded us to eat and drink on Yom Kippur when the fast is likely to endanger life.
The intention is not merely in a situation where as a result of fasting a significant percentage of sick individuals will die; rather, as long as there is a possibility the fast will cause an ill person’s death, or weaken his ability to cope with his dangerous illness, it is a mitzvah for him to eat as necessary. Similarly, if the fast is liable to hasten the death of a terminally ill person on the verge of dying, it is a mitzvah for him to eat and drink as needed, because in order to save life – even for a short period of time – it is permissible to eat and drink on Yom Kippur.
Not to Be Overly Concerned
On the other hand, however, one should not be overly concerned, for if we worry about ‘sakanat nefashot’ (endangering life) over every common illness, in effect, we cancel the halakha which determines that a sick person is obligated to fast on Yom Kippur.
Not only that, but if we overly exaggerate and worry about extremely remote dangers, we would have to hospitalize every sick person with the flu, and ban unnecessary car travel out of fear of automobile accidents, and so forth.
Rather, the general rule is that any danger that people usually treat urgently, investing time and effort, such as rushing a sick person to a hospital in the middle of a working day, is considered ‘sakanat nefashot’, and in order to prevent it, it is a mitzvah to desecrate Shabbat and drink and eat on Yom Kippur. But dangers in which people do not rush and devote time and resources to take care of, is not considered ‘sakanat nefashot‘.
How to Evaluate ‘Sakanat Nefashot’
A doctor who is in doubt should contemplate what he himself would do if on Yom Kippur he learned about a sick patient who was fasting. If he would get in his car and drive ten minutes in order to instruct the patient to drink and eat thereby saving the patient from ‘safek sakana’, it is a sign that indeed it is a case of ‘safek sakanat nefashot’, and he should instruct an ill person coming to him to eat and drink on Yom Kippur. But if in spite of his responsibility for human life he would not be willing to drive on Yom Kippur for ten minutes, it’s a sign there is no ‘safek sakana’, and he should instruct the patient to fast. This advice is beneficial for a normal doctor who, on the one hand, is not lazy, but on the other hand, does not particularly enjoy scurrying between patients.
Ask an Observant Doctor
This halakha is entrusted to doctors, namely, that in accordance with the medical information at their disposal and their personal experience, they must determine when there is – or is not – a fear of danger. Still, a problem arises: there are doctors who, due to over-hesitation or disregard of mitzvoth, inevitably instruct every sick person to drink and eat on Yom Kippur.
Therefore, in regards to this issue, people who are ill must take advice from a religiously observant doctor. And religious observance is not dependent on the kippa one wears; rather, the most important thing is that the doctor should be honest and ethical, and determine with exceeding responsibility, towards both the sanctity of the fast, and that of human life.
An ill person who mistakenly asked a doctor who is not observant and naturally, was instructed to eat and drink, should hasten and ask an observant doctor before Yom Kippur. If one erred and did not ask an observant doctor, and has no opportunity to do so, he should drink and eat on Yom Kippur because although there is doubt whether the doctor replied correctly, the realm of doubt still remains, and in any situation of ‘safek nefashot’, one must be ‘machmir‘ (stringent) and eat and drink.
The Greatest Mistake in Eating in Measurements
A common and widespread misconception among doctors and the ill is the belief that the advice to drink in ’shiurim‘ (measured quantities) is sort of a middle-path, suitable for sick individuals for whom the fast is not life-threatening. In truth, however, the status of ill people not in a life-threatening situation is similar to all others, and the severe Torah prohibition applies to them as well, i.e., it is forbidden for them to drink or eat anything.
Rather, the point about drinking in ‘shiurim’ is that even when a dangerously ill person needs to eat and drink on Yom Kippur, some authorities say it is preferable to eat and drink in ‘shiurim’. The ‘shiur’ for drinking is ‘k’mlo peev’ (a cheek-full of liquid), each person according to the size of his mouth. The ‘shiur’ for eating is ‘k’kotevet hagasa‘ (a type of large date). In other words, eating and drinking less than a ‘shiur’ means drinking less than ‘k’mlo peev’, and eating less than ‘k’kotevet’, which is approximately 30 ml (S.A. 612:1-5, 8-10). The interval between drinking and eating is approximately nine minutes. Some authorities say that if the sick person is dangerously ill, he should drink and eat normally. And if there is a danger, even remote, that drinking and eating in ‘shiurim’ will cause even the slightest negligence in the strengthening of the dangerously ill person, he should drink and eat normally. For example, if a ‘yoledet‘ (a women after childbirth) is tired, it is better for her to drink normally so she can sleep uninterrupted, rather than having to stay awake in order to drink in ‘shiurim’.
