Shulchan Aruch: Chapter 618 - Laws Related to a Sick Person on Yom Kippur

SECTION 618 Laws Relating to a Sick Person on Yom Kippur. (1–18)

1 [The following principles apply with regard to] a sick person who says, “I need to eat”1 — even when he does not say that if he does not eat, [his life] might be endangered.2 If, after he is informed that it is Yom Kippur, or [it is obvious] that he himself knows that it is Yom Kippur, he [nevertheless] says “Give me [food] to eat,” or “I cannot bear the fast because of my sickness,” or any similar expression indicating that even though he knows it is Yom Kippur he wishes to eat, he should immediately be given food until he says, “Enough.”

[The rationale:] It is not assumed that he is a wicked person [who desires to violate the prohibition]. The assumption is that he feels that he requires this [food], for a person’s own heart knows the bitterness of his soul.3 Therefore, even if a hundred doctors say that he does not need to eat, and even if they say that food will harm him, it is the words of the patient that are to be heeded.4 [It is assumed that] he certainly needs [to eat], because he knows that it is Yom Kippur, and he nevertheless requests food.

2 Even though the patient himself says that [he] does not have to eat, but there is a doctor — even a non-Jew — who says that he must eat, the patient should be given food as directed by the doctor, provided he is an expert.5

[Moreover,] even if the doctor does not say that if the patient does not eat he will be endangered, but merely that his illness might possibly intensify, the patient should be given food, for fear that such deterioration may lead to mortal danger. Even though the patient says that he does not have to eat, his statement carries no weight in justifying a stringent ruling, for he may have spoken out of confusion and distress, being so weak that he is unaware of [the severity of] his illness. [Hence the rule applies:] Whenever a question of life and death is in the balance, the lenient ruling is to be followed.6

3 [The following principles apply if] one doctor says that [the patient] must eat and another doctor says that it is not necessary. If the sick person does not say anything, or if he says that he does not know, he should be given food, for whenever a question of life and death is in the balance, the lenient ruling is to be followed.⁶

If, however, the patient himself also says that he does not need [to eat], he should not be given food. Since one doctor shares his opinion, it is not assumed that he spoke out of confusion and distress.

4 If the patient says nothing or if he says that he does not know, and one doctor says that he needs to eat, and two doctors say that he does not need [to eat], the patient should not be given food, because one voice does not outweigh two.

If, however, the first [doctor] is distinguished for his expertise when compared to the two [doctors] who say that the patient need not eat, his words should be respected: the ruling should be lenient and the patient should be given food, because a question of life and death is involved.

5 If, however, two doctors state that the patient must eat,⁵ then even if a hundred doctors say that he does not have to eat, and even if the patient himself says that he does not have to eat, he should be given food. [This applies] even when the hundred who say that he does not have to eat are greater experts and are more distinguished for their knowledge than the two [who rule leniently. For] in an uncertainty involving life and death, a stringent ruling is not determined by greater wisdom or greater numbers. Instead, since two [doctors] who are knowledgeable in this discipline say that the patient must eat, they are considered as distinguished experts. We see [a parallel] to this in [the laws of] testimony. There, by Scriptural decree, two witnesses are considered equivalent to a hundred.

6 In this context, a doctor who is a woman or a non-Jew is equivalent to the most legally competent Jewish male,7 whether [that doctor’s] opinion is more lenient or more stringent. [That doctor’s] word is trusted to outweigh the opinion of the most legally competent Jewish doctor, according to the guidelines discussed above.

7 [Even] if the patient says that he does not need [to eat] and [even if] a doctor says that he does not know whether he must eat, since possibly there is no [reason] whatever for concern or doubt that the illness will intensify because food was withheld, food should be given to him. [The rationale is that] if the doctor had said that he knew that there was [reason] for concern or doubt that the illness would intensify, the patient would have been given food. Therefore even now, when the doctor is undecided, [the patient] should be given food. For whenever a question of life and death is in the balance, the lenient ruling is to be followed, even if there are many cumulative doubts involved.

8 If, however, a doctor says that there is no need for [the patient to eat] and the patient himself does not know, he should not be given food.8 The patient’s statement that he does not know is of no consequence, for most patients do not know, nor are they knowledgeable with regard to their illness.

[The ruling is different] if the patient is himself an expert doctor and is knowledgeable with regard to his illness. If he says that he does not know whether he must eat on Yom Kippur, he should be given food. The rationale is that if he had said that he must eat, he would be given food. Therefore even now, when he says that he does not know, he should be given food because of the doubt involved.

