Siman 618

Know that in the Mishnah (82a), and in the Gemara, and in the poskim, it is explained that the eating of a sick person on Yom Kippur depends on the doctors and on the sick person himself. As we learned in the Mishnah there: A sick person—one feeds him according to the word of experts. If there are no experts there—one feeds him according to his own word. And what is the law when there is no doctor there, and the sick person says nothing, as is the case in most illnesses? And we know that the sick person will always speak to be stringent, and one should not rely on his words. And it would seem appropriate to say that all the laws that will be explained apply to sick people where we do not know if there is danger in them or not. But in an illness of danger—there is neither a question nor opinions here, and it is obvious that one does not allow him to fast, for you have no greater danger than this! And what is called danger, when there is no doctor here? It appears that when he is bedridden and cannot get out of it—he is a sick person whose life is in danger. And likewise, if he is among those with consumption, which they call sukhatka or der—it is a danger. And even if we have a doubt—behold, a doubt regarding the saving of a life also overrides Shabbat and Yom Kippur.

However, from the words of the Rambam in chapter two, law 8, it does not appear so, for he wrote: A person with a life-threatening illness who asked to eat on Yom Kippur, even though the expert doctors say he does not need to—we feed him, etc. Thus far his words. Behold, even in a case of a life-threatening illness, it requires the statement of the sick person that he needs to eat; yet it is possible to say that this is in a place where the doctors say he does not need to. But when there are no doctors here—we do not even require his statement that he needs to, but rather we feed him as a matter of course. And so it appears primary for the practical halacha. And one should not wonder that if there is a life-threatening illness—how could the doctor say he does not need to? For this is not a difficulty at all, as there are several illnesses that do not require eating, and the absence of eating will not harm them. However, this depends on the wisdom of the doctor who understands the illness, and understands that this illness does not require eating and drinking. But as a matter of course, when there is no doctor before us, if there is a life-threatening illness—we feed and give him drink as on any day, but in less and less than the shiur if it suffices for him, as will be explained before us. And there are illnesses where their entire cure is through abundant eating, such as those with tuberculosis which they call sukhatka, or dar, for in these, less and less than the shiur will not suffice, and we must give them much according to their soul's desire, for this is their cure.

This is the wording of the Tur: A sick person who needs to eat, if there is an expert physician there who says: if they do not give to him it is possible that the illness will become heavy upon him and he will be endangered – they feed him according to his word. And it is not necessary that he says "perhaps he will die." And if there is no physician there – they feed him according to his own word, for since they informed him that it is Yom Kippur, and he asks to eat – one does not need to be more exacting with him, etc. Thus far his words. And he was exacting to say "a sick person who needs to eat" to indicate that he is not speaking specifically of a sick person whose life is in danger, and like the words of the Rambam, but rather even in one whose life is not in danger, and he says that he needs to eat – they feed him (Bach). For behold, there are illnesses where they walk in the marketplace, and in these certainly in an ordinary case they do not feed, except when the physician says that he needs, or he himself says that he needs. But in illnesses of danger, such as the sick person confined to bed – one does not need any statement, but rather even in an ordinary case they feed him, as we have written.

Furthermore, we have learned from his words that it is not necessary for the physician to say that if he does not eat, he will die. Rather, even if he said that the illness will become heavy upon him, and consequently he could come to danger through this, we feed him. Moreover, even if he does not say this with certainty, but rather that it is possible the illness will become heavy upon him, we also feed him, for it is a great principle: a doubt regarding lives is to be treated leniently, and it is forbidden to be stringent in this matter. And a sick person who needs to eat and does not want to, we feed him against his will. And we rebuke him with words that he is obligated according to the Torah to eat, and if he does not eat and dies, he is like one who destroys himself intentionally, and he has no portion in the World to Come. And so too, there is no difference between an Israelite physician and one who is not an Israelite regarding the laws that will be explained, and likewise between a male physician and a female.

And if he says that he needs [to eat], even if a hundred expert doctors say that he does not need to—we listen to the patient, for "the heart knows its own bitterness." And even if they say that the food will harm him—we listen to the patient (Magen Avraham, subsection 3, in the name of the Radbaz). And even though above in siman 328, when the patient says he needs a certain medicine and the doctor says it will harm him, we listen to the doctor—this is because in matters of medicine, the doctor is certainly more expert. However, regarding the core matter of eating—certainly the patient knows himself better when he says he needs it (Acharonim). But the matter is astonishing, for it appears that even not on Yom Kippur, if the patient requests to eat and the doctor says the eating will harm him—we do not give it to him. And such are the daily occurrences. For this too is among the laws of the doctors, to understand that the eating will harm him. And many times we see that the patient requests something that harms him, and we do not give it to him based on the doctor's command. And because it is now Yom Kippur, should it be worse?! [This is said] in astonishment. And it is understandable when the doctor says he does not need it, meaning: that he will live without it—we listen to the patient because of the doubt, since even in the doctor's opinion the eating will not harm him. But when he says the eating will harm him—how is it possible to feed him, even without Yom Kippur, and all the more so on Yom Kippur? And it requires great study.

