Sick or ill person fasting:[1]

Whenever a person’s life is in danger he is obligated to transgress a Torah command when needed to help save his life. This is with exception to the three cardinal sins of adultery, murder, and idolatry. Thus, if one is sick and fasting will place his life in danger, then he must eat. If he does not do so, he is held responsible for the spilling of his own blood, which G-d will avenge against him.[2] In general, this matter is determined by a doctor, and the modern medical practice, and not by a Rav. If a doctor says there is possible danger of life involved if one fasts, then he may not fast. It is therefore imperative for every sick person, or person with a medical condition, to first speak to his doctor and receive up to date medical instruction for his personal condition, to help determine whether or not he can fast, and whether or not eating and drinking less than the Shiurim suffices, and whether he can fast if he remains in bed throughout the duration of the fast. Bringing the question to a Rav without having the personal medical advice for one’s situation from one’s doctor, can lead the Rav to give a mistaken Pesak, or not give a Pesak at all. The following are the detailed laws of this matter.

           

A. If the patient asks to eat:[3]

Any [G-d fearing] person who is sick and knows that the day is Yom Kippur and nevertheless says that he needs to eat [due to danger], is to be fed even if a hundred doctors say that he does not need to eat. This applies even if they say that eating will worsen his condition.[4]

 

B. If the doctor says he needs to eat:[5]

If the doctors say the patient needs to eat, then even if the patient says he does not need to eat, he is to immediately be fed until he says that it suffices. This applies even if the doctor is a gentile and even if the doctor says it is merely questionable whether he needs to eat.

 

C. If the doctor is in doubt whether the patient needs to eat:[6]

If the doctor is in question whether the patient must eat, then the patient is to be fed even if the patient says that he does not need to eat, as we are lenient in a case that involves danger of life even if it involves many doubts.

 

D. If there is a dispute amongst the doctors:[7]

One versus one:[8] If one doctor says the patient needs to eat while a second doctor says he does not need to eat, then if the patient does not voice an opinion, he is to be fed, as we are lenient in a case of doubt that involves danger of life. If, however, the patient says he does not need to eat, then he is not to be fed as there is also a doctor that confirms his opinion.[9]

One versus two:[10] If one doctor says the patient needs to eat while two doctors say the patient does not need to eat, then if the patient does not voice an opinion, he is not to be fed. If, however, the doctor who says that he needs to eat is a much greater physician than the other two doctors, then the patient is to be fed.

Two versus many:[11] If two doctors say the patient needs to be fed, then even if one hundred doctors say he does not need to be fed, he is nevertheless to be fed.[12]

 

E. The Halachic definition of a doctor:

Any doctor, whether man or woman, Jewish or gentile, who states that he is familiar with the illness, carries the same weight as any other doctor. Such a person is believed to even contradict a Jewish religious Doctor [who says that the illness it is not life threatening].[13] However, a doctor who is not familiar with the particular illness in question, is not given an opinion on the matter.[14]

 

F. An area without a doctor:[15]

Even if the patient does not voice an opinion and does not say he needs to eat, if he appears to majority of people to be in danger, then he is to be fed.

 

G. How much may the patient eat when obligated to do so?

If doctor told him to eat:[16] Whenever a patient is told by a doctor to eat, as opposed to him asking to be fed, then he is to be fed less than the measurement of Kareis. The same applies for one who smells a food and needs to be calmed down, that he is to be fed less than the measurement of Kareis, unless told otherwise by the doctors.

If he said he must eat:[17] If the sick person says that he must eat, then he is to eat as much as he deems necessary.

 

Q&A

May one who is sick take medicine on Yom Kippur?[18]

If he is bed ridden or weak in his entire body, then he may swallow [without water] tasteless pills. If the pill has a taste, then he is to wrap it in precut tissue [as one may not cut it on Shabbos or Yom Kippur] and swallow it with the tissue.