9 If a doctor9 says that he is not knowledgeable about the patient’s illness, he is like any other person and his opinion is of no consequence when he says that the sick person must eat or that he does not know.

Similarly, if [such a doctor] says that there is no need for the patient to eat, his words are of no consequence. [Thus,] if the patient says (that [he] does not know or) that he does not have to [eat], and one [other] doctor says that he must [eat], the patient should be given food. No attention is paid to the words of the doctor who says that the patient need not [eat], since he is not familiar with this illness.

10 Even in a place where there are no expert doctors to evaluate whether [the patient] must eat, if he becomes so weak that most of the people around him regard him as dangerously ill, he should be given food.

11 As to a patient who knows himself that he must eat, but is stringent with himself and does not eat, of him Scripture says,10 “But I will demand the blood of your souls…”11

12 Whenever it is permitted for one to eat [on Yom Kippur] and he does not wish to eat, he should be fed against his will.

13 [The following rules apply when,] following the advice of experts, food is given to a patient who does not say that he must eat.12 They also apply to a pregnant woman who smells [the aroma of] food and her face begins to change [color]13 — or to any other person whose face changes color because he [smells] the aroma of food — who was not satisfied when given a taste of the sauce. They apply similarly to a woman within three days of childbirth, who does not say that [she] must eat.

A person in any of these situations should be given small portions at a time, so that when combined they will not add up to the measure defined in sec. 612[:1], for which one is liable for kares and lashes.14 [In this way,] this person’s liability will be reduced from [that associated with a violation punishable by] kares or lashes to the mere violation of the prohibition [against eating even less than the required measure].

For this reason, such a person is initially given less than the size of a date,15 i.e., two-thirds the size of an average-sized egg or slightly more, but not approaching the size of an egg;16 this is the measure of the size of a date. Afterwards, [his attendants] should wait the time it takes to eat four eggs, or at least the time it takes to eat three eggs (see sec. 612[:4]),17 and then give him the initial measure again.

14 With regard to drinking,18 it should first be determined how much a particular patient’s cheekful contains; [i.e., not an entire cheekful, but the amount of liquid which] if moved to one side of his mouth would look like a cheekful. He should be given less than this amount. [His attendants] should then wait the amount of time necessary to eat four eggs, or at least the amount of time necessary to eat three eggs, or at the very least the amount of time necessary to drink a revi’is (see sec. 612[:15]). He should then be given the same measure to drink again.

If, however, doctors or other knowledgeable people (for example, most women know the needs of a woman after childbirth, and their word can be relied upon, as stated in sec. 330[:4-5]) assess that these limited quantities are insufficient or if they are unsure about this, the patient should immediately be given all the food and drink he needs, as prescribed by these knowledgeable individuals.

15 If a patient — a pregnant woman, or a woman who is within seven days of childbirth, or a sick person — knows himself that he must eat, we do not show concern for any of these measures. Instead, we place food before him and say: “Today is Yom Kippur. If you know — or if you think it is possible — that you will be in [mortal] danger if you do not eat more than the minimum quantity [for which one is held liable], eat [that quantity, or more]. If not, eat less than that quantity at recurring intervals.” The person will then eat in whatever way appears appropriate in his own eyes.

16 If a person is seized by bulmus, an ailment caused by hunger whose symptom is that his vision is dimmed and he cannot see, he should be given food until his sight is restored.19 If there is no kosher food available, he may be given non-kosher food. If there are two types of forbidden food, one governed by a more serious prohibition than the other, we give him the one governed by the lesser prohibition first, [in the hope that] it alone will be sufficient for him.

17 [The laws that apply when a patient] requires meat, there is an animal that must be slaughtered,20 and meat is also available from an animal that was not ritually slaughtered,21 [are discussed in] sec. 328[:16].22

18 When a patient who ate [out of necessity] on Yom Kippur becomes composed and is able to recite the Grace After Meals,23 he should mention Yom Kippur in the Grace; i.e., he should add the passage Yaaleh VeYavo in the blessing Boneh Yerushalayim.24 If Yom Kippur falls on Shabbos, he should also add the passage beginning Retzeh. He is not, however, required to recite a blessing over two loaves of bread, nor is he required to recite Kiddush over wine or over bread, because the Sages did not ordain such matters for Yom Kippur.