And it appears in my humble opinion that the great authorities who stated this law—this is not regarding a sick person lying in bed. For with such a sick person—it is obvious that one listens to the doctor when he says that eating will harm him. And even on a weekday it is so. And only when he says that it will not harm and will not improve, and the sick person says that he will be harmed if he does not eat in this case—our sages, of blessed memory, said that one listens to the sick person, and not when the doctor says that eating will harm him. And the words of the great authorities refer to those with pains who walk in the marketplace, but who have a strong pain in the heart, or in the head, or in the intestines, such as the disease of tuberculosis and the like. For in this, the person himself is more expert in his nature than the doctor who visits him occasionally, and the doctors do not possess clear laws regarding those with pains, as is known. In this, one listens to the sick person even when the doctor says it will harm him, because the sick person with the pain is more expert in his nature than the doctor.

If the sick person says that he does not need to eat, and the doctor says he needs to—we listen to the doctor, and we feed him. And the Rambam added regarding this to say: and this is provided that he is an expert doctor, see there. And I do not know what this comes to teach us—for every doctor involved in this matter is considered an expert doctor, just as the Rambam himself began to say previously: This sick person etc. who asked to eat, even though the expert doctors say etc., see there. And behold, in the laws that follow regarding doctors against doctors—he does not specify this condition, for a doctor, without qualification, is an expert. (And the Maggid Mishneh wrote that he mentioned "expert" because "experts" was also mentioned in the Mishnah, see there. And I wonder: for the Rambam also mentioned this previously, as I have written.)

And it appears to me that he has informed us of a great matter in this. For behold, in the Yerushalmi (chapter eight, halacha 4) it says regarding this Mishnah: A sick person says "I am able to fast," and a physician says "I do not know" – Rabbi Elazar in the name of Rabbi Yochanan: It is treated as a doubt regarding a life, and a doubt regarding a life is to be lenient. See there. But our Shas does not hold thus, for behold, specifically when a physician says he "needs" [to eat] does it hold that we listen to the physician, and not in a case of doubt. This is because our Shas holds that the statement of the sick person has substance, because he knows himself. And only when the physician says the opposite – of necessity we hang [the matter on the fact] that it is a weakness that has seized him, as it is stated in the Gemara. That is to say: that he is not in his right mind. But when the physician is in doubt, his [the patient's] statement is a certainty, and the doubt of the physician does not remove [the matter] from his certainty. And the Yerushalmi holds that his statement is nothing, and therefore even with the doubt of a physician – it is a doubt regarding a life. And behold, according to the Yerushalmi, even if the physician is not so expert – nevertheless when he says "he needs," at any rate it is a doubt regarding a life, for the certainty of one who is not expert is no worse than the doubt of one who is expert. But according to our Shas, it is only with one who is expert. And for this the Rambam was precise to say: "And that is provided he is an expert physician," in order to exclude [the view] of the Yerushalmi. And this is the opinion of the Rambam.

But the Ramban, and the Ran, and the Maggid Mishneh brought this Yerushalmi, and ruled accordingly. And so wrote our teacher, the Beit Yosef, in section 5: If the sick person says he does not need, and the physician is in doubt – we feed him. But if the physician says he does not need and the sick person says "I do not know" – we do not feed him. Thus far his words. For the "I do not know" of the sick person is certainly nothing, for from where would he know? And behold, regarding the law, even though we explained that the Rambam does not hold accordingly, nevertheless the halacha is like the Yerushalmi, since these authorities ruled like it, and a doubt regarding lives is treated leniently. Therefore, according to what we explained regarding a physician who is not expert, when he says "he needs" – it is like an expert who says "I do not know." And therefore, regarding one who says "he needs" – it is even with one who is not expert. (And the Beit Yosef in section 1 who wrote "expert" – it appears that he does not hold accordingly. And in practice, it appears in my humble opinion to be lenient in a doubt regarding lives. And be precise and you will find it easy.)

If one doctor says it is necessary, and one says "it is not necessary" – we feed him, for a doubt regarding lives is resolved leniently. And the same law applies to two against two, or three against three. And even if those who say it is not necessary are more expert – it is of no concern to us, and we feed him. And there are those who hold that when they are equal, we follow the more expert, even for stringency (Ran, see Beit Yosef). But it does not appear so from the poskim, for certainly for leniency we must follow the experts, but not for stringency. And this is the opinion of the Ramban that the Tur cited, see there (see Magen Avraham subsection 4, and it appears there is a printing error there). And see in section 13.

And if the sick person, and one doctor with him, say that he does not need it, and one doctor says he needs it; or if the sick person says nothing, but one doctor says he needs it, and two say he does not need it – we do not feed him, for an individual against two is nothing. But some say that if the individual is preeminent in wisdom – we follow his words to be lenient, even against many (Magen Avraham subsection 5 in the name of the Ramban, and Taz subsection 5). And one should be lenient in a case of doubt regarding pikuach nefesh.

And if two say "he needs"—even if a hundred say that he does not need, and even if the patient is also with them—we feed him, for two are as a hundred. And since two say "he needs," there is nothing after their words. And likewise, if the patient and one doctor with him say that he needs, even though a hundred say he does not need—we feed him. And we do not say that in such a case the words of the patient are nothing because he is drawn after the doctor. We do not say so. And a doctor who says that he does not recognize the illness at all is like an ordinary person, and there is nothing in his words; they neither add nor subtract. And it is not similar to the doubt of a doctor, as has been explained, for there he recognizes the illness, but it is a doubt in his hand whether he will endure the fast or not. But when he does not recognize the illness, he is not in the category of a doctor regarding this matter. However, if he has weakened greatly, until it appears to most people who are with him that he is in danger if he does not eat—we feed him. And certainly regarding a patient lying in bed, who does not require opinions concerning him, and he is certainly in the category of a patient who is in danger, as I have written.

But the Rambam wrote there: Some doctors say "he needs," and some say "he does not need" – we follow the majority, or the more expert, etc. And if the doctors disagreed, and they were all experts, and those who said "he does not need" were equal in number to those who said "he needs" – we feed him. Thus far his words, and we learn from his words that there is no difference between two and fewer than two, and there is no difference according to him between being lenient or being stringent, but rather we always follow the majority or the expertise. This means that when they are equal in wisdom – we follow the majority, and when they are equal in number – we follow those who are more expert. And if on one side there is a majority, and in the minority there are those who are more expert – it appears that it is like half and half, and we follow the lenient path. But the Tur and the Shulchan Aruch ruled as I wrote previously. And regarding the law, it is a great principle: that whether in a doubt of the law, or in a dispute of the poskim – we follow the lenient path in pikuach nefesh. (However, it appears to me that in our time, when there are practitioners called felshers, who do not have certification from the government to give medicines, and doctors called doctors, who have certification from the government – the words of the practitioner are nothing against the words of the doctor. And perhaps for leniency we are concerned for his words, if he is an expert in his city, for a doubt of lives is to be lenient.)

The Tur and the Shulchan Aruch wrote in section 7: When one feeds a pregnant woman or a sick person – one feeds them little by little, so that it does not combine to the shiur. Therefore, one feeds him approximately two-thirds of a medium egg, and slightly more, and they should wait the time of eating four eggs, and no less than three eggs. And afterward he may eat a bit more. And so on always, so that he does not eat a kotevet within the time of achilat pras. And regarding drinking, as was explained in siman 612 that we measure for each person according to his own melo lugmav – one must check the sick person to see how much his own melo lugmav is, and he should drink slightly less than this shiur, and wait between drinking and drinking the time of eating four or three eggs, and no less than the time of drinking a revit, for such is the opinion of the Rambam as I wrote there, and afterward he may drink more. And so on always. And we are accustomed to give a measure to the one who asks for eating and drinking, and the shiur of "achilat pras" we estimate as six or seven minutes.

And it is a simple matter that all of this is when this suffices for the sick person. But if they assessed him that he needs much at once, or if the sick person says so, or if they have a doubt whether this will suffice for him – they feed him all his needs, and give him to drink all his needs, without precision. And it is almost known to us that for illnesses where one is bedridden, and likewise for a woman after childbirth – these shiurim will suffice for them for the most part. But those with consumption, which they call sukhatka or der – their cure is to eat much, and one is not precise with them. The Rambam and likewise the Rif did not write this law at all, because in the Shas this law is not found regarding the matter of Yom Kippur. Rather, this is in Keritot (13a) regarding the matter of a pregnant woman who smelled the scent of forbidden food, that they feed her less than a shiur at a time. The Rosh, the Tur, and the Shulchan Aruch learned from this also regarding the matter of the sick. But the Rif and the Rambam would hold that this is only for a pregnant woman who smelled the scent, where the eating is not the primary thing for her, but it is not so for a sick person. Regarding the matter of a pregnant woman, the Rambam wrote this law in chapter fourteen of Ma'akhalot Assurot, law 14, see there. And the custom is like the Tur and the Shulchan Aruch. (And we do not practice as the Magen Avraham wrote in subsection 8 in the name of the Bach.)

One who is seized by bulmus, which is an illness that comes on account of hunger, and its sign is that his eyes are dimmed and he cannot see—they feed him until his eyes are enlightened. And if there is no permitted food there—they feed him forbidden food. And if there are two types of forbidden things here—they feed him the lighter one first. The Rambam explained them in chapter fourteen, halacha 16 of Ma'akhalot Assurot. And we explained this in Yoreh Deah siman 85. And if he requires meat, whether they feed him nevelah or slaughtered meat—it was explained above in siman 328.

A sick person who ate on Yom Kippur, and his mind became settled in a manner that he is able to recite a blessing – he must mention Yom Kippur in Birkat HaMazon. That is to say, he should say "Ya'aleh V'Yavo" as in the prayer, and he should say it in "Boneh Yerushalayim" as on every Yom Tov. And if it falls on Shabbat, he says "Retzei VeHachalitzeinu." The great later authorities question this law extensively, for the day did not cause the eating, but rather his illness caused it for him, so why should he mention Yom Kippur in Birkat HaMazon (Taz, and Magen Avraham subsection 10)? And I do not know how the sick are accustomed to act in this matter. However, he certainly does not need to perform kiddush (ibid.).