 

Practical list of Shiurim for food and drink:

• Food:[19] A sick person, or person with a medical condition, who has been instructed to eat less than the Shiur, is to eat less than the size of a Kusebes, which is less than 30 cc and 30 grams, within the amount of time it takes to eat a Peras of bread, which is nine minutes: The food is measured based on volume and[20][21] Hence, the Shiur is [less than[22]] the amount of food to fill 30 cc in a measuring cup [or typical match box], and this amount itself is not to weigh more than 30 grams.[23] One is not to eat more than this amount of food within nine minutes.
• Drink: A sick person, or person with a medical condition, who has been instructed to drink less than the Shiur, is to drink within nine minutes less than the amount of water that can fill one cheek. Hence, before Yom Kippur, he is to fill a cheek with water, pour it into a cup, and mark the water level on the cup. When there is Halachic need to drink based on the Shiurim, one is to drink less than this marked amount of liquid within every 9 minutes. One is not to drink the exact amount marked, as this is the Shiur Kareis for liquid.

 

The amount of time to eat the Shiurim:

All the food and liquid that one consumes within nine minutes is counted as part of the Shiur. Meaning, that one should make sure not to eat the more than the Shiur of liquid or food within nine minutes, and hence the shiur restarts every nine minutes after completing eating or drinking less than the Shiur. If nine minutes is too long of an interval, one may go down to 8, 7.5, 6, 5, 4.5,4 minutes, as is medically necessary.

 

Preparing the Shiurim before Yom Kippur:[24]

An ill person is to prepare the Shiurim before Yom Kippur. He is to fill one cheek with water and place it into a cup and then mark the water level. She is to mark on a cup the 30cc level mark for the sake of measuring food and liquid.

 

How to measure the food:

One is to crumble the food and enter it into an area which holds 30cc, which is the common size of a match box.

 

List of conditions that typically require drinking and/or eating, upon directive of a doctor:

• Kidney stones
• Diabetes

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[1] Shulchan Aruch chapter 618

[2] Admur 618/11

[3] Admur 618/1

[4] The reason: The reason for this is because we do not assume that the person is a sinner who will eat on Yom Kippur without valid reason. Thus, if he says he needs to eat despite the doctor’s analysis he must really feel that if he does not eat, it will endanger his life, which is something that only he can feel and not the doctors. [ibid] Vetzaruch Iyun if the sick person does not know that the doctors said that he doesn’t need to eat, does the sick person need to be told in order to try to calm down his worry, or not?

[5] Admur 618/2

[6] Admur 618/2

[7] Admur 618/3-5

[8] Admur 618/3

[9] We thus cannot depend the patient’s opinion on his confused state of mind. [Admur ibid]

[10] Admur 618/4

[11] Admur 618/5

[12] The reason: As the two doctors are considered like witnesses, and are thus equal to even one hundred, as by danger of life we do not follow majority in wisdom or in people to be stringent [Admur ibid; To note the Rambam rules that we do follow the majority in number or in wisdom.]

[13] Admur 618/6

[14] Admur 618/9

[15] Admur 618/10

[16] Admur 618/13

[17] 618/15

[18] Sdei Chemed Yom Kippur 3/8; Yeshuops Yaakov 612; Kesav Sofer 111; Pischeiy Teshuvah Y.D. 155/6; Eretz Tzevi 88; Igros Moshe 3/91; Tzitz Elieser 10/25; SSH”K 39/8; Nishmas Avrahma 612/7; Piskeiy Teshuvos 612/2

[19] Piskeiy Teshuvos 618; Shiurei Torah 3/10

[20] So is implied from Shiureiy Torah ibid towards end that by a food which weighs more than water it is to be less than 30 grams and less than 30 cc.

[21] Shiurei Torah 3/10, unlike Kaf Hachaim [and so rules Yalkut Yosef] which measures all based on weight.

[22] As 2/3 of an egg, which is the Shiur of the Kuseves [618/13] is 30 cc. [Shiureiy Torah ibid] Vetzaruch Iyun as Admur there writes 2/3 of an egg or a little more is the Shiur of a Kuseves, hence there is no exact Shiur. In any event seemingly to be on the safe side one is to eat less than that amount, and so is implied in Shiureiy Torah ibid. However, from Piskeiy Teshuvos 618/8 it is implied that one may eat that amount Vetzaruch Iyun.

[23] So is implied from Shiureiy Torah ibid towards end that by a food which weighs more than water it is to be less than 30 grams and less than 30 cc.

[24] Rav Cohen