For a person with diabetes, for whom fasting is life-threatening, it is better to eat more than a ‘shiur’ and pray in synagogue, than to stay at home and eat in ‘shiurim‘. There are two reasons for this: one, eating in ‘shiurim’ is a ‘hidur mitzvah’ (an enhancement of the mitzvah), while praying in a minyan is more important. Second, if we ask people who are sick to stay at home so they can eat in ‘shiurim’, there will be some who nevertheless will go to synagogue, with the intention of eating in ‘shiurim’ in the synagogue discreetly, but in practice for various reasons will forget to eat as much as necessary, and as a result will blackout, become unconscious, or die, God forbid, as occasionally happens on Yom Kippur.
Pregnant Women are Obligated to Fast
Pregnant and nursing women are obligated to fast on Yom Kippur (Pesachim 54b; S.A.617:1). Even on Tisha B’Av, pregnant and nursing women are obligated to fast, kal v’chomer (all the more so) on Yom Kippur, whose requirement stems from the Torah.
There are some poskim (Jewish law authorities) who sought to permit pregnant women to drink in ‘shiurim’ because in their opinion, women have become weaker nowadays, and fasting may cause them to miscarry. However, from studies conducted in Israel and abroad, it was revealed that fasting does not increase the risk of miscarriage. Only in rare cases is fasting liable to induce labor in the ninth month of pregnancy and, in any event, this does not entail ‘sakanat nefashot’. Also, there is no evidence to the claim that nowadays women are weaker. On the contrary – today people are healthier than in the past, due to both the diversity and abundance of food, better hygiene, and medical advancements. This is also reflected in the rise of life expectancy by tens of years. Consequently, there is no room to be more lenient than in the past, and the halakha remains firm that pregnant and nursing women are obligated to fast (Nishmat Avraham 617:1).
Therefore, even a pregnant woman who suffers from vomiting, high blood pressure, low hemoglobin (iron) or various ailments is obligated to fast on Yom Kippur, and it is forbidden for her to drink in ‘shiurim‘. Only in exceptional cases where the pregnancy is at risk, and in accordance with the advice of a religiously observant doctor, should a pregnant woman be instructed to drink, and in such a case, preferably in ‘shiurim’.
Nursing Women are Obligated to Fast
A nursing woman is obligated to fast on Yom Kippur (Pesachim 54b; S.A. 617:1). Although nursing causes fasting to be difficult seeing as it results in a further loss of fluids, there is no danger to the mother or the fetus. Some poskim sought to be lenient regarding nursing women because in their opinion weakness has descended upon the world, and today, without nursing, babies are at risk. However, their opinions are extremely puzzling, for although there are certainly positive benefits to nursing and mother’s milk, nevertheless, there are many women who do not nurse at all, and we have yet to hear doctors wage a war over women continuing to nurse in order to save their children from mortal danger. If in the past when numerous babies died in their first year of life and there were no good substitutes for mother’s milk, the clear-cut halakha was that a pregnant woman was obligated to fast – even on Tisha B’Av – how is it conceivable that nowadays when there are good substitutes, this issue has become one of pikuach nefesh?!
Good Advice for Nursing Women
The doctors we are acquainted with advise nursing women to drink three days before Yom Kippur at least four liters per day, and on the eve of Yom Kippur – from morning, until the fast begins – about five liters, in order to store fluids ahead of Yom Kippur, and as a result, also increase milk. According to experience, if a woman does so, not only will Yom Kippur not affect her nursing, but as a result, her milk supply will increase. Very possibly, she might even be able to extract surplus milk ahead of Yom Kippur.
Another piece of advice from my wife for the fast to be easier for both mother and baby: to alternately skip two feedings – one at noon-time on Yom Kippur, and another towards the end of the fast, and in its place, feed the baby a milk substitute.
This article appears in the ‘Besheva’ newspaper, and was translated from Hebrew. Other interesting, informative, and thought-provoking articles by Rabbi Melamed can be found at: http://en.yhb.org